Abstract
Background: One of the complication during spinal anesthesia is shivering. It is supposed to increase tissue oxygen demand thereby interfering with patient monitoring.
Aims and Objectives: To compare dexmedetomidine with ketamine in preventing shivering during spinal anesthesia.
Materials and Methods: This prospective randomized controlled study included 80 ASA grade I and II patients of either sex, aged 18–60 years, scheduled for elective lower abdominal and lower limb surgeries, under spinal anesthesia. They were divided randomly into two groups of 40 patients each. Group K received low-dose ketamine (0.25mg/kg) and group D received dexmedetomidine infusion. Along with intraoperative shivering, hemodynamic changes and sedation scores were used as parameters.
Results: Patients in group D had a lower incidence of postspinal anesthesia shivering compared with patients in group K.
Conclusion: Dexmedetomidine infusion was more effective as an anti shivering and sedating agent than low-dose ketamine injection in patients receiving spinal anesthesia.
Keywords: Dexmedetomidine, Ketamine, Shivering, Spinal Anesthesia.
References
- Houssein MM, Ibrahim IM. Intravenous low-dose ketamine injection versus dexmedetomidine infusion for prevention of intraoperative shivering during spinal anesthesia. Ain-Shams Journal of Anaesthesiology 2016, 9:524–530.
- Hatem Saber Mohamed HS. Dexmedetomidine versus Nefopam for the management of post-spinal anesthesia shivering: A randomized double-blind controlled study. Egyptian Journal of Anaesthesia (2015) 31, 315–320.
- Jeon YT, Jeon YS, Kim YC, Bahk JH, Do SH, Lim YJ. Intrathecal clonidine does not reduce post-spinal shivering. Acta Anaesthesiol Scand 2005; 49:1509–1513.
- Sessler Daniel I. Temperature monitoring. In: Miller RD, editor. Textbook of anaesthesia. 5th ed. New York: Churchill Livingstone Inc; 1994. p. 1367–89.
- Dal D, Kose A, Honca M, et al. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth 2005:189–92.
- Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg 2001; 93:1288–1292.
- Dal D, Kose A, Honca M, Akinci B, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth 2005; 95:189–192.
- Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesthesiol Scand 2007; 51:44–49.
- Elvan EG, Oç B, Uzun S, Karabulut E, Coşkun F, Aypar U. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hystere-ctomy. Eur J Anaesthesiol 2008; 255:357–364.
- Bromage PR. A comparison of the hydrochloride and carbondioxide salt of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand 1965; 16:55–69.
- Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg 2001; 93:1288–1292.
- Wilson E, David A, MacKenzie N, Grant IS. Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth 1990; 64:48–52.
- Berti M, Fanelli G, Casati A, Aldegheri G, Lugani D, Torri G. Hypothermia prevention and treatment. Anaesthesia 1998; 53:46–47.
- Frank SM, El-Rahmany HK, Cattaneo CG, Barns RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology 2000; 92:1330– 1334.
- Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesio-logy.2003 Feb;98(2):428-36.
- Jorm CM, Stamford JA. Actions of the hypnotic anesthetic, dexmedetomidine, on noradrenaline release and cell firing in rat locus coeruleus slices. Br J Anaesth 1993; 71:447–449.
- Guyton AC. Body temperature, temperature regulation and fever. In: Guyton AC, Hall JE, editors. Text book of medical physiology. 9th ed. Philadelphia: W.B. Saunders; 1996: 911–922.
- TakadaK, ClarkDJ, DaviesMF, Tonner PH, Krause TK, Bertaccini Eet al. Meperidine exerts agonist activity at the α2 B-adrenoceptor subtype. Anesthesio-logy 2002; 96:1420–1426.
- Horn EP, Sessler DI, Standl T, Schroeder F, Bartz HJ, Beyer JC, Schulte am Esch J,et al. Non thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology 1998; 89:878–886.
- Elvan EG, Oç B, Uzun S, Karabulut E, Coşkun F, Aypar U. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy. Eur J Anaesthesiol 2008; 255:357–364.
- Coskuner I, Tekin M, Kati I, Yagmur C, Elcicek K. Effects of dexmedetomidine on the duration of anaesthesia and wakefulness in bupivacaine epidural block. Eur J Anaesthesiol 2007; 24:535–540.
- Bicer C, Esmaoglu A, Akin A, Boyaci A. Dexmedetomidine and meperidine prevent post anaesthetic shivering. Eur J Anaesthesiol 2006;232:149–153.
- Dal D, Kose A, Honca M, Akinci SB, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth 2005; 95:189–192.
- Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesthesiol Scand 2007; 51:44–49.
Corresponding Author
Dr K.Kalyan Kumar
Post Graduate, Department of Anesthesiology, Chalmeda Anandrao Institute of Medical Sciences
Bommakal Village, Karimnagar District, Telangana State, India
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.24
