Mao C C, Tsou M Y, Chia Y Y, Chow L H, Chan K H, Lee T Y
Division of Anesthesia, Yuen-San Veterans Hospital, Taipei, R.O.C.
Acta Anaesthesiol Sin. 1998 Sep;36(3):137-42.
Shivering is a common event during spinal anesthesia. Customarily we just treat it rather than prevent it. This study was designed to evaluate the efficacy of oral clonidine as a premedication to prevent post-spinal shivering.
One hundred males of ASA physical status I-III, aged above 40, scheduled for elective urological surgery under spinal anesthesia, were included in this study. All participants were randomly divided into the clonidine and control groups. They received either oral clonidine 150 micrograms (n = 48) or placebo (n = 52) 90 min before spinal anesthesia in a double-blind fashion. Spinal blockade was induced with heavy bupivacaine to a dermatomal level near T10. The shivering was graded as: none, no perceptible tension of muscles observed; mild, slight muscle tonus (masseter muscle); moderate, real shivering (proximal muscles); and severe, generalized shivering (whole body). The tympanic membrane temperature was recorded 30 min after spinal anesthesia. Data were expressed as mean +/- standard deviation. Chi-square and Student's t-test were used. A p value less than 0.05 was considered statistically significant.
The incidence of post-spinal shivering, which was graded as none, mild, moderate, and severe, showed statistically significant differences (p < 0.05) between clonidine 150 micrograms and placebo (83% vs. 42%, 10% vs. 6%, 10% vs. 19%, 0% vs. 33%, respectively) during the 30 min immediately after spinal anesthesia. The respective mean tympanic temperature in oral clonidine and placebo groups showed no difference (clonidine vs. control = 35.9 +/- 0.8 degrees C vs. 35.9 +/- 0.7 degrees C).
Pre-anesthetic medication with oral clonidine 150 micrograms is effective to prevent post-spinal shivering in patients undergoing elective urological surgery.
寒战是脊髓麻醉期间的常见现象。通常我们只是对其进行治疗而非预防。本研究旨在评估口服可乐定作为预防脊髓麻醉后寒战的术前用药的疗效。
本研究纳入了100例年龄在40岁以上、ASA身体状况分级为I - III级、计划在脊髓麻醉下进行择期泌尿外科手术的男性患者。所有参与者被随机分为可乐定组和对照组。他们在脊髓麻醉前90分钟以双盲方式分别接受口服150微克可乐定（n = 48）或安慰剂（n = 52）。用重比重布比卡因诱导脊髓阻滞至T10附近的皮节水平。寒战分级为：无，未观察到肌肉有明显张力；轻度，轻微肌肉紧张（咬肌）；中度，真正的寒战（近端肌肉）；重度，全身性寒战（全身）。脊髓麻醉后30分钟记录鼓膜温度。数据以平均值±标准差表示。采用卡方检验和学生t检验。p值小于0.05被认为具有统计学意义。
在脊髓麻醉后立即的30分钟内，脊髓麻醉后寒战的发生率，分级为无、轻度、中度和重度，在150微克可乐定组和安慰剂组之间显示出统计学显著差异（p < 0.05）（分别为83%对42%、10%对6%、10%对19%、0%对33%）。口服可乐定组和安慰剂组各自的平均鼓膜温度无差异（可乐定组对对照组 = 35.9 ± 0.8℃对35.9 ± 0.7℃）。
术前口服150微克可乐定对预防择期泌尿外科手术患者的脊髓麻醉后寒战有效。
