1
|
Wahdan AS, Loza GE, Alshehri HO, Shedid AF, Salama AK, Wahdan WS, Mohamed MM. Paracetamol Versus Ondansetron for Prevention of Postoperative Shivering in Liposuction Surgeries Under Combined General Epidural Anaesthesia: A Randomized Controlled Trial. Turk J Anaesthesiol Reanim 2023; 51:199-206. [PMID: 37455437 DOI: 10.4274/tjar.2022.22927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia. Methods One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects. Results The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (P <0.001). Tympanic temperature and complications were comparable between the groups with no significant differences. Conclusion Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.
Collapse
Affiliation(s)
- Amr Samir Wahdan
- Department of Anaesthesia, Surgical ICU and Pain Management, Cairo University Faculty of Medicine, Cairo, Egypt
- Department of Anaesthesia, Al-hada Armed Force Hospital, Taif, Saudi Arabia
| | - George Eshak Loza
- Department of Anaesthesia, Surgical ICU and Pain Management, Cairo University Faculty of Medicine, Cairo, Egypt
| | | | - Ahmed Farag Shedid
- Department of Anaesthesia, Surgical ICU and Pain Management, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Atef Kamel Salama
- Department of Anaesthesia, Surgical ICU and Pain Management, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Wessam Samir Wahdan
- Department of Plastic and Reconstructive Surgery, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Mennatallah Magdi Mohamed
- Department of Anaesthesia, Surgical ICU and Pain Management, Cairo University Faculty of Medicine, Cairo, Egypt
| |
Collapse
|
2
|
Zheng G, Zhang J, Liu J, Chen C, Zhang L, Cao F. A meta-analysis of randomized controlled trials: efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. Arch Gynecol Obstet 2023; 307:223-231. [PMID: 35325278 DOI: 10.1007/s00404-022-06523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although ondansetron was considered to prevent post-anesthesia shivering during cesarean section, its efficiency remained controversial. Our review was conducted to estimate the efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. METHODS The literature were searched from their inception to October 2020 without restriction of language. All randomized controlled trials investigating the efficacy of ondansetron versus placebo in preventing shivering during cesarean section under neuraxial anesthesia were included. The meta-analysis was conducted using Stata software. RESULTS Eleven randomized controlled studies with a total of 748 individuals were finally included in our meta-analysis. Our results manifested that intravenous ondansetron compared with intravenous placebo significantly reduced the incidence of post-anesthesia shivering (PAS) (RR 0.53, 95% CI 0.14-0.68). Subgroup analysis according to doses of ondansetron indicated that the efficacy of 4 mg doses of ondansetron (RR 0.37, 95% CI 0.21-0.64) is equivalent to that of 8 mg doses of ondansetron (RR 0.61, 95% CI 0.47-0.81) in preventing PAS. In addition, the intravenous ondansetron led to a lower incidence of hypotension than intravenous placebo (OR 0.47, 95% CI 0.32-0.70). We could not demonstrate differences in the incidence of bradycardia between intravenous ondansetron and intravenous placebo. CONCLUSION Our results found that intravenous ondansetron was effective in preventing shivering during cesarean section under neuraxial anesthesia, and had an advantage in reducing the incidence of hypotension compared with intravenous placebo.
Collapse
Affiliation(s)
- Guanghao Zheng
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Jieyu Zhang
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Jianpin Liu
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Chunxiang Chen
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Li Zhang
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Fei Cao
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China.
| |
Collapse
|
3
|
Wallace SKA, Goulding KR, Myles PS. Consumer engagement and patient reported outcomes in perioperative clinical trials in Australia: a systematic review. ANZ J Surg 2022; 92:2464-2473. [DOI: 10.1111/ans.17897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie K. A. Wallace
- Department of Anaesthesiology and Perioperative Medicine Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Karen R. Goulding
- Central Clinical School Monash University Melbourne Victoria Australia
- Australian and New Zealand College of Anaesthetists Clinical Trials Network Melbourne Victoria Australia
| | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| |
Collapse
|
4
|
Tubog TD, Bramble RS. Ondansetron for Shivering after Spinal Anesthesia in Cesarean Delivery: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2021; 37:105-113. [PMID: 34836765 DOI: 10.1016/j.jopan.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Evaluate the efficacy of ondansetron in preventing shivering after spinal anesthesia in cesarean delivery. DESIGN Systematic review and meta-analysis METHODS: Following the PRISMA statement, PubMed, CINAHL, Cochrane, EMBASE, Google scholar and other grey literature databases were searched for eligible studies. FINDINGS The overall incidence of shivering after spinal anesthesia in cesarean delivery is 32%, with 24% in patients who received ondansetron compared to 40% in the placebo group. A total of 19 trials consisting of 1399 patients were evaluated. Compared to placebo, ondansetron is effective in reducing the incidence of shivering (RR, 0.47; 95% CI, 0.29 to 0.78; P = 0.003). The quality of evidence is low due to substantial heterogeneity, imprecision and suspected publication bias. Patients who received ondansetron are less likely to require rescue treatment for shivering (RR, 0.34; 95% CI, 0.15 to 0.76; P = 0.009). Also, ondansetron is associated with a lower incidence of hypotension necessitating vasopressor treatment, and nausea and vomiting with no effects on the incidence of bradycardia. CONCLUSION Ondansetron is effective in mitigating shivering after spinal anesthesia in cesarean delivery.
