Comparison of dexmedetomidine and meperidine for the prevention of shivering following coronary artery bypass graft: study protocol of a randomised controlled trial

Abstract

IntroductionShivering is a common complication in the postoperative period. The incidence of shivering has been reported to range from 5% to 65% under general anaesthesia and as 33% during epidural anaesthesia. Shivering can increase perioperative risk in patients. Both dexmedetomidine and meperidine are effective agents for the prevention of postanaesthetic shivering. However, few studies have compared the anti-shivering effects of different agents following coronary artery bypass graft (CABG). This study aims to compare the effects of dexmedetomidine and meperidine on the incidence of shivering in patients undergoing CABG.Methods and analysisA total of 180 patients aged 18–75 years, with an American Society of Anesthesiologists (ASA) grade of II–IV, undergoing elective CABG will be enrolled and randomly assigned to the dexmedetomidine, meperidine and control groups (placebo) in an intended 1:1:1 allocation ratio. The patients will be followed up for 7 days after surgery. The primary outcome is the incidence of shivering within 24 hours postoperatively. The secondary outcomes are the number of remedial drugs used after surgery, the incidence of postoperative hypotension and bradycardia, sedation scores, endotracheal extubation time, intensive care unit length of stay, incidence of postoperative delirium within 7 days after surgery, incidence of postoperative arrhythmias, incidence of postoperative nausea and vomiting, average hospital length of stay and mortality rate 30 days after surgery.Ethics and disseminationThe study protocol was approved by the ethics committee of The First Affiliated Hospital of Shandong First Medical University on 20 January 2021 (YXLL-KY-2021(002)) and registered at ClinicalTrials.gov. The results of this study will be presented at national and international scientific meetings and conferences. We plan to publish the data in peer-reviewed international scientific journals.Trial registration numberNCT04735965.

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“…The current study showed that both Dexmedetomidine 0.5 µg/kg and Tramadol 0.5mg/kg decreased the incidence and intensity of shivering in patients exposed to elective operations under spinal anaesthesia when compared to the control group, but these drugs could not prevent the significant decrease in the core temperature after the subarachnoid block. This anti-shivering effect was not associated with increased side effects 8 .…”

Percepciones de anestesiólogos sobre prevención y tratamiento del temblor postoperatorio - Perceptions of anesthesiologists on prevention and treatment of postoperative tremor

“…Se ha reportado una incidencia del temblor postoperatorio, que oscila entre el 5% y el 65% bajo anestesia general y el 33% bajo anestesia neuroaxial 4 . La hipotermia perioperatoria es la principal causa de temblor postoperatorio debido a la inhibición del mecanismo termorregulador 7 .…”

“…El temblor postoperatorio es un movimiento involuntario que afecta a una o varias fibras musculares, generalmente se presenta en la primera fase de la recuperación tras anestesia general 3 . De acuerdo a datos establecidos la incidencia fluctúa entre 6 y 66%; predomina en género masculino y se ha visto que el tiempo y tipo de cirugía parecen ser uno de los factores determinantes para su presentación 4 .…”

Effect of Different Doses of Butorphanol on Postoperative Shivering in Elderly Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

“…In addition, its metabolites can cause central nervous system symptoms of excitement. 4,9,10 Butorphanol is a mixed agonist and antagonist of the opioid receptor. It produces analgesic and shivering resistance effects for moderate affinity to the κ opioid receptor (KOR), with partial antagonism to the μ opioid receptor (MOR), so it has little effect on respiration and circulation with minor adverse reactions.…”