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Rashwan DA, Rashwan SA, Abd Al Raouf S. Efficacy of preoperative hydrocortisone versus tramadol for attenuation of postoperative shivering after percutaneous nephrolithotripsy: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Doaa A. Rashwan
- Anesthesia and Surgical ICU Department, Faculty of Medicine, Beni Sueif University, Egypt
| | - Samaa A. Rashwan
- Anesthesia and Surgical ICU Department, Faculty of Medicine, Beni Sueif University, Egypt
| | - Sabah Abd Al Raouf
- Anesthesia, Pain and Surgical ICU Department, Faculty of Medicine, Cairo University, Egypt
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Abstract
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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Affiliation(s)
- Maria Bermudez Lopez
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Clinic of Anaesthesia, University Hospital of Lucus Augusti, Lugo, Spain
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Nakagawa T, Hashimoto M, Hashimoto Y, Shirozu K, Hoka S. The effects of tramadol on postoperative shivering after sevoflurane and remifentanil anesthesia. BMC Anesthesiol 2017; 17:1. [PMID: 28125971 PMCID: PMC5267365 DOI: 10.1186/s12871-016-0295-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Remifentanil has been reported to cause post-anesthetic shivering (PAS). Higher doses of remifentanil reportedly induce more intense PAS. Tramadol, a synthetic opioid that acts at multiple sites, is considered to be an effective treatment for PAS, but the evidence for its therapeutic benefit after remifentanil anesthesia is limited. We investigated the effect of tramadol on the incidence of PAS after remifentanil anesthesia. METHODS Sixty-three patients who had undergone upper abdominal surgery under general anesthesia were studied retrospectively. Tramadol was administered at induction of anesthesia. The patients were divided into four groups: HT(+), high dose remifentanil (1-1.5 μg/kg/min) with tramadol; HT(-), high dose remifentanil without tramadol; LT(+), low dose remifentanil (0.15-0.25 μg/kg/min) with tramadol; and LT(-), low dose remifentanil without tramadol. We recorded perioperative changes in nasopharyngeal temperature and episodes of PAS on emergence from anesthesia. RESULTS The incidences of PAS in both tramadol treatment groups were significantly lower than the groups that did not receive tramadol. Nasopharyngeal temperature after surgery fell significantly more from baseline in the tramadol treatment groups compared with the non-treatment groups. CONCLUSION Tramadol administered at induction of anesthesia appears to suppress PAS following remifentanil anesthesia.
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Affiliation(s)
- Taku Nakagawa
- Department of Anesthesiology, Hachinohe city Hospital, Aomori, Japan.,Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Miki Hashimoto
- Department of Anesthesiology, Hachinohe city Hospital, Aomori, Japan
| | | | - Kazuhiro Shirozu
- Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Sumio Hoka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Elmawgood AA, Rashwan S, Rashwan D. Effect of parecoxib on remifentanil induced postoperative shivering. EGYPTIAN JOURNAL OF ANAESTHESIA 2014. [DOI: 10.1016/j.egja.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Samaa Rashwan
- Department of Anesthesia, Faculty of Medicine , Beni Sueif University , Egypt
| | - Doaa Rashwan
- Department of Anesthesia, Faculty of Medicine , Beni Sueif University , Egypt
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Mahoori A, Noroozinia H, Hasani E, Soltanahmadi M. Comparison of ondansetron and meperidine for treatment of postoperative shivering: a randomized controlled clinical trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e13079. [PMID: 25389473 PMCID: PMC4221999 DOI: 10.5812/ircmj.13079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/28/2013] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Abstract
Background: The involved neurotransmitter pathways in the postoperative shivering (POS) are poorly understood. Recently, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists have been reported to prevent POS. We investigated the effect of ondansetron, a 5-HT3 antagonist that is used to treat postoperative nausea and vomiting, on shivering. Objectives: This study aimed to compare the efficacy of ondansetron and meperidine in the treatment of shivering after general anesthesia. Patients and Methods: In this double-blinded randomized clinical trial, 83 patients (age range, 18-60 years) who had shivering after general anesthesia were randomly allocated to any of these three groups: Group A, (number = 27) received 4 mg of intravenous ondansetron, Group B, (number = 27) received 8 mg of intravenous ondansetron, and Group C, (number = 29) received 0.4 mg/kg of intravenous meperidine at recovery room. The surface temperatures and the incidence as well as intensity of shivering were recorded. Results: Shivering was controlled in 16 patients (59%) in Group A, 22 (81%) in Group B, and 25 (86%) in Group C (P = 0.01). Within each group, there were no significant differences among the surface temperature in recovery room. Patients in groups A and B had significantly lower incidence of nausea and vomiting than group C (P = 0.01). Conclusions: Ondansetron and meperidine have similar effects on shivering. We concluded that 8 mg of intravenous ondansetron can control shivering and this is the dose of choice, especially in patients with POS with nausea and vomiting.
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Affiliation(s)
- Alireza Mahoori
- Department of Anesthesiology, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Heydar Noroozinia
- Department of Anesthesiology, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, IR Iran
- Corresponding Author: Heydar Noroozinia, Department of Anesthesiology, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, IR Iran. Tel: +98-4413468967; +98-9143416531, Fax: +98-4413468967, E-mail:
| | - Ebrahim Hasani
- Department of Anesthesiology, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Maryam Soltanahmadi
- Department of Anesthesiology, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, IR Iran
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Song YK, Lee C, Seo DH, Park SN, Moon SY, Park CH. Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil. Korean J Anesthesiol 2014; 66:44-51. [PMID: 24567813 PMCID: PMC3927001 DOI: 10.4097/kjae.2014.66.1.44] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/14/2013] [Accepted: 09/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS. METHODS Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 µg/kg/min; group H at 0.3 µg/kg/min; and group HK at 0.3 µg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 µg/kg/min ketamine until skin closure. RESULTS PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups. CONCLUSIONS OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.