Collapse
|
5
|
Mohammadzadeh Jouryabi A, Sharami SH, Mansour Ghanaie M, Sedighinejad A, Imantalab V, Rafiee Sorouri Z, Biazar G, Zohari Nobijari T. Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section. Anesth Pain Med 2021; 11:e116429. [PMID: 34692439 PMCID: PMC8520676 DOI: 10.5812/aapm.116429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/26/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. To date, pethidine has been considered as the gold standard for post-SA shivering control, but it is contraindicated in breastfeeding women. Methods This randomized, double-blind study was conducted at Alzahra hospital in Guilan, Iran, From January 2019 to November 2020. A total of 508 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K), tramadol (T), ondansetron (O), and placebo (P). The incidence and severity of shivering and patients' complications were recorded and compared among the groups. Results The patients were homogenous in terms of demographic variables. Shivering was witnessed in 68 (53.5%), 26 (20.5%), 75 (59.1%), and 82 (64.6%) patients in K, T, O, and P groups, respectively (P = 0.0001). Regarding shivering severity, there was a significant difference among the four groups (P = 0.0001). In addition, a significant difference was seen regarding Apgar scores at the first minute, but not at the fifth minute (P = 0.168). Conclusions Considering the high incidence of shivering in placebo group, prophylactic intervention in CS under SA seems to be necessary. Among the studied drugs, tramadol was the most effective one, followed by a low dose of ketamine and ondansetron.
Collapse
Affiliation(s)
- Ali Mohammadzadeh Jouryabi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyedeh Hajar Sharami
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mandana Mansour Ghanaie
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Sedighinejad
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Vali Imantalab
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Rafiee Sorouri
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, 4144654839, Rasht, Iran. Tel: +98-9111350987,
| | - Tahereh Zohari Nobijari
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
6
|
Sharma MK, Mishra D, Goel N. Efficacy of ondansetron and palonosetron in prevention of shivering under spinal anesthesia: A prospective randomized double-blind study in patients undergoing elective LSCS. J Anaesthesiol Clin Pharmacol 2021; 37:63-66. [PMID: 34103825 PMCID: PMC8174421 DOI: 10.4103/joacp.joacp_215_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 06/25/2019] [Accepted: 08/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Material and Methods: A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally. Results: No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group). Conclusion: Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.
Collapse
Affiliation(s)
- Manoj K Sharma
- Department of Anaesthesiology and Critical Care, Military Hospital, Meerut, Uttar Pradesh, India
| | - Deepak Mishra
- Department of Anaesthesiology and Critical Care, Military Hospital, Meerut, Uttar Pradesh, India
| | - Nitin Goel
- Department of Anaesthesiology and Critical Care, Military Hospital, Meerut, Uttar Pradesh, India
| |
Collapse
|
7
|
Wódarski B, Chutkowski R, Banasiewicz J, Moorthi K, Wójtowicz S, Malec‐Milewska M, Iohom G. Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study. Acta Anaesthesiol Scand 2020; 64:112-116. [PMID: 31436313 DOI: 10.1111/aas.13462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/21/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Shivering during caesarean section (CS) under spinal anaesthesia is a common phenomenon. It could not only alter patient's physiology by increasing oxygen consumption but also affect the parturient's experience of childbirth. Shivering is thought to be associated with intraoperative hypothermia, but the risk factors and exact mechanism remain unclear. METHODS We conducted a prospective, observational study to examine the potential risk factors for intraoperative shivering, including anxiety levels. Two hundred patients undergoing elective CS under spinal anaesthesia were recruited. Parturient anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI) questionnaire. Age, weight, height, BMI, anxiety level, number of previous deliveries, sensory block level, level of education, temperature difference during surgery and American Society of Anesthesiologists score were investigated as potential risk factors. Stepwise logistic regression was used to assess the predictors for shivering. RESULTS Data from 155 parturients were analysed. Shivering incidence was 21.9% (34 parturients). The statistical model predicted 8.5% of a shivering incidence variability (R-square Nagelkerke = 0.085). Out of all measured variables, only the number of previous deliveries [(W) = 4.295 Exp(B) = 0.562 P < .05] and STAI-X1 [(W) = 4.127 Exp(B) = 1.052 P < .05] were significant. In our model, the risk of shivering decreased by 44% with every previous delivery and increased by 5.2% with each 1-point increase in STAI-X1. CONCLUSION We failed to prove a strong correlation between the measured variables and shivering. Our findings, however, support the hypothesis, that to a limited extent, anxiety promotes shivering during CS.
