A comparison of prophylactic use of meperidine, meperidine plus dexamethasone, and ketamine plus midazolam for preventing of shivering during spinal anesthesia: a randomized, double-blind, placebo-controlled study

Solhpour, Ali; Jafari, Alireza; Hashemi, Masoud; Hosseini, Behnam; Razavi, Sajad; Mohseni, Gholamreza; Vosoughian, Maryam; Behnaz, Faranak; Nejad, Reza Amin; Pourhoseingholi, Mohamad Amin; Soltani, Fatemeh

doi:10.1016/j.jclinane.2016.03.036

Cited by 20 publications

(26 citation statements)

References 25 publications

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“…Also shivering may cause discomfort in PACU and may relate to complications such as pain, haemorrhage, wound infection and prolonged hospital stay 27 . Along with the use of meperidine in the literature, different drugs have been tried for postoperative shivering treatment 28 . However, there are various side effects of drug treatments and there is not yet a gold standard treatment in this regard.…”

Section: Discussionmentioning

confidence: 99%

The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors

Sari

Aksoy

But

2021

Int J Clinical Practice

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Background Unintended perioperative hypothermia, defined as core body temperature less than 36°C, is closely related to many complications such as cardiovascular diseases, peroperative hemorrhagic diathesis and impairment of drug metabolism. Determination of the incidence of perioperative hypothermia and examination of risk factors may help to prevent hypothermia and its complications. Methods We conducted a prospective, observational study of 2015 patients who underwent various operations under general anesthesia, and the risk factors of developing hypothermia were analysed. Results The incidence of perioperative hypothermia was 78.6%. The incidence of hypothermia within 2 hours was 56.6%, and after 2 hours, it was 100%. Mean age was 49.36 ± 16.10, and 17.8% were over 65 years old. The mean body mass index (BMI) was 27.96 ± 3.94 kg/m2; 60.8% of the patients had American Society of Anesthesiologists (ASA) I score, 33.4% had ASA II and 5.8% had ASA III; 35.8% of the patients had co‐morbidities. Intravenous and irrigation fluids were unwarmed; 99.9% of the patients were warmed passively, and only 0.1% of patients received active heating intraoperatively. The incidence of hypothermia was higher in overweight (BMI ≥ 25 kg/m2), elderly (>65 years) patients and those with co‐morbidities. High American Society of Anesthesiologists (ASA) scores, grade 3‐4 surgery, endoscopic surgery, duration of anesthesia >2 hours, infusion or irrigation >1000 mL significantly increased the incidence of hypothermia. Conclusion The incidence of perioperative hypothermia found was high. Important risk factors were found as prolonged duration of anesthesia and surgery, advanced age, overweight, high ASA scores, major surgeries, endoscopic operations and unwarmed fluid administration. High incidence may be reduced by raising awareness, considering fossible risk factors and following the recommendations of the guidelines on prevention of perioperative hypothermia.

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Section: Discussionmentioning

confidence: 99%

The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors

Sari

Aksoy

But

2021

Int J Clinical Practice

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“…Among these, meperidine is the medication most often recommended for clinical use. Meperidine’s anti-shivering effects have been attributed to its actions on the κ-opioid receptor [6] and the α 2b adrenoreceptor subtype [7]. Side effects associated with meperidine administration include nausea, vomiting, and pruritus [8], as well as respiratory depression at higher doses [9].…”

Section: Introductionmentioning

confidence: 99%

The effects of novel α2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section

