Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study

Sukhminder Jit Singh Bajwa, Sachin Gupta, Jasbir Kaur, Amarjit Singh, Ss Parmar, Sukhminder Jit Singh Bajwa, Sachin Gupta, Jasbir Kaur, Amarjit Singh, Ss Parmar

Abstract

Background and aims: Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been employed to abolish the occurrence of shivering. The present study aims to explore the effectiveness of dexmedetomidine in suppressing the postanesthetic shivering in patients undergoing general anesthesia.

Materials and methods: The present study was carried out on 80 patients, in American Society of Anesthesiologists I and II, aged 22-59 years, who underwent general anesthesia for laparoscopic surgical procedures. Patients were allocated randomly into two groups: group N (n = 40) and group D (n = 40). Group D were administered 1 μg/kg of dexmedetomidine intravenously, while group N received similar volume of saline during peri-op period. Cardiorespiratory parameters were observed and recorded during the preop, intraop, and postop periods. Any incidence of postop shivering was observed and recorded as per 4 point scale. Side effects were also observed, recorded, and treated symptomatically. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni's correction.

Results: The two groups were comparable regarding demographic profile (P > 0.05). Incidence of shivering in group N was 42.5%, which was statistically highly significant (P = 0.014). Heart rate and mean arterial pressure also showed significant variation clinically and statistically in group D patients during the postop period (P = 0.008 and 0.012). A high incidence of sedation (P = 0.000) and dry mouth (P = 0.000) was observed in group D, whereas the incidence of nausea and vomiting was higher in group N (P = 0.011 and 0.034).

Conclusions: Dexmedetomidine seems to possess antishivering properties and was found to reduce the occurrence of shivering in patients undergoing general anesthesia.

Keywords: Dexmedetomidine; hypothermia; shivering; tramadol.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

