Elvan E G, Oç B, Uzun S, Karabulut E, Coşkun F, Aypar U
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Sihhiye, Ankara, Turkey.
Eur J Anaesthesiol. 2008 May;25(5):357-64. doi: 10.1017/S0265021507003110. Epub 2008 Jan 21.
Post-anaesthetic shivering is one of the most common complications, occurring in 5-65% of patients recovering from general anaesthesia and 33% of patients receiving epidural anaesthesia. Our objective was to investigate the efficacy of intraoperative dexmedetomidine infusion on postoperative shivering.
Ninety female patients, ASA I-II, 35-60 yr old, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized into two groups. After endotracheal intubation one group received normal saline infusion and the other received dexmedetomidine as a loading dose of 1 microg kg(-1) for 10 min followed by a maintenance infusion of 0.4 microg kg(-1) h(-1). In the recovery room, pain was assessed using a 100 mm visual analogue scale and those patients who had a pain score of more than 40 mm were administered 1 mg kg(-1) intramuscular diclofenac sodium. Patients with shivering grades more than 2 were administered 25 mg intravenous meperidine. Patients were protected with passive insulation covers.
Post-anaesthetic shivering was observed in 21 patients in the saline group and in seven patients in the dexmedetomidine group (P = 0.001). Shivering occurred more often in the saline group. The Ramsay Sedation Scores were higher in the dexmedetomidine group during the first postoperative hour. Pain scores were higher in the saline group for 30 min after the operation. The need for intraoperative atropine was higher in the dexmedetomidine group. Intraoperative fentanyl use was higher in the saline group. Perioperative tympanic temperatures were not different between the groups whereas postoperative measurements were lower in the dexmedetomidine group (P < 0.05).
Intraoperative dexmedetomidine infusion may be effective in the prevention of post-anaesthetic shivering.
麻醉后寒战是最常见的并发症之一，发生于5% - 65%的全身麻醉术后恢复患者及33%的接受硬膜外麻醉的患者。我们的目的是研究术中输注右美托咪定对术后寒战的疗效。
90例年龄35 - 60岁、ASA分级I - II级、计划行择期全腹子宫切除术（有或无双侧输卵管卵巢切除术）的女性患者被随机分为两组。气管插管后，一组输注生理盐水，另一组先静脉注射负荷剂量右美托咪定1μg/kg，持续10分钟，随后以0.4μg·kg⁻¹·h⁻¹的速度持续输注。在恢复室，使用100mm视觉模拟评分法评估疼痛，疼痛评分超过40mm的患者肌内注射双氯芬酸钠1mg/kg。寒战分级超过2级的患者静脉注射哌替啶25mg。患者使用被动保温罩保暖。
生理盐水组有21例患者出现麻醉后寒战，右美托咪定组有7例（P = 0.001）。寒战在生理盐水组更常见。术后第1小时内，右美托咪定组的Ramsay镇静评分更高。术后30分钟内，生理盐水组的疼痛评分更高。右美托咪定组术中阿托品的使用需求更高。生理盐水组术中芬太尼的使用量更高。两组围术期鼓膜温度无差异，但右美托咪定组术后测量的温度较低（P < 0.05）。
术中输注右美托咪定可能有效预防麻醉后寒战。
