THE EFFICACY OF DEXMEDETOMIDINE FOR THE PREVENTION OF SHIVERING DURING SPINAL ANESTHESIA: A RANDOMIZED CONTROLLED TRIAL
Main Article Content
Keywords
Intravenous Dexmedetomidine, Intrathecal Spinal Anesthesia, Incidence of shivering, Sedation level
Abstract
This study aimed to assess the effectiveness of dexmedetomidine in preventing shivering during spinal anesthesia. A total of 377 patients aged 18 to 50 were registered for elective minor surgical procedures under bupivacaine spinal anesthesia. The study divided the patients into two groups: those receiving intravenous dexmedetomidine (DEX) and those receiving saline (Placebo). The Bromage Scale was used to evaluate motor block, and an observer blinded to the situation evaluated if shivering occurred following a subarachnoid medication injection loaded with cerebrospinal fluid.
The results showed that shivering occurred in 14% of the DEX group and 28% in the placebo group. The DEX group experienced less severe shivering than the Placebo group. The duration between the initiation of shivering in the DEX group and the placebo group was 30 and 82 minutes, respectively. Additionally, 78% of the DEX group and 3% of the placebo group experienced sedation at level 2.
In conclusion, dexmedetomidine infusion significantly reduced shivering during the perioperative period due to its quick start of action, higher cessation rates, and decreased recurrence. These findings highlight the safety and effectiveness of adding dexmedetomidine to anesthesia protocols to improve patient outcomes and offer insights for anesthesiologists and other healthcare professionals.
References
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3. Alfonsi P. Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol. 2013;69:438–442.
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5. Al-Mustafa MM, Badran I, Fares KM. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East Journal of Anesthesiology. 2009;20(2):225–231.
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7. Azhagappan C. A Study of Dexmedetomidine, Tramadol and Pethidine in the Prevention of Intra Operative Shivering in Patients Undergoing Surgery under Spinal anesthesia [Doctoral dissertation]. Stanley Medical College, Chennai; 2016.
8. Bajwa SJS, Gupta S, Kaur J, Singh A, Parmar SS. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. Journal of anaesthesiology, clinical pharmacology. 2012;28(1):86.
9. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anesthesia: A comparative evaluation. Indian J Anaesth. 2011;55(2):116-121.
10. Baxendale BR, Mahajan RP, Crossley AW. Anticholinergic premedication influences the incidence of postoperative shivering. British Journal of Anaesthesia. 1994;72.
11. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263–268.
12. Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidine prevent postanaesthetic shivering. European Journal of Anaesthesiology. 2006;23:149–153.
13. Bilotta F, Pietropaoli P, La Rosa I, Spinelli F, Rosa G. Effects of shivering prevention on hemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients. Anaesthesia. 2001;56:514–519.
14. Bilotta F, Pietropaoli P, Sanita R, et al. Nefopam and tramadol for prevention of shivering during neuroaxial anesthesia. Regional Anesthesia and Pain Medicine. 2002;27:380–384.
15. Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering. British Journal of Anaesthesia. 2000;84(5):615–628.
16. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Current Opinion in Anesthesiology. 2008;21(4):457-461.
17. Chow TC, Cho PH. The influence of small dose intrathecal fentanyl on shivering during transurethral resection of the prostate. Acta Anaesthesiologica Sinica. 1994;32(3):165–170.
18. 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.
19. Cortinez LI, Hsu Y-W, Sum-Ping ST, et al. Dexmedetomidine pharmacodynamics. Part II. Anesthesiology. 2004;101:1077–1083.
20. Crossley AW. Peri-operative shivering (Editorial). Anaesthesia. 1992;47:193–195.
21. Crossley AW. Six months of shivering in a district general hospital. Anaesthesia. 1992;47:845–848.
22. Crossley AW. Postoperative shivering: the influence of body temperature. BMJ. 1995;311:764–765.
23. Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008;33:241-252.
