Postanesthetic Shivering Research Articles

Clinical considerations in the use of forced-air warming blankets during orthognathic surgery to avoid postanesthetic shivering.

BackgroundDuring head and neck surgery including orthognathic surgery, mild intraoperative hypothermia occurs frequently. Hypothermia is associated with postanesthetic shivering, which may increase the risk of other postoperative complications. To improve intraoperative thermoregulation, devices such as forced-air warming blankets can be applied. This study aimed to evaluate the effect of supplemental forced-air warming blankets in preventing postanesthetic shivering.MethodsThis retrospective study included 113 patients who underwent orthognathic surgery between March and September 2015. According to the active warming method utilized during surgery, patients were divided into two groups: Group W (n = 55), circulating-water mattress; and Group F (n = 58), circulating-water mattress and forced-air warming blanket. Surgical notes and anesthesia and recovery room records were evaluated.ResultsInitial axillary temperatures did not significantly differ between groups (Group W = 35.9 ± 0.7℃, Group F = 35.8 ± 0.6℃). However, at the end of surgery, the temperatures in Group W were significantly lower than those in Group F (35.2 ± 0.5℃ and 36.2 ± 0.5℃, respectively, P = 0.04). The average body temperatures in Groups W and F were, respectively, 35.9 ± 0.5℃ and 36.2 ± 0.5℃ (P = 0.0001). In Group W, 24 patients (43.6%) experienced postanesthetic shivering, while in Group F, only 12 (20.7%) patients required treatment for postanesthetic shivering (P = 0.009, odds ratio = 0.333, 95% confidence interval: 0.147–0.772).ConclusionsAdditional use of forced-air warming blankets in orthognathic surgery was superior in maintaining normothermia and reduced the incidence of postanesthetic shivering.

Magnitude and Associated Factors of Postanaesthesia Shivering Among Patients Who Operated Under General and Regional Anesthesia, Northwest Ethiopia: A Cross Sectional Study

Background: Post-anesthesia shivering is well-documented event which, can be distressing to patients and occasionally associated with numerous adverse effects. This study investigated the magnitude and the possible risk factors of post-anesthesia shivering. Methods: A total of 203 patients undergoing general anesthesia or spinal anesthesia were reviewed. Axillary temperature was recorded preoperatively and postoperatively every 15 minutes in the recovery. Also grade of shivering, anesthetic and surgical data, and methods used to treat shivering were recorded. Both bivariate and multivariate logistic regressions were used to identify associated factors. Results: The overall incidence of post-anesthesia shivering was 26%. Twenty-five patients had grade two shivering and six patient's grade three. In multiple logistic regression analysis, older age (AOR=0.067, CI; 0.01, 0.441; P=0.005), patients who didn't get opioid analgesics (OR=3.531; CI, 1.445, 8.73; P=0.011), and low axillary temperature (AOR=2.357, P ≤ 0.001) were considered associated factors of PAS. Conclusion and recommendation: The incidence of PAS was very high. Low axillary temperature, and patients who didn't take opioids for postoperative analgesia was factors which increase the incidence of PAS. Being older age was protective to PAS. Interventions on prevention and treatment of PAS better if focus on patients less than sixty five years old, long duration of anesthesia, and low axillary temperature to reduce the incidence. Administration of opioids for postoperative analgesia is highly recommended.

Effectiveness of addition of intrathecal tramadol with hyperbaric bupivacaine in prevention of shivering in parturients undergoing cesarean section under spinal anesthesia: A randomized Placebo-controlled study

