Intravenous dexmedetomidine for the treatment of shivering during Cesarean delivery under neuraxial anesthesia: a randomized-controlled trial

Dexmedetomidine for every Cesarean delivery…maybe not?

“…1 Les frissons sévères induisent un stress physiologique, interfèrent avec les moniteurs des patientes et réduisent le confort et la satisfaction globale des femmes pendant l'accouchement. 2 Plusieurs études ont cherché à trouver des agents pharmacologiques afin de traiter les frissons associés à l'anesthésie neuraxiale, tant chez les parturientes que dans la population générale. Parmi les agents précédemment examinés, il a été démontré que le butorphanol, 3 la clonidine, 4 le fentanyl, 5 la mépéridine, 6 le tramadol 7 et la dexmédétomidine 8 réduisaient les frissons survenant après une anesthésie neuraxiale.…”

“…1 Severe shivering causes physiologic stress, interferes with patient monitors, and decreases the comfort and overall satisfaction of women during childbirth. 2 Many studies have evaluated pharmacologic agents to treat shivering associated with neuraxial anesthesia in both parturients and the general population. Previously studied agents including butorphanol, 3 clonidine, 4 fentanyl, 5 meperidine, 6 tramadol, 7 and dexmedetomidine 8 decrease established shivering following neuraxial anesthesia.…”

“…In obstetrical anesthesia, it has been used as part of multi-modal intravenous labour and post-CD analgesia, 10-13 as a neuraxial adjunct in the epidural space for labour, 14 and intrathecally for shivering prevention during CD. 15 In this issue of the Journal, Lamontagne et al 2 present a novel use of this drug in parturients to treat shivering during CD. The authors conducted a singlecentre, randomized, double-blind, placebo-controlled, parallel-group study in 80 healthy parturients undergoing CD with neuraxial anesthesia (spinal or epidural) who showed significant shivering after delivery.…”

“…Lamontagne et al 2 included labouring and nonlabouring parturients that required CD. The physiology of parturients changes significantly when in labour.…”

“…With possible nuances in the mechanism for shivering between labour epidural and spinal anesthesia, the groups were not mechanistically equivalent. Lamontagne et al 2 should be commended on their innovative study that provides an important contribution to the literature on a problem in obstetrical anesthesia still lacking an optimal solution. We hope this study will be a stimulus for further definitive research within mechanistically similar groups as we continue to strive towards improved patient-centred care in obstetrical anesthesia.…”