Sajedi Parvin, Yaraghi Ahmad, Moseli Heidar Ali
Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran.
Acta Anaesthesiol Taiwan. 2008 Dec;46(4):166-70. doi: 10.1016/S1875-4597(09)60004-7.
Recently, 5-hydroxytryptamine 3 (5-HT3) receptor antagonists have been reported to prevent postanesthetic shivering. This placebo-controlled study was performed to evaluate the efficacy of granisetron, a 5-HT3 antagonist, in comparison with meperidine and tramadol in preventing postanesthetic shivering.
In this prospective, randomized, double-blind study, 132 ASA I and II patients undergoing elective orthopedic surgery under standardized general anesthesia were included. At the end of surgery, patients were randomly assigned to one of four groups (each group n = 33) using a double-blinded protocol. Group T received 1 mg/kg tramadol, group G received 40 microg/kg granisetron (an antiemetic dose), group M received 0.4 mg/kg meperidine, and group P received saline 0.9% as placebo. Shivering was graded according to the following: 0 = no shivering; 1 = piloerection, peripheral vasoconstriction or peripheral cyanosis without other cause; 2 = visible muscular activity confined to one muscle group; 3 = visible muscular activity in more than one muscle group; and 4 = gross muscular activity involving the entire body. The emergence time from anesthesia, defined as the time between withdrawal of isoflurane and tracheal extubation, was documented.
The number of patients with observable shivering was 19 in group P, nine in group G, seven in group T and six in group M. Granisetron significantly reduced the incidence of shivering in comparison with placebo (p = 0.013). Although the frequency of shivering was higher with granisetron in comparison to tramadol and meperidine, it was not statistically significant (p > 0.05). The number of patients with a shivering score of 2, 3 and 4 was significantly higher in group P compared with the other groups (p = 0.001). Both meperidine and tramadol caused a significantly prolonged emergence time (20.58 +/- 3.56 and 16.45 +/- 4.13 minutes, respectively) as opposed to granisetron (13.58 +/- 3.41 minutes) and placebo (12.61 +/- 3.31 minutes).
The prophylactic use of granisetron 40 microg/kg is as effective as meperidine (0.4 mg/kg) and tramadol (0.1 mg/kg) in preventing postanesthetic shivering without prolonging the emergence time from anesthesia.
最近，有报道称5-羟色胺3（5-HT3）受体拮抗剂可预防麻醉后寒战。本安慰剂对照研究旨在评估5-HT3拮抗剂格拉司琼与哌替啶和曲马多相比，在预防麻醉后寒战方面的疗效。
在这项前瞻性、随机、双盲研究中，纳入了132例接受标准化全身麻醉下择期骨科手术的美国麻醉医师协会（ASA）I级和II级患者。手术结束时，采用双盲方案将患者随机分为四组（每组n = 33）。T组接受1 mg/kg曲马多，G组接受40 μg/kg格拉司琼（止吐剂量），M组接受0.4 mg/kg哌替啶，P组接受0.9%生理盐水作为安慰剂。根据以下标准对寒战进行分级：0 = 无寒战；1 = 竖毛、外周血管收缩或外周发绀，无其他原因；2 = 可见肌肉活动局限于一个肌肉群；3 = 可见肌肉活动在一个以上肌肉群；4 = 涉及全身的明显肌肉活动。记录麻醉苏醒时间，定义为异氟烷停用至气管拔管之间的时间。
P组有19例患者出现可观察到的寒战，G组9例，T组7例，M组6例。与安慰剂相比，格拉司琼显著降低了寒战的发生率（p = 0.013）。尽管与曲马多和哌替啶相比，格拉司琼引起的寒战频率更高，但差异无统计学意义（p > 0.05）。P组寒战评分为2、3和4的患者数量显著高于其他组（p = 0.001）。与格拉司琼（13.58 ± 3.41分钟）和安慰剂（12.61 ± 3.31分钟）相比，哌替啶和曲马多均导致苏醒时间显著延长（分别为20.58 ± 3.56分钟和16.45 ± 4.13分钟）。
预防性使用40 μg/kg格拉司琼在预防麻醉后寒战方面与0.4 mg/kg哌替啶和0.1 mg/kg曲马多同样有效，且不延长麻醉苏醒时间。
