Pharmacological Management of Perioperative Shivering

Golembiewski, Julie

doi:10.1016/j.jopan.2015.05.002

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Management of postoperative shivering is an important aspect of patient wellbeing after the surgery, and it is associated with a number of complications [3,14,15]. In this study, the effect of ondansetron and meperidine was evaluated in the prevention of postoperative shivering among patients undergoing elective cesarean section, under spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia

Vahabi¹,

Beiranvand²,

Karimi³

et al. 2021

TOATJ

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Purpose: Post-anesthesia shivering is one of the most common problems after surgery and may lead to multiple complications such as hypoxemia, lactate acidosis and catecholamine release. The purpose of this study was to compare the effects of intravenous meperidine and ondansetron on postoperative shivering in patients having an elective cesarean section under spinal anesthesia. Design: Cross-sectional study Methods: In this cross-sectional study, 105 patients with the age of 18-45 years and ASA class I-II undergoing elective cesarean section were randomly assigned into three groups. Group O was administered 8mg ondansetron, group M patients were given 0.4mg/kg meperidine and group P was placebo that was administered with 2cc of saline intravenously after the delivery. The incidence and intensity of shivering and postoperative nausea was monitored and recorded by the trained nurse. The data obtained was analyzed using SPSS v18. Results: All three groups (n=35) had no significant difference in terms of age, weight and time of spinal anesthesia. Postoperative shivering was reported in 4 patients (11.4%) in group A and 3 patients (8.6%) in group B and in 14 patients (40%) in group C. The incidence of postoperative shivering was significantly less in groups A and B as compared to the placebo, p=0.03. The intensity of shivering was greater in group C as compared to groups A and B, p=0.01. The incidence and intensity of postoperative nausea was significantly less in group A, p=0.03, p<0.001, respectively, while no difference was reported in groups B and C, p<0.05. Conclusion: 8mg ondansetron and 0.4 mg/kg of meperidine are equally effective in managing postoperative shivering; however, ondansetron has an additional effect of reducing the incidence of postoperative nausea among patients undergoing caesarean section with spinal anesthesia.

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Section: Discussionmentioning

confidence: 99%

Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia

Vahabi¹,

Beiranvand²,

Karimi³

et al. 2021

TOATJ

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“…Shivering may therefore be considered both thermogenic and non-thermogenic (14,23). As such, a variety of measures are widely used to prevent postoperative shivering (22,26,27).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of prophylactic epidural ketamine for reducing shivering in patients undergoing caesarean section with combined spinal‑epidural anesthesia

Xue

Zhao

et al. 2018

biom rep

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Abstract.Intravenous ketamine is known to inhibit postoperative shivering; however, at present, there has been little research on whether this effect may be achieved with epidural application. The aim of the present study was to evaluate the efficacy and safety of epidural ketamine as a prophylactic agent to prevent shivering in patients undergoing caesarean section during combined spinal-epidural anesthesia. A prospective, randomized, double-blind study was performed. A total of 60 patients who were undergoing elective caesarean section under combined spinal-epidural anesthesia and had an American Society of Anesthesiologists physical status of I or II were recruited. Patients were randomly allocated to group S (epidural administration of normal saline; n=30) or group K (epidural ketamine 0.5 mg/kg; n=30). An investigator, blinded to the treatment groups, graded postoperative shivering using a 4-point scale and postoperative sedation on a 5-point scale. Operative time, hemodynamic changes and side effects, including hypotension, bradycardia, nausea and hallucinations, were recorded. The results demonstrated that patients' characteristics were not significantly different between groups. Heart rate, peripheral capillary oxygen saturation (SpO 2 ) values and Apgar scores at 1 and 5 min also did not differ significantly between groups. The incidence and severity of shivering in group K was significantly reduced compared with group S (P<0.05). The mean arterial pressure (MAP) was significantly different in groups S and K compared with baseline values at 10, 30 and 60 min (P<0.05). Furthermore, MAP values at 10, 30 and 60 min were significantly higher in group K compared with in group S (P<0.05). The results of the present study suggest that epidural administration of prophylactic low-dose ketamine may be an effective strategy for preventing postoperative shivering.

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“…On the other hand, the use of cold liquids exacerbates hypothermia ( 5 , 6 ). Persistent hypothermia can lead to complications such as postoperative shivering, coagulopathy, decreased immunity, cardiac morbidity ( 7 ), postsurgical wound infection, impaired wound healing, prolonged recovery from anesthesia and prolonged hospital stay ( 6 , 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intravenous Ketamine with Intrathecal Meperidine in Prevention of Post-anesthetic Shivering after Spinal Anesthesia for Lower Limb Orthopedic Surgeries: A Double-blind Randomized Clinical Trial

Gholinataj

Baradari

Najafi

et al. 2021

Ethiop J Health Sci

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BACKGROUND፡ Post-anesthetic shivering is one of the most common complications after anesthesia. Ketamine has been considered to be an effective treatment for post-anesthetic shivering, but the evidence for its therapeutic benefit after spinal anesthesia is limited. The aim of this study was to compare the effects of intravenous ketamine with intrathecal meperidine in the prevention of post-anesthetic shivering after spinal anesthesia for lower limb orthopedic surgeries.METHODS: In a double-blind randomized parallel-group clinical trial, a total of 150 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were selected and randomly divided into three equally sized groups of intravenous ketamine (0.5mg/kg), intrathecal meperidine (0.2mg/kg) or intravenous normal saline (as placebo). The intensity of shivering in patients were evaluated during surgery and after transfer into the post anesthesia care unit. Also, changes in patients' drowsiness, nausea, vomiting, pruritus, mean arterial pressure, heart rate, and arterial oxygen saturation (SPO2) during surgery and until the end of anesthesia were evaluated.RESULTS: In all times of evaluation (20, 60, 80, 100 and 120 minutes after onset of spinal anesthesia) patients in control group showed a greater intensity of shivering compared to other groups. However, patients who received intrathecal meperidine experienced significantly lower intensity of post anesthetic shivering (p<0.05). The results showed a significant mean arterial pressure and heart rates differences between the three groups, only on 20 and 60 minutes after initiation of spinal anesthesia. The incidence of nausea, vomiting, and pruritus was not significantly different in all three groups, although all patients who received ketamine experienced drowsiness after surgery (p<0.001).CONCLUSION: The results of the present study showed that, although both intrathecal meperidine and intravenous ketamine could effectively prevent postoperative shivering after spinal anesthesia in lower limb orthopedic surgeries, intrathecal meperidine was associated with more efficacy benefits and a lower frequency of side effects such as post-anesthesia drowsiness.

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Pharmacological Management of Perioperative Shivering

Cited by 6 publications

References 18 publications

Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia

Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia

Efficacy of prophylactic epidural ketamine for reducing shivering in patients undergoing caesarean section with combined spinal‑epidural anesthesia

Comparison of Intravenous Ketamine with Intrathecal Meperidine in Prevention of Post-anesthetic Shivering after Spinal Anesthesia for Lower Limb Orthopedic Surgeries: A Double-blind Randomized Clinical Trial

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