Prevention Of Postanesthetic Shivering Research Articles

Prevention of post-anaesthetic shivering under subarachnoid block for lower limb surgeries: A randomised controlled study comparing nefopam and tramadol

Prevention of post-anaesthetic shivering under subarachnoid block for lower limb surgeries: A randomised controlled study comparing nefopam and tramadol

Effect of Granisetron Plus Dexamethasone versus Granisetron Alone on Postoperative Shivering in patients undergoing Gynecological surgery under general anesthesia

Abstract Background and rational Shivering, a very common complication of surgery owing to postoperative pain and post anesthesia hypothermia, is distressing for both patients and clinicians. It can be defined as involuntary and oscillatory muscular activities that increase the metabolic rate by two to three folds to maintain the core temperature. Both neuraxial (epidural and spinal anesthesia) and general anesthesia are associated with a significant incidence of shivering. The incidence is 40%-60% in regional anesthetic patients and up to 60% in general anesthetic ones. Patients and Methods This study was conducted at Ain Shams University Hospitals between September 2018 and February 2019, after obtaining approval of research ethical committee and patients’ informed consents, 150 patients were included in the study and underwent elective gynecological, and received general anesthesia. Results this study show incidence of post anesthetic shivering is significantly reduced after combination of granisetron and dexamethasone compared to control group Conclusion Combination of granisetron and dexamethasone significantly reduced Post anesthetic shivering (PAS) compared to granisetron alone. It is difficult to establish which drug can be considered the gold standard in prevention of PAS after general anesthesia. Because many research centers have reported that the effects of different anti-shivering drugs are similar, it is wise to administer the cheapest and safest drugs.

Prevention of postanesthetic shivering under subarachnoid block for cesarean section: A randomized, controlled study comparing tramadol versus ondansetron.

Shivering is a frequent undesirable event in patients undergoing cesarean delivery under spinal anesthesia. Postanesthetic shivering has a multitude of deleterious effects and different methods have been used to prevent it. We therefore compare the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. Comparison of the efficacy of ondansetron to that of tramadol in preventing postanesthetic shivering in women undergoing cesarean section under subarachnoid block. This is a prospective, double-blind, placebo-controlled, randomized study. The patients (n = 109) were randomly allocated to three groups according to the study drugs, namely tramadol 50 mg group (Group T), ondansetron 4 mg group (Group O), and saline 4 ml group (Group S) using envelope randomization. Statistical analyses were done using Statistical Package for Social Sciences 20.0. A total of 100 patients completed the study (33 in Group S, 33 in Group T, and 34 in Group O). The three groups were comparable with respect to demographic characteristics. Shivering was observed in 16 (48.5%) of the patients in Group S; 13 (39.4%) patients in Group T, and in only 2 (5.9%) patients in Group O. The differences in incidence of shivering were statistically significant between Groups O and S (P = 0.000) and Groups O and T (P = 0.001) but not between Groups T and S (P = 0.460). The differences across the groups were not statistically significant in terms of incidence of intraoperative hypotension, bradycardia, and the cumulative amount of ephedrine consumed. This study demonstrated that ondansetron is superior to tramadol in preventing shivering under spinal anesthesia in women undergoing cesarean section.

Comparison of three different doses of dexmedetomidine for prevention of postspinal anesthesia shivering in transurethral resection of prostate surgery

Background and Aims: Postanesthetic shivering (PAS) is an unpleasant and potentially serious complication. It is often neglected, and no universal protocols are established for its prevention. The efficacy of dexmedetomidine for the treatment and prevention of PAS is well demonstrated. Very few studies have been done regarding the optimal effective dose of dexmedetomidine for the prevention of postspinal anesthesia (SA) shivering. Thus, we aimed to compare and evaluate three different doses of intravenous dexmedetomidine and to investigate the optimum dose of dexmedetomidine that effectively prevents shivering in patients undergoing transurethral resection of the prostate (TURP). Methods: In this randomized, double-blind, prospective study, 150 patients of the American Society of Anesthesiologists I and II scheduled for elective TURP under SA were enrolled. Patients were randomly allocated into one of the three groups receiving dexmedetomidine: Group P: 0.5 μg/kg, Group Q: 0.75 μg/kg, and Group R: 1.0 μg/kg. The primary outcome of the study was intraoperative incidence of shivering. The secondary outcomes, such as hemodynamic parameters and adverse reactions, were also noted. Results: Shivering score of different groups revealed statistically significant lower incidence and severity of shivering in Group Q and Group R when compared to Group P(P = 0.0395). Incidences of nausea/vomiting, bradycardia, and hypotension were more in Group R when compared to Group P and Group Q. Axillary temperature and sedation scores were comparable among different groups (P > 0.05). Conclusion: Dexmedetomidine in the dose of 0.75 μg/kg provides adequate antishivering effect with added benefit of sedation and less hemodynamic instability.

Effectiveness of dexmedetomidine use in general anesthesia to prevent postoperative shivering: a systematic review protocol.

