Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia

Lewis, Sharon R; Nicholson, Amanda; Smith, Andrew F.; Alderson, Phil

doi:10.1002/14651858.cd011107.pub2

Cited by 40 publications

(37 citation statements)

References 69 publications

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“…Several studies have demonstrated that dexmedetomidine alleviated shivering mainly through its central α2-adrenoreceptor agonist effect. 18,19) Alpha-2 adrenergic receptors, which are widely distributed in the hypothalamus, are thought to mediate thermoregulatory inhibition. In many studies, dexmedetomidine was shown to increase the temperature range without triggering thermoregulatory defenses through stimulation of central α2-adrenergic receptors, thereby decreasing the central thermoregulatory threshold for shivering.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Liu

et al. 2017

Biological & Pharmaceutical Bulletin

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Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient, which may also cause adverse effects. In this prospective, randomized, double-blind, placebocontrolled study, we sought to evaluate the effect of intrathecal dexmedetomidine, administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery, on the incidence and severity of shivering associated with spinal anesthesia. Patients undergoing Cesarean delivery were randomly allocated to three groups of 30 patients each. Experimental treatments were added to hyperbaric bupivacaine as follows: Patients in group I (control) were administered isotonic saline. Patients in groups II and III received dexmedetomidine (2.5, 5 µg, respectively), mixed with isotonic saline. Shivering was observed in 11, 10 and 2 patients in groups I, II and III, respectively. The incidence of shivering in group III was significantly lower than that in groups I (p 0.005) and II (p 0.01). The severity of shivering was significantly different between the three groups (p 0.01). There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia (p>0.05). Intrathecal dexmedetomidine (5 µg) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia.

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Section: Discussionmentioning

confidence: 99%

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Liu

et al. 2017

Biological & Pharmaceutical Bulletin

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“…Several reviews [5, 46] conclude the potential role ofα2 adrenoreceptor (α2-AR) agonist for perioperative shivering control. Dexmedetomidine, a highly lipophilic anesthetic [47], demonstrates almost 8- 10times higher affinity to α2-ARs than clonidine [48].…”

Section: Discussionmentioning

confidence: 99%

“…However, mechanisms of hypothermia and shivering may differ in parturients. The parturients can occur shivering even after normal delivery[46], and the anti-shivering mechanism of dexmedetomidine can be explained by the attenuation of hyperadrenergic response to perioperative stress[44]. …”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Zhang

Wang

et al. 2017

PLoS ONE

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BackgroundDexmedetomidine, a highly selective α2-adrenoceptor agonist, has been investigated for anti-shivering effects in some trials. This current meta-analysis was conducted to evaluate the effectiveness of dexmedetomidine as a neuraxial adjuvant in preventing perioperative shivering.MethodsThis systematic review and meta-analysis was registered in PROSPERO [www.crd.york.ac.uk/PROSPERO] with the unique identification number CRD42017055991. The electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) were searched to select high-quality randomized controlled trials (RCTs) that evaluated the anti-shivering efficacy for neuraxial application dexmedetomidine as local anesthetic adjuvant. Effects were summarized using pooled risk ratios (RRs), weighed mean differences (MDs), or standardized mean differences (SMDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. The primary outcome was perioperative shivering.ResultsA total of 1760 patients from 24 studies were included in this meta-analysis. Compared with the placebo, dexmedetomidine reduced the incidence of perioperative shivering (RR: 0.34; 95% Cl: 0.21 to 0.55; P < 0.00001), with a maximum effective dose of 5μg via subarachnoid space injection (RR: 0.55; 95% CI: 0.32 to 0.92; P = 0.02), especially in cesarean section (RR: 0.20; 95% CI: 0.09 to 0.45; P = 0.0001). Dexmedetomidine also could improve the characteristics of the block, with an increase only in the incidence of bradycardia (RR: 2.11; 95% CI: 1.23 to 3.60; P = 0.006). No significant difference could be found compared dexmedetomidine with other adjuvants, except morphine.ConclusionsThis meta-analysis shows that dexmedetomidine as a neuraxial adjuvant had statistically significant efficacy on prevention of perioperative shivering. Moreover, dexmedetomidine could improve the characteristics of the block. However, the potential induction of bradycardia should be taken seriously.

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“…Shivering is a common complication in intraoperative and postoperative periods . In addition to being an uncomfortable experience for patients and interfering with many monitoring devices, perioperative shivering can increase intraocular pressure, pain on the surgical site, and oxygen consumption …”

mentioning

confidence: 99%

5‐HT₃Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta‐Analysis

Wang

Song

Wang

et al. 2016

The Journal of Clinical Pharma

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The aim of this meta-analysis was to evaluate the preventive efficacy and safety of 5-HT receptor antagonists (5-HT RAs) on perioperative shivering. Relevant databases were searched to identify eligible randomized, controlled trials through January 2016. Primary outcome was the incidence of perioperative shivering, and secondary outcomes were the incidence of safety-related outcomes including postoperative nausea and vomiting (PONV), bradycardia, and hypotension. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data. Trial sequential analysis was performed to assess the risk of random errors and calculate the required information size. Sixteen studies with a total of 1126 patients were included in the meta-analysis. Compared with the control group, 5-HT RAs administered intravenously could statistically significantly reduce the incidence of perioperative shivering (RR, 0.44; 95%CI, 0.35 to 0.56; P < .00001; heterogeneity: I = 30%) as well as PONV (RR, 0.52; 95%CI, 0.28 to 0.97; P = .04; heterogeneity: I = 0%). However, they did not show superiority in lowering the rate of bradycardia (RR, 0.75; 95%CI, 0.38 to 1.49; P = 0.42; heterogeneity: I = 0%) or hypotension (RR, 0.79; 95%CI, 0.44 to 1.43; P = .44; heterogeneity: I = 24%). Trial sequential analysis of primary outcome showed that the required information size was 2634 patients and that the trial sequential monitoring boundary was crossed. Thus, more high-quality randomized, controlled trials with larger sample sizes are still required to draw a definite conclusion about the preventive efficacy of 5-HT RAs on perioperative shivering prevention in the future.

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Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia

Abstract: There is evidence that clonidine and dexmedetomidine can reduce postoperative shivering, but patients given dexmedetomidine may be more sedated. However, our assessment of the quality of this evidence is very low.

Cited by 40 publications

References 69 publications

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

5‐HT₃Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta‐Analysis

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Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia

Abstract: There is evidence that clonidine and dexmedetomidine can reduce postoperative shivering, but patients given dexmedetomidine may be more sedated. However, our assessment of the quality of this evidence is very low.

Cited by 40 publications

References 69 publications

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

5‐HT3Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta‐Analysis

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5‐HT₃Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta‐Analysis