Postanesthetic Shivering Research Articles

Comparisons of tramadol with pethidine for prevention of post anaesthetic shivering in elective abdominal surgery

Background: Postoperative shivering is a common event of unknown etiology. Objectives: To compare the efficiency of tramadol with that of pethidine in controlling post anaesthetic shivering. Methods: This double . blind randomized clinical trial was performed on 120 consecutive patients who received general anaesthesia for elective abdominal surgery. Intravenous tramadol (1mg.kg-1) or pethidine (0.5mg.kg-1) was administered to alternate subjects who developed post anaestheic shivering. They were monitored in the recovery room for 1 hour and the cessation time of shivering, recurrence of the events, duration of recovery, respiratory depression, arterial O2 saturation, nausea and vomiting were recorded. Results: Forty-eight patients (40%) had post anaesthetic shivering. In the tramadol group, shivering terminated within 5 minutes after injection. They had no recurrence of shivering, respiratory depression, reduction in SPO2, nausea and vomiting during the period of recovery. In the pethidine group, shivering terminated within 8 minutes after injection, but in 7 patients it recurred after 30 minutes. Similarly, 6 patients had respiratory depression, reduction in SPO2 and 10 patients had nausea, vomiting but none of them needed further medication. Conclusion: Tramadol is superior to pethidine as it induces a faster termination of post anaesthetic shivering and does not entail adverse effects on the respiratory system. DOI: http://dx.doi.org/10.3126/hren.v10i3.7139 Health Renaissance; September-December 2012; Vol 10 (No.3);220-223

Effect of electroacupuncture in postanesthetic shivering during regional anesthesia: a randomized controlled trial

BackgroundShivering during regional anesthesia is a common complication and is related to a decrease in the patient’s core body temperature. Previous studies have shown that acupuncture on specific acupoints can preserve core body temperature. The present study evaluated the effect of electroacupuncture in preventing the shivering caused by regional anesthesia.MethodsThis prospective and randomized controlled study analyzed the data from 80 patients undergoing urological surgery, who were classified as ASA I or II. Spinal anesthesia was performed in all patients using 15 mg of bupivacaine. The patients were randomly allocated to receive either placebo acupuncture (Group P, n = 40) or electroacupuncture (Group A, n = 40) for 30 min before administration of spinal anesthesia. Shivering score was recorded at 5 min intervals, with 0 representing no shivering and 4 representing the most severe shivering possible. Heart rate, blood pressure, and tympanic temperature were recorded before the intrathecal injection, and again every 5 min thereafter until 30 min.ResultsAfter spinal anesthesia, the decrease in tympanic temperature was less for Group A patients than Group P, with the difference being statistically significant. After 15 min, 13 patients in Group P attained a shivering score of 3 or more, compared with 3 patients in Group A. Significantly more patients in Group P attained a shivering score of at least 1.ConclusionsThe prophylactic use of electroacupuncture might maintain core body temperature, and may effectively prevent the shivering that commonly develops during regional anesthesia.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000096853.

Effects of Clonidine Premedication Upon Postoperative Shivering and Recovery Time in Patients With and Without Opium Addiction After Elective Leg Fracture Surgeries

BackgroundOpium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly.ObjectivesIn this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time.Patients and MethodsIn a randomized clinical trial, 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group 1 (placebo 1) were patients without addiction who got placebo 90 minutes before the operation. Group 2 (placebo 2) were patients with opium addiction which received placebo as group 1. Group 3 (Clonidine 1) patients without addiction who got clonidine 90 minutes before the operation and group 4 (Clonidine 2) who were opium addicted ones which received clonidine as premedication.ResultsNone of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P < 0.01). Recovery time in clonidine groups of patients with and without addiction was less than placebo ones (both P < 0.01) which the magnitude of difference was higher in opium addicted than non-addicted patients (P = 0.04).ConclusionsPremedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.

A placebo-controlled comparison of ketamine with pethidine for the prevention of postoperative shivering

AbstractObjective: Postanaesthetic shivering is a recognised complication of general and regional anaesthesia. Pharmacological and nonpharmacological methods have been used to prevent shivering. This study was conducted to determine the efficacy of ketamine when compared with pethidine and placebo for the prevention of postanaesthetic shivering.Design: A randomised, double-blind study was conducted.Setting and subjects: This study was conducted on 90 American Society of Anesthesiologists (ASA) I and II patients of both genders, aged 18–70 years, who were to undergo surgery under general anaesthesia. Patients were randomised into three equal groups: Group S received a saline placebo, Group P received pethidine 20 mg and Group K received ketamine 0.5 mg/kg. The study medication was given within 20 minutes of the estimated end of surgery.Outcome measures: Haemodynamic parameters were noted before, during and after anaesthesia. Tympanic temperature was recorded during the intraoperative period, on arrival in ...

Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study

Background and Aims:Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been employed to abolish the occurrence of shivering. The present study aims to explore the effectiveness of dexmedetomidine in suppressing the postanesthetic shivering in patients undergoing general anesthesia.Materials and Methods:The present study was carried out on 80 patients, in American Society of Anesthesiologists I and II, aged 22–59 years, who underwent general anesthesia for laparoscopic surgical procedures. Patients were allocated randomly into two groups: group N (n = 40) and group D (n = 40). Group D were administered 1 μg/kg of dexmedetomidine intravenously, while group N received similar volume of saline during peri-op period. Cardiorespiratory parameters were observed and recorded during the preop, intraop, and postop periods. Any incidence of postop shivering was observed and recorded as per 4 point scale. Side effects were also observed, recorded, and treated symptomatically. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni's correction.Results:The two groups were comparable regarding demographic profile (P > 0.05). Incidence of shivering in group N was 42.5%, which was statistically highly significant (P = 0.014). Heart rate and mean arterial pressure also showed significant variation clinically and statistically in group D patients during the postop period (P = 0.008 and 0.012). A high incidence of sedation (P = 0.000) and dry mouth (P = 0.000) was observed in group D, whereas the incidence of nausea and vomiting was higher in group N (P = 0.011 and 0.034).Conclusions:Dexmedetomidine seems to possess antishivering properties and was found to reduce the occurrence of shivering in patients undergoing general anesthesia.

Infusion of Warm Fluid During Abdominal Surgery Prevents Hypothermia and Postanaesthetic Shivering

BACKGROUND: Perioperative hypothermia is a frequent occurrence and can lead to several complications. The aim of this study is to evaluate the efficacy of warm fluid in maintaining normal core temperature during the intraoperative period. METHODS: We studied 30 American Society of Anesthesiologists (ASA) physical status I or II adult patients who required general anesthesia for abdominal surgery. In control group (n=15), fluids were infused at room temperature; in test group (n=15), fluids were infused at 37° C. Core temperature was measured at the tympanic site. During recovery, shivering was evaluated by an independent observer. RESULTS: The two groups did not differ significantly in patient characteristics. In control group, core temperature decreased to 35.5±0.3° C during the first 3 hours, and then stabilized at the end of anesthesia. In test group, core temperature decreased during the first 60 min, but increased to 36.9±0.3° C at the end of anesthesia. In control group, 8 patients shivered at grade ≥2. In test group, none of the patients reached grade ≥ 2 (P < 0.01). CONCLUSIONS: Infusion of warm fluid is effective to keep patients nearly normothermic and prevent postanaesthetic shivering. It may provide an easy and effective method for perioperative hypothermia prevention.

An Intraoperative Small Dose of Ketamine Prevents Remifentanil-Induced Postanesthetic Shivering

Patients undergoing gynecological laparotomy were randomized to receive either 0.5 mg/kg ketamine at induction of anesthesia followed by an infusion of 0.3 mg/kg/h until the end of surgery (ketamine group, n = 32), or an equivalent volume of normal saline (control group, n = 32). Anesthesia was maintained with IV propofol, a fixed infusion rate of remifentanil (0.25 μg/kg/min), and epidural ropivacaine. Postanesthetic shivering (PAS) was evaluated for 30 minutes after emergence. Intraoperative temperatures were similar between the 2 groups. The incidence of PAS was less frequent in the ketamine group (n = 2, 6%) compared with the control group (n = 12, 38%, P = 0.005). We conclude that, during the early recovery phase, intraoperative ketamine reduces remifentanil-induced PAS.