Collapse
Affiliation(s)
- Bartłomiej Wódarski
- Department of Anaesthesiology and Intensive Care Centre of Postgraduate Medical Education Clinical Hospital Warsaw Poland
| | - Radosław Chutkowski
- Department of Anaesthesiology and Intensive Care Centre of Postgraduate Medical Education Clinical Hospital Warsaw Poland
| | | | - Katarzyna Moorthi
- Department of Anaesthesiology and Intensive Care Centre of Postgraduate Medical Education Clinical Hospital Warsaw Poland
| | | | - Małgorzata Malec‐Milewska
- Department of Anaesthesiology and Intensive Care Centre of Postgraduate Medical Education Clinical Hospital Warsaw Poland
| | - Gabriella Iohom
- Department of Anaesthesiology Cork University Hospital Cork Ireland
| |
Collapse
|
8
|
Liu J, Huang S, Sun S, Sun X, Wang T. Comparison of nalbuphine, ondansetron and placebo for the prevention of shivering after spinal anaesthesia for urgent caesarean delivery: a randomised double-blind controlled clinical trial. Int J Obstet Anesth 2019; 42:39-46. [PMID: 31734098 DOI: 10.1016/j.ijoa.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/28/2019] [Accepted: 10/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shivering is a common complication of caesarean delivery with neuraxial anaesthesia. The effective prevention and treatment of shivering, especially before delivery, is important and difficult. We tested the hypothesis that prophylactic nalbuphine and ondansetron can prevent post-spinal anaesthesia shivering in parturients undergoing urgent caesarean delivery. METHODS Sixty parturients scheduled for urgent caesarean delivery before spinal anaesthesia were selected and divided randomly into three groups. After peripheral venous catheterisation, parturients were given intravenous nalbuphine 0.08 mg/kg (group N), ondansetron 8 mg (group O), or normal saline (group C). RESULTS The incidence of shivering and of severe (grade ≥3) shivering was significantly lower in group N (15% and 15%, respectively) than in group C (80% and 65%) before delivery (P <0.001 and P=0.003); and significantly less shivering was observed in group N than in group C in the first 30 min after anaesthesia (P=0.001). Up to 60 min after anaesthesia, the incidence of grade ≥3 shivering remained lowest in group N (P=0.003). According to the data during the period from anaesthesia until delivery, the number needed-to-treat for nalbuphine was 1.54 (95%CI 1.13 to 2.41). No significant differences were found between groups O and N or groups O and C at any time. The incidence of dizziness in group N was significantly higher than that of groups O or C (P=0.009). CONCLUSION Nalbuphine 0.08 mg/kg can prevent post-spinal anaesthesia shivering in parturients undergoing urgent caesarean delivery but causes transient dizziness, while ondansetron 8 mg had no significant effect.
