Prevention of Shivering during Regional Anesthesia in Cesarean Section: Comparison of the Two Different Doses of Ketamine and Placebo

Document Type : Original Article (s)

Authors

1 Professor, 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

3 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Postanesthetic shivering is one of the important complications of regional anesthesia that causes discomfort for patient and increases the metabolic rate up to 400%. We compared the efficacy of two low doses of ketamine on prevention of postanesthetic shivering in Cesarean section under spinal anesthesia.Methods: In this randomized double-blind placebo-controlled clinical trial, 135 patients with classes I-II of American Society of Anesthesiologists (ASA) grading undergoing elective Cesarean section under spinal anesthesia were involved. Patients were randomly allocated to three group: K1:0.3 mg/kg ketamine + up to 4 cc normal saline, K2: 0.5mg/kg ketamine + up to 4 cc normal saline, and C: 4 cc normal saline. Drugs were injected after cord clamping and vital signs and outbreak and grade of shivering were detected immediately after the anesthesia and every 15 minutes until leaving the recovery room.Findings: Rate of the postanesthetic shivering in groups that receive medication (K1 and K2) was significantly less than control group at 45 (K1: 11.1%, K2: 0.0%, and C: 17.8%) and 60 (K1: 15.6%, K2: 8.9%, and C: 51.1%) minutes after initiation of the surgery and the 15th minutes in recovery (K1: 42.2%, K2: 24.4%, C: 68.9%) (P = 0.015, P < 0.001, and P < 0.001, respectively). In addition, the amount of pethidine for treatment of shivering was significantly higher in control group (P < 0.001).Conclusion: Using ketamine with the dosage of 0.5 mg/kg is more effective than 0.3 mg/kg in prevention of postanesthetic shivering in Cesarean section under spinal anesthesia.

Keywords

References

  1. Bansal P, Jain G. Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study. Local Reg Anesth 2011; 4: 29-34.
  2. 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.
  3. Piper SN, Rohm KD, Suttner SW, Maleck WH, Kranke P, Boldt J. A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study. Anaesthesia 2004; 59(6): 559-64.
  4. Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg 2000; 90(6): 1423-7.
  5. Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg 2001; 93(5): 1288-92.
  6. Fern L, Misiran K. Comparison of dexmedetomidine, pethidine and tramadol in the treatment of post-neuraxial anaesthesia shivering. South Afr J Anaesth Analg 2015; 21(1): 14-8.
  7. Sessler DI, Ponte J. Shivering during epidural anesthesia. Anesthesiology 1990; 72(5): 816-21.
  8. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002; 96(2): 467-84.
  9. Chen JC, Hsu SW, Hu LH, Hong YJ, Tsai PS, Lin TC, et al. Intrathecal meperidine attenuates shivering induced by spinal anesthesia. Ma Zui Xue Za Zhi 1993; 31(1): 19-24. [In Chinese].
  10. Nazir A, Dar FA, Javed T. A Comparative study; prophylactive intravenous ketamine and tramodol in preventing intraoperative shivering in patients undergoing elective lower limb surgery under spinal anaesthesia. Am J Adv Drug Delivery 2015; 28; 3(1): 11-7.
  11. Hong JY, Lee IH. Comparison of the effects of intrathecal morphine and pethidine on shivering after Caesarean delivery under combined-spinal epidural anaesthesia. Anaesthesia 2005; 60(12): 1168-72.
  12. 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.
  13. Joris J, Ozaki M, Sessler DI, Hardy AF, Lamy M, McGuire J, et al. Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia. Anesthesiology 1994; 80(2): 268-77.
  14. Hui CK, Huang CH, Lin CJ, Lau HP, Chan WH, Yeh HM. A randomised double-blind controlled study evaluating the hypothermic effect of 150 microg morphine during spinal anaesthesia for Caesarean section. Anaesthesia 2006; 61(1): 29-31.
  15. Abdelrahman RS. Prevention of shivering during regional anaesthesia: Comparison of Midazolam, Midazolam plus ketamine,Tramadol, and Tramadol plus Ketamine. Life Sci J 2012; 9(2): 132-9.
  16. Kamal MM, Hussein NS. Prevention of postspinal shivering by using ketamine plus midazolam in comparison with nefopam. Eg J Anaesth 2011; 27(1): 1-5.
  17. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological aspects and potential new clinical applications of ketamine: reevaluation of an old drug. J Clin Pharmacol 2009; 49(8): 957-64.
  18. Ayatollahi V, Hajiesmaeili MR, Behdad S, Gholipur M, Abbasi HR. Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial. J Res Med Sci 2011; 16(10): 1340-6.
  19. Jabalameli M, Radmanesh A. Comparing the efficacy of prophylactic intravenous dexamethasone and pethidine on postoperative shivering in elective cesarean section under spinal anaesthesia. J Isfahan Med Sch 2014; 32(285): 678-89. [In Persian].
  20. 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.
  21. Sharma DR, Thakur JR. Ketamine and shivering. Anaesthesia 1990; 45(3): 252-3.
  22. 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.
  23. Norouzi M, Doroodian MR, Salajegheh S. Optimum dose of ketamine for prevention of postanesthetic shivering; a randomized double-blind placebo-controlled clinical trial. Acta Anaesthesiol Belg 2011; 62(1): 33-6.
Journal of Isfahan Medical School
Volume 34, Issue 401 - Serial Number 401
September and October 2016
Pages 1168-1173

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History

  • Receive Date: 20 July 2016
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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