Prophylactic vs. therapeutic magnesium sulfate for shivering during spinal anesthesia

Ibrahim, Ibrahim T.; Megalla, Soheir A.; Khalifa, Omyma Sh M; Deen, Hala M. salah El

doi:10.1016/j.egja.2013.07.007

Cited by 27 publications

(26 citation statements)

References 25 publications

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“…Magnesium sulphate is an attractive choice for shivering control because hypomagnesemia is observed during induced hypothermia [45]. Ibrahim et al further observed that following spinal anesthesia prophylactic magnesium sulphate infusion lowered the incidence of shivering [46].…”

Section: Management Of Shiveringmentioning

confidence: 99%

Magnesium: Emerging Potentials in Anesthesia Practice

Bansal¹

2015

J Anesth Clin Res

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Magnesium, a non-competitive blocker of N-methyl-D-aspartate receptor, initially used for management of preeclampsia, arrhythmia and bronchial asthma, is of great importance in anesthesia practice nowadays. It is being used intravenously, intrathecally as well as epidurally for postoperative pain relief. Recently it has gained popularity as an adjuvant in blocks. Anesthetic and analgesic sparing characteristics of magnesium enable anesthesiologists to reduce the dose of anesthetics during surgery and the use of analgesics after surgery.

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Section: Management Of Shiveringmentioning

confidence: 99%

Magnesium: Emerging Potentials in Anesthesia Practice

Bansal¹

2015

J Anesth Clin Res

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“…Shivering may occur as a response to hypothermia. However, it may also occur in normothermic patients [4]. SA impairs the thermoregulation system by inhibiting tonic vasoconstriction below the level of anesthesia through sympathetic and somatic neural blockade [5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: A randomized controlled trial

Moawad

Elawdy

2015

Egyptian Journal of Anaesthesia

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Background: Shivering is a frequent complication following spinal anesthesia (SA). It is more common in transurethral resection of the prostate (TURP) that may be due to absorption of large amount of irrigating fluids. We aimed to investigate the role of intrathecal dexmedetomidine in attenuation and prevention of shivering in patients undergoing TURP under SA. Methods: In a randomized, controlled trial, eighty patients were scheduled for elective TURP under SA. Patients were randomly allocated into two groups: control group (group C): patients received 2.5 ml of hyperbaric bupivacaine 0.5% plus 0.5 ml of normal saline and dexmedetomidine group (group D); patients received 2.5 ml of hyperbaric bupivacaine 0.5%, plus 10 lg dexmedetomidine in 0.5 ml of normal saline. Hemodynamic parameters, shivering score and any adverse effects were recorded. Results: The incidence of shivering was significantly reduced in group D, 6/40 patients (15%) compared with 23/40 patients (57%) in group C (P < 0.001). The frequency of bradycardia, hypotension, number of patients treated with meperidine and ephedrine were significantly higher in group D compared with group C (P = 0.048, P = 0.043, P = 0.011, P = 0.043) respectively. There was insignificant difference in the incidence of nausea, vomiting and TUR syndrome in patients in both groups (p > 0.05). Conclusion: Our results suggest that the use of 10 lg intrathecal dexmedetomidine in patients undergoing TURP has a noticeable control of shivering even in occurrence of tolerable side effects.

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“…It has a good safety profile, as there are no side effects related to the intrathecal use of the drug and no significant changes in haemodynamic parameters have been reported (17). Intravenous (IV) MgSO 4 has been effectively examined in many trials (2,(18)(19)(20), but few trials involving intrathecal MgSO 4 (3) to control shivering have been conducted.…”

Section: Introductionmentioning

confidence: 99%

“…Different drugs that act on these receptors have been examined in different trials for the prevention or treatment of shivering after SA(4). The studied drugs include meperidine, fentanyl, clonidine, ketamine, and tramadol; they have resulted in different degrees of efficacy and many associated side effects, such as haemodynamic instability, respiratory depression, nausea and vomiting(27).Dexmedetomidine(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and magnesium sulfate(2,3,(17)(18)(19)(20) have been demonstrated to be effective and safe for the prevention and treatment of shivering following SA; their efficacy and safety are equal or superior to other adjuvants, with fewer adverse effects. Few trials(3,5,15,17) have examined intrathecal administration to prevent SA-related shivering.…”

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confidence: 99%

Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery. (RCT)

Omar

adel

Hassan

et al. 2019

Preprint

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Background: Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering. Methods: This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n=35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications. Results: Group C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6) , which were comparable to each other. The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3. Conclusions: Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post -spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine.

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Prophylactic vs. therapeutic magnesium sulfate for shivering during spinal anesthesia

Cited by 27 publications

References 25 publications

Magnesium: Emerging Potentials in Anesthesia Practice

Magnesium: Emerging Potentials in Anesthesia Practice

Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: A randomized controlled trial

Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery. (RCT)

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