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Affiliation(s)
- Yoon-Kang Song
- Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Cheol Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Dong-Hyuk Seo
- Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Seong-Nam Park
- Department of Obstetrics and Gynecology, Wonkwang University College of Medicine, Iksan, Korea
| | - Seo-Young Moon
- Department of Anesthesiology and Pain Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Chang-Hyun Park
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
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Heidari SM, Rahimi M, Soltani H, Hashemi SJ, Shabahang S. Premedication with oral tramadol reduces severity of postoperative shivering after general anesthesia. Adv Biomed Res 2014; 3:64. [PMID: 24627872 PMCID: PMC3950796 DOI: 10.4103/2277-9175.125845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 08/02/2012] [Indexed: 11/26/2022] Open
Abstract
Background: Postanesthetic shivering (PAS) is an accompanying part of general anesthesia with different unpleasant and stressful complications. Considering the importance of proper prevention of PAS in order to reduce its related adverse complications in patients undergoing surgery, in this study, we investigated the effect of orally administrated tramadol in the prevention of this common complication of general anesthesia. Materials and Methods: In this prospective randomized double-blind clinical trial, 80 ASA I and II patients aged 15-70 years, scheduled for elective surgery under general anesthesia, were randomized to intervention (oral tramadol 50 mg) and placebo groups. PAS was evaluated during surgery and in the recovery room, and compared in the two study groups. Results: PAS was seen in 5 patients (12.5%) in the intervention group and 10 patients (25%) in the placebo group (P = 0.12). The prevalence of grade III and IV shivering was 7.5% (3/40) and 25% (10/40) in tramadol and placebo groups, respectively (P = 0.03). Conclusion: The overall prevalence of PAS was not significantly different in the two study groups, but the higher grades of shivering which needed treatment were significantly lower in the tramadol group than in the placebo, and those patients who received tramadol experienced milder form of shivering. It is suggested that higher doses of tramadol would have better anti-shivering as well as analgesic effects. Studying different doses of tramadol would be helpful in this regard.
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Affiliation(s)
- Sayed Morteza Heidari
- Anaesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Rahimi
- Anaesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasanali Soltani
- Anaesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed J Hashemi
- Anaesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Shabahang
- Anaesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Barros A, Vale CP, Oliveira FC, Ventura C, Assunção J, Fontes Ribeiro CA, Pereira FC. Dexamethasone effect on postoperative pain and tramadol requirement after thyroidectomy. Pharmacology 2013; 91:153-7. [PMID: 23392332 DOI: 10.1159/000346612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022]
Abstract
Tramadol is a central-acting analgesic associated with nausea and vomiting. Clinical studies have demonstrated that glucocorticoids have analgesic and antiemetic effects when administered perioperatively. The aim of this study is to test the hypothesis that coadministration of tramadol and dexamethasone decreases both postoperative pain and tramadol requirement by patient-controlled analgesia (PCA). Forty female patients undergoing thyroidectomy under general anesthesia were enrolled in a double-blind randomized controlled study and allocated to receive dexamethasone 4 mg i.v. (dexamethasone group, n = 20) or saline (control group, n = 20). At 0, 1, 2, 4 and 22 h of PCA, tramadol consumption and pain were evaluated. Although pain (numerical rating scale 0-10) was significantly lower in the dexamethasone group compared to the control group (2.9 ± 1.4 vs. 3.8 ± 1.2, p = 0.02) at the beginning of PCA, tramadol demand was not significantly different. Although the results herein show a possible beneficial effect of a preoperative single low dose of dexamethasone on postoperative pain, the hypothesis that this corticosteroid decreases tramadol requirement is not supported.
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Affiliation(s)
- Ana Barros
- Department of Anaesthesiology, Centro Hospitalar Tondela-Viseu, E.P.E, Viseu, Portugal
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Park SM, Mangat HS, Berger K, Rosengart AJ. Efficacy spectrum of antishivering medications. Crit Care Med 2012; 40:3070-82. [DOI: 10.1097/ccm.0b013e31825b931e] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu-DeRyke X, Saely S, Rhoney DH. Temperature management in acute neurologic injury: to cool or not to cool. J Pharm Pract 2011; 23:483-91. [PMID: 21507851 DOI: 10.1177/0897190010372335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Therapeutic hypothermia is becoming an important intervention following acute neurologic injury despite inconclusive results concerning efficacy. This enthusiasm primarily stems from a lack of other effective interventions in this population. With the increase in the use of therapeutic hypothermia, several practical issues must be considered when initiating this intervention. Clinical pharmacists can play an important role in anticipating and addressing some complications such as shivering, slow drug metabolism, and infection. This review will discuss the available literature concerning the efficacy of therapeutic hypothermia in various neurologic injuries, as well as the most common adverse events associated with it.
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Affiliation(s)
- Xi Liu-DeRyke
- Department of Pharmacy, Orlando Regional Medical Center, Orlando, FL 32806, USA.
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Vale C, Oliveira F, Assunção J, Fontes-Ribeiro C, Pereira F. Co-Administration of Ondansetron Decreases the Analgesic Efficacy of Tramadol in Humans. Pharmacology 2011; 88:182-7. [DOI: 10.1159/000330740] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/24/2011] [Indexed: 11/19/2022]
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