Optimal Dose of Prophylactic Dexmedetomidine for Preventing Postoperative Shivering

Abstract

Objective The aim of this study was to investigate the optimum dosage of dexmedetomidine for prevention of postanesthetic shivering.Methods One-hundred thirty two ASA physical status I-II patients scheduled for elective laparoscopic total hysterectomy were enrolled in this randomised, placebo-controlled study. Patients were randomly allocated to receive dexmedetomidine in four groups: group S (0.9% normal saline), group D0.5 (dexmedetomidine 0.5 µg/kg), group D0.75 (dexmedetomidine 0.75 µg/kg), group D1.0 (dexmedetomidine 1.0 µg/kg). Time to extubation and tympanic temperature during and after operation were measured. Shivering was graded (0-3 scale) upon patients arrival to the PACU and every ten minutes thereafter up to forty minutes. Sedation and first rescue analgesic time at the PACU were evaluated.Results The incidence of shivering was significantly lower in group D0.75 and D1.0 than in group S (P < 0.05). There were significantly fewer patients with a shivering score of 2 or 3 in groups D0.75 and D1.0 than in group S (P < 0.05, P < 0.001). Extubation time was shorter in group S than in groups D0.75 and D1.0 (P < 0.05). Tympanic temperature at 40 minutes postoperatively in the recovery room was higher in group S than in the other dexmedetomidine groups (P < 0.05)Fewer patients required rescue analgesia in groups D0.75 and D1.0 than in group S (P < 0.001), and the time to rescue analgesia was longer in group D1.0 than in group S (P < 0.001). Modified Observer's Assessment of Alertness/Sedation (MOAA/S) at arrival in the PACU was lower in all dexmedetomidine groups than in group S (P < 0.05).Conclusions Our results suggest that dexmedetomidine 0.75 or 1.0 µg/kg provides effective prophylaxis against postoperative shivering as well as an analgesic effect. Though potential for intraoperative requirement for atropine, sedation in the immediate recovery period and delayed extubation time with dexmedetomidine was noted, there were no major clinical impacts on the overall recovery from anesthesia.

Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials

“…50 Several elements for the clinical use of dexmedetomidine should be considered. Kim et al 19 recommended the minimum effective dose of 0.75 lgÁkg -1 for adults. Furthermore, Bozgeyik et al 24 did not find any difference between 0.5 lgÁkg -1 dexmedetomidine and placebo; however, this investigation was hampered by a relatively small sample size (30 patients per group).…”

“…3,9,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Other control agents included fentanyl, [33][34][35][36] remifentanyl, 37,38 meperidine, 15 midazolam, [39][40][41] propofol, 43,44 ketamine, 45,46 tramadol, 24,47 clonidine, 42 propacetamol, 48 and buprenorphine 49 ( 8 were reported in the 39 included trials, and all studies reported every endpoint mentioned in the Methods section (reporting bias). 8 however, some bias 8 may exist in of the two trials, 27,32 as the length of surgery was not clear.…”

“…A sensitivity analysis to remove a high-risk study 21 (high risk of bias for one or more key domains, refer to Methods section) showed a similar result favouring dexmedetomidine (pooled RR = 0.52; 95% CI: 0.31 to 0.87) and decreased heterogeneity (I 2 from 73% to 42%). One trial 19 presented that 0.75 lgÁkg -1 dexmedetomidine reduced the incidence of shivering with a reported P value of 0.002. A subgroup of dexmedetomidine 1.0 lgÁkg -1 also reduced the incidence of shivering (pooled RR of six trials: 0.24; 95% CI: 0.16 to 0.37) (Fig.…”

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

“…[20][21][22][23] Moreover, robust data on safety of use of IV dexmedetomidine in parturients is largely lacking. Callaway et al reported a decreased incidence of shivering with use of i.v.…”

Is It Time for an Expanded Role of Dexmedetomidine in Contemporary Anesthesia Practice? - A Clinician's Perspective

“…The combination of dexmedetomidine with opioids had better analgesia, less nausea and vomiting, less pruritus and less gastrointestinal impairment than opioids alone [54]. It abolishes post-operative shivering [55]. It is therefore essential to keep the patient warm intraoperatively because the patient tachycardia and hypertension on emergence and this helps to reduce complications like myocardial ischemia and subdural hematoma.…”