Incidence of postoperative shivering comparing remifentanil with other opioids: a meta-analysis

Song

The Journal of Clinical Pharma

et al. 2016

The aim of this meta-analysis was to evaluate the preventive efficacy and safety of 5-HT receptor antagonists (5-HT RAs) on perioperative shivering. Relevant databases were searched to identify eligible randomized, controlled trials through January 2016. Primary outcome was the incidence of perioperative shivering, and secondary outcomes were the incidence of safety-related outcomes including postoperative nausea and vomiting (PONV), bradycardia, and hypotension. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data. Trial sequential analysis was performed to assess the risk of random errors and calculate the required information size. Sixteen studies with a total of 1126 patients were included in the meta-analysis. Compared with the control group, 5-HT RAs administered intravenously could statistically significantly reduce the incidence of perioperative shivering (RR, 0.44; 95%CI, 0.35 to 0.56; P < .00001; heterogeneity: I = 30%) as well as PONV (RR, 0.52; 95%CI, 0.28 to 0.97; P = .04; heterogeneity: I = 0%). However, they did not show superiority in lowering the rate of bradycardia (RR, 0.75; 95%CI, 0.38 to 1.49; P = 0.42; heterogeneity: I = 0%) or hypotension (RR, 0.79; 95%CI, 0.44 to 1.43; P = .44; heterogeneity: I = 24%). Trial sequential analysis of primary outcome showed that the required information size was 2634 patients and that the trial sequential monitoring boundary was crossed. Thus, more high-quality randomized, controlled trials with larger sample sizes are still required to draw a definite conclusion about the preventive efficacy of 5-HT RAs on perioperative shivering prevention in the future.

mentioning

confidence: 99%

mentioning

confidence: 99%

5‐HT₃ Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta‐Analysis

Song

The Journal of Clinical Pharma

et al. 2016

“…7 Subarachnoid block with local anaesthetics and opioids enable efficacious spinal anaesthesia because of their synergistic effect and permit the use of low-dose local anaesthetics, which results in a stable hemodynamic state. 8,9 In addition to the fact that shivering is poorly understood, the gold standard for the treatment and prevention has not been defined yet. 10 Postoperative shivering in patients severely increases oxygen consumption (400 times) which is followed by a rise in CO 2 production leading to acidosis when the alveolar ventilation is not increased proportionally.…”

Section: Introductionmentioning

confidence: 99%

Control of Shivering with Prophylactic Ketamine During Subarachnoid Block: A Placebo-Controlled Randomised Double- Blind Study

Zoengmawia¹,

Sailo²

2019

IJCMR

Introduction: Shivering is a common and challenging side effect of anaesthesia and may result in different degrees of perioperative hypothermia. Hence, the aim of the study was to compare the efficacy of ketamine to prevent shivering during subarachnoid block inpatient undergoing elective surgery. Material and Methods: We conducted a prospective randomized, double-blind placebo-controlled trial with total of 90 ASA I and II patients of either sex between the ages of 18-60 years undergoing elective infra-umbilical surgery under subarachnoid blocks. Random allocation of patients was done into Group1: ketamine at dose of 0.5 mg /kg (n=30), Group2: ketamine at dose of 0.25 mg /kg (n=30), Group3: saline (n=30). Results: The study groups were comparable at the baseline. After spinal anaesthesia and concomitant administration of the study drug, shivering was observed only in 10% of patient with score 1 in Group 1 and Group 2. Whereas in placebo group 50% patients suffered different degrees of shivering and required treatment (p<0.05). After drug injection % of patient had higher sedation score (3 or 2) which was significantly higher in Group 1 (3%) than Groups 2 and 3 (0%) (P=0.002). Only 3.3% patients of group1 experienced hallucination and rest of the patients in any group had no hallucination (P value= 0.045) Conclusion: Ketamine at a dose of 0.5 mg /kg had similar effects as that of ketamine at dose of 0.25 mg /kg when compared to placebo group. However, ketamine at dose of 0.5 mg /kg caused higher effects of sedation and hallucination.

“…Buna rağmen, titreme özellikle respiratuar ve kardiyak rezervi düşük hastalarda oksijen tüketimindeki artış ile beraber hipoksemiye neden olabilir. Etiyolojisi tam olarak bilinmemekle beraber, birçok mekanizma öne sürülmüş olmasına rağmen, tedavisi ve önlenmesinde kesin bir görüş mevcut değildir (5) . Bu çalışma, genel anestezi sırasında kas gevşetici (KG) kullanılan erişkinlerde bu mekanizmanın bloke olabileceğini ve bu nedenle intraoperatif hipotermi olabileceğini postoperatif dönemde KG etkisi kalkınca da ısı üretimi amacı ile titreme olabileceği hipotezini test etmeyi amaçlamıştır.…”

Section: Introductionunclassified

The Effect of Neuromuscular Agent on Postoperative Shivering in Patients Undergoing Retrograde Intrarenal Surgery: A randomized controlled clinical trial

Baran¹,

Oksar²,

Altınsoy³

2019

JARSS

ÖZAmaç: Titreme ve aktif hareket bilinci açık ve hareket edebilen hastalarda ısı üretimi ve ısınma için çok etkin bir mekanizmadır. Bu çalışma, genel anestezi sırasında kas gevşetici (KG) kullanılan erişkinlerde intraoperatif hipotermi ve buna bağlı postoperatif titreme olabileceği hipotezini test etmeyi amaçlamıştır. Yöntem: Retrograd intrarenal cerrahi (RIRS) geçirecek 80 hasta rastgele kas gevşetici (KG) kullanılan (Grup R, N=40), KG kullanılmayan (Grup K, N=40) olarak iki gruba ayrıldı. Tüm hastalara hava yolu kontrolü için Laringeal Maske (LMA) kullanıldı ve KG verilmesi dışında, standart bir anestezi protokolü uygulandı. Cilt ve iç sıcaklıklarının monitörizasyonlarından elde edilen veriler ve titreme muayeneleri anestezi indüksiyonundan önce (t0), KG verildiğinde (t 1 ), intraoperatif 15 (t 2 ), 30 (t 3 ), ve 60 (t 4 ) ve postoperatif 0 (t 5 ), 10 (t 6 ), 15 (t 7 ), 30 (t 8 ), 60 (t 9 ) dk.'larda kaydedildi. Bulgular: Grup R'de t 0 , t 1 , t 2 , t 3 ve t 5 cilt ısısı Grup K'den anlamlı derecede yüksek iken iç sıcaklıklar bakımından gruplar arasında fark yoktu. (t 5 , t 6 ve t 7 'de titreme olanların oranı Grup R'de Grup K'den anlamlı derecede fazla idi (p<0.05). Her iki grupta da cilt sıcaklığında t0'a göre istatistiksel olarak anlamlı fark görülmektedir. Buna göre K grubunda t 7,8,9 'da t 0 'a göre anlamlı fark saptanırken R grubunda t1'de farklılık saptanmıştır. Grup R'de iç sıcaklık t 3 'de t 2 'ye ve Grup K'de t 3 de t 1 , ve t 2 'ye göre anlamlı düşüktü. Sonuç: Postoperatif titreme ve buna neden olan mekanizmaların anlaşılması önemli bir konudur. Hipotermi üzerinden sinir kas gevşetici kullanımı ile olası bir ilişki ise intraoperatif ısı yönetimi ve respiratuar ve kardiyak rezervi düşük hastalar açısından araştırılmaya değer. Bu çalışmadan elde edilen veriler, KG kullanımı ile intraoperatif hipotermi arasında bir ilişkiyi desteklemezken, postoperatif titreme ile bir ilişkiyi açıkça göstermiştir. Bununla beraber, vücut sıcaklığına kas gevşeticilerin olası etkileri ve erişkinlerdeki periferik savunma mekanizmalarının ve belki ilave olarak santral mekanizmaların çalışılmasına gereksinim vardır.Anahtar kelimeler: Postoperatif titreme, sinir kas gevşetici, vücut sıcaklığı, hipotermi, genel anestezi ABSTRACT Objective: Shivering, and active movements, are very effective mechanisms for heat generation and warming in ambulatory mobile patients with open conscious. This study aimed to test the hypothesis that intraoperative hypothermia and postoperative shivering may be present in adults for whom neuromuscular blocker (NMB) was used during general anesthesia. Method: Eighty patients who underwent retrograde intrarenal surgery (RIRS) were randomly divided into two groups as those receiving or not receiving neuromuscular blocking agent (NMB) [Group R (NMB+), N=40; Group K (control), N=40)]. Laryngeal mask (LMA) was used for airway control in all patients and a standard anesthetic protocol was performed except for NMB administration. Data obtained from the monitoring of skin and internal temperatures and shiverin...