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Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy

Published online by Cambridge University Press:  01 May 2008

E. G. Elvan ,
B. Öç ,
Ş. Uzun ,
E. Karabulut ,
F. Coşkun  and
Ü. Aypar
E. G. Elvan
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Sıhhıye, Ankara, Turkey
B. Öç
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Sıhhıye, Ankara, Turkey
Ş. Uzun*
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Sıhhıye, Ankara, Turkey
E. Karabulut
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Biostatistics, Sıhhıye, Ankara, Turkey
F. Coşkun
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Sıhhıye, Ankara, Turkey
Ü. Aypar
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Sıhhıye, Ankara, Turkey
*
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, 06100 Sıhhıye, Ankara, Turkey. E-mail: sennuruzun@superonline.com; Tel: +90 312 305 12 50; Fax: +90 312 310 96 00
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Summary

Background

Post-anaesthetic shivering is one of the most common complications, occurring in 5–65% of patients recovering from general anaesthesia and 33% of patients receiving epidural anaesthesia. Our objective was to investigate the efficacy of intraoperative dexmedetomidine infusion on postoperative shivering.

Methods

Ninety female patients, ASA I-II, 35–60 yr old, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized into two groups. After endotracheal intubation one group received normal saline infusion and the other received dexmedetomidine as a loading dose of 1 μg kg−1 for 10 min followed by a maintenance infusion of 0.4 μg kg−1 h−1. In the recovery room, pain was assessed using a 100 mm visual analogue scale and those patients who had a pain score of more than 40 mm were administered 1 mg kg−1 intramuscular diclofenac sodium. Patients with shivering grades more than 2 were administered 25 mg intravenous meperidine. Patients were protected with passive insulation covers.

Results

Post-anaesthetic shivering was observed in 21 patients in the saline group and in seven patients in the dexmedetomidine group (P = 0.001). Shivering occurred more often in the saline group. The Ramsay Sedation Scores were higher in the dexmedetomidine group during the first postoperative hour. Pain scores were higher in the saline group for 30 min after the operation. The need for intraoperative atropine was higher in the dexmedetomidine group. Intraoperative fentanyl use was higher in the saline group. Perioperative tympanic temperatures were not different between the groups whereas postoperative measurements were lower in the dexmedetomidine group (P < 0.05).

Conclusion

Intraoperative dexmedetomidine infusion may be effective in the prevention of post-anaesthetic shivering.