Review question/objective The following question guides the systematic review: In adult patients undergoing general anesthesia, what is the effectiveness of dexmedetomidine, compared to placebo, in preventing shivering in the first two hours after surgery? The objective of this systematic review is to synthesize the best available evidence on the efficacy of dexmedetomidine in preventing the occurrence of postanesthetic shivering. Inclusion Criteria Types of participants This review will consider studies that include adult patients between 18 and 70 years of age receiving general anesthesia for any surgical procedure in any clinical setting. Only studies examining patients with American Society of Anesthesiologist physical status 1 or 2 will be considered. Studies including anesthetic techniques other than general anesthesia will be excluded. Studies including patients less than 18 years of age will also be excluded, as the incidence of postanesthetic shivering in this population is low and the risk to benefit ratio doesn’t warrant prophylactic treatment. Type of intervention This review will evaluate the effectiveness of dexmedetomidine in preventing postanesthetic shivering. Studies that compare preoperative or intraoperative administration of dexmedetomidine to placebo will be considered. Only intravenous administration techniques of dexmedetomidine will be included. Studies to be examined will include dexmedetomidine administration times of 30 minutes prior to induction of general anesthesia and any other intraoperative administration times. Dexmedetomidine boluses and infusions will be completed prior to patient arrival to post-anesthesia care unit. Studies will be excluded if the dexmedetomidine is administered during post-anesthesia care unit stay. Examined studies will include the administration of dexmedetomidine as a one-time bolus, continuous infusion, or a combination of bolus and infusion doses. Only studies evaluating dexmedetomidine as the sole pharmacological agent in the prevention of postanesthetic shivering will be considered. Studies evaluating dexmedetomidine for the treatment of postanesthetic shivering will be excluded. Types of outcomes This review will consider studies that include the following outcome measure: presence of postanesthetic shivering observed in the post-anesthesia care unit during the first hour after the completion of surgery. Intensity of shivering will be measured with variations of a shivering scale validated by Crossley and TRUNCATED AT 350 WORDS

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.

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.

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

Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy

Post-anaesthetic shivering is one of the most common complications, occurring in 5-65% of patients recovering from general anaesthesia and 33% of patients receiving epidural anaesthesia. Our objective was to investigate the efficacy of intraoperative dexmedetomidine infusion on postoperative shivering. Ninety female patients, ASA I-II, 35-60 yr old, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized into two groups. After endotracheal intubation one group received normal saline infusion and the other received dexmedetomidine as a loading dose of 1 microg kg(-1) for 10 min followed by a maintenance infusion of 0.4 microg kg(-1) h(-1). In the recovery room, pain was assessed using a 100 mm visual analogue scale and those patients who had a pain score of more than 40 mm were administered 1 mg kg(-1) intramuscular diclofenac sodium. Patients with shivering grades more than 2 were administered 25 mg intravenous meperidine. Patients were protected with passive insulation covers. Post-anaesthetic shivering was observed in 21 patients in the saline group and in seven patients in the dexmedetomidine group (P = 0.001). Shivering occurred more often in the saline group. The Ramsay Sedation Scores were higher in the dexmedetomidine group during the first postoperative hour. Pain scores were higher in the saline group for 30 min after the operation. The need for intraoperative atropine was higher in the dexmedetomidine group. Intraoperative fentanyl use was higher in the saline group. Perioperative tympanic temperatures were not different between the groups whereas postoperative measurements were lower in the dexmedetomidine group (P < 0.05). Intraoperative dexmedetomidine infusion may be effective in the prevention of post-anaesthetic shivering.

Pharmacological Prevention of Postanesthetic Shivering

Pharmacological Prevention of Postanesthetic Shivering

Pharmacological Prevention of Postanesthetic Shivering

Pharmacological Prevention of Postanesthetic Shivering

Prevention of Postanesthetic Shivering with Intravenous Administration of Aspirin

There have been many reports of postanesthetic shivering (PAS); however, the causes have not been defined clearly, and the reported methods of inhibiting PAS are not always available clinically. In the present study, we assessed the effect of the intravenous administration of aspirin on the prevention of PAS in 62 patients undergoing oral or maxillofacial surgery, anesthetized with enflurane-nitrous oxide. Thirty of the patients were randomly selected, and received intravenous aspirin DL-lysine 900 mg (equivalent to aspirin 495 mg) before the end of surgery. No significant differences were noted in the rectal temperatures between the group given aspirin and the control group. Shivering was observed in 17 of the 32 patients of control group. In contrast, shivering was observed in 5 of the 30 patients who received aspirin. This was a statistically significant difference ( P < 0.01). These data indicate that intravenous administration of aspirin significantly inhibited PAS. The finding suggests that PAS is related to prostaglandin synthesis or to the formation of derivatives of arachidonic acid, since aspirin inhibits both the synthesis of prostaglandins and the formation of derivatives of arachidonic acid.