Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology, Nanjing Maternal and Child Health Care Hospital, Nanjing Medical University, Nanjing, China.
Int J Obstet Anesth. 2021 Feb;45:49-55. doi: 10.1016/j.ijoa.2020.11.004. Epub 2020 Nov 17.
Intravenous dexmedetomidine 30 µg reduces shivering after cesarean delivery but can result in sedation and dry mouth. We hypothesized that prophylactic administration of 10 µg of IV dexmedetomidine would reduce the patient-reported severity of shivering after cesarean delivery, without an increased incidence of side effects.
After institutional review board approval and informed written consent, women undergoing scheduled cesarean delivery with spinal or combined spinal-epidural anesthesia were randomized to receive either intravenous normal saline or dexmedetomidine 10 µg immediately after delivery. The primary outcome was a patient-rated subjective shivering score using a 10-cm visual analog scale at 30 and 60 min after arrival in the Post-Anesthesia Care Unit. Secondary outcomes included subjective scores for pain, nausea, itching, dry mouth, and sedation, as well as 24-h medication administration and investigator-rated observations of shivering, vomiting, pruritus, and sedation. Repeated measures ANOVA with Tukey-Kramer multiple-comparison test was applied for primary outcomes.
One hundred patients were enrolled, and 85 completed the study and were included in analysis. The mean ± SD shivering score in the dexmedetomidine group was significantly lower by repeated measures analysis than among controls across the first 60 min (P=0.0002), and individually at both 30 and 60 min (placebo 1.8 ± 2.6 vs. dexmedetomidine 0.6 ± 1.4 at 30 min; 1.2 ± 2.1 vs. 0.3 ± 0.6 at 60 min; both P <0.01). Patient-rated and observer-rated side effects did not significantly differ between groups.
Prophylactic administration of intravenous dexmedetomidine 10 µg after delivery reduces shivering without notable side effects.
静脉注射右美托咪定 30μg 可减少剖宫产术后寒战，但可能导致镇静和口干。我们假设预防性给予 10μg 静脉注射右美托咪定可降低剖宫产术后患者寒战的严重程度，而不会增加不良反应的发生率。
在机构审查委员会批准和书面知情同意后，接受椎管内麻醉下择期剖宫产的女性被随机分为静脉注射生理盐水或右美托咪定 10μg 组，在分娩后立即给予。主要结局是在到达麻醉后恢复室后 30 和 60 分钟时使用 10cm 视觉模拟量表评估患者的主观寒战评分。次要结局包括疼痛、恶心、瘙痒、口干和镇静的主观评分，以及 24 小时药物管理以及研究者评估的寒战、呕吐、瘙痒和镇静观察。主要结局采用重复测量方差分析和 Tukey-Kramer 多重比较检验。
共纳入 100 例患者，85 例完成研究并纳入分析。重复测量分析显示，右美托咪定组的平均（±SD）寒战评分在 60 分钟内明显低于对照组（P=0.0002），且在 30 和 60 分钟时单独评分也明显低于对照组（安慰剂组 1.8±2.6 比右美托咪定组 0.6±1.4，30 分钟；1.2±2.1 比 0.3±0.6，60 分钟；均 P<0.01）。患者和观察者评估的不良反应在两组之间无显著差异。
分娩后预防性给予 10μg 静脉注射右美托咪定可减少寒战，且无明显不良反应。
