بررسی مقایسه‌ای سه روش پروفیلاکسی استفاده از داروهای دگزامتازن، پتیدین و هیوسین وریدی بر روی لرز پس از عمل جراحی به دنبال بیهوشی عمومی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، مرکز تحقیقات بیهوشی و مراقبتهای ویژه، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه‌: پیش‌گیری و کنترل لرز پس از عمل جراحی از اهمیت قابل توجهی برخوردار است؛ روش‌های مختلی بدین منظور مورد استفاده قرار می‌گیرد. در این تحقیق، به بررسی مقایسه‌ای سه داروی دگزامتازون، پتیدین و هیوسین در پیش‌گیری از بروز لرز پس از عمل جراحی پرداخته شد.روش‌ها: در این تحقیق کارآزمایی بالینی، 90 بیمار کاندید عمل جراحی کله‌سیستکتومی ار طریق لاپاروسکوپی، به طور تصادفی به 3 گروه مساوی تقسیم‌بندی شدند. در گروه اول mg/kg 5/0 پتیدین، در گروه دومmg/kg  1/0دگزامتازون و در گروه سوم mg/kg 15/0 هیوسین مورد استفاده قرار گرفت و شیوع لرز پس از عمل جراحی و شدت آن در سه گروه بررسی و مقایسه شد. داده‌های مطالعه با استفاده از نرم‌افزار SPSS تجزیه و تحلیل آماری شد.یافته‌ها: در سه گروه پتیدین، هیوسین و دگزامتازون به ترتیب 0/60، 3/43 و 4/54 درصد افراد فاقد لرز بودند. همچنین، در این سه گروه به ترتیب، 0/20، 3/13 و 3/23 درصد بیماران لرز خفیف، 7/16، 3/33 و 7/6 درصد افراد لرز متوسط و 3/3، 0/10 و 0/10 افراد لرز شدید داشتند. شدت لرز در سه گروه اختلاف معنی‌داری نداشت (16/0 = P). استفاده از پتیدین باعث کاهش معنی‌دار در شدت درد بعد عمل شد و دو داروی هیوسین و دگزامتازون بر کاهش شدت تهوع و مصرف متوکلوپرامید، تأثیر مطلوب‌تری نسبت به پتیدین داشتند.نتیجه‌گیری: سه داروی پتیدین، هیوسین و دگزامتازون تفاوت قابل توجهی در کاهش بروز لرز بعد عمل ندارند ولی در کنترل سایر عوارض، متفاوتند. پیشنهاد می‌گردد، در مطالعات بعدی، تأثیر ترکیبی داروهای مذکور بر عوارض بعد عمل در بیماران تحت اعمال جراحی مورد مطالعه قرار گیرد.

کلیدواژه‌ها

عنوان مقاله [English]

Comparing Three Methods of Dexamethasone, Pethidine and Hyoscine in Prophylaxis of Postoperative Shivering after General Anesthesia

نویسندگان [English]

  • Morteza Heidari 1
  • Gholamreza Khalili 1
  • Ehsan Zolfi 2
1 Associate Professor, Anesthesiology and Critical Care Research Center, 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
چکیده [English]

Background: Prevention and control of shivering after surgery is of significant importance and different methods are used for this purpose. In this study, three drugs of dexamethason, petidine and hyoscine were compared in the prevention of postoperative shivering.Methods: In a clinical trial study, 90 patients who were candidates for laparascopic cholesistectomia were selected and randomly divided in three equal groups. The first group received 0.5 mg/kg pethidine, the second group 0.1 mg/kg dexamethason and the third group 0.15 mg/kg hyoscine. The prevalence of postoperative shivering was compared between the three groups. The data was analyzed using SPSS software.Findings: In three groups of pethidine, hyoscine and dexamethason, 60%, 43.3% and 54.4% had no postoperative shivering, respectively. In these groups, 20.0%, 13.3% and 23.3% had mild shivering, 16.7%, 33.3% and 6.7% had moderate shivering and 3.3.%, 10.0% and 10.0% had sever postoperative shivering, respectively, and no statistically difference were seen between the three groups (P = 0.16). Pain was lower in pethidine group than the other groups. In addition, dexamethasone and hyoscine had positive effects of postoperative nausea and methoclopramide consumption.Conclusion: Three drugs of pethidine, hyoscine and dexamethason have not different effects of prevention of postoperative shivering but the complications such were different. We recommend that in future studies, the combined effect of these drugs on postoperative complications in patients undergoing surgical procedures could be studied.