24. Dabir S, Jahandideh M, Abbasinazari M, Kouzekanani H, Parsa T, Radpay B. The efficacy of a single dose of pethidine, fentanyl and morphine in treating postanesthesia shivering. Pak J Pharm Sci. 2011;24:513-517.
25. Dal D, Kose A, Honca M, et al. Efficacy of prophylactic ketamine in preventing postoperative shivering. British Journal of Anaesthesia. 2005;95(2):189–192.
26. De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anesthesiology. 2001;96(2):367-455.
27. De Witte J, Sessler DI. Perioperative Shivering Physiology and Pharmacology. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2002;96(2):467-484.
28. Delaunay L, Bonnet F, Liu N. Clonidine comparably decreases the thermoregulatory threshold for vasoconstriction and shivering in humans. Anaesthesiology. 1993;79:470–474.
29. Doufas AG, Lin CM, Suleman MI, et al. Dexmedetomidine and meperidine additively reduce the shivering threshold in humans. Stroke. 2003;34:1218–1223.
30. Doze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic anesthetic action in rats via activation of central alpha-2 adrenoceptors. Anesthesiology. 1987;71:75-79.
31. Doze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha-2 adrenoceptors. Anesthesiology. 1989;71(1):75-79.
32. Ebert TJ, Hall JE, Barney JA. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93(2):382-394.
33. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. The Journal of the American Society of Anesthesiologists. 2001;93(2).
34. El-Tahan MR, Warda OM, Diab DG. A systematic review of intravenous dexmedetomidine in elective cesarean section: Is it time for a paradigm shift? Saudi Journal of Anaesthesia. 2018;12(4):618–624.
35. El-Tahir KE-D H. Dexmedetomidine a sedative-analgesic drug for the 21st century. Middle East Journal of Anesthesiology. 2002;16(6):577–585.
36. Erkola O, Korttila K, Aho M, et al. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesthesia and Analgesia. 1994;79(4):646–653.
37. Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92(5):1330-1334.
38. Frank SM, Higgins MS, Breslow MJ, Fleisher LA, Gorman RB, Sitzmann JV, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. The Journal of the American Society of Anesthesiologists. 1995;82(1):83-93.
39. Glosten B, Sessler DI, Faure EA, Karl L, Thisted RA. Central temperature changes are poorly perceived during epidural anesthesia. Anesthesiology. 1992;77:10-16.
40. Holdcroft A, Hall GM. Heat loss during anaesthesia. British Journal of Anaesthesia. 1978;50:157–164.
41. Hsu YW, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, et al. Dexmedetomidine pharmacodynamics: Part I: Cross-validation of a mathematical model. Anesthesiology. 2003;113(2):347–358.
42. Hu J, Zhu M, Cao L, Chen J, Lu Y. Dexmedetomidine reduces shivering during epidural anesthesia. Int J Clin Exp Med. 2016;9(6):11355-60.
43. Hurford WE. Sedation. In: Hurford WE (Ed.), Critical Care Handbook of the Massachusetts General Hospital, 3rd edn. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 100.
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May 11, 2024
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Dr. Rizwan Afzal, & Prof. Dr Syed Nurul Haque. (2024). THE EFFICACY OF DEXMEDETOMIDINE FOR THE PREVENTION OF SHIVERING DURING SPINAL ANESTHESIA: A RANDOMIZED CONTROLLED TRIAL. Journal of Population Therapeutics and Clinical Pharmacology, 31(5), 529-543. https://doi.org/10.53555/jptcp.v31i5.5894
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Author Biographies
Dr. Rizwan Afzal
MBBS, MCPS Anesthesias
Prof. Dr Syed Nurul Haque
FCPS Anesthesiology
How to Cite
Dr. Rizwan Afzal, & Prof. Dr Syed Nurul Haque. (2024). THE EFFICACY OF DEXMEDETOMIDINE FOR THE PREVENTION OF SHIVERING DURING SPINAL ANESTHESIA: A RANDOMIZED CONTROLLED TRIAL. Journal of Population Therapeutics and Clinical Pharmacology, 31(5), 529-543. https://doi.org/10.53555/jptcp.v31i5.5894