Efficacy of prophylactic use of hydrocortisone and low dose ketamine for prevention of shivering during spinal anesthesia

Elmawgood, Ashraf Abd; Rashwan, Samaa; Rashwan, Doaa

doi:10.1016/j.egja.2012.04.002

Cited by 6 publications

(15 citation statements)

References 11 publications

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“…Sagir et al 17 also used a similar prophylactic dose of 0.5 mg kg −1 IV ketamine, but in patients undergoing SAB, and found it to be effective in preventing POS. Using similar lower doses, Elmawgood et al 21 in their study in patients undergoing posterior vaginal repair surgeries under SAB found that the prophylactic administration of low-dose ketamine (0.25 mg kg −1 ) and hydrocortisone (2 mg kg −1 ) were comparable in reducing the incidence of shivering from 60% in the control group to 20% in the ketamine group.…”

Section: Discussionmentioning

confidence: 95%

Efficacy of Prophylactic Ketamine, Ondansetron, and Pethidine in Preventing Perioperative Shivering in Patients Undergoing Elective Knee Replacement Surgery Under Spinal Anaesthesia

R¹,

Sethi²,

Singh³

et al. 2022

Turk J Anaesthesiol Reanim

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Objective Perioperative shivering is a very common complication. Despite the vast array of knowledge regarding perioperative shivering and its after-effects, its prophylaxis is often overlooked. The study aims to compare the efficacy and safety of low-dose ketamine, ondansetron, and pethidine in the prevention of perioperative shivering in patients undergoing total knee replacement surgery under the subarachnoid block. Methods In this randomized controlled study, 203 patients aged 18-75 were included and allocated to one of the 4 groups; normal saline (group S), ondansetron 4 mg (group O), ketamine 0.25 mg kg −1 (group K), and pethidine 0.25 mg kg −1 (group P). Side effects, namely hypotension, nausea and vomiting, sedation, hallucinations, and respiratory depression were recorded. Results Perioperative shivering was present in 22 (44%), 8 (16%), 4 (7.84%), and 4 (7.69%) patients respectively in group S, O, K, and P, which was statistically significant when compared to group S with group K and P ( P < .01). No difference in the incidence of hypothermia was observed across the groups ( P < .17). A significantly lower incidence of hypotension was observed in group K. In group K, 5.9% of the patients were scored as being under severe sedation, according to the modified Wilson sedation scale. There was no incidence of hallucination or respiratory depression observed in any of the groups. Conclusions Patients undergoing total knee replacement surgeries are highly predisposed to the development of hypothermia. Temperature monitoring is thus imperative for all patients. Prophylactic administration of low-dose ketamine or ondansetron or low-dose pethidine produces a significant anti-shivering effect without any significant side effects. However, low-dose ketamine has the advantages of a lower incidence of hypotension, nausea, and vomiting than pethidine.

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Section: Discussionmentioning

confidence: 95%

Efficacy of Prophylactic Ketamine, Ondansetron, and Pethidine in Preventing Perioperative Shivering in Patients Undergoing Elective Knee Replacement Surgery Under Spinal Anaesthesia

R¹,

Sethi²,

Singh³

et al. 2022

Turk J Anaesthesiol Reanim

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“…While 2 studies evaluated the effect of prophylactic steroids on shivering in patients undergoing cardiac surgery, 7,27 19 studies were in patients undergoing various noncardiac surgeries, 15,26,28–39,42–46 and 4 studies were performed in women undergoing cesarean deliveries. 14,40,41,47 Perioperative shivering was the primary outcome in 21 studies.…”

Section: Resultsmentioning

confidence: 99%

“…14,40,41,47 Perioperative shivering was the primary outcome in 21 studies. 7,14,15,26,29–31,33–43,45–47 However, a power analysis was reported in only 16 studies. 7,14,15,30,31,33–36,38,40,41,43,45–47 Dexamethasone was administered intravenously in 18 studies, 7,14,26,27,29,31,32,35,37–39,41–47 and through the intrathecal route in 3 studies.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Misra¹,