کلیدواژه‌ها [English]

  • Postoperative shivering
  • Pethidine
  • Hyoscine
  • Dexamathasone

مراجع

  1. Lienhart A, Fiez N, Deriaz H. Postoperative shivering: analysis of main associated factors. Ann Fr Anesth Reanim 1992; 11(5): 488-95. [In French].
  2. Crossley AW. Six months of shivering in a district general hospital. Anaesthesia 1992; 47(10): 845-8.
  3. Moir D, Doyle P. Halothane and postoperative shivering. Anesth Analg 1963; 42(4): 423-8.
  4. Guffin A, Girard D, Kaplan JA. Shivering following cardiac surgery: hemodynamic changes and reversal. J Cardiothorac Anesth 1987; 1(1): 24-8.
  5. Smith RM, Bachman L, Bougas T. Shivering following thiopental sodium and other anesthetic agents. Anesthesiology 1955; 16(5): 655-64.
  6. Panah M, Rosenblatt MA, Bronheim D, Andres LA. Intraoperative administration of low dose meperidine reduces shivering after general anesthesia in patients undergoing laparoscopic abdominal surgery. Anesthesiology (hagerstown) 1997; 87(3 Suppl 1): A38.
  7. Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999; 88(5): 1085-91.
  8. Sessler DI. Temperature monitoring. In: Miller RD, editor. Anesthesia. 4th ed. New York, NY: Churchill Livingstone; 1994. p. 1363-82.
  9. Horn EP, Sessler DI, Standl T, Schroeder F, Bartz HJ, Beyer JC, et al. Non-thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology 1998; 89(4): 878-86.
  10. Camus Y, Delva E, Just B, Lienhart A. Leg warming minimizes core hypothermia during abdominal surgery. Anesth Analg 1993; 77(5): 995-9.
  11. Sessler DI, Israel D, Pozos RS, Pozos M, Rubinstein EH. Spontaneous post-anesthetic tremor does not resemble thermoregulatory shivering. Anesthesiology 1988; 68(6): 843-50.
  12. Horn EP, Schroeder F, Sessler DI, Standl T, am Esch JS. Postanesthetic shivering in normothermic or hypothermic patients after isoflurane anesthesia. Anesth Analg 1998; 86 (2S): 33S.
  13. Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg 1997; 85(4): 766-82.
  14. Jansen NJ, van Oeveren W, van den Broek L, Oudemans-van Straaten HM, Stoutenbeek CP, Joen MC, et al. Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 102(4): 515-25.
  15. Blick M, Sherwin SA, Rosenblum M, Gutterman J. Phase I study of recombinant tumor necrosis factor in cancer patients. Cancer Res 1987; 47(11): 2986-9.
  16. Negishi C, Lenhardt R, Sessler DI, De Witte J, Ikeda T, Kurz A, et al. Desflurane reduces the febrile response to administration of interleukin-2. Anesthesiology 1998; 88(5): 1162-9.
  17. Horn EP, Schroeder F, Wilhelm S, Sessler DI, Standl T, von dem BK, et al. Postoperative pain facilitates nonthermoregulatory tremor. Anesthesiology 1999; 91(4): 979-84.
  18. Bay J, Nunn JF, Prys-Roberts C. Factors influencing arterial PO2 during recovery from anaesthesia. Br J Anaesth 1968; 40(6): 398-407.
  19. Macintyre PE, Pavlin EG, Dwersteg JF. Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering. Anesth Analg 1987; 66(8): 751-5.
  20. Zwischenberger JB, Kirsh MM, Dechert RE, Arnold DK, Bartlett RH. Suppression of shivering decreases oxygen consumption and improves hemodynamic stability during postoperative rewarming. Ann Thorac Surg 1987; 43(4): 428-31.
  21. Alfonsi P. Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs 2001; 61(15): 2193-205.
  22. Murphy MT, Lipton JM, Loughran P, Giesecke AH, Jr. Postanesthetic shivering in primates: inhibition by peripheral heating and by taurine. Anesthesiology 1985; 63(2): 161-5.
  23. Liem ST, Aldrete JA. Control of post-anaesthetic shivering. Can Anaesth Soc J 1974; 21(5): 506-10.
  24. Ciofolo MJ, Clergue F, Devilliers C, Ben AM, Viars P. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70(5): 737-41.
  25. Piper SN, Maleck WH, Boldt J, Suttner SW, Schmidt CC, Reich DG. A comparison of urapidil, clonidine, meperidine and placebo in preventing postanesthetic shivering. Anesth Analg 2000; 90(4): 954-7.
  26. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 2002; 94(2): 453-60, table.
  27. Song YK, Lee C. Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery. J Anesth 2013; 27(1): 29-34.
  28. 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.
  29. Terasako K, Yamamoto M. Comparison between pentazocine, pethidine and placebo in the treatment of post-anesthetic shivering. Acta Anaesthesiol Scand 2000; 44(3): 311-2.
  30. 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.
  31. Vanderstappen I, Vandermeersch E, Vanacker B, Mattheussen M, Herijgers P, Van Aken H. The effect of prophylactic clonidine on postoperative shivering. A large prospective double-blind study. Anaesthesia 1996; 51(4): 351-5.
  32. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology 2002; 96(2): 467-84.
  33. 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.
  34. Tribukait A, Nobel G, Mekjavic IB, Eiken O. Effects of anti-histaminic and anti-cholinergic substances on human thermoregulation during cold provocation. Brain Res Bull 2010; 81(1): 100-6.
  35. 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.
  36. Mathews S, Al MA, Varghese PK, Radim K, Mumtaz S. Postanaesthetic shivering--a new look at tramadol. Anaesthesia 2002; 57(4): 394-8.
مجله دانشکده پزشکی اصفهان
دوره 33، شماره 341 - شماره پیاپی 341
مرداد و شهریور 1394
صفحه 1044-1056

فایل ها

سابقه مقاله

  • تاریخ دریافت: 19 فروردین 1394
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

هم رسانی

ارجاع به این مقاله

آمار