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      Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

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          Abstract

          Background

          Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean sections (CSs). The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA.

          Subjects and methods

          Fifty parturients planned for elective CSs under SA were enrolled in this prospective, double-blinded, controlled study and randomly divided into two equal groups. Spinal block was achieved with 12.5 mg 0.5% heavy bupivacaine plus 5 μg dexmedetomidine (BD group) or 0.5 mL 0.9% normal saline (BN group). The incidence and intensity of shivering, peripheral and core body temperature, hemodynamic parameters, and adverse events was recorded.

          Results

          The incidence of shivering was significantly higher in the BN group (52%) than the BD group (24%) ( P=0.04). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group ( P=0.04). The incidence of adverse events, such as hypotension, nausea/vomiting, and bradycardia, was not significantly different between the two groups, although the grade of sedation was higher in the BD group than the BN group ( P=0.004).

          Conclusion

          We conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects.

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          Most cited references 17

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          Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study

          Background and Aims: Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been employed to abolish the occurrence of shivering. The present study aims to explore the effectiveness of dexmedetomidine in suppressing the postanesthetic shivering in patients undergoing general anesthesia. Materials and Methods: The present study was carried out on 80 patients, in American Society of Anesthesiologists I and II, aged 22–59 years, who underwent general anesthesia for laparoscopic surgical procedures. Patients were allocated randomly into two groups: group N (n = 40) and group D (n = 40). Group D were administered 1 μg/kg of dexmedetomidine intravenously, while group N received similar volume of saline during peri-op period. Cardiorespiratory parameters were observed and recorded during the preop, intraop, and postop periods. Any incidence of postop shivering was observed and recorded as per 4 point scale. Side effects were also observed, recorded, and treated symptomatically. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni's correction. Results: The two groups were comparable regarding demographic profile (P > 0.05). Incidence of shivering in group N was 42.5%, which was statistically highly significant (P = 0.014). Heart rate and mean arterial pressure also showed significant variation clinically and statistically in group D patients during the postop period (P = 0.008 and 0.012). A high incidence of sedation (P = 0.000) and dry mouth (P = 0.000) was observed in group D, whereas the incidence of nausea and vomiting was higher in group N (P = 0.011 and 0.034). Conclusions: Dexmedetomidine seems to possess antishivering properties and was found to reduce the occurrence of shivering in patients undergoing general anesthesia.
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            A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients.

            Tramadol is effective for treating shivering during epidural anesthesia in parturients. In addition to its low affinity to opioid receptors, tramadol exerts a modulatory effect on central monoaminergic pathways. In this respect, there are parallels between the mechanisms of the action of tramadol and antidepressants such as amitriptyline. Meperidine is often recommended for the treatment of postanesthetic shivering. This prospective, double-blinded, and randomized clinical study was performed to compare the antishivering effects and accompanying side effects among tramadol, meperidine, and amitriptyline for the treatment of postepidural anesthetic shivering. Forty-five parturients who shivered during cesarean delivery under epidural anesthesia and requested antishivering treatment were randomly allocated to one of three groups for IV treatment: Group T (n = 15) received tramadol 0.5 mg/kg, Group M (n = 15) received meperidine 0.5 mg/kg, and Group A (n = 15) received amitriptyline 15 or 20 mg. The response rate (shivering ceased after treatment in 15 min) was 87% and 93% for Groups T and M, respectively, compared with 13% in Group A (P < 0.01). The time that elapsed from treatment to the time shivering ceased was 5.1 +/- 3.6 min (mean +/- SD) for Group T and 4.2 +/- 2.3 min for Group M. There was a significantly more frequent incidence (33%) of somnolence in Group M when compared with Groups T (7%) and A (0%) (P < 0.01). However, no significant differences were shown for pruritus, nausea, vomiting, or Apgar scores of newborns. We concluded that both tramadol and meperidine show a significantly faster response rate in the treatment of postepidural anesthetic shivering when compared with amitriptyline in the dosage used; tramadol had a decreased incidence of somnolence when compared with meperidine. This study was performed to compare the antishivering and side effects among tramadol, amitriptyline, and meperidine for the treatment of postepidural anesthetic shivering in parturients. Both tramadol and meperidine show a significantly faster response rate in the treatment of shivering when compared with amitriptyline. Tramadol had a less frequent incidence of somnolence than meperidine.
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              Shivering and neuraxial anesthesia.

               L. Crowley,  D Buggy (2008)
              Shivering, which usually occurs as a thermoregulatory response to cold, may also occur following general or neuraxial anesthesia. Some of the causative factors of this type of shivering may be common to both, but some are particular to neuraxial anesthesia. Although shivering may have beneficial thermoregulatory effects, it places the body under increased physiological stress. In a broad sample of 21 studies, the median incidence of shivering related to neuraxial anesthesia in the control groups was 55%. Both pharmacological and nonpharmacological mechanisms have been found to be effective in reducing this shivering. This review aims to elucidate the mechanisms of the shivering that occurs during neuraxial anesthesia, and to examine strategies for prevention and treatment of this shivering.
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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2017
                03 April 2017
                : 11
                : 1107-1113
                Affiliations
                [1 ]Department of Anesthesiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
                [2 ]Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
                Author notes
                Correspondence: Karim Nasseri, Department of Anesthesiology, Kurdistan University of Medical Sciences, Pasdaran Street, 6617713446, Sanandaj, Iran, Tel +98 87 3366 0733, Fax +98 871 3323 3600, Email nasseri_k@ 123456muk.ac
                Article
                dddt-11-1107
                10.2147/DDDT.S131866
                5388208
                © 2017 Nasseri et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Clinical Trial Report

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