Collapse
Affiliation(s)
- J Liu
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - S Huang
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| | - S Sun
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - X Sun
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - T Wang
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| |
Collapse
|
9
|
Gicheru M, Mung'ayi V, Mir S, Kabugi J. Comparison of weight-adjusted dose versus fixed dose ondansetron in preventing shivering following spinal anaesthesia for caesarean deliveries. Afr Health Sci 2019; 19:2740-2751. [PMID: 32127847 PMCID: PMC7040271 DOI: 10.4314/ahs.v19i3.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Spinal anaesthesia is an effective regional anaesthesia technique, which is preferred in almost 86% of caesarean sections in the United States and United Kingdom. Eighty percent of caesarean sections done at the Aga Khan University hospital are under spinal anaesthesia. Shivering is a common complication of spinal anaesthesia, it occurs in 40%-64% of patients after neuraxial anaesthesia. Shivering may cause maternal and fetal hypoxemia, maternal discomfort and a problem to the anaesthesiologists when it comes to monitoring the patient during caesarean sections. Ondansetron a 5-HT3 receptor antagonist is effective in treatment and prevention of post-spinal anesthesia shivering. In published studies, use of a fixed dose in patients with different weights, masked the dose effect ondansetron in preventing shivering, such that not adjusting the dose according to the weight of patients' resulted in a higher occurrence of shivering. No study has compared different doses of ondansetron in preventing shivering in parturient women who have had spinal anaesthesia for caesarean section. Objectives To determine if a weight-adjusted dose is better than a fixed dose of ondansetron in preventing shivering following spinal anesthesia for caesarean delivery. Method This was a randomized, double-blinded controlled trial of 124 women scheduled for elective caesarean surgery. The women were randomized into two equal groups. The intervention group received intravenous ondansetron weight adjusted dosing at 0.1mg/kg and the control group received a fixed dose of 4mg before spinal anesthesia. The occurrence and severity of shivering and other outcomes, such as headache, pruritus were assessed and recorded during the surgery and post-operative period. Results A total of 124 patients were included in the study. Social demographic data and baseline vital signs did not differ significantly between the groups. Shivering was observed in 14 patients (22.6%) in the control group that received 4mg ondansetron and 7 patients (11.3%) in the intervention group that had 0.1mg/kg of ondansetron, but there was no statistical difference between the groups (p- value 0.090). The severity of shivering was greater in the control group compared to intervention group where patients who developed grade two shivering were 8.1% to 0% respectively. (P value 0.047). There was no difference in the occurrence of pruritus between the two groups. No patient required treatment for very severe shivering. Conclusion This study, found that ondansetron weight adjusted dose at 0.1mg/kg, reduced the severity of shivering when compared to a fixed dose ondansetron at 4mg.
Collapse
Affiliation(s)
- Moses Gicheru
- Department of Anaesthesia, Aga Khan University, East Africa
| | | | - Samina Mir
- Department of Anaesthesia, Aga Khan University, East Africa
| | - Jimmie Kabugi
- Department of Anaesthesia, Aga Khan University, East Africa
| |
Collapse
|
10
|
Badawy AA, Mokhtar AM. The role of ondansetron in prevention of post-spinal shivering (PSS) in obstetric patients: A double-blind randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ahmed A. Badawy
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Ali M. Mokhtar
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| |
Collapse
|
11
|
Botros JM, Mahmoud AMS, Ragab SG, Ahmed MAA, Roushdy HMS, Yassin HM, Bolus ML, Goda AS. Comparative study between Dexmedetomidine and Ondansteron for prevention of post spinal shivering. A randomized controlled trial. BMC Anesthesiol 2018; 18:179. [PMID: 30501612 PMCID: PMC6267838 DOI: 10.1186/s12871-018-0640-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Regional anesthesia could affect the homeostatic system functions resulting frequently in perioperative hypothermia and consequently shivering. The objective of this trial was to evaluate the efficacy of dexmedetomidine and ondansetron to reduce the incidence and severity of shivering after intrathecal blocks. Methods This randomized placebo-controlled trial included 120 patients allocated equally in three groups. All patients were anesthetized by standard intrathecal blocks for surgical procedure at lower half of the body and received one of the study drugs intravenously (IV) according to the group assignments. Group S patients (placebo) were administered saline, Group O (ondansetron) were given 8 mg ondansetron, and Group D (dexmedetomidine) were given 1 μg/kg of dexmedetomidine. Shivering incidence and scores, sedation scores, core body temperature, hemodynamic variables, and incidence of complications (nausea, vomiting, hypotension, bradycardia, over-sedation, and desaturation) were recorded. Results The incidence and 95% confidence interval (95% CI) of shivering in group S 57.5% (42.18–72.82%) was significantly higher than that of both group O 17.5% (5.73–29.27%), P < 0.001 and group D 27.5% (13.66–41.34%), P = 0.012. However, the difference in the incidence of shivering between group O and group D was comparable, P = 0.425. The sedation scores were significantly higher in group D than those of both group S and group O, P < 0.001. Sedation scores between group S and group O were comparable, P = 0.19. Incidences of adverse effects were comparable between the three groups. Conclusion Prophylactic administrations of dexmedetomidine or ondansetron efficiently decrease the incidence and severity of shivering after spinal anesthesia as compared to placebo without significant difference between their efficacies when compared to each other. Trial registration Pan African Clinical Trial Registry (PACTR) under trial number (PACTR201710002706318). 18-10-2017. ‘retrospectively registered’.