Context: Intravenous (IV) tramadol has been in use for the treatment of postanesthetic shivering. Aims: To assess the efficacy of addition of tramadol to bupivacaine in subarachnoid block to reduce the incidence of shivering. Settings and Design: The study was conducted as a single-blind study in a 350-bedded teaching hospital. Materials and Methods: One hundred parturients undergoing cesarean section were randomly divided into two groups of 50 each. Group T received 0.2 mL (10 mg) of tramadol with 2 mL of 0.5% bupivacaine. The presence of shivering was noted intraoperatively and postoperatively. Statistical Analysis Used: Student's t-test (two-tailed, independent) was applied for continuous variables and Chi-square/Fisher's exact test was applied for categorical variables between the two groups. Results: Shivering was noted in 66% of the patients in Group NS as against the 16% noted in Group T with a majority of the cases (88%) noted in the intraoperative period. The mean duration to the two-segment regression was 135 ± 26 min in Group T versus 104 ± 22 min in Group NS and duration to 1-grade motor block regression was 128 ± 21 min in Group T versus 103 ± 18 min in Group NS. The analgesic effect of the block lasted for a mean duration of 232 min in Group T and 176 min in Group NS while nausea and vomiting were increased in group T versus NS. Conclusions: Tramadol (10 mg), along with bupivacaine given intrathecally plays a significant role in reducing the incidence of anesthesia-induced shivering in parturients while prolonging both the sensory and motor components of the subarachnoid block.

Role of Intravenous Dexmedetomidine in Prolonging Postoperative Analgesia and Quality of Block Following Spinal Anaesthesia. A Systemic Review and Update

Intravenous dexmedetomidine is been increasingly used in perioperative setting including as an adjunct to local anaesthetic in various regional techniques with an intent either to improve the block quality, to increase the duration of block or to provide sedation and patient comfort during the periblock period. Intravenous dexmedetomidine when used just before or after spinal anaesthesia has many desirable effects such as adequate sedation and patient comfort, longer sensory-motor blockade, prolong postoperative analgesia and reduces post-anaesthesia shivering. A systemic review was done to evaluate and provide update on the use of intravenous dexmedetomidine as an adjunct for spinal anaesthesia. The optimal dose or method of administration of intravenous dexmedetomidine under spinal anaesthesia has not been defined yet. Current literatures suggest a ceiling effect on prolonging post-spinal analgesia after 0.5 mcg/kg boluses. With increasing the dose beyond 0.5 mcg/kg resulted in unwanted side effects notably bradycardia and excessive sedation. Further study with diverse population is needed to define the optimal dose of intravenous dexmedetomidine.

Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials

BackgroundShivering is a very common complication in the postanesthesia period. Increasing studies have reported ondansetron may be effective in prevention of postanesthesia shivering (PAS). However, the results remained controversial; hence we conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of ondansetron on the prevention of postanesthesia shivering.MethodsPubMed and Embase databases were searched to identify the eligible randomized controlled trials assessing the effect of ondansetron on the prevention of PAS. Results were expressed as risk ratios (RRs) with accompanying 95% confidence intervals (CIs). The meta-analysis was performed with fixed-effect model or random-effect model according to the heterogeneity.ResultsSix trials including 533 subjects were included. Compared with placebo, ondansetron was associated with a significant reduction of PAS (RR 0.43, 95% CI, 0.27-0.70), without an increased risk of bradycardia (RR 0.37, 95% CI, 0.12-1.15). Compared with meperidine, no difference was observed in the incidence of PAS (RR 0.68, 95% CI, 0.39-1.19) and bradycardia (RR 2.0, 95% CI, 0.38-10.64).ConclusionsOndansetron has a preventive effect on PAS without a paralleled side effect of bradycardia.

Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil

BackgroundHigh-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS.MethodsSeventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 µg/kg/min; group H at 0.3 µg/kg/min; and group HK at 0.3 µg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 µg/kg/min ketamine until skin closure.ResultsPAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups.ConclusionsOIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

Premedication with oral tramadol reduces severity of postoperative shivering after general anesthesia

