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

Abstract

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.

Nalbuphine versus dexmedetomidine for treatment of combined spinal-epidural post-anesthetic shivering in pregnant women undergoing cesarean section

“…Yu et al. 9 suggested that dexmedetomidine 0.05 μg/kg/hour is a better choice for anti-shivering, which is consistent with our study.…”

<p>Effect of intrathecal dexmedetomidine on cesarean section during spinal anesthesia: a meta-analysis of randomized trials</p>

“…In the case of spinal anesthesia, the possibility of shivering during cesarean section is 55%.3 Intraoperative shivering leads to increased oxygen consumption and carbon dioxide production, which has a certain impact on maternal physiological functions.21 The cause of shivering during cesarean section under spinal anesthesia is still unknown, but the occurrence of shivering may be related to the loss of heat, the suppression of the body’s thermoregulatory mechanism, and the redistribution of heat in the body. Dexmedetomidine may play an antishivering role by regulating the shivering threshold of the central thermoregulatory system and reducing the contraction of vessels 12,22. Although intravenous dexmedetomidine can reduce the incidence of shivering, it has an inhibitory effect on the respiratory rate.23 Intrathecal dexmedetomidine inhibits the body’s thermoregulatory center by inhibiting the transmission of body temperature information at the level of the spinal cord, ultimately reducing the incidence of shivering during cesarean section.2 Our meta-analysis found that intrathecal dexmedetomidine significantly reduces the incidence of shivering during cesarean section.…”

“…Dexmedetomidine can be administered intravenously or intrathecally during spinal anesthesia, but there is some controversy about which method should be used during anesthesia for pregnant women. The use of dexmedetomidine by the intravenous route has been reported to result in hemodynamic instability.12 Therefore, we aimed to investigate the effect of intrathecal dexmedetomidine on the adverse effects of spinal anesthesia during cesarean section.…”

Effects of anesthetic agents on contractions of the pregnant rat myometrium in vivo and in vitro

“…α 2 -Adrenergic agonists cause myometrial contraction by inducing an influx of extracellular Ca 2+ , probably through VDCCs and the release of arachidonic acid [22]. Several recent studies reported that dexmedetomidine is effective for treating postpartum shivering in cesarean sections [23][24][25] and can improve early breastfeeding outcomes [26]. α 2 -Adrenoceptor activation reportedly results in the release of arachidonic acid in vascular smooth muscle [27].…”