Collapse
|
12
|
Fu S, Qu PS, Cai SN. Effect of anesthetic methods on postoperative CD3 +, CD4 + and CD4 +CD25 + in patients with lung cancer undergoing radical operation. Oncol Lett 2018; 16:6547-6551. [PMID: 30344761 PMCID: PMC6176376 DOI: 10.3892/ol.2018.9416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022] Open
Abstract
Effects of anesthesia methods on immune function in patients with lung cancer undergoing radical operation were investigated. A total of 122 patients undergoing radical resection of lung cancer who were treated in Zhejiang Cancer Hospital from September 2013 to April 2016 were randomly divided into the combined anesthesia group and the intravenous anesthesia group, with 61 cases in each group. The patients in the combined anesthesia group were given intravenous combined epidural anesthesia. Patients in the intravenous anesthesia group were given intravenous anesthesia. The change of CD3+, CD4+ and CD4+CD25+ at time-point T0 (before anesthesia), T1 (the time of anesthesia), T2 (after operation), T3 (24 h after operation), T4 (72 h after operation) were compared between the two groups. The levels of CD3+, CD4+ and CD4+CD25+ at T1, T2, T3 and T4 in the combined anesthesia group were higher than that in the intravenous anesthesia group (P<0.05). Αfter starting anesthesia, the levels of CD3+, CD4+ and CD4+CD25+ began to decrease in both groups. The levels of CD3+, CD4+ and CD4+CD25+ at T2 and T1 were lower than those at T0 (P<0.05). The levels of CD3+, CD4+ and CD4+CD25+ at T2 were lower than T1 (P<0.05). After T3, the levels of CD3+, CD4+ and CD4+CD25+ began to increase in both groups. Τhe levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were higher in both groups than those at T2 and T1 (P<0.05), and the levels of CD3+, CD4+ and CD4+CD25+ at T4 were higher in both groups than those at T3, but the levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were lower than those at T0 (P<0.05). Intravenous combined epidural anesthesia can maintain a relatively stable immune function compared with simple intravenous anesthesia patients.
Collapse
Affiliation(s)
- Shuang Fu
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Pi-Sheng Qu
- Department of Pain Treatment, Hospital of Integrated Traditional Chinese and Western Medicine in Zhejiang Province, Hangzhou, Zhejiang 310022, P.R. China
| | - Shu-Nv Cai
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| |
Collapse
|
13
|
Liu J, Wang Y, Ma W. Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review. Minerva Anestesiol 2018; 84:1393-1405. [PMID: 29945433 DOI: 10.23736/s0375-9393.18.12478-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Perioperative shivering during cesarean sections (CSs) under neuraxial anesthesia (NA) is clinically common but often under-treated. It may prominently increase oxygen consumption, which can be catastrophic for parturients with ischemic cardiovascular disease. Thus, the prevention and treatment of shivering may be of great significance in parturients. The purpose of this systematic review was to investigate the effectiveness of several drugs on shivering prevention and treatment during CSs under NA. EVIDENCE ACQUISITION A literature search was carried out using PubMed, EMBASE and the Cochrane Library to identify relevant studies. After literature screening and information extraction, a systematic review was performed. EVIDENCE SYNTHESIS Eighteen randomized controlled trials met the inclusion criteria. Intrathecal dexmedetomidine effectively reduced shivering, but effectiveness depended on the dose administered. Intrathecal fentanyl, intrathecal sufentanil, intrathecal meperidine, intravenous ketamine and intravenous tramadol were beneficial for reducing shivering during CSs under NA. MgSO4 administered intrathecally resulted in transient alleviation of shivering, and the effect did not persist. Two trials investigated the antishivering effect of intravenous ondansetron. The medication appeared to be effective in one trial, but ineffective in the other. CONCLUSIONS Appropriate use of dexmedetomidine, fentanyl, sufentanil, ketamine, meperidine, tramadol and MgSO4 may effectively reduce the incidence and severity of shivering during CSs under NA, while trials on the effect of intravenous ondansetron reached inconclusive results.