Background:Postanesthetic shivering (PAS) is an accompanying part of general anesthesia with different unpleasant and stressful complications. Considering the importance of proper prevention of PAS in order to reduce its related adverse complications in patients undergoing surgery, in this study, we investigated the effect of orally administrated tramadol in the prevention of this common complication of general anesthesia.Materials and Methods:In this prospective randomized double-blind clinical trial, 80 ASA I and II patients aged 15-70 years, scheduled for elective surgery under general anesthesia, were randomized to intervention (oral tramadol 50 mg) and placebo groups. PAS was evaluated during surgery and in the recovery room, and compared in the two study groups.Results:PAS was seen in 5 patients (12.5%) in the intervention group and 10 patients (25%) in the placebo group (P = 0.12). The prevalence of grade III and IV shivering was 7.5% (3/40) and 25% (10/40) in tramadol and placebo groups, respectively (P = 0.03).Conclusion:The overall prevalence of PAS was not significantly different in the two study groups, but the higher grades of shivering which needed treatment were significantly lower in the tramadol group than in the placebo, and those patients who received tramadol experienced milder form of shivering. It is suggested that higher doses of tramadol would have better anti-shivering as well as analgesic effects. Studying different doses of tramadol would be helpful in this regard.

Intramuscular dexmedetomidine for prevention of shivering after general anesthesia in patients undergoing arthroscopic anterior cruciate ligament reconstruction

Background Postanesthetic shivering (PAS) can influence hemodynamic stability and recovery from general anesthesia. We tested the efficacy of intramuscular dexmedetomidine in prevention of PAS in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Materials and methods In this prospective, randomized, and double-blind controlled study, 85 ASA I male patients, aged 18-40 years, scheduled for arthroscopic anterior cruciate ligament reconstruction under general anesthesia were enrolled. Forty-five minutes before the expected end of surgery, the patients were randomized to receive an intramuscular injection in the deltoid muscle of either dexmedetomidine 2.5 μg/kg (group D, n = 43) or isotonic saline (group C, n = 42). Extubation time, the incidence and grades of shivering, pain intensity, degree of sedation, and side effects were recorded. Results The mean ± SD extubation time was prolonged in the dexmedetomidine group than in the control group (8.4 ± 2.3 vs. 7.2 ± 2.6 min, respectively; P = 0.0268). The incidence of shivering was 64.28% in the control group compared with 11.62% in the dexmedetomidine group ( P ≤ 0.0001), with lower intensity in group D. Assessment of pain intensity until 2 h postoperatively revealed significantly lower scores in dexmedetomidine-treated patients ( P = 0.0239 at the second hour). Sedation scores were higher in the dexmedetomidine group until 4 h postoperatively ( P = 0.032 at the fourth hour). The mean heart rates and blood pressure were significantly lower in group D than in group C ( P Conclusion Intramuscular dexmedetomidine provides effective prophylaxis against PAS without major side effects.

Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia.

BackgroundIn the present study, we compared changes in body temperature and the occurrence of shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia during warming with either a forced-air warming system or a circulating-water mattress.MethodsForty-six patients were randomly assigned to either the forced-air warming system (N = 23) or circulating-water mattress (N = 23) group. Core temperature was recorded using measurements at the tympanic membrane and rectum. In addition, the incidence and intensity of post-anesthesia shivering and verbal analogue score for thermal comfort were simultaneously assessed.ResultsCore temperature outcomes did not differ between the groups. The incidence (13.0 vs 43.5%, P < 0.05) and intensity (20/2/1/0/0 vs 13/5/3/2/0, P < 0.05) of post-anesthesia shivering was significantly lower in the forced-air system group than in the circulating-water mattress group.ConclusionsThe circulating-water mattress was as effective as the forced-air warming system for maintaining body temperature. However, the forced-air warming system was superior to the circulating-water mattress in reducing the incidence of post-anesthesia shivering.

Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering.