Singh

Sarkar³

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Shivering is common following anesthesia and surgery. Corticosteroids (steroids) have been tried to reduce the risk of shivering, but the evidence in favor of their use is uncertain. The primary objective of this review was to evaluate the effect of steroids on the risk of perioperative (intra- and postoperative) shivering versus controls (placebo and active controls). Additional objectives were to assess the risk of severity of shivering, patient satisfaction with shivering prophylaxis, quality of recovery (QoR), and the risk of steroid-related adverse effects. METHODS: PubMed, Embase, Cochrane Central Registry of Trials, Google Scholar, and preprint servers were searched from inception until November 30, 2022. Randomized controlled trials (RCTs) published in the English language were retrieved, provided they reported on shivering either as a primary or secondary outcome following steroid prophylaxis in adult patients undergoing surgery under spinal or general anesthesia. RESULTS: A total of 3148 patients from 25 RCTs were included in the final analysis. The steroids used in the studies were either dexamethasone or hydrocortisone. Dexamethasone was administered intravenously or intrathecally, while hydrocortisone was administered intravenously. Prophylactic administration of steroids reduced the risk of overall shivering (risk ratio [RR], 0.65 [95% confidence interval {CI}, 0.52–0.82]; P = .0002; I 2 = 77%) as well as the risk of moderate to severe shivering (RR, 0.49 [95% CI, 0.34–0.71]; P = .0002; I 2 = 61%) in comparison to controls. Administration of intravenous dexamethasone (RR, 0.67 [95% CI, 0.52–0.87]; P = .002; I 2 = 78%) and hydrocortisone (RR, 0.51 [95% CI, 0.32–0.80]; P = .003; I 2 = 58%) were effective in shivering prophylaxis. For intrathecal dexamethasone (RR, 0.84 [95% CI, 0.34–2.08]; P = .7; I 2 = 56%), the null hypothesis of no subgroup difference was not rejected (P = .47), preventing definitive conclusions about the efficacy of this route of administration. The prediction intervals for both overall shivering risk (0.24–1.70) and risk of severity of shivering (0.23–1.0) precluded generalization of results in future studies. Meta-regression analysis was used to further explore heterogeneity. Factors like the dose and timing of administration of steroids or the type of anesthesia were not found to be significant. Patient satisfaction and QoR were higher in the dexamethasone groups versus placebo. No increased risk of adverse events of steroids was noted versus placebo or controls. CONCLUSIONS: Prophylactic steroid administration may be beneficial in reducing the risk of perioperative shivering. However, the quality of evidence in favor of steroids is very low. Further well-designed studies are needed for establishing generalization.

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“…Furthermore, it makes more sense to avoid the issue and keep the patient at a normal temperature while under neuraxial anesthesia than to try to fix it after the fact. In clinical settings, medical techniques are the gold standard since they are both reliable and economical (11) . Anti-shivering drugs such as clonidine, meperidine, tramadol, nefopam, hydrocortisone, dexmedetomidine, and ketamine have been shown to be effective in a variety of studies.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Ketamine Versus Tramadol on Prophylactic Post-Spinal Shivering in Those Patients Undergoing Orthopedic Surgery

Waheed¹,

Raza²,

Saleh³

et al. 2023

PJMHS

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Background/Objective: Orthopedic patients have a particularly high risk for post-spinal shivering, a typical consequence of spinal anesthesia. Without treatment, shaking may worsen wound pain, increase oxygen use, and impair healing. There have been a number of studies looking at the efficacy of ketamine and other medications for reducing post-spinal shivering. Despite this, there is a dearth of data on more effective and widely available preventive medicines. As a result, the purpose of this research was to evaluate the efficacy of 0.25 mg/kg of Ketamine (K) against 0.5 mg/kg of Tramadol (T) in preventing shivering after spinal anesthesia. Methodology: 200 patients who were to have orthopedic surgery under spinal anesthesia were randomly chosen to participate in this prospective cohort study. Patients who were given a prophylactic dosage of intravenous ketamine prior to spinal anesthesia are referred to as the Ketamine group(n=100), whereas those who were given Tramadol are referred to as the Tramadol group (N=100). During the intraoperative phase, vital signs such as shivering intensity and frequency, blood pressure, heart rate, and axillary body temperature were monitored hourly at 10-minute intervals for a whole hour. Results: There were 87 patients (43%) who had post-spinal shivering; this number was 32 (32%) for those given ketamine and 55(55%) for those given tramadol (p=0.001). With a p-value of 0.000, the incidence of nausea and vomiting was statistically significantly higher in the tramadol group of 82(82%). The ketamine group had significantly more intraoperative sedation than the tramadol group (p 0.007). Conclusion: After spinal anesthesia, low-dose ketamine is more active in lowering the frequency and intensity of shivering. Therefore, we advise patients having orthopedic surgery under spinal anesthesia to take low-dose ketamine beforehand as a preventative measure against post-spinal shivering. Keywords: Ketamine, Tramadol, Shivering, Orthopedic surgery

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Efficacy of prophylactic use of hydrocortisone and low dose ketamine for prevention of shivering during spinal anesthesia

Cited by 6 publications

References 11 publications

Efficacy of Prophylactic Ketamine, Ondansetron, and Pethidine in Preventing Perioperative Shivering in Patients Undergoing Elective Knee Replacement Surgery Under Spinal Anaesthesia

Efficacy of Prophylactic Ketamine, Ondansetron, and Pethidine in Preventing Perioperative Shivering in Patients Undergoing Elective Knee Replacement Surgery Under Spinal Anaesthesia

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The Effect of Ketamine Versus Tramadol on Prophylactic Post-Spinal Shivering in Those Patients Undergoing Orthopedic Surgery

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