Collapse
Affiliation(s)
- Jie Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Wang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wuhua Ma
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China -
| |
Collapse
|
14
|
Zhou C, Zhu Y, Bao Z, Wang X, Liu Q. Efficacy of ondansetron for spinal anesthesia during cesarean section: a meta-analysis of randomized trials. J Int Med Res 2017; 46:654-662. [PMID: 28856920 PMCID: PMC5971492 DOI: 10.1177/0300060517716502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the efficacy and safety of ondansetron during cesarean section under spinal anesthesia. Methods We sought randomized controlled trials (RCTs) on ondansetron during spinal anesthesia for cesarean section in The Cochrane Library, PubMed, MEDLINE, and Web of Science from their inception to September 2016. Results Altogether, 21 RCTs were included in this study. Meta-analysis showed that the ondansetron group had a lower incidence of nausea/vomiting and bradycardia than the placebo group during cesarean section under spinal anesthesia [relative risk (RR) = 0.43, 95% confidence interval (CI) (0.36, 0.51) and RR = 0.45, 95% CI (0.26, 0.80), respectively]. There were no significant differences in the incidences of pruritus, hypotension, or shivering during cesarean section under spinal anesthesia [RR = 0.92, 95% CI (0.83, 1.02); RR = 0.72 (0.50, 1.06), 95% CI (0.50, 1.06); and RR = 0.89, 95% CI (0.71, 1.11), respectively]. Conclusion Ondansetron effectively reduces the incidences of nausea/vomiting and bradycardia under spinal anesthesia during cesarean section.
Collapse
Affiliation(s)
| | - Yu Zhu
- 1 117835 Zhaoqing Medical College , Zhaoqing, China
| | - Zeqing Bao
- 1 117835 Zhaoqing Medical College , Zhaoqing, China
| | - Xianxue Wang
- 2 Department of Anesthesiology, The First People's Hospital of Changde, Changde, China
| | - Qili Liu
- 1 117835 Zhaoqing Medical College , Zhaoqing, China
| |
Collapse
|
15
|
Zhou C, Zhu Y, Liu Z, Ruan L. 5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis. J Int Med Res 2016; 44:1174-1181. [PMID: 27856931 PMCID: PMC5536761 DOI: 10.1177/0300060516668776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective We evaluated the efficacy of 5-HT3 receptor antagonists for the prevention of postoperative shivering. Methods We searched PubMed, the Cochrane Library, EMBASE and Web of Knowledge to find randomized controlled trials (RCT) of 5-HT3 receptor antagonists for the prevention of postoperative shivering. Two researchers independently screened studies, extracted data, and assessed quality in accordance with the inclusion and exclusion criteria, and then conducted a meta-analysis using RevMan 5.2. Results Ultimately, 14 RCTs that included 980 patients were included in the analysis. We found that: 1) the incidence of shivering was significantly lower in 5-HT3 groups than placebo groups (relative risk, [RR] = 0.48, 95% confidence interval [CI] 0.40 – 0.58); 2) there was no significant difference in the incidence of shivering between 5-HT3 groups and meperidine groups (RR = 0.89, 95% CI 0.60 – 1.34). Conclusion 5-HT3 receptor antagonists appear to prevent postoperative shivering, with a broadly comparable efficacy to meperidine.
Collapse
Affiliation(s)
- Chengmao Zhou
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China.,2 Department of Surgery, Zhaoqing Medical College, Zhaoqing 526000, China
| | - Yu Zhu
- 2 Department of Surgery, Zhaoqing Medical College, Zhaoqing 526000, China
| | - Zhen Liu
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Lin Ruan
- 1 Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| |
Collapse
|
16
|
Meta-analysis of randomized controlled trials on the efficacy and safety of ondansetron in preventing postanesthesia shivering. Int J Surg 2016; 35:34-43. [DOI: 10.1016/j.ijsu.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 12/16/2022]
|
17
|
Wang W, Song X, Wang T, Zhang C, Sun L. 5-HT3Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta-Analysis. J Clin Pharmacol 2016; 57:428-439. [PMID: 27628928 DOI: 10.1002/jcph.829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/12/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Wen Wang
- Department of Anesthesiology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Xiaojing Song
- Department of Emergency; Peking University People's Hospital; Beijing China
| | - Tong Wang
- Institute for Hospital Management; Tsinghua University; Beijing China
| | - Chaobin Zhang
- Department of Anesthesiology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Li Sun
- Department of Anesthesiology; National Cancer Center/Cancer Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| |
Collapse
|
18
|
He K, Zhao H, Zhou HC. Efficiency and safety of ondansetron in preventing postanaesthesia shivering. Ann R Coll Surg Engl 2016; 98:358-66. [PMID: 27138855 PMCID: PMC5209977 DOI: 10.1308/rcsann.2016.0152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Shivering is one of the most frequent complications of operation during the postanaesthesia period. Ondansetron has been proved to be valid in preventing postanaesthesia shivering (PAS) in several studies. However, its efficiency and safety are still disputable. We therefore performed an updated meta-analysis of randomised controlled trials (RCTs) for evaluation and to clarify this issue. Methods A literature search using the PubMed, Embase™ and Cochrane Library databases was performed (from inception to January 2015). RCTs that evaluated the efficiency and safety of ondansetron in the prevention of PAS were included in the meta-analysis. The primary outcome measure was incidence of PAS, and secondary outcomes included subgroup analysis and the side effects of ondansetron. Results A total of 8 RCTs containing 905 subjects were identified as suitable for this review. Compared with placebo, ondansetron was associated with a significant reduction of PAS (relative risk [RR]: 0.33, 95% confidence interval [CI]: 0.19-0.58, p=0.0001) while no difference was detected between ondansetron and pethidine (RR: 0.89, 95% CI: 0.41-1.94, p=0.78). There was no significant difference between ondansetron and placebo or pethidine in terms of risk of bradycardia but ondansetron was associated with a lower risk of hypotension (RR: 0.26, 95% CI: 0.08-0.79, p=0.020) than placebo. There was no difference in hypotension when ondansetron was compared with pethidine. Conclusions Ondansetron can prevent PAS effectively and reduce the risk of hypotension.