Jin

Chen

et al. 2019

Bioscience Reports

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Objective: Meperidine used to control shivering during perioperative period has associated side effects. The present study compared the safety of selective α2-adrenoreceptor agonist dexmedetomidine and meperidine for anti-shivering in primiparas after caesarean delivery under combined spinal-epidural anesthesia (CSEA).Methods: 100 primiparas scheduled for caesarean delivery were randomly allocated to dexmedetomidine group (Group D, n=50) and meperidine positive control group (Group M, n=50). Primiparas experienced shivering that continued to cord clamping were treated with dexmedetomidine (0.5 μg/kg) or meperidine (0.5 mg/kg) after cord clamping. The primary outcome measures were incidence of nausea, vomiting, and respiratory depression. Secondary outcome measures were shivering score, vital signs including blood pressure, heart rate and O2 saturation, tympanic temperature, and sedation score.Results: Dexmedetomidine provided similar anti-shivering effects as meperidine in patients after caesarean delivery under CSEA, evidenced as all shivering primiparas responded to either dexmedetomidine or meperidine treatment within 15 min. However, incidence of nausea and vomiting were significantly lower after dexmedetomidine treatment, accompanied with more stable blood pressure. Dexmedetomidine also provided well regulation of tympanic temperature and good sedation.Conclusion: Selective α2-adrenoreceptor agonist dexmedetomidine has a better safety profile compared with meperidine for anti-shivering in primiparas undergoing caesarean delivery. Dexmedetomidine could be a better choice for anti-shivering in patients requiring caesarean section. The mechanism of anti-shivering for dexmedetomidine may relate to well regulation of temperature and good sedation.

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“…Anesthesia was performed with premedication by midazolam (30 mcg/Kg) and fentanyl (1 mcg/Kg) and induction by propofol (1 mg/Kg over 2-3 minutes) to achieve deep sedation level as a routine practice in our department with respect to recently updated guideline of American Society for Gastrointestinal Endoscopy (ASGE). 2 All patients were monitored by pulse oximetry, 3 lead ECG and automated NIBP (Non-Invasive Blood Pressure) measurements immediately prior to injection of premedication drugs up to 30 minutes after termination of the procedure (in post anesthesia care unit). Supplemental oxygen was delivered to all patients during the procedure via nasal cannula (3 Lit/min).…”

Section: Methodsmentioning

confidence: 99%

“…Sedation/anesthesia carries a spectrum of risks from shivering to death. 1,2 In this regard, choosing a best individualized method of sedation/anesthesia has a great importance. A systematic review of randomized controlled trials of patients undergoing esophago-gastro-duodenoscopy and/or colonoscopy showed that 6%–11% of patients experiences hypoxemia and hypotension is occurred in 5%–7%.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia Related Complications of Gastrointestinal Endoscopies; A Retrospective Descriptive Study

Hormati

Mohammadbeigi

Mousavi

et al. 2019

Middle East J Dig Dis

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BACKGROUND Gastrointestinal endoscopic procedures are widely used for diagnostic and therapeutic measures. Analgesia and sedation/anesthesia are inseparable parts of these studies and their related complications are inevitable.METHODS In a retrograde descriptive study in Shahid Beheshti Hospital, affiliated to Qom University of Medical Sciences, Qom, Iran from March 2013 to March 2017, we gathered information regarding common anesthesia related complications and analyzed them.RESULTS 44659 procedures were performed during the study period and records of 21342 men (47.79%) and 23317 women (52.21%) were evaluated. Hemodynamic instability (9998; 22.39%), dysrhythmia (1600; 3.58%), desaturation (608; 1.36%), prolonged apnea (34; 0.08%), aspiration (43; 0.10%), postoperative nausea and vomiting (PONV) (636; 1.42%), headache (106; 0.24%), delirium (51; 0.11%), aphasia (1; 0.00%), masseter muscle spasm (1; 0.01%), myocardial infarction (2; 0.00%), and death (5; 0.01%) were seen in the patients.CONCLUSION Sedation/anesthesia is enough safe in gastrointestinal endoscopic procedures to enhance the patients’ satisfaction and cooperation. If anesthesia with spontaneous breathing and unsecure airway is selected for this purpose, vigilance of anesthesia provider will be the key element of uneventful and safe procedure.

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A comparison of prophylactic use of meperidine, meperidine plus dexamethasone, and ketamine plus midazolam for preventing of shivering during spinal anesthesia: a randomized, double-blind, placebo-controlled study

Cited by 20 publications

References 25 publications

The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors

The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors

The effects of novel α2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section

Anesthesia Related Complications of Gastrointestinal Endoscopies; A Retrospective Descriptive Study

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