Retraction Note to: Urapidil does not prevent postanesthetic shivering: a dose-ranging study

Retraction Note to: Urapidil does not prevent postanesthetic shivering: a dose-ranging study

Effects of the increasing doses of dexmedetomidine on the post-anesthetic shivering

s and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Evidence-based Practice and Quality Improvement

A Comparison of Urapidil, Clonidine, Meperidine and Placebo in Preventing Postanesthetic Shivering

A Comparison of Urapidil, Clonidine, Meperidine and Placebo in Preventing Postanesthetic Shivering

Prevention of Hypothermia by Infusion of Warm Fluid During Abdominal Surgery

Perioperative hypothermia can lead to a number of complications for patients after surgery. The aim of this pilot study was to evaluate the efficacy of warm fluids in maintaining normal core temperature during the intraoperative period. We studied 30 American Society of Anesthesiologists (ASA) physical status I or II adult patients who required general anesthesia for abdominal surgery. In the control group (n = 15), fluids were infused at room temperature; in the test group (n = 15), fluids were infused at 37° C. In the control group, core temperature decreased to 35.5 ± 0.3° C during the first 3 hours, and then stabilized at the end of anesthesia. In the test group, core temperature decreased during the first 60 minutes, but increased to 36.9 ± 0.3° C at the end of anesthesia. In the control group, eight patients shivered at grade ≥2. In the test group, none of the patients reached grade ≥2 (P < .01). Infusion of warm fluid is effective in keeping patients nearly normothermic and preventing postanesthetic shivering. It may provide an easy and effective method for prevention of perioperative hypothermia.

Prophylactic Ketamine Reduces Incidence of Postanaesthetic Shivering

General anesthesia influences the thermoregulatory process. The aim of this study was to compare the efficacy of low-dose prophylactic ketamine with that of placebo in preventing postoperative shivering. A prospective randomized double-blind study involved 76 ASA I and II patients undergoing general anesthesia that was expected to last no more than 2 hours. Patients were randomly allocated to receive normal saline (Group P, n = 33) or ketamine 0.5 mg kg1 (Group K, n = 33) intravenously 20 min before completion of surgery. The anesthesia was induced with propofol 2.5-3.0 mg kg(-1) and fentanyl (2-3 microg kg(-1)), atracurium 0.5 mg kg(-1) was given to facilitate orotracheal intubation. It was maintained with propofol (510 mg kg(-1) hr(-1)), fentanyl up to (5 microg x kg1 x h1) and a mixture of nitrous oxide/oxygen (2:1). Ambient temperature was maintained at 20 degrees-22 degrees C with constant humidity. Postoperative shivering in the recovery room was evaluated according to 5 point scale of Wrench. The two groups did not differ significantly regarding patient characteristics. The number of patients shivering on arrival in the recovery room, and at 10 and 20 min after operation was significantly less in Groups K than in Group P. In group P 36% have had shivering in TO whereas in group K 6%, in T10 45% in group P whereas 18% in group K. In T20 24% in group P have had shivering compared with 6% in group K, whereas in T30 9% in group P compared with 0% in group K. The incidence of free Postanaesthetic shivering (no shivering) on arrival in the recovery room T0 was: 63.6% in group P compared with 90.9 % in group K. The postoperative hemodynamic parameters were similar in the two groups. Active warming was not required in group K but was needed in 8 cases in group P. None of patients had episodes of O2 desaturation or respiratory depression during the study period. No hallucinations, delirium, nausea, vomiting, hypertension, tachycardia, and feeling like walking in the space or nystagmus were seen in any of the patients. Prophylactic low-dose ketamine was found to be effective in preventing postoperative shivering.

Preventive effect of epidural injection with low-dose of ketamine on postanesthesia shivering undergoing percutaneous nephrolithotomy

Objective To observe the preventive effect of epidural injection with low - dose of ketamine on postanesthesia shivering(PAS) undergoing percutaneous nephrolithotomy. Methods Sixty ASA Ⅰ～Ⅱ grade patients aged 35 ～ 72 years undergoing PCNL were randomly divided into kctamine group (n = 30, Epidural injection of 0.5mg/kg of ketamine) ,Control group(n = 30, Epidural injection of 10ml saline). The rate of shivering was observed and recorded during operation,and blood pressure and respiration were measured. Results The rate of shivering in ketamine group(10%) was significantly lower than that in control group(46.7%, P ＜ 0.05) ,There were no significant differences of blood pressure and respiration between two groups (P ＞ 0.05). Conclusion Epidural injection 0.5 mg/kg of ketamine on postanesthesia can prevent shivering in PCNL. Key words: Ketamine; Shivering; Percutaneous; nephrolithotomy