Background and Aims:Dexmedetomidine (α2 adrenergic agonist) has been used for prevention of post anaesthesia shivering. Its use for the treatment of post-spinal anaesthesia shivering has not been evaluated. The aim of this study was to evaluate and compare the efficacy, haemodynamic and adverse effects of dexmedetomidine with those of tramadol, when used for control of post-spinal anaesthesia shivering.Methods:A prospective, randomised, and double-blind study was conducted in 50 American Society of Anaesthesiologists Grade I and II patients of either gender, aged between 18 and 65 years, scheduled for various surgical procedures under spinal anaesthesia. The patients were randomised in two groups of 25 patients each to receive either dexmedetomidine 0.5 μg/kg or tramadol 0.5 mg/kg as a slow intravenous bolus. Grade of shivering, onset of shivering, time for cessation of shivering, recurrence, response rate, and adverse effects were observed at scheduled intervals. Unpaired t-test was used for analysing the data.Results:Time taken for cessation of shivering was significantly less with dexmedetomidine when compared to tramadol. Nausea and vomiting was observed only in tramadol group (28% and; 20% respectively). There was not much difference in the sedation profile of both the drugs.Conclusion:We conclude that although both drugs are effective, the time taken for cessation of shivering is less with dexmedetomidine when compared to tramadol. Moreover, dexmedetomidine has negligible adverse effects, whereas tramadol is associated with significant nausea and vomiting.

Hypothermia, shivering, and dexmedetomidine.

CC Postoperative temperature is increasingly used to indicate the quality of anesthesia. Anesthesiologists should measure and record the body temperature of their patients perioperatively and maintain it within normal limits. Hypothermia is usually defined as a body temperature less than 36 o C and occurs commonly during surgery [1]. Although hypothermia can be protective during cerebral or cardiac ischemia, unintentional perioperative hypothermia is associated with an increased mortality rate. To prevent hypothermia during surgery, several methods are used. In this issue of the Korean Journal of Anesthesiology, Kim et al. [2] compared the effect of a forced-air warming system and circulating-water mattress on core temperature and the inci dence of postanesthesia shivering in elderly patients. They found that the changes in core temperature over time did not differ be tween the two types of warming device. However, the incidence of postanesthesia shivering was different (13.0 vs 43.5%). The forced-air warming system is more effective in terms of reducing the incidence of postanesthesia shivering. Here, we postulate that the cause of postanesthesia shivering is not confined to hy pothermia. De Witte et al. [3] evaluated the efficacy of resistiveheating or forced air warming versus no prewarming, applied before inducing anesthesia, and recommended that prewarming before the induction of anesthesia should be considered as part ofanesthetic management.

Medications in Treatment of Postherpetic Neuralgia

Among many various neuropathic pain syndromes, postherpetic neuralgia (PHN) is one of the most typical and difficult neuropathic pains to control in some patients. To prevent progression to PHN, vaccination against herpes zoster has been developed. There are reviews about herpes zoster vaccination in recently published articles in the Korean Journal of Pain (KJP) and other journals [1,2]. As is written in those and other reviews, once herpes zoster progresses to PHN, the syndrome could result in severe personal and social burdens for patients. Although PHN has been known for a long time and is a typical neuropathic pain, many treatment modalities and options continue to be reported. There have even been case reports on the effectiveness of systemic vitamin C administration and transforaminal epidural magnesium injection [3-6]. The treatment for PHN varies among hospitals, and commonly used pharmacological and interventional methods include anticonvulsants and interlaminar epidural blocks [7]. According to the suggested treatment algorithm for acute or subacute herpes zoster and PHN, adjuvant pharmacological medications are tricyclic antidepressants, anticonvulsants, opioids, tramadol, topical lidocaine, and capsaicin [8]. In this month's issue of KJP, Joo et al. [9] report on the controllability of PHN with nefopam. They used systemic nefopam during the titration of the oral medication. Although there have been many clinical reports on nefopam for the treatment of pain, to date, few reports may be found regarding the treatment of chronic neuropathic pain. Nefopam has been known to be effective in acute postoperative pain and postanesthetic shivering [10-13]. In animal research, intrathecal nefopam is reported to have an antinociceptive effect in an acute inflammatory rat pain model [14]. Systemic administration of nefopam was shown to enhance the analgesia with morphine and nimesulide and decrease pain behavior and reduce adverse effects in a chronic constrictive nerve injury rat model [15]. Nefopam's mechanism of action is suggested to be through the activities of the serotonin, glutamate, and dopamine circuits [16], and it might be successfully tried in the treatment of various chronic neuropathic pain conditions. If we consider the chronicity and intractability of many neuropathic pain conditions, and the continuity of medication in these patients, many trials for neuropathic treatments are anticipated.

