Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Effect of Intravenous Hydrocortisone (1 or 2 mg/kg) on Postoperative Shivering in Cesarean Section with Spinal Anesthesia

Document Type : Original Article (s)

Authors
Azim Honarmand 1
Mohammadreza Safavi 1
Anahita Hirmanpour 2
Soheila Afzali 3
1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Postoperative shivering is one of the most prevalent complications that several methods were used for controlling it. This study aimed to determine the effect of two doses of intravenous hydrocortisone (1 or 2 mg/kg) on postoperative shivering in cesarean section with spinal anesthesia.Methods: In a randomized controlled clinical trial study, 135 pregnant women candidate for cesarean were randomly divided in three equal groups. The groups were received 1 or 2 mg/kg hydrocortisone, or the same volume of normal saline (as control group) during the 5 minutes after umbilical clamping and postoperative shivering was determined and compared between the groups.Findings: Postoperative shivering was happened in 23 patients (54.8%) in 1 mg/kg hydrocortisone group, 16 patients (36.4%) in 2 mg/kg hydrocortisone group, and 36 patients (85.7%) in control group; the difference between the three groups was statistically significant (P < 0.001).Conclusion: Intravenous injection of 2 mg/kg hydrocortisone in patients under cesarean with spinal anesthesia led to decrease postoperative shivering. It seems that using this dose does not lead to serious complications. But, more studies are recommended to determine real effect of this dose of hydrocortisone.
Keywords
Postoperative
Shivering
Hydrocortisone
Anesthesia
Spinal
  1. 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.
  2. Talakoob R, Nouri Meshkati S. Effect of tramadol in post spinal shivering in caeserian section [MD Thesis]. Isfahan, Iran: Isfahan University of Medical Sciences; 2004. [In Persian].
  3. 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.
  4. 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.
  5. Sessler DI. Temperature regulation and monitoring. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-kronish JP, Young WL, editors. Miller's anesthesia. 7th ed. New York, NY: Churchill Livingstone; 2010. p. 1533-57.
  6. Shibli KU, Russell IF. A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anesth 2000; 9(3): 160-7.
  7. Zahra FA, Abudallah HM, Shabana RI, Abdulmageed WM, Abdulrazik SI, Nassar AM. Intramuscular ketamine for prevention of postanesthesia shivering in children. Saudi Med J 2008; 29(9): 1255-9.
  8. Sharma DR, Thakur JR. Ketamine and shivering. Anaesthesia 1990; 45(3): 252-3.
  9. Wrench IJ, Cavill G, Ward JE, Crossley AW. Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering. Br J Anaesth 1997; 79(4): 541-2.
  10. Heid F, Grimm U, Roth W, Piepho T, Kerz T, Jage J. Intraoperative tramadol reduces shivering but not pain after remifentanil-isoflurane general anaesthesia. A placebo-controlled, double-blind trial. Eur J Anaesthesiol 2008; 25(6): 468-72.
  11. Wadhwa A, Sengupta P, Durrani J, Akca O, Lenhardt R, Sessler DI, et al. Magnesium sulphate only slightly reduces the shivering threshold in humans. Br J Anaesth 2005; 94(6): 756-62.
  12. Kizilirmak S, Karakas SE, Akca O, Ozkan T, Yavru A, Pembeci K, et al. Magnesium sulfate stops postanesthetic shivering. Ann N Y Acad Sci 1997; 813: 799-806.
  13. Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg 2000; 90(6): 1423-7.
  14. Bock M, Bauer M, Rosler L, Sinner B, Motsch J. Dolasetron and shivering. A prospective randomized placebo-controlled pharmaco-economic evaluation. Anaesthesist 2007; 56(1): 63-70. [In German].
  15. Rohm KD, Riechmann J, Boldt J, Schuler S, Suttner SW, Piper SN. Physostigmine for the prevention of postanaesthetic shivering following general anaesthesia - a placebo-controlled comparison with nefopam. Anaesthesia 2005; 60(5): 433-8.
  16. Hosseinzadeh H, Eidi M, Kolahdouzan KH, Pessianian I, Dadashzadeh S. The effect of preoperative hydrocortisone on the rate and severity of post anesthesia shivering. Pharmaceutical Sciences 2005; 25(3): 33-7. [In Persian].
  17. Pawar MS, Suri N, Kaul N, Lad S, Khan RM. Hydrocortisone reduces postoperative shivering following day care knee arthroscopy. Can J Anaesth 2011; 58(10): 924-8.
  18. Eydi M, Golzari SE, Aghamohammadi D, Kolahdouzan K, Safari S, Ostadi Z. Postoperative Management of Shivering: A Comparison of Pethidine vs. Ketamine. Anesth Pain Med 2014; 4(2): e15499.
Journal of Isfahan Medical School
Volume 35, Issue 438
May and June 2017
Pages 821-827

  • Receive Date 08 May 2017
  • Accept Date 06 April 2022