The role of meperidine in reduction of postanesthetic shivering and its possible impact on flap outcomes

Abstract

Postoperative vascular compromise is a common but critical complication requiring emergent re-exploration, and remains a chief cause of free flap failure. This study investigated the relationship between postanesthetic shivering (PAS) and the development of postoperative complications associated with free flap reconstruction. One hundred thirty-six patients who underwent head and neck cancer resection and free flap reconstruction were retrospectively enrolled. Fifteen patients were assigned to the PAS group, while the others were assigned to the non-PAS (NPAS) group. The odds ratios of acute re-exploration or total failure of the free flap in the PAS group was 3.5 and 14.9, respectively. The dose of meperidine was positively correlated with PAS prevention in our statistical ROC curve analysis. The minimum effective dose of meperidine for PAS prevention was 0.35 mg/kg with 75% sensitivity and 60% specificity. These findings indicate that an optimal dose of meperidine could prevent PAS, which is shown to be associated with a decrease in the incidence of the early post-surgical re-exploration rate of these free flaps related to circulatory compromise.

Postanaesthetic shivering – from pathophysiology to prevention

“…Regarding intrathecal via low dose intrathecal meperidine as an adjuvant for spinal anaesthesia could effectively prevent shivering and reduce need for rescue analgesics, yet still might increase the risk of nausea and vomiting [39]. Chiang et al studied the relationship between PS and free flap failure owing to postoperative compromise, and demonstrated that an optimal dose of meperidine could prevent PS, which is shown to be associated with a decrease in the incidence of the early post-surgical re-exploration rate of these free flaps related to circulatory compromise [40].…”

Efficacy of forced‐air warming for preventing perioperative hypothermia and related complications in patients undergoing laparoscopic surgery: A randomized controlled trial

“…Approximately, 45% to 70% of surgical patients experience hypothermia because of the effect of anaesthesia, which causes core heat loss to the periphery by redistribution and heat loss from the body surface to the operation room (OR) without a concomitant increase in metabolic heat production (Sessler, 2016). If perioperative warming measures are inadequate, core temperature could decrease by 2°C to 6°C (Horosz & Malec-Milewska, 2013), leading to various complications (Chiang et al, 2014;Harder, Ross, & Paul, 2013;Jeyadoss, Thiruvenkatarajan, Watts, Sullivan, & Wijk, 2013). Hypothermia prevention guidelines emphasize maintaining normothermia for surgical patients (Bashaw, 2016;Hooper et al, 2009).…”

Association Between Bispectral Index (BIS) Value and Postoperative Shivering in Patients Undergoing Orthopedic Surgery

“…Contradictory to these results, in our study, a higher stage of shivering happened for the female; this may have happened because of the type of surgeries in this study. A few researchers have found that less use of opiates can cause more shivering, as well as we know that pain threshold is higher in women and indeed BIS monitor would show a less score for a woman suffering from a pain compare to a man in the same situation [7], [9]. It has been previously shown that patients who underwent anaesthesia with Pentothal experience a higher incidence of postoperative shivering compare to propofol [2], [22].…”

“…Nonetheless, they are less efficient than certain drugs such as tramadol, dexamethasone, pethidine, clonidine and physostigmine [6], [7], [8]. Pethidine is the most prevalent drug for managing postoperative shivering [9]. This drug may cause respiratory depression.…”