English

Postanesthetic shivering (POS) is a common complication following spinal anesthesia. Several drugs have been used to prevent POS, including ondansetron and pethidine. This study was conducted to compare the efficacy of ondansetron 8 mg with pethidine 0.4 mg/kg BW for prevention of shivering in pregnant patients undergoing a cesarean section with spinal anesthesia. This is a double blind controlled trial involving 96 pregnant patients between the age 18-40 years with ASA physical status I-II, gestational age of 37-42 weeks, body weight of 40-70kg or Body Mass Index (BMI) 145 cm who underwent a cesarean section with spinal anesthesia in Dr. Sardjito General Hospital, Yogyakarta and affiliated hospital. Exclusion criteria included patients or families who refused to participate in the study, having a history of allergy to bupivacaine, ondansetron, and pethidin, patients with a fetus known to have congenital abnormalities earlier, body temperature early > 38 oC or 0.05). The incidence of nausea on the ondansetron group (4.2%) was lower than the pethidine group (16.7%) (p 0.05). In conclusion, the efficacy of ondansetron 8 mg is comparable to pethidine 0.4 mg/kgBW for prevention of shivering in pregnant patients after spinal anesthesia.

Low-dose intraoperative ketamine for prevention of post-anesthetic shivering: a systematic review protocol

Review question/objective The objective of this systematic review is to synthesize the best available evidence on the effectiveness of intraoperative administration of low-dose intravenous ketamine on prevention of post-anesthetic shivering (PAS) in adult patients undergoing general or regional anesthesia. Inclusion criteria Types of participants This review will consider studies that include adult patients 18 years of age and older receiving general or regional anesthesia for any medical procedure. Studies including patients less than 18 years of age will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies evaluating the use of ketamine at doses less than 0.75 mg/kg administered intravenously in the operating room for prevention of PAS. Studies utilizing any route of administration other than intravenous, will be excluded. This review will only consider studies evaluating ketamine as the sole preventative measure for PAS and those using ketamine as a treatment for PAS will be excluded. Types of outcomes This review will consider studies that include the following outcome measure: presence or absence of PAS.

The role of meperidine in reduction of postanesthetic shivering and its possible impact on flap outcomes

Postoperative vascular compromise is a common but critical complication requiring emergent re-exploration, and remains a chief cause of free flap failure. This study investigated the relationship between postanesthetic shivering (PAS) and the development of postoperative complications associated with free flap reconstruction. One hundred thirty-six patients who underwent head and neck cancer resection and free flap reconstruction were retrospectively enrolled. Fifteen patients were assigned to the PAS group, while the others were assigned to the non-PAS (NPAS) group. The odds ratios of acute re-exploration or total failure of the free flap in the PAS group was 3.5 and 14.9, respectively. The dose of meperidine was positively correlated with PAS prevention in our statistical ROC curve analysis. The minimum effective dose of meperidine for PAS prevention was 0.35 mg/kg with 75% sensitivity and 60% specificity. These findings indicate that an optimal dose of meperidine could prevent PAS, which is shown to be associated with a decrease in the incidence of the early post-surgical re-exploration rate of these free flaps related to circulatory compromise.