Intraoperative high-dose remifentanil increases post-anaesthetic shivering

BackgroundRemifentanil is associated with increased incidence of post-anaesthetic shivering (PAS). The aim of this study was to compare the effects of intraoperative high and low doses of remifentanil on PAS. MethodsWe investigated 50 consecutive patients, aged <60 yr, who underwent gynaecological laparotomy. Patients who underwent prolonged surgery (>4 h) were excluded from the study. Anaesthesia throughout surgery was maintained with i.v. propofol and remifentanil, and epidural ropivacaine, and no nitrous oxide was used. Fifty patients were randomly assigned to receive intraoperative remifentanil at 0.1 µg kg−1 min−1 (low-dose group, n=25) or 0.25 µg kg−1 min−1 (high-dose group, n=25) until the end of surgery. Intraoperative analgesia was achieved by a fixed infusion rate of remifentanil and titrated epidural ropivacaine. PAS was evaluated by nursing stuff over the first hour after surgery. ResultsPAS occurred more frequently in the high-dose group than in the low-dose group (60% vs 20%, P=0.009). None of the patients complained of pain during the observation period due to epidural analgesia. There were no significant differences in rectal or palm skin temperature after extubation between the two dose groups. ConclusionsRemifentanil-induced PAS is not a phenomenon of intraoperative hypothermia. The higher incidence of PAS with higher doses of remifentanil probably reflects acute opioid tolerance and stimulation of N-methyl-d-aspartate receptors, similar to hyperalgesia. We conclude that patients administered high doses of remifentanil are sensitive to shivering after sudden drug withdrawal.

The role of perioperative warming in surgery: a systematic review.

The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

Comparative Study on Effectiveness of Doxapram and Pethidine for Postanaesthetic Shivering

Postanaesthetic shivering is a common condition after surgery which needs proper management with pharmacologic agents so as to make postoperative period comfortable to the patient and prevent from the untoward complications that can arise from it. This study was done to compare the effectiveness of Pethidine and Doxapram in the treatment of postanaesthetic shivering. Patients were randomly divided into three groups, ten in each. All received volume of 3 ml as Group I (Doxapram 1.5 mg/kg), Group II (Pethidine 0.35 mg/kg) and Group III (Normal Saline). All patients were observed for 30 minutes after reversal of muscle relaxant and occurrence of shivering within this period was observed, scored and treated. All treated patients were observed for 10 minutes after the test drug was given for control of shivering and any untoward effects. Pethidine was found more effective than Doxapram in treating postanaesthetic shivering as it was effective in 80% followed by Doxapram in 60% and Normal saline in 20%. Statistically the results between Normal saline and Pethidine was significant as P < 0.05. As statistical significance between Doxapram and Normal Saline was p = 0.16; and between Pethidine and Doxapram was p = 0.62, the difference is statistically not significant. Pethidine was found to be more effective compared to Doxapram in treating patients with postoperative shivering.

The effects of pre-treatment with butorphanol on postanesthesia shivering in patients undergoing operation of hypogustric zone after combined spinal-epidural anesthesia

Objective To assess the effects of pre-treatment with butorphanol on postanesthesia shivering in patients undergoing operation of hypogastric zone after combined spinal-epidural anesthesia. Methods Sixty patients (ASA Ⅰ,Ⅱ) undergoing operation of hypogastric zone were randomly assigned into two groups(n = 30). Group A(test group) : The patients were injected intravenously with butorphanoi 1 mg/5 ml at the time of 10 min before combined spinal-epidural anesthesia. Group B(control group) : The patients were injected intravenously with 0.9% saline 5 ml at the same time point. The development of shivering and sedation degree was observed after the anesthesia. Results The incidence rate on shivering in test group was significantly lower than that in control group(P <0.01). While the satisfaction rate on sedation score in test group was higher than that in control group(P < 0.05). Conclusion Pre-treatment with butorphanol is effective and safe on poatanesthesia shivering in patients undergoing operation of hypogastric zone. Key words: Butorphanol; Combined spinal-epidural anesthesia; Shivering; Sedation score

Tramadol for prevention of postanaesthetic shivering: a randomised double‐blind comparison with pethidine

The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg(-1) with pethidine 0.5 mg.kg(-1) for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. Tramadol in doses of 1, 2 and 3 mg.kg(-1), pethidine 0.5 mg.kg(-1) or normal saline were administered at the time of wound closure. All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg(-1) had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period.

