Lakhe Gajal, Adhikari Krishna Murari, Khatri Kiran, Maharjan Anil, Bajracharya Akriti, Khanal Himdip
Department of Anesthesia, Manipal College of Medical Sciences, Phulbari-11, Pokhara, Nepal.
JNMA J Nepal Med Assoc. 2017 Oct-Dec;56(208):395-400.
Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering.
In this randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I and II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software.
The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions.
Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects.
寒战是脊髓麻醉后令人不适的体验。我们开展本研究以评估昂丹司琼、氯胺酮和曲马多预防寒战的效果。
在这项随机对照研究中，纳入120例年龄在18至65岁、美国麻醉医师协会（ASA）身体状况为I级和II级、接受各种外科手术的患者，并将其交替分配至4组之一；生理盐水组（第1组）、4毫克昂丹司琼组（第2组）、0.25毫克/千克氯胺酮组（第3组）和0.5毫克/千克曲马多组（第4组）。记录寒战发生率、对血流动力学的影响、恶心、呕吐、镇静及苏醒反应。使用SPSS（社会科学统计软件包）20.0版软件进行数据分析。
患者在人口统计学变量、基线体温、手术类型、感觉阻滞中位平面、手术及麻醉持续时间方面具有可比性。第1、2、3和4组出现寒战的患者分别为17例（56.7%）、5例（16.7%）、3例（10%）和3例（10%），与第1组相比具有统计学意义（P = 0.00）。生理盐水与昂丹司琼、生理盐水与氯胺酮、生理盐水与曲马多的比值比分别为6.53、11.76和11.76，表明研究药物在预防寒战方面有效。第1组和第2组无患者出现镇静。第3组和第4组出现轻至中度镇静（P = 0.00）。无患者出现药物相关不良反应。
预防性使用昂丹司琼、低剂量氯胺酮和曲马多可有效预防脊髓麻醉后寒战，且无不良影响。
