Postoperative Shivering Among Cannabis Users at a Public Hospital in Trinidad, West Indies

Sankar-Maharaj, Sasha; Chen, Deryk; Subramanian, Hariharan

doi:10.1016/j.jopan.2016.03.010

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…Bradycardia was determined as a heart rate <50 beats/min and was managed with atropine (0.5 mg). Shivering was measured after clamping of the umbilical cord via a 5-point scoring system (0, no visible shivering; 1, no visible shivering, but peripheral vasoconstriction or piloerection was observed; 2, activity in one muscle group only; 3, activity in more than one muscle group, but shivering was not generalized; 4, shivering involving the whole body) (16). Umbilical venous and arterial blood samples were drawn from a double-clamped segment of the umbilical cord for analysis of blood gas at delivery.…”

Section: Methodsmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

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Section: Methodsmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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“…Shivering score was measured when shivering appeared. Shivering was graded according to a validated scale [15] where 0 = no visible shivering; 1 = no visible shivering, but peripheral vasoconstriction or piloerection was observed; 2 = activity in one muscle group only; 3 = activity in more than one muscle group, but shivering was not generalized; 4 = shivering involving the whole body.…”

Section: Methodsmentioning

confidence: 99%

The effects of novel α2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section

Jin

Chen

et al. 2019

Bioscience Reports

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Objective: Meperidine used to control shivering during perioperative period has associated side effects. The present study compared the safety of selective α2-adrenoreceptor agonist dexmedetomidine and meperidine for anti-shivering in primiparas after caesarean delivery under combined spinal-epidural anesthesia (CSEA).Methods: 100 primiparas scheduled for caesarean delivery were randomly allocated to dexmedetomidine group (Group D, n=50) and meperidine positive control group (Group M, n=50). Primiparas experienced shivering that continued to cord clamping were treated with dexmedetomidine (0.5 μg/kg) or meperidine (0.5 mg/kg) after cord clamping. The primary outcome measures were incidence of nausea, vomiting, and respiratory depression. Secondary outcome measures were shivering score, vital signs including blood pressure, heart rate and O2 saturation, tympanic temperature, and sedation score.Results: Dexmedetomidine provided similar anti-shivering effects as meperidine in patients after caesarean delivery under CSEA, evidenced as all shivering primiparas responded to either dexmedetomidine or meperidine treatment within 15 min. However, incidence of nausea and vomiting were significantly lower after dexmedetomidine treatment, accompanied with more stable blood pressure. Dexmedetomidine also provided well regulation of tympanic temperature and good sedation.Conclusion: Selective α2-adrenoreceptor agonist dexmedetomidine has a better safety profile compared with meperidine for anti-shivering in primiparas undergoing caesarean delivery. Dexmedetomidine could be a better choice for anti-shivering in patients requiring caesarean section. The mechanism of anti-shivering for dexmedetomidine may relate to well regulation of temperature and good sedation.

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“…Perioperative hypothermia is defined as a core temperature, 33°C to 35°C, while the shivering threshold in nonanaesthetized patients is 35.5°C. Anaesthetic agents increase the heat response thresholds and decrease the cold response thresholds so that the normal interthreshold range (hypothalamic set point) is increased [16]. However, the study of Sessler et al [8] suggested that special factors related to surgery, stress or pain, might contribute to the genesis of postoperative tremor because they failed to identify any shivering-like activity in normothermic volunteers.…”

Section: Aetiologymentioning

confidence: 99%

“…Moreover, there is a suggestion that pain and temperature signals are transmitted along similar fibber systems in the dorsal horn of the spinal cord. Cannabis has been shown to interfere with both thermogenic and nonthermogenic mechanisms of PS [16].…”

Section: Aetiologymentioning

confidence: 99%

Postanaesthetic shivering – from pathophysiology to prevention

López

2018

Rom J Anaesth Int Care

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Postoperative shivering is a common complication of anaesthesia. Shivering is believed to increase oxygen consumption, increase the risk of hypoxemia, induce lactic acidosis, and catecholamine release. Therefore, it might increase the postoperative complications especially in high-risk patients. Moreover, shivering is one of the leading causes of discomfort for postsurgical patients. Shivering is usually triggered by hypothermia. However, it occurs even in normothermic patients during the perioperative period. The aetiology of shivering has been understood insufficiently. Another potential mechanism is pain and acute opioid withdrawal (especially with the use of short-acting narcotics). Besides that shivering is poorly understood, the gold standard for the treatment and prevention has not been defined yet. Perioperative hypothermia prevention is the first method to avoid shivering. Many therapeutic strategies for treating shivering exist and most are empiric. Unfortunately, the overall quality of the antishivering guidelines is low. Two main strategies are available: pharmacological and non-pharmacological antishivering methods. The combination of forced-air warming devices and intravenous meperidine is the most validated method. We also analysed different medications but final conclusion about the optimal antishivering medication is difficult to be drawn due to the lack of high-quality evidence. Nevertheless, control of PS is possible and clinically effective with simple pharmacological interventions combined with non pharmacological methods. However, to be consistent with the most up-to-date, evidence-based practice, future antishivering treatment protocols should optimize methodological rigor and transparency.

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Postoperative Shivering Among Cannabis Users at a Public Hospital in Trinidad, West Indies

Cited by 13 publications

References 27 publications

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

The effects of novel α2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section

Postanaesthetic shivering – from pathophysiology to prevention

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