A Comparative Study on the Effect of Intravenous Dexamethasone, Ondansetron, and Ketamine in Preventing Postoperative Shivering in Cesarean Section under General Anesthesia

Document Type : Original Article (s)

Authors

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

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

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

4 Nurse Anesthetists, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study aimed to compare the effect of intravenous dexamethasone, ondansetron, and ketamine in preventing postoperative shivering in patients undergoing cesarean section under general anesthesia.Methods: A random, double-blind clinical trial was carried out on 160 patients with class I or II of American Society of Anesthesiologists (ASA) scale, undergoing cesarean with general anesthesia. They were divided into four groups of patients receiving ondansetron, dexamethasone, ketamine, and placebo. Applying the formula, the sample size consisted of 40 patients in each group. Data were analyzed using analysis of variance (ANOVA), frequency table, and chi-square test at the significant level of P less than 0.05.Findings: There was a significant difference in the level of shivering at four times of entering recovery, and 10th, 20th, and 70th minutes in recovery between the four groups (P < 0.050). Shivering was higher in control group than other ones at four mentioned periods (percentage of no-shivering was higher in other groups than control group); but no significant difference was found concerning shivering in dexamethasone, ondansetron, and ketamine groups (P > 0.050 for all).Conclusion: Prescribing dexamethasone, ondansetron, and ketamine was equally effective in preventing postoperative shivering.

Keywords

References

  1. Mahoori A, Valizade Hasanloei M, Hassani E, Sadighi F. The effect of intravenous low dose ketamine for prevention of shivering after ingouinal herniorrhaphy. J Urmia Univ Med Sci 2013; 24(10): 779-84. [In Persian].
  2. Singh P, Dimitriou V, Mahajan RP, Crossley AW. Double-blind comparison between doxapram and pethidine in the treatment of postanaesthetic shivering. Br J Anaesth 1993; 71(5): 685-8.
  3. Horn EP, Werner C, Sessler DI, Steinfath M, Schulte am EJ. Late intraoperative clonidine administration prevents postanesthetic shivering after total intravenous or volatile anesthesia. Anesth Analg 1997; 84(3): 613-7.
  4. Alfonsi P. Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol 2003; 69(5): 438-42.
  5. Entezariasl M, Isazadehfar K. Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine. Int J Prev Med 2013; 4(7): 818-24.
  6. Yared JP, Starr NJ, Hoffmann-Hogg L, Bashour CA, Insler SR, O'Connor M, et al. Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg 1998; 87(4): 795-9.
  7. Dabir S, Parsa T, Radpay B. The incidence of postanesthesia shivering and clinical relevant factors in women in Javaheri Hospital in Tehran. J Mazandaran Univ Med Sci 2010; 20(78): 42-8. [In Persian].
  8. 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.
  9. Sessler DI. Perioperative heat balance. Anesthesiology 2000; 92(2): 578-96.
  10. Emadi S, Nasiri A, Zamani A, Kabirzadeh A, Ebadi A. A comparison of pethidine and tramadol on post operative shivering. J Mazandaran Univ Med Sci 2010; 20 (78): 36-40. [In Persian].
  11. Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol 2010; 26(4): 465-9.
  12. Iqbal A, Ahmed A, Rudra A, Wankhede RG, Sengupta S, Das T, et al. Prophylactic granisetron vs pethidine for the prevention of postoperative shivering: a randomized control trial. Indian J Anaesth 2009; 53(3): 330-4.
  13. 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.
  14. 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.
  15. 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.
  16. Farzi F, Sobhani A, Keshtkar A. Effect of dexamethasone before induction of anesthesia on postoperative shivering. J Guilan Univ Med Sci 2002; 10(39-40): 42-9. [In Persian].
  17. Sun Y, Lu Y, Huang Y, Jiang H. Is dexmedetomidine superior to midazolam as a premedication in children? A meta-analysis of randomized controlled trials. Paediatr Anaesth 2014; 24(8): 863-74.
Journal of Isfahan Medical School
Volume 35, Issue 423 - Serial Number 423
January and February 2017
Pages 310-317

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History

  • Receive Date: 29 April 2016
  • Revise Date: 29 April 2024
  • Accept Date: 06 April 2022

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