Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O
Inonu University, School of Medicine, Malatya, Turkey.
Acta Anaesthesiol Scand. 2007 Jan;51(1):44-9. doi: 10.1111/j.1399-6576.2006.01196.x.
The aim of the present study was to compare placebo, ketamine, granisetron and a combination of ketamine and granisetron in the prevention of shivering caused by regional anaesthesia.
In this prospective, randomized, double-blind study, 160 ASA I and II patients undergoing urological surgery were included. Subarachnoid anaesthesia was performed in all patients with bupivacaine 15 mg. The patients were randomly allocated to receive saline (group P, n= 40), ketamine 0.5 mg (group K, n= 40), granisetron 3 mg (group G, n= 40) or ketamine 0.25 mg + granisetron 1.5 mg (group KG, n= 40). Shivering was graded as 0 = no shivering, 1 = piloerection or peripheral vasoconstriction but no visible shivering, 2 = muscular activity in only one muscle group, 3 = muscular activity in more than one muscle group but not generalized, and 4 = shivering involving the whole body. If 15 min after spinal anaesthesia and concomitant administration of a prophylactic dose of one of the study drugs, the patients shivered according to at least grade 3, the prophylaxis was regarded as ineffective and intravenous (i.v.) pethidine 25 mg was administered.
After 15 min, the number of patients with observed shivering was 22 in group P, 6 in group G, 7 in group GK and 0 in group K. The difference between group K and all the other groups was statistically significant (P < 0.0001). The number of patients with a shivering score of 3 was statistically significantly higher in group P compared with the other groups.
The prophylactic use of 0.5 mg/kg i.v. ketamine was effective in preventing shivering developed during regional anaesthesia.
本研究旨在比较安慰剂、氯胺酮、格拉司琼以及氯胺酮与格拉司琼联合用药在预防区域麻醉引起的寒战方面的效果。
在这项前瞻性、随机、双盲研究中，纳入了160例接受泌尿外科手术的美国麻醉医师协会（ASA）I级和II级患者。所有患者均采用15mg布比卡因进行蛛网膜下腔麻醉。患者被随机分配接受生理盐水（P组，n = 40）、0.5mg氯胺酮（K组，n = 40）、3mg格拉司琼（G组，n = 40）或0.25mg氯胺酮 + 1.5mg格拉司琼（KG组，n = 40）。寒战分级为：0级 = 无寒战；1级 = 竖毛或外周血管收缩但无明显寒战；2级 = 仅一个肌肉群有肌肉活动；3级 = 一个以上肌肉群有肌肉活动但未全身性发作；4级 = 全身寒战。如果在脊髓麻醉及给予一种研究药物的预防剂量后15分钟，患者寒战至少达到3级，则预防措施被视为无效，并静脉注射25mg哌替啶。
15分钟后，P组观察到寒战的患者有22例，G组6例，GK组7例，K组0例。K组与其他所有组之间的差异具有统计学意义（P < 0.0001）。P组寒战评分为3分的患者数量与其他组相比具有统计学显著差异。
静脉注射0.5mg/kg氯胺酮预防性用药可有效预防区域麻醉期间发生的寒战。
