Journal of Isfahan Medical School

Journal of Isfahan Medical School

Evaluating the Prophylactic Effect of Magnesium Sulfate and Combination of Midazolam and Ketamine for Prevention of Shivering during Regional Anaesthesia

Document Type : Original Article (s)

Authors
Azim Honarmand 1
Mohammad Reza Safavi 1
Simin Mansorian 2
1 Professor, Department of Anesthesiology, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Shivering after spinal anaesthesia is an unpleasant feeling that causes discomfort for patient and interferes with monitoring systems. The goal of this study was comparing the prophylactic use of magnesium sulfate infusion and midazolam plus ketamine for prevention of shivering in spinal anaesthesia.Methods: In this double-blinded study, 90 patients with status 1 or 2 of American Society of Anesthesiologists (ASA) classification, undergoing orthopedic surgery under spinal anaesthesia (with 15 mg of bupivacaine), were included. All the patients were randomly allocated to one of three equal groups: 1) Group MK received 0.25 mg ketamine + 37.5 μg/kg midazolam. 2) Group Mg received intravenous (IV) bolus dose of 80 mg/kg MgSO4 over 30 minute period followed by infusion of 2 g/hour. Group S received saline without any prophylactic drug. Shivering score was recorded at 10-minutes intervals. Peripheral and core body temperature were recorded at 10-minutes intervals.Findings: Shivering frequency and intensity were significantly higher in group S compared to groups MK (P = 0.001) and Mg (P < 0.001); but there was no significant difference between groups MK and Mg (P = 0.232 for frequency, and P = 0.248 for intensity). Receiving pethidine to control shivering was significantly higher in group S compared to proup MK and Mg (P < 0.001 for both); but there was no significant difference between groups MK and Mg (P > 0.999).Conclusion: There was no difference between the use of ketamine plus midazolam and magnesium sulfate in preventing shivering during spinal anaesthesia.
Keywords
Shivering
Spinal anaesthesia
Magnesium sulfate
Midazolam
Ketamine
  1. Kurz A, Sessler DI, Annadata R, Dechert M, Christensen R, Bjorksten AR. Midazolam minimally impairs thermoregulatory control. Anesth Analg 1995; 81(2): 393-8.
  2. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002; 96(2): 467-84.
  3. Miyakawa H, Matsumoto K, Matsumoto S, Mori M, Yoshitake S, Noguchi T, et al. A comparison of three drugs (pethidine, magnesium sulfate and droperidol) in patients with post-anesthesia shivering. Masui 1991; 40(10): 1503-6. [In Japanese].
  4. Jeon YT, Jeon YS, Kim YC, Bahk JH, Do SH, Lim YJ. Intrathecal clonidine does not reduce post-spinal shivering. Acta Anaesthesiol Scand 2005; 49(10): 1509-13.
  5. Hopkin DA. Postoperative spasticity and shivering. Anaesthesia 1984; 39(7): 725-6.
  6. Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg 2001; 93(5): 1288-92.
  7. Alfonsi P. Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol 2003; 69(5): 438-42.
  8. Buggy D, Higgins P, Moran C, O'Donovan F, McCarroll M. Clonidine at induction reduces shivering after general anaesthesia. Can J Anaesth 1997; 44(3): 263-7.
  9. Schwarzkopf KR, Hoff H, Hartmann M, Fritz HG. A comparison between meperidine, clonidine and urapidil in the treatment of postanesthetic shivering. Anesth Analg 2001; 92(1): 257-60.
  10. Sibai BM. Magnesium sulfate prophylaxis in preeclampsia: evidence from randomized trials. Clin Obstet Gynecol 2005; 48(2): 478-88.
  11. Honarmand A, Safavi MR. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. Br J Anaesth 2008; 101(4): 557-62.
  12. Gozdemir M, Usta B, Demircioglu RI, Muslu B, Sert H, Karatas OF. Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study. J Clin Anesth 2010; 22(3): 184-9.
  13. Katzung BG, Masters SB, Trevor AT. Basic and clinical pharmacology. 11th ed. New York, NY: McGraw-Hill Press; 2009. p. 364-377, 426-437.
  14. Tariq MA. Use of ketamine plus midazolam versus ketamine alone in prevention of shivering during spinal anaesthesia: A randomized controlled trial. Khyber Med Univ J 2014; 6(1): 5-8.
  15. Atashkhoyi S, Hatami Marandi P. Effect of ketamine in prevention of shivering after spinal anesthesia for cesarean section. J Iran Society Anaesthesiol Intensive Care 2012; 34(2): 39-42. [In Persian].
  16. Nowak L, Bregestovski P, Ascher P, Herbet A, Prochiantz A. Magnesium gates glutamate-activated channels in mouse central neurones. Nature 1984; 307(5950): 462-5.
  17. Cotton DB, Hallak M, Janusz C, Irtenkauf SM, Berman RF. Central anticonvulsant effects of magnesium sulfate on N-methyl-D-aspartate-induced seizures. Am J Obstet Gynecol 1993; 168(3 Pt 1): 974-8.
  18. Lee C, Zhang X, Kwan WF. Electromyographic and mechanomyographic characteristics of neuromuscular block by magnesium sulphate in the pig. Br J Anaesth 1996; 76(2): 278-83.
  19. Hwang JY, Na HS, Jeon YT, Ro YJ, Kim CS, Do SH. I.V. infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia. Br J Anaesth 2010; 104(1): 89-93.
  20. Alipour M, Sharifian Attar A, Dastkhosh A. Effects of magnesium sulfate on prevention of shivering during spinal anesthesia in cesarean section. Iran J Obstet Gynecol Infertil 2013; 16(79): 1-9. [In Persian].
  21. Misiran KB, Aziz FZ. Effectiveness of low-dose midazolam plus ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery. South Afr J Anaesth Analg 2013; 19(3): 164-70.
Journal of Isfahan Medical School
Volume 34, Issue 399 - Serial Number 399
July and August 2016
Pages 1097-1105

  • Receive Date 31 May 2016
  • Accept Date 06 April 2022