Magnesium Sulphate Infusion Prevents Shivering During Spinal Anaesthesia: A Randomised Double Blinded Controlled Study

Abstract

Spinal anaesthesia is the most common form of anaesthesia in our hospital. Shivering is a very common complication in patients undergoing surgery under spinal anaesthesia. Shivering increases expenditure of cardiac and systemic energy resulting in increased oxygen consumption and carbon dioxide production, lactic acidosis and raises intraocular and intracranial pressure. It also interferes with haemodynamic monitoring intraoperatively. Regional anaesthesia produces vasodilatation, which facilitates core to peripheral distribution of heat. It also increases sweating threshold and decreases vasoconstriction and shivering threshold. Intra-and postoperative management of shivering is usually done by external heating (Forced air warming, warming blankets), warmed fluids or pharmacological intervention. Prevention and treatment of established shivering should be regarded as clinically relevant intervention in the perioperative period. Therefore, a randomized double-blind control study was done using magnesium sulphate infusion in the prevention of shivering in our hospital. The aim of our study is to assess the efficacy of magnesium sulphate when used for prevention of shivering following spinal anaesthesia. METHODSInstitutional Ethical Committee approval and informed consent were obtained from all patients.INCLUSION CRITERIA 80 patients of ASA 1 and 2 belonging to either sex, aged between 18-65 years undergoing lower abdominal and lower limb surgeries were included in the study. EXCLUSION CRITERIAPatients suffering from neuromuscular disease, hyperthyroidism, cardiopulmonary disease, psychological disease, refusal to participate or temperature more than 38*C or less than 36.5*C. The patients were randomized into 2 groups namely Group M and Group C. Group M -Each of Group M patients were designated to receive 2 gms (4 mL) of magnesium sulphate in the preloading fluid over a period of 20-30 minutes. Group C -Each of Group C patients were designated to receive 4 mL of normal saline as control in the preloading fluid over a period of 20-30 minutes. Following a detailed pre-anaesthetic checkup along with relevant investigations, patients were brought to the operation theatre and connected to monitors. Then the vital signs of the patients including heart rate, temperature, non-invasive blood pressure, respiratory rate and SpO2 were continuously monitored and recorded. Both group of patients were pre-loaded with 15 mL/kg of Ringer lactate before giving spinal anaesthesia. GROUP MThe study drug of 4 mL of Inj. Magnesium Sulphate was coded and presented to the anaesthetist not involved in the management of the patient and administered by intravenous infusion by adding it in the preloading fluid before spinal anaesthesia over a period of 20-30 minutes. GROUP CThe control drug of 4 mL of normal saline was coded and presented to the anaesthetist not involved in the management of the patient and administered by intravenous infusion by adding it in the preloading fluid before spinal anaesthesia over a period of 20-30 minut...

Investigating the Effect of Magnesium in Preventing Tremors after Anesthesia: A Systematic Review

“…The evaluated studies included data from 4303 people. 2300 of them magnesium (1114 by IV in 35 studies [6,), by epidural in 12 studies [47][48][49][50][51][52][53][54][55][56][57][58], 638 by intraperitoneal injection in 16 studies [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] and 108 by Other routes received 4 interventions. All studies compared magnesium sulfate with placebo or no drug.…”

The impact of magnesium on shivering incidence in cardiac surgery patients: A systematic review

“…The scope of our evaluation encompassed a significant volume of data from a total of 4303 individuals. Among them, 2300 individuals received magnesium through various routes, including 1114 participants who received intravenous magnesium in 35 studies [ 10 , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] ], 12 studies that administered magnesium epidurally [ [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] ] to a total of 638 participants, and 16 studies that utilized intraperitoneal injection to deliver magnesium to 638 individuals [ [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] ]. Additionally, 108 participants received magnesium through alter...…”

“…In this study, a total of 54 clinical trials were analyzed [ [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [65] , [66] , [67] , [68] , [69] , 72 , 73 , 77 , 82 , 83 ], and the incidence of shivering was analyzed in different groups based on the method of magnesium administration. The results revealed that the incidence of shivering was lower in the group that received magnesium via IV injection compared to the control group.…”

“…The scientific text reports that 36 studies [ [19] , [20] , [21] , [22] , [23] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , 35 , 36 , [39] , [40] , [41] , [42] , [44] , [45] , [46] , [47] , [49] , [50] , [51] , [52] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ] were conducted to examine the occurrence of a blood pressure drop, and the overall incidence rate was found to be similar across all studies. The hazard ratio was 0.91, with a confidence interval of 0.79–1.01, and I 2 = 2 %.…”

The effects of intravenous tramadol vs. intravenous ketamine in the prevention of shivering during spinal anesthesia: A meta-analysis of randomized controlled trials

“…Shivering may have beneficial thermoregulatory effects; however, it is a distressing experience and causes several undesirable detrimental effects (8). It leads to an increase in oxygen consumption and carbon dioxide production, intraocular and intracranial pressure (9)(10)(11). It may also lead to an increase in sympathetic tone that enhances the chances of myocardial ischemia (12,13), pain (14), and bleeding (15).…”