Perfusion index as a possible predictor for postanesthetic shivering

Postanesthetic shivering can be triggered by surgical stress and several aspects of anesthetic management and is frequently preceded by a decrease in peripheral blood flow due to thermoregulatory vasoconstriction. As perfusion index correlates with peripheral blood flow, we examined whether perioperative perfusion index, measured using pulse oximetry, might be correlated with postanesthetic shivering. Twenty-eight patients presenting for elective abdominal surgery were enrolled. Core (esophagus) and peripheral (finger) temperatures and perfusion index were recorded in the perioperative periods. Correlations between perfusion index and peripheral temperature and core-to-peripheral temperature gradient were then explored. Plasma levels of epinephrine and norepinephrine were also measured. The extent of shivering was graded after emergence from anesthesia. Perfusion index declined before emergence from anesthesia in patients who then developed postanesthetic shivering. This coincided with the time at which the difference between core and peripheral temperature became dissociated and peripheral temperature declined. Perioperative perfusion index was correlated with peripheral temperature and peripheral-core temperature gradient. Perfusion index at closure of the peritoneum predicted postanesthetic shivering and was significantly correlated with the extent of shivering. Plasma levels of both epinephrine and norepinephrine were significantly elevated after shivering events. Perfusion index was significantly lower in patients with postanesthetic shivering before emergence from anesthesia, indicating that measurement of perfusion index during and before the end of anesthesia might be a useful means of predicting postanesthetic shivering.

Comparison of ondansetron and meperidine in treatment of post anesthesia shivering A randomized placebo controlled triple blind clinical trial

زمینه و هدف: لرز بعد از بیهوشی باعث افزایش نیاز بدن به اکسیژن تا حد 500%، افزايش درد بعد از عمل، طولاني شدن ريكاوري، افزايش تهوع -استفراغ، بالا رفتن فشار خون، افزايش فشار چشم و مغز می ‎ شود. مپریدین از پرکاربردترین داروها در درمان و پیشگیری از آن است ولی دارای عوارض شناخته شده مخدرها است. با ه دف یافتن درمان موثر با عوارض جانبی کمتر، اين مطالعه به مقايسه اثر درماني دو داروی اندانسترون و مپريدين در درمان لرز بعد از بيهوشي پرداخت. مواد و روشکار: در این کار آزمائی بالینی تصادفی سه سوکور تعداد 206 بیمار در 3 گروه مساوی مورد مطالعه قرار گرفتند. روش آنالیز آماری تست کای دو و آزمون تي زوجي بود. همه بیماران در همان گروهی که بر اساس تصادفی‏سازی قرار گرفته بودند آنالیز شدند ( Intention to treat ). کلیه تحلیل های آماری در نرم افزار SPSS 18 انجام گردید. یافته ها: تفاوت معنی ‎ دار آماری از نظر پاسخ به درمان در سه گروه مشاهده شد و در گروه مپریدین تعداد درمان شده‏ها بیشتر بود (001/0 P< ). همچنین افرادی که با مپریدین درمان شدند به طور معنی داری از 50 درصد بیشتر بودند، در حالی‏که افرادی که با اندانسترون درمان شدند با 50% تفاوت معنی‏دار آماری نشان ندادند و در بیماران درمان شده با دارونما این تعداد به طور معنی داری از 50 درصد کمتر بود. نتیجه گیری : هر چند مپریدین در درمان لرز بعد از بیهوشی مؤثرتر از اندانسترون است، ولی با توجه به تفاوت معنی دار مشاهده شده اندانسترون نسبت به دارو نما، اندانسترون نیز می‏تواند در مواردی که کنتراندیکاسیون استفاده از مپریدین وجود دارد، یک درمان مناسب باشد. واژ ه های کلیدی: لرز بعد از بیهوشی، درمان ، اندانسترون ، مپریدین