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Figure 1
Response rate

References

    1. Giesbrecht GG, Sessler DI, Mekjavic IB, Schroeder M, Bristow GW. Treatment of immersion hypothermia by direct body-to-body contact. J Appl Physiol. 1994;76:2373–9.
    1. Henneman E. Organization of the motoneuron pool: The size principle. In: Mountcastle VB, editor. Medical Physiology. 14th ed. St. Louis: CV Mosby; 1980. pp. 718–41.
    1. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharma-cological treatment of postoperative shivering a quan-titative systemic review of randomized controlled trials. Anesth Analg. 2002;94:453–60.
    1. Powell R, Buggy D. Ondansetron given before induc-tion of anesthesia reduces shivering after general anes-thesia. Anesth Analg. 2000;90:1413–7.
    1. Ciofolo MJ, Clergue F, Devilliers C, Ben Ammar M, Viars P. Changes in ventilation, oxygen uptake and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology. 1989;70:737–41.
    1. Piper SN, Maleck WH, Boldt J, suttner SW, Schmidt CC, Reich DG. A comparison of clonidine, meperidine and placebo in preventing postanesthetic shivering. Anesth Analg. 2000;90:954–7.
    1. Alfonsi P. Postanesthetic shivering epidemiology, pathophysiology and approaches to prevention and management. Drugs. 2001;61:2193–205.
    1. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth. 2011;55:116–21.
    1. Linde He Mo. The clinical use of dexmedetomidine. Rev Bras Anestesiol. 2004;54:1–4.
    1. Ribeiro RN, Nascimento JP. The use of dexmedetomidine in anesthesiology. Rev Bras Anestesiol. 2003;53:97–113.
    1. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnesic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699–705.
    1. Kamibayashi T, Maze M. Clinical uses of alpha-2 adrenergic agonists. Anaesthesiology. 2000;93:1345–9.
    1. Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1997;87:835–41.
    1. Quan N, Xin L, Ungar AL, Blatteis CM. Preoptic norepinephrine-induced hypothermia is mediated by α2-adrenoceptors. Am J Physiol. 1992;262:R407–11.
    1. Buggy D, Higgens P, Moran C, O’Donovan F, Mc Carroll M. Clonidine at induction reduces shivering after general anesthesia. Can J Anaesth. 1997;44:263–7.
    1. Piper SN, Rohm KD, Suttner SW, Maleck WH, Kranke P, Boldt J. A comparison of nefopam and clonidine for the prevention of postanesthetic shivering: A comparative, double blind and placebo controlled dose ranging study. Anaesthesia. 2004;59:559–64.
    1. Kranke P, Eberhart LH, Roewer N, Tramer MR. Single dose parenteral pharmacological interventions for the prevention of postoperative shivering: A quantitative systematic review of randomized controlled trials. Anesth Analg. 2004;99:718–27.
    1. Witte JD, Sessler DI. Perioperative shivering physiology and pharmacology. Anesthesiology. 2002;96:467–84.
    1. Katyal S, Tewari A. Shivering: Anesthetic Considerations. J Anaesth Clin Pharmacol. 2002;18(4):363–76.
    1. Sessler DI. Temperature Monitoring. In: Miller RD, editor. Textbook of Anaesthesia. 5th ed. Philadelphia: Churchill Livingstone Inc; 1994. pp. 1367–89.
    1. Mathews S, Al Mulla A, Varghese PK, Radim K, Mumtaz S. Postanaesthetic shivering-a new look at Tramadol. Anaesthesia. 2002;57:387–403.
    1. Vanderstappen I, Vanermeerch 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;51:351–5.
    1. Kurz A, Ikeda T, Sessler DI, Larson M, Bjorksten AR, Dechert M, et al. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology. 1997;86:1046–54.
    1. Takada K, Clark DJ, Davies MF, Tonner PH, Krause TK, Bertaccini E, et al. Meperidine exerts agonist activity at the a2B-adrenoceptor subtype. Anesthesiology. 2002;96:1420–6.
    1. Mokhtarani M, Mahgoub AN, Morioka N, Doufas AG, Sessler DI. Buspirone and meperidine synergistically reduce the shivering threshold. Anesth Analg. 2001;93:1233–9.
    1. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382–94.
    1. Boulant JA. The effect of firing rate on preoptic neuronal thermosensitivity. J Physiol. 1974;240:661–9.
    1. Maze M, Tranquilli W. Alpha-2 adrenoceptor agonists: Defining the role in clinical anesthesia. Anesthesiology. 1991;74:581–605.
    1. Surprenant A, North RA. Mechanism of synaptic inhibition by noradrenaline acting at α2-adrenoceptors. Proc R Soc Biol. 1988;234:85–114.
    1. Evans RJ, Surprenant A. Effects of phospholipase A2 inhibitors on coupling of α2-adrenoceptors to inwardly rectifying potassium currents in guinea pig submucosal neurones. Br J Pharmacol. 1993;10:591–6.
    1. Maze M. Clinical uses of alpha-2 agonists, 46th Annual Refresher Course Lectures. Atlanta: American Society of Anesthesiologists; 1995. p. 125.
    1. Lipscombe D, Kongsamut S, Tsien RW. α-adrenergic inhibition of sympathetic neurotransmitter release mediated by modulation of N-type calcium-channel gating. Nature. 1989;340:639–42.
    1. Myers RD, Simpson CW, Higgins D, Nattermann RA, Rice JC, Redgrave P, et al. Hypothalamic Na+ and Ca++ ions and temperature set-point: New mechanisms of action of a central or peripheral thermal challenge and intrahypothalamic 5-HT, NE, PGE1, and pyrogen. Brain Res Bull. 1976;1:301–27.
    1. Alojado ME, Ohta Y, Kemmotsu O. The effect of clonidine on the activity of neurons in the rat dorsal raphe nucleus in vitro. Anesth Analg. 1994;79:257–60.
    1. De Witte J, Sessler DI. Perioperative shivering: Physiology and Pharmacology. Anaesthesiology. 2002;96:467–84.
    1. Bajwa SS, Bajwa SK, Kaur J, Sharma V, Singh A, Singh A, et al. Palonosetron: A novel approach to control postoperative nausea and vomiting in day care surgery. Saudi J Anaesth. 2011;5:19–24.
    1. Bock M, Sinner B, Gottlicher M, Simon E, Martin E, Motsch J. Involvement of serotonergic pathways in pos-tanesthetic cold defence: Dolasetron prevents shiver-ing. J Thermal Biol. 2002;27:159–66.
    1. Wrench IJ, Cavill G, Ward JE, Crossley AW. Com-parison between alfentanil, pethidine and placebo in the treatment of postanesthetic shivering. Br J Anaesth. 1997;79:541–2.
    1. Terasako K, Yamamoto M. Comparison between pentazo-cine, pethidine and placebo in the treatment of postanes-thetic shivering. Acta Anaesthesiol Scand. 2000;44:311–2.
    1. De Witte J, Deloof T, De Veylder J, Housemans PR. Tramadol is the treatment of postanaesthetic shivering. Acta Anaesthesiol Scandinavica. 1997;41:506–10.
    1. Saha E, Ray M, Mukherjee G. Effect of tramadol in prevention of postanaesthetic shivering following general anaesthesia for cholecystectomy. Indian J Anaesth. 2005;49:208–12.
    1. Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an “atypical” opioid analgesic. J Pharmacol Exp Ther. 1992;260:275–85.
    1. Frink MC, Hennies HH, Englberger W, Haurand M, Wilffert B. Influence of tramadol on neurotransmitter systems of the rat brain. Arzneimittelforschung. 1996;46:1029–36.
    1. De Witte JL, Kim JS, Sessler DI, Bastanmehr H, Bjorksten AR. Tramadol reduces the shivering, vasoconstriction, and sweating thresholds. Anesth Analg. 1998;87:173–9.

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