Keywords

ANAESTHESIA GENERALSHIVERINGSURGERY GYNAECOLOGICALDEXMEDETOMIDINEPOSTOPERATIVE PERIOD
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 5 , May 2008 , pp. 357 - 364
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Buggy, DJ, Crossley, AWA. Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering. Br J Anaesth 2000; 84 (5): 615–628. Review.CrossRefGoogle ScholarPubMed
2.Ciofolo, MJ, Clergue, F, Devilliers, C et al. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70: 737–741.CrossRefGoogle ScholarPubMed
3.Horn, E-P. Postoperative shivering; aetiology and treatment. Curr Opin Anaesth 1999; 12: 449–453.CrossRefGoogle ScholarPubMed
4.Doufas, AG, Lin, CM, Suleman, MI et al. Dexmedetomidine and meperidine additively reduce the shivering threshold in humans. Stroke 2003; 34: 1218–1223.CrossRefGoogle ScholarPubMed
5.Talke, P, Tayefeh, F, Sessler, DI et al. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology 1997; 87 (4): 835–841.CrossRefGoogle Scholar
6.Bicer, C, Esmaoglu, A, Akin, A et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesth 2006; 23: 149–153.CrossRefGoogle ScholarPubMed
7.Bilotta, F, Pietropaoli, P, La Rosa, I, Spinelli, F, Rosa, G. Effects of shivering prevention on haemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients. Anaesthesia 2001; 56: 514–519.CrossRefGoogle ScholarPubMed
8.Hurford, WE. Sedation. In: Hurford, WE, ed. Critical Care Handbook of the Massachusetts General Hospital, 3rd edn. Philadelphia: Lippincott Williams and Wilkins, 2000: 100.Google Scholar
9.Crossley, AWA. Postoperative shivering: the influence of body temperature. BMJ 1995; 311: 764–765.CrossRefGoogle ScholarPubMed
10.Crossley, AW. Peri-operative shivering (Editorial). Anaesthesia 1992; 47: 193–195.CrossRefGoogle Scholar
11.Crossley, AW. Six months of shivering in a district general hospital. Anaesthesia 1992; 47: 845–848.CrossRefGoogle Scholar
12.Bhana, N, Goa, KL, Mc Clellan, KJ. Dexmedetomidine. Drugs 2000; 59: 263–268.CrossRefGoogle ScholarPubMed
13.Dal, D, Kose, A, Honca, M et al. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth 2005; 95 (2): 189–192.CrossRefGoogle ScholarPubMed
14.Piper, SN, Fent, MT, Röhm, KD et al. Urapidil does not prevent postanesthetic shivering: a dose-ranging study. Can J Anesth 2001; 48 (8): 742–747.CrossRefGoogle Scholar
15.Sahin, A, Aypar, U. Effect of amino acid solutions on intraoperative hypothermia and postoperative shivering. Comparison of two anesthetic regimens. Acta Anaesthesiol Scand 2002; 46 (1): 64–67.Google ScholarPubMed
16.Horn, E-P, Sessler, DI, Standl, T et al. Nonthermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology 1998; 89: 878–886.CrossRefGoogle ScholarPubMed
17.Panzer, O, Ghazanfari, N, Sessler, DI et al. Shivering and shivering-like tremor during labor with and without epidural analgesia. Anesthesiology 1999; 90: 1609–1616.CrossRefGoogle ScholarPubMed
18.Holdcroft, A, Hall, GM. Heat loss during anaesthesia. Br J Anaesth 1978; 50: 157–164.CrossRefGoogle ScholarPubMed
19.El-Tahir, KE-DH. Dexmedetomidine a sedative-analgesic drug for the 21st century. Middle East J Anesthesiol 2002; 16 (6): 577–585.Google ScholarPubMed
20.Bilotta, F, Pietropaoli, P, Sanita, R et al. Nefopam and tramadol for prevention of shivering during neuroaxial anesthesia. Reg Anesth Pain Med 2002; 27: 380–384.Google Scholar
21.Erkola, O, Korttila, K, Aho, M, Haasio, J, Aantaa, R, Kallio, A. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg 1994; 79 (4): 646–653.CrossRefGoogle ScholarPubMed
22.Jalonen, J, Hynynen, M, Kuitunen, A et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 1997; 86 (2): 331–345.CrossRefGoogle ScholarPubMed
23.Cortinez, LI, Hsu, Y-W, Sum-Ping, ST et al. Dexmedetomidine pharmacodynamics. Part II. Anesthesiology 2004; 101: 1077–1083.CrossRefGoogle ScholarPubMed
24.Shelly, MP. Dexmedetomidine: a real innovation or more of the same. Br J Anaesth 2001; 87: 678–679.Google ScholarPubMed
25.Mack, PF, Perrine, K, Kobylarz, E et al. Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol 2004; 16 (1): 20–25.CrossRefGoogle ScholarPubMed
26.Chow, TC, Cho, PH. The influence of small dose intrathecal fentanyl on shivering during transurethral resection of prostate under spinal anesthesia. Acta Anaesthesiol Sin 1994; 32 (3): 165–170. Abstract.Google ScholarPubMed
27.Baxendale, BR, Mahajan, RP, Crossley, AW. Anticholinergic premedication influences the incidence of postoperative shivering. Br J Anaesth 1994; 72: 291–294.CrossRefGoogle ScholarPubMed
28.Greif, R, Laciny, S, Rajek, A et al. Neither nalbuphine nor atropine possesses special anti-shivering activity. Anaesth Analg 2001; 93: 620–627.CrossRefGoogle Scholar
29.Ebert, TJ, Hall, JE, Barney, JA. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382–394.CrossRefGoogle ScholarPubMed
30.Pauca, AL, Savage, RT, Simpson, S et al. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand 1984; 28: 138–143.CrossRefGoogle ScholarPubMed
31.Wrench, IJ, Singh, P, Dennis, AR et al. The minimum effective doses of pethidine and doxapram in the treatment of postanaesthetic shivering. Anaesthesia 1997; 52: 32–36.CrossRefGoogle Scholar
32.Horn, EP, Standl, T, Sessler, DI et al. Physostigmine prevents postanesthetic shivering as does meperidine or clonidine. Anesthesiology 1998; 88: 108–113.CrossRefGoogle ScholarPubMed
33.Powell, RM, Buggy, DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg 2000; 90 (6): 1423–1427.CrossRefGoogle ScholarPubMed
34.Bock, M, Sinner, B, Göttlicher, M et al. Dolasetron prevents postanesthetic shivering (abstract). Anesthesiology 1999; 91: A–1184.Google Scholar
35.Guler, G, Akın, A, Tosun, Z et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand 2005; 49: 1088–1091.CrossRefGoogle ScholarPubMed