Collapse
Affiliation(s)
- K He
- Jinan Central Hospital , China
| | - H Zhao
- Jinan Central Hospital , China
| | - H C Zhou
- Jinan Seventh People's Hospital , China
| |
Collapse
|
19
|
Ghadimi T, Gheitasi B, Nili S, Karimi M, Ghaderi E. Occupation, smoking, opium, and bladder cancer: A case-control study. South Asian J Cancer 2016; 4:111-4. [PMID: 26942139 PMCID: PMC4756483 DOI: 10.4103/2278-330x.173174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The aim of this study was to investigate occupational risk factors associated with bladder cancer. MATERIALS AND METHODS In this case-control study, control group included patients who referred to a specialized clinic in the same city and hospitals where patients had been registered. Data were entered into SPSS software. Odds ratios (OR) were calculated for occupational variables and other characteristics. Then, using logistic regression, the association between cancer and drugs was studied while smoking was controlled. RESULTS Cigarette smoking, even after quitting, was also associated with bladder cancer (OR = 2.549). Considering the classification of occupations, the OR of working in metal industry in patients was 10.629. Multivariate analysis showed that use of the drug by itself can be a risk factor for bladder cancer. Drug abuse together with the control of smoking increased the risk of bladder cancer by 4.959. CONCLUSION According to the findings of this study, contact with metal industries such as welding, and working with tin was found as a risk factor for bladder cancer. In addition, cigarette smoking and opium abuse individually were associated with bladder cancer.
Collapse
Affiliation(s)
- Tayeb Ghadimi
- Department of Surgery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bahman Gheitasi
- Department of Epidemiology and Biostatistics, Social Determinant of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sayran Nili
- Department of Epidemiology and Biostatistics, Social Determinant of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Karimi
- Department of Epidemiology and Biostatistics, Social Determinant of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Department of Epidemiology and Biostatistics, Social Determinant of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
20
|
Teymourian H, Mohajerani SA, Bagheri P, Seddighi A, Seddighi AS, Razavian I. Effect of Ondansetron on Postoperative Shivering After Craniotomy. World Neurosurg 2015; 84:1923-8. [DOI: 10.1016/j.wneu.2015.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 12/24/2022]
|
21
|
Sane S, Hasanlui MV, Abbasivash R, Mahoori A, Hashemi ST, Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Adv Biomed Res 2015; 4:230. [PMID: 26623405 PMCID: PMC4638052 DOI: 10.4103/2277-9175.167030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/14/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of postdelivery intra- and post-operative nausea and vomiting during CS under spinal anesthesia. Materials and Methods: A randomized, prospective, double-blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. The patients received 4 mg ondansetron in Group O, 8 mg dexamethasone in Group D, and 4 mg ondansetron +8 mg dexamethasone in Group OD intravenously within 1–2 min after the umbilical cord was clamped. Frequency of postdelivery intra- and post-operative nausea and vomiting episodes was recorded. Results: A total of 90 eligible patients were included in the study. There were 30 patients in Group O, 30 patients in Group D, and 30 patients in Group OD. Intraoperative nausea in Group D was more than the other two groups. Postoperative nausea in group OD was lesser than the other two groups. Intraoperative vomiting in Group OD was lesser than the other two groups. There was no statistically significant difference among the groups in postoperative vomiting (P > 0.05). Conclusion: Combined use of dexamethasone and ondansetron for the same indication seems to increase the antiemetic efficacy.