Pharmacological treatment of post-anesthetic shivering: a systematic review and meta-analysis

Background: Shivering is one of the most common unpleasant complications in the postoperative period. Many clinical trials have been published and revealed various efficacious drugs for the treatment of postanesthetic shivering. Objective: To perform an updated quantitative review of randomized controlled trials (RCTs) studying efficacy of pharmacological treatment of post-anesthetic shivering. Methods: We initiated a systematic search for original articles of randomized, controlled studies of drugs for postanesthetic shivering. Reports were appraised, and binary data of shivering within 15 minutes after treatment were extracted. Relative risk (RR) and the number-needed-to-treat (NNT) were subsequently analyzed and then reported with 95% confidence interval (CI). Results: The efficacy of anti-shivering drugs was analyzed by using data from 32 RCTs. Meperidine 25 to 50 mg, tramadol 0.5 to 1 mg/kg, clonidine 30 to 150 μg, ketanserin 10 mg, doxapram 25 to 100 mg, and nalbuphine 0.05 to 0.1 mg/kg, reported in at least two trials, were significantly more effective than placebo within 15 minutes after treatment. The NNT of meperidine 25 to 50 mg was 1.39, of tramadol 0.5 to 1 mg/kg was 1.56, of ketanserin 10 mg was 2.44, of doxapram 25 to 100 mg was 1.82, and of nalbuphine 0.05 to 0.1 mg/kg was 1.75. The efficacy of tramadol 0.5 to 1 mg/kg was not significantly different from meperidine 0.5 mg/kg (25 mg) at 15 minutes of observation (p = 0.34). Moreover, clonidine 30 to 150 μg was more effective in treating tremor than placebo, with the NNT of 1.43. Studies in efficacy of alfentanil, magnesium sulfate, fentanyl, ondansetron, nefopam, pentazocine, urapidil, morphine, lignocaine, metamizol, and butorphanol, were inadequate for quantitative analysis. Conclusion: Meperidine 25 to 50 mg, tramadol 0.5 to 1 mg/kg, clonidine 30 to 150 μg, doxapram 25 to 100 mg, ketanserin 10 mg, and nalbuphine 0.05 to 0.1 mg/kg can effectively treat postanesthestic shivering within 15 minutes. Tramadol 0.5 to 1 mg was found to a be good alternative compared to meperidine 25 to 50 mg. Side effects of treatments were mild and treatable.

Efficacy of Granisetron in Preventing Postanesthetic Shivering

Recently, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists have been reported to prevent postanesthetic shivering. This placebo-controlled study was performed to evaluate the efficacy of granisetron, a 5-HT3 antagonist, in comparison with meperidine and tramadol in preventing postanesthetic shivering. In this prospective, randomized, double-blind study, 132 ASA I and II patients undergoing elective orthopedic surgery under standardized general anesthesia were included. At the end of surgery, patients were randomly assigned to one of four groups (each group n = 33) using a double-blinded protocol. Group T received 1 mg/kg tramadol, group G received 40 microg/kg granisetron (an antiemetic dose), group M received 0.4 mg/kg meperidine, and group P received saline 0.9% as placebo. Shivering was graded according to the following: 0 = no shivering; 1 = piloerection, peripheral vasoconstriction or peripheral cyanosis without other cause; 2 = visible muscular activity confined to one muscle group; 3 = visible muscular activity in more than one muscle group; and 4 = gross muscular activity involving the entire body. The emergence time from anesthesia, defined as the time between withdrawal of isoflurane and tracheal extubation, was documented. The number of patients with observable shivering was 19 in group P, nine in group G, seven in group T and six in group M. Granisetron significantly reduced the incidence of shivering in comparison with placebo (p = 0.013). Although the frequency of shivering was higher with granisetron in comparison to tramadol and meperidine, it was not statistically significant (p > 0.05). The number of patients with a shivering score of 2, 3 and 4 was significantly higher in group P compared with the other groups (p = 0.001). Both meperidine and tramadol caused a significantly prolonged emergence time (20.58 +/- 3.56 and 16.45 +/- 4.13 minutes, respectively) as opposed to granisetron (13.58 +/- 3.41 minutes) and placebo (12.61 +/- 3.31 minutes). The prophylactic use of granisetron 40 microg/kg is as effective as meperidine (0.4 mg/kg) and tramadol (0.1 mg/kg) in preventing postanesthetic shivering without prolonging the emergence time from anesthesia.