Blaine Easley R, Brady Kenneth M, Tobias Joseph D
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA.
Paediatr Anaesth. 2007 Apr;17(4):341-6. doi: 10.1111/j.1460-9592.2006.02100.x.
Shivering is a common postanesthesia adverse event with multiple etiologies and multiple suggested prophylactic and abortive treatment regimens. Dexmedetomidine, a centrally acting alpha(2)-adrenergic agonist, has been used as a sedative agent and is known to reduce the shivering threshold. We hypothesized that children with postanesthesia shivering would reduce shivering behavior following a single bolus dose of dexmedetomidine.
Dexmedetomidine was administered in a prospective, open-label fashion. The anesthesia management was uniform consisting of maintenance inhaled anesthesia (sevoflurane) and the intraoperative administration of fentanyl (1-2 microg.kg(-1)) plus a regional anesthetic technique (either a neuraxial or peripheral block) for postoperative analgesia. Criteria for treatment included: (i) shivering, (ii) successful extubation, and (iii) no other complaint/indication of pain. All children who met the criteria were treated with a single intravenous bolus dose of dexmedetomidine (0.5 microg.kg(-1)) over 3-5 min. Following the completion of drug administration, shivering activity was recorded every minute (up to 10 min) with any adverse effects or complaints. The efficacy of shivering reduction at 5 min in this cohort is compared with previous reports from the literature of the efficacy of clonidine and meperidine.
Twenty-four children ranging in age from 7 to 16 years (11.5 +/- 2.5 years) were treated. All children had a cessation of shivering behavior within 5 min following the completion of dexmedetomidine administration. The onset of effect was 3.5 +/- 0.9 min. No adverse effects were observed. No shivering behavior recurred.
This study demonstrates the efficacy of dexmedetomidine in the treatment of postanesthesia shivering.
寒战是一种常见的麻醉后不良事件，病因多样，且有多种预防性和治疗性方案。右美托咪定是一种中枢作用的α₂肾上腺素能激动剂，已被用作镇静剂，并且已知其可降低寒战阈值。我们假设麻醉后寒战的儿童在单次静脉推注右美托咪定后会减少寒战行为。
以前瞻性、开放标签的方式给予右美托咪定。麻醉管理统一，包括维持吸入麻醉（七氟醚）以及术中给予芬太尼（1 - 2微克·千克⁻¹）加区域麻醉技术（脊髓或外周阻滞）用于术后镇痛。治疗标准包括：（i）寒战，（ii）成功拔管，以及（iii）无其他疼痛主诉/指征。所有符合标准的儿童在3 - 5分钟内接受单次静脉推注右美托咪定（0.5微克·千克⁻¹）治疗。给药完成后，每分钟记录寒战活动（最长10分钟）以及任何不良反应或主诉。将该队列中5分钟时寒战减少的疗效与之前文献中可乐定和哌替啶疗效的报道进行比较。
治疗了24名年龄在7至16岁（11.5 ± 2.5岁）的儿童。所有儿童在右美托咪定给药完成后5分钟内寒战行为停止。起效时间为3.5 ± 0.9分钟。未观察到不良反应。寒战行为未复发。
本研究证明了右美托咪定治疗麻醉后寒战的疗效。