Collapse
Affiliation(s)
- Shahryar Sane
- Department of Anesthesiology, Imam Khomeini Hospital, Urmia, Iran
| | | | | | - Alireza Mahoori
- Department of Anesthesiology, Imam Khomeini Hospital, Urmia, Iran
| | - Seyed Taghi Hashemi
- Department of Anesthesia, Medical School, St-Alzahra Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahime Rafiei
- School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
22
|
Abstract
Given its profound analgesic nature, neuraxial opioids are frequently used for pain management. Unfortunately, the high incident rate of itch/pruritus after spinal administration of opioid analgesics reported in postoperative and obstetric patients greatly diminishes patient satisfaction and thus the value of the analgesics. Many endeavors to solve the mystery behind neuraxial opioid-induced itch had not been successful, as the pharmacological antagonism other than the blockade of mu opioid receptors remains elusive. Nevertheless, as the characteristics of all opioid receptor subtypes have become more understood, more studies have shed light on the potential effective treatments. This review discusses the mechanisms underlying neuraxial opioid-induced itch and compares pharmacological evidence in nonhuman primates with clinical findings across diverse drugs. Both nonhuman primate and human studies corroborate that mixed mu/kappa opioid partial agonists seem to be the most effective drugs in ameliorating neuraxial opioid-induced itch while retaining neuraxial opioid-induced analgesia.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Tie HT, Su GZ, He K, Liang SR, Yuan HW, Mou JH. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2014; 14:12. [PMID: 24588846 PMCID: PMC3945808 DOI: 10.1186/1471-2253-14-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shivering is a very common complication in the postanesthesia period. Increasing studies have reported ondansetron may be effective in prevention of postanesthesia shivering (PAS). However, the results remained controversial; hence we conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of ondansetron on the prevention of postanesthesia shivering. METHODS PubMed and Embase databases were searched to identify the eligible randomized controlled trials assessing the effect of ondansetron on the prevention of PAS. Results were expressed as risk ratios (RRs) with accompanying 95% confidence intervals (CIs). The meta-analysis was performed with fixed-effect model or random-effect model according to the heterogeneity. RESULTS Six trials including 533 subjects were included. Compared with placebo, ondansetron was associated with a significant reduction of PAS (RR 0.43, 95% CI, 0.27-0.70), without an increased risk of bradycardia (RR 0.37, 95% CI, 0.12-1.15). Compared with meperidine, no difference was observed in the incidence of PAS (RR 0.68, 95% CI, 0.39-1.19) and bradycardia (RR 2.0, 95% CI, 0.38-10.64). CONCLUSIONS Ondansetron has a preventive effect on PAS without a paralleled side effect of bradycardia.
Collapse
Affiliation(s)
| | - Guang-Zhu Su
- Department of Pharmacy, Jinan Central Hospital, Jinan 250013, Shandong, China.
| | | | | | | | | |
Collapse
|
25
|
Ondansetron and shivering during cesarean delivery under combined spinal epidural anesthesia: a live issue. Reg Anesth Pain Med 2013; 38:252. [PMID: 23598731 DOI: 10.1097/aap.0b013e318289efaa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
Jo YY, Kwak HJ, Lee MG, Lim OK. Effect of palonosetron on postanesthetic shivering after propofol-remifentanil total intravenous anesthesia. J Anesth 2013; 27:535-40. [PMID: 23334613 DOI: 10.1007/s00540-013-1556-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/03/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The authors conducted a prospective, randomized, double-blind study to evaluate the anti-shivering efficacy of palonosetron for patients after gynecological laparoscopy under total intravenous propofol-remifentanil anesthesia. METHODS Sixty female patients were randomly assigned to one of two groups and administered palonosetron 0.075 mg (palonosetron group, n = 30) or the same volume of normal saline (control group, n = 30) immediately after anesthesia induction. Anesthesia was induced and maintained with propofol and remifentanil, using a target-controlled infusion device. Esophageal and index finger temperatures were measured immediately after anesthesia induction (baseline) and at 15-min intervals until the end of the surgery. Postanesthetic shivering and side effects were assessed in a postanesthetic care unit. RESULTS Incidence of shivering was comparable in the control and palonosetron groups (10/30 vs. 8/30, respectively, P = 0.779). No significant intergroup differences were observed between esophageal and index finger temperatures. Compared with baseline values, esophageal temperatures decreased immediately after pneumoperitoneum in the control group and from 30 min after pneumoperitoneum in the palonosetron group. CONCLUSION Use of palonosetron (0.075 mg) did not reduce the incidence of postanesthetic shivering after gynecological laparoscopy under propofol-remifentanil anesthesia. Further study including other 5-HT3 antagonists or male patients would elucidate the effect of palonosetron on shivering after propofol-remifentanil anesthesia.
Collapse
Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | | | | | | |
Collapse
|