English

Post-anaesthetic shivering (PAS) is a common and distressing complication, with most studies conducted in adults (Kranker et al., 2003). The aim of this study was to compare the effectiveness of tramadol and pethidine in the treatment of PAS in children. A randomized, double blind, comparative study was carried out on 80 children of American Society of Anesthesiologists (ASA) physical status I or II who presented with PAS during recovery from general anaesthesia. The children were randomized to receive 0.4 mg/kg of either drug. The response to treatment was assessed in 5, 15, 30, 45 and 60 min. The mean time [SD] for cessation of shivering following treatment with tramadol was 5.57 min (0.8) while with pethidine cessation occurred after 7.42 min (0.94), which was statistically significant. However, 17 patients in the pethidine group developed significant side effects when compared with the 4 patients in the tramadol group. Finally, there was a 10% recurrence of PAS with tramadol as against 50% with pethidine after 45 min. Both regimens were effective in treating PAS, but tramadol had a quicker onset time, with less side effects and recurrence rates of PAS. Key words: Shivering, anaesthesia, pethidine, tramadol.

Effect of palonosetron on postanesthetic shivering after propofol–remifentanil total intravenous anesthesia

The authors conducted a prospective, randomized, double-blind study to evaluate the anti-shivering efficacy of palonosetron for patients after gynecological laparoscopy under total intravenous propofol-remifentanil anesthesia. Sixty female patients were randomly assigned to one of two groups and administered palonosetron 0.075 mg (palonosetron group, n = 30) or the same volume of normal saline (control group, n = 30) immediately after anesthesia induction. Anesthesia was induced and maintained with propofol and remifentanil, using a target-controlled infusion device. Esophageal and index finger temperatures were measured immediately after anesthesia induction (baseline) and at 15-min intervals until the end of the surgery. Postanesthetic shivering and side effects were assessed in a postanesthetic care unit. Incidence of shivering was comparable in the control and palonosetron groups (10/30 vs. 8/30, respectively, P = 0.779). No significant intergroup differences were observed between esophageal and index finger temperatures. Compared with baseline values, esophageal temperatures decreased immediately after pneumoperitoneum in the control group and from 30 min after pneumoperitoneum in the palonosetron group. Use of palonosetron (0.075 mg) did not reduce the incidence of postanesthetic shivering after gynecological laparoscopy under propofol-remifentanil anesthesia. Further study including other 5-HT3 antagonists or male patients would elucidate the effect of palonosetron on shivering after propofol-remifentanil anesthesia.

Efficacy of Prophylactic Clonidine in Preventing Postanesthetic Shivering in Laparoscopicassisted Vaginal Hysterectomy

ABSTRACT Objective Postanesthetic shivering occurs in up to 60% of patients following general anesthesia and is associated with deleterious consequences. Various drugs have been used to prevent or treat postanesthetic shivering, but the ideal one has not yet been found. In this study, we have studied the efficacy of prophylactic clonidine in preventing postanesthetic shivering. Meterials and methods Sixty ASA (American Society of Anesthesiologists) I and II patients scheduled for laparoscopicassisted vaginal hysterectomy (LAVH) were randomly allocated to receive either clonidine 2 μg.kg—1 (group C, n = 30) or normal saline (group S, n = 30) intravenously at the time of vault closure. Core body temperature (nasopharyngeal) along with NIBP, heart rate and ECG were monitored at regular intervals. The severity of shivering was assessed according to a five-point scale (0 to 4). Results Significantly less shivering occurred in clonidine group 5 (17%) compared to normal saline group 20 (67%). The recovery time (between end of anesthesia and extubation) was significantly longer in the clonidine group (12.5 ± 4.3 minutes) compared with normal saline group (8.0 ± 4.5 minutes). Mean arterial blood pressure and heart rate were significantly lower in the clonidine group compared with saline group. Conclusion Prophylactic clonidine is effective in the prevention of postanesthetic shivering. Following clonidine administration, the recovery time was prolonged and incidence of bradycardia and hypotension were more than placebo. How to cite this article Chattopadhyay S, Goswami S, Rudra A. Efficacy of Prophylactic Clonidine in Preventing Postanesthetic Shivering in Laparoscopic-assisted Vaginal Hysterectomy. J South Asian Feder Obst Gynae 2013;5(3): 120-123.