Dexamethasone Decreases the Incidence of Shivering After Cardiac Surgery

Jp, Yared; Starr, Norman J.; Hoffmann-Hogg, L; Ca, Bashour; Insler,; OʼConnor, Michael; Piedmonte, Marion; Dm, Cosgrove

doi:10.1097/00000539-199810000-00010

Cited by 20 publications

(9 citation statements)

References 20 publications

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“…PONV after thyroidectomy is especially common and vomiting may increase the risk of postoperative bleeding, and neck hematoma. Postanesthetic shivering (PAS) occurs in the postoperative period in up to 76% of patients and varies according to age, sex, anesthetic drugs, and the type of surgery [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Ramosetron Plus Dexamethasone with Ramosetron Alone on Postoperative Nausea, Vomiting, Shivering and Pain after Thyroid Surgery

Lee

Kim

et al. 2015

Korean J Pain

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BackgroundPostoperative nausea and vomiting (PONV), postanesthetic shivering and pain are common postoperative patient complaints that can result in adverse physical and psychological outcomes. Some antiemetics are reported to be effective in the management of postoperative pain and shivering, as well as PONV. We evaluated the efficacy of dexamethasone added to ramosetron on PONV, shivering and pain after thyroid surgery.MethodsOne hundred and eight patients scheduled for thyroid surgery were randomly allocated to three different groups: the control group (group C, n = 36), the ramosetron group (group R, n = 36), or the ramosetron plus dexamethasone group (group RD, n = 36). The patients were treated intravenously with 1 and 2 ml of 0.9% NaCl (group C); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 0.9% NaCl (group R); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 5 mg/ml dexamethasone (group RD) immediately after anesthesia.ResultsIncidence of nausea and the need for rescue antiemetics, verbal rating scale (VRS) 1 hour pain value, ketorolac consumption, and incidence of shivering were significantly lower in group R and group RD, than in group C (P < 0.05). Moreover, these parameters were significantly lower in group RD than in group R (P < 0.05).ConclusionsCombination of ramosetron and dexamethasone significantly reduced not only the incidence of nausea and need for rescue antiemetics, but also the VRS 1 hour pain value, ketorolac consumption, and the incidence of shivering compared to ramosetron alone in patients undergoing thyroid surgery.

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Section: Introductionmentioning

confidence: 99%

“…Ramosetron is a newly developed 5-HT 3 antagonist with higher receptor affinity and a longer duration of action than older agents in its class [ 7 , 10 ]. Dexamethasone enhances antiemetic efficacy, as well as reduces PAS and pain [ 3 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ramosetron Plus Dexamethasone with Ramosetron Alone on Postoperative Nausea, Vomiting, Shivering and Pain after Thyroid Surgery

Lee

Kim

et al. 2015

Korean J Pain

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“…Although a high level of spinal blockade [ 30 ] was achieved in this study (Block height) (dermatome level) (T 5 -T 6 ) and a significant relationship between prespinal and 90 min after intrathecal injection core body temperature readings in the 3 study groups was documented by the investigators, a clinically significant shivering was significantly lower in P and D groups compared to C group. This could be explained due to paracetamol acts by inhibiting cyclooxygenase-mediated prostaglandin synthesis to lower the hypothalamic set point [ 8 ] while dexamethasone decreases the temperature gradient between core and skin temperatures via its anti-inflammatory action and inhibition of the release of vasoconstrictor and pyrogenic cytokines [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of preoperative dexamethasone (8 mg), with a biologic half-life of 36–72 h, improved postdischarge quality of recovery [ 11 ] and decreased nausea, vomiting [ 11 , 12 ], pain, and fatigue in the early postoperative period [ 11 ]. As it reduces the gradient between skin and body core temperature and modifies the inflammatory response, dexamethasone has been reported to be effective in reducing shivering after cardiac surgeries [ 13 ]. Dexamethasone may cause unpleasant symptoms following rapid IV injection [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone

et al. 2021

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Background Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%. Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found. This study evaluated the efficacy of paracetamol and dexamethasone to prevent PSAS in patients undergoing lower abdominal and lower limb surgeries. Methods Three hundred patients scheduled for surgeries under spinal anesthesia (SA) were allocated into three equal groups to receive a single preoperative dose of oral paracetamol 1 g (P group), dexamethasone 8 mg intravenous infusion (IVI) in 100 ml normal saline (D group) or placebo (C group), 2 h preoperatively, in a randomized, double-blind trial. The primary endpoint was the incidence of clinically significant PSAS. Secondary endpoints included shivering score, the change in hemodynamics, adverse events (e.g., nausea, vomiting and pruritis) and patients` satisfaction. Results Clinically significant PSAS was recorded as (15%) in P group, (40%) in D group and (77%) in C group (P < 0.001). The mean blood pressure values obtained over a 5-25 min observation period were significantly higher in the D group (P < 0.001). Core temperature 90 min after SA was significantly lower in the 3 groups compared to prespinal values (P < 0.001). Nausea, vomiting and pruritis were significantly higher in the C group (P < 0.001). P and D groups were superior to C group regarding the patients’ satisfaction score (P < 0.001). Conclusion Paracetamol and dexamethasone were effective in prevention of PSAS in patients undergoing lower abdominal and lower limb surgeries compared to placebo controls. Trial registration ClinicalTrials.gov Identifier: NCT03679065 / Registered 20 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov.

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“…We decided to give first-line betamethasone for several reasons, including cost, effectiveness for PONV prophylaxis, tolerance, and its anti-inflammatory properties that may be valuable for improving shivering, and recovery after ischemia reperfusion, despite no valuable effects for hard outcomes after cardiac surgery. [ 5 11 12 13 14 15 ] This approach was also used to allow for administration of rescue antiemetics with first-line ondansetron and metoclopramide.…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

2018

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Dexamethasone Decreases the Incidence of Shivering After Cardiac Surgery

Cited by 20 publications

References 20 publications

Comparison of Ramosetron Plus Dexamethasone with Ramosetron Alone on Postoperative Nausea, Vomiting, Shivering and Pain after Thyroid Surgery

Comparison of Ramosetron Plus Dexamethasone with Ramosetron Alone on Postoperative Nausea, Vomiting, Shivering and Pain after Thyroid Surgery

Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

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