Comparing Alfentanil, Sufentanil, Ketamine and Pethidine for Prevention of Postanesthetic Shivering: A Randomized Placebo-Controlled Clinical Trial

Document Type : مقاله کوتاه

Authors

1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Recent studies have shown that anesthetic drugs can cause postoperative shivering. The incidence of postanesthetic shivering varies between 5 and 65% and patients report it as one of the leading causes of discomfort after operation. It may also induce a variety of physiological consequences such as increased O2 consumption and cardiac output. The effect of alfentanil, sufentanil and ketamine on prevention or decrease of postanesthetic shivering is not still clear. This study was performed to find out a suitable alternative for pethidine in prevention of postanesthetic shivering.Methods: In this randomized double-blind prospective study, 160 patients were classified into five equal groups according to drugs used for prevention of postoperative shivering after general anesthesia. Alfentanil, sufentanil, ketamine and pethidine groups received the drugs 30 minutes before the end of surgery and were compared with placebo (control group). The primary outcome measures were the incidence and severity of postoperative shivering.Findings: The five groups were were not different regarding age, gender, height, weight and the physical status class based on the American Society of Anesthesiologists score. In recovery room, postoperative shivering was seen in 18 patients, 2 in ketamine, 2 in pethidine, 4 in alfentanil, 3 in sufentanil and 7 in placebo group. Fisher’s exact test showed no statistically difference between the groups (P = 0.34). Conclusion: Intravenous infusion of alfentanil, sufentanil and ketamine 30 minutes before the end of surgery effectively reduced the occurrence and severity of postoperative shivering after the general anesthesia, without significant side effects but not as well as pethidine.

Keywords

References

  1. Miller RD. Miller's anesthesia. 7th ed. London, UK: Elsevier Churchill Livingstone; 2010.
  2. Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P. Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J 2005; 73(1): 47-53.
  3. Eberhart LH, Doderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesth Analg 2005; 101(6): 1849-57.
  4. Dabir S, Radpey B, Parsa T. Evaluation of the incidence of postanesthesia shivering. J Iran Society Anaesthesiol Intensive Care 2006; 28(1): 60-9. [In Persian].
  5. Bilotta F, Ferri F, Giovannini F, Pinto G, Rosa G. Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology. Anaesthesia 2005; 60(2): 124-8.
  6. Diaz M, Becker DE. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Prog 2010; 57(1): 25-32.
  7. Alfonsi P. Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs 2001; 61(15): 2193-205.
  8. Wallis R. Post-anaesthetic shaking. A review of the literature. Nurs Prax N Z 2000; 15(1): 23-32.
  9. Dal D, Kose A, Honca M, Akinci SB, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth 2005; 95(2): 189-92.
  10. Mathews S, Al Mulla A, Varghese PK, Radim K, Mumtaz S. Postanaesthetic shivering--a new look at tramadol. Anaesthesia 2002; 57(4): 394-8.
  11. de Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002; 96(2): 467-84.
  12. Crossley AW. Postoperative shivering: the influence of body temperature. BMJ 1995; 311(7008): 764-5.
  13. Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 1994; 49(3): 205-7.
  14. Kose EA, Dal D, Akinci SB, Saricaoglu F, Aypar U. The efficacy of ketamine for the treatment of postoperative shivering. Anesth Analg 2008; 106(1): 120-2, table.
  15. Akin A, Esmaoglu A, Boyaci A. Postoperative shivering in children and causative factors. Paediatr Anaesth 2005; 15(12): 1089-93.
  16. Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesthesiol Scand 2007; 51(1): 44-9.
  17. Asl ME, Isazadefar K, Mohammadian A, Khoshbaten M. Ondansetron and meperidine prevent postoperative shivering after general anesthesia. Middle East J Anaesthesiol 2011; 21(1): 67-70.
Journal of Isfahan Medical School
Volume 33, Issue 324 - Serial Number 324
January and February 2015
Pages 212-220

Files

History

  • Receive Date: 21 June 2014
  • Revise Date: 03 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics