The effect of forced-air warmer, ondansetron or their combination on shivering in pregnant women coming for elective cesarean section under spinal anesthesia: A prospective, randomized controlled comparative study

Abstract

Context: Perioperative shivering can occur in up to 85% of patients undergoing cesarean section under spinal anesthesia. It has many detrimental effects and disrupts early mother-child bonding. Therefore, it should ideally be prevented by either pharmacologic or nonpharmacological means. Aims: The primary aim of this study was to evaluate the efficacy of intraoperative forced-air warming, ondansetron or their combination in preventing perioperative shivering in patients undergoing elective cesarean section under spinal anesthesia. Settings and Design: A prospective randomized controlled comparative study done at the tertiary care center. Subjects and Methods: A total of 120 patients undergoing elective cesarean section under spinal anesthesia were randomly assigned to three groups. Group O received ondansetron 4 mg intravenously (i.v.) after giving block with no forced air warming. Group W received forced-air warming intraoperatively. Group C received ondansetron 4 mg i.v. after giving block plus intraoperative forced-air warming. Core temperature (tympanic membrane) and the arm skin temperature were measured and shivering was graded simultaneously. Statistical Analysis Used: Parametric data were analyzed using one-way ANOVA and Student's paired t -test where ever appropriate. Nonparametric data were analyzed using the Kruskal–Wallis and the Chi-square test. Values of P < 0.05 were considered statistically significant. Results: Shivering incidence was higher in Group O and Group W being 17.5% and 20%, respectively, and least in Group C being 5%. The incidence of Grade ≥3 shivering requiring rescue drug was lower in Group C (2.5%) compared to that of the Groups W (5%) and O (10%) but was not statistically significant ( P = 0.21). Conclusions: Combined use of ondansetron and forced- air warmer was more effective in reducing the incidence of shivering in pregnant women during elective cesarean section than when used individually.

5-HT3receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

“…Several studies have reported that preoperative 5-HT 3 receptor antagonists effectively prevent POS after spinal anaesthesia. [8][9][10] However, Rashad and Farmawy did not report any statistically significant differences in the occurrence of shivering between patients administered prophylactic 5-HT 3 receptor antagonists and controls. 11 Previous meta-analyses 12 13 revealed that 5-HT 3 receptor antagonists prevented POS; however, these studies investigated both general and spinal anaesthesia.…”

Comparing the Effects of Low Doses of Ketamine and Tramadol in the Prevention of Post-Spinal Anesthesia Shivering in Cesarean Section

“…To prevent shivering, pharmacologic drugs, including magnesium sulfate (MS), opioids, α2-agonists, NMDA receptor antagonists, and serotonin 5-HT3 receptor antagonists have been studied (Lema et al, 2017;Liu et al, 2018;Sachidananda et al, 2018). Non-pharmacological therapies such as sheets, radiant warmth, and heated air warmers have also reduced shivering during the intraoperative and perioperative periods (Kiran and Sangineni, 2019). However, there is still a need for alternative therapies that are both effective and safe.…”

Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section

“…Shivering induces several complications such as interfering with standard monitoring, lactic acidosis, increased carbon dioxide production, and oxygen consumption (6)(7)(8). To date, a variety of pharmacologic agents including magnesium sulfate, opi-oids, α 2 -agonists, N-methyl D-aspartate receptor antagonists, serotonin 5-HT3 receptor antagonist (9)(10)(11), and nonpharmacological interventions such as blankets, radiant heat, and forced air warmers have been used to suppress perioperative shivering (12). However, the problem still exists, and investigation for novel approaches with enough safety and efficacy is strongly recommended.…”