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Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial.
Br J Anaesth. 2008 Oct; 101(4):557-62.BJ

Abstract

BACKGROUND

Regional anaesthesia, like general anaesthesia, influences the thermoregulatory process. The aim of the present study was to compare the efficacy of low-dose prophylactic midazolam with that of placebo, ketamine, and a combination of ketamine and midazolam in the prevention of shivering caused by regional anaesthesia.

METHODS

In this double-blind study, 120 ASA I and II patients undergoing orthopaedic surgery were included. Subarachnoid anaesthesia was performed in all patients with bupivacaine 15 mg. The patients were randomly allocated to receive saline (Group C), ketamine 0.5 mg (Group K), midazolam 75 microg kg(-1) (Group M), or ketamine 0.25 mg+midazolam 37.5 microg kg(-1) (Group KM). During surgery, a shivering score was recorded at 5 min intervals. Tympanic and axillary temperature were recorded at 10 min intervals during the perioperative period.

RESULTS

After 15 min, the incidences of shivering in Groups C, M, K, and KM were 60%, 50%, 23.3%, 3.3%, respectively (P=0.000). The differences between Group KM and Groups M, K, and C were statistically significant (P=0.000, P=0.026, P<0.001, respectively). The number of patients with a shivering score of > or =3 was significantly higher in Group C compared with Groups M, K, and KM (8 vs 4, 1, and 0, respectively, P=0.040).

CONCLUSIONS

Prophylactic use of ketamine 0.25 mg kg(-1)+midazolam 37.5 microg kg(-1) i.v. was more effective than ketamine 0.5 mg kg(-1) i.v. or midazolam 75 microg kg(-1) i.v. in preventing shivering developed during regional anaesthesia.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran. honarmand@med.mui.ac.irNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18621986

Citation

Honarmand, A, and M R. Safavi. "Comparison of Prophylactic Use of Midazolam, Ketamine, and Ketamine Plus Midazolam for Prevention of Shivering During Regional Anaesthesia: a Randomized Double-blind Placebo Controlled Trial." British Journal of Anaesthesia, vol. 101, no. 4, 2008, pp. 557-62.
Honarmand A, Safavi MR. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. Br J Anaesth. 2008;101(4):557-62.
Honarmand, A., & Safavi, M. R. (2008). Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. British Journal of Anaesthesia, 101(4), 557-62. https://doi.org/10.1093/bja/aen205
Honarmand A, Safavi MR. Comparison of Prophylactic Use of Midazolam, Ketamine, and Ketamine Plus Midazolam for Prevention of Shivering During Regional Anaesthesia: a Randomized Double-blind Placebo Controlled Trial. Br J Anaesth. 2008;101(4):557-62. PubMed PMID: 18621986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. AU - Honarmand,A, AU - Safavi,M R, Y1 - 2008/07/11/ PY - 2008/7/16/pubmed PY - 2008/10/23/medline PY - 2008/7/16/entrez SP - 557 EP - 62 JF - British journal of anaesthesia JO - Br J Anaesth VL - 101 IS - 4 N2 - BACKGROUND: Regional anaesthesia, like general anaesthesia, influences the thermoregulatory process. The aim of the present study was to compare the efficacy of low-dose prophylactic midazolam with that of placebo, ketamine, and a combination of ketamine and midazolam in the prevention of shivering caused by regional anaesthesia. METHODS: In this double-blind study, 120 ASA I and II patients undergoing orthopaedic surgery were included. Subarachnoid anaesthesia was performed in all patients with bupivacaine 15 mg. The patients were randomly allocated to receive saline (Group C), ketamine 0.5 mg (Group K), midazolam 75 microg kg(-1) (Group M), or ketamine 0.25 mg+midazolam 37.5 microg kg(-1) (Group KM). During surgery, a shivering score was recorded at 5 min intervals. Tympanic and axillary temperature were recorded at 10 min intervals during the perioperative period. RESULTS: After 15 min, the incidences of shivering in Groups C, M, K, and KM were 60%, 50%, 23.3%, 3.3%, respectively (P=0.000). The differences between Group KM and Groups M, K, and C were statistically significant (P=0.000, P=0.026, P<0.001, respectively). The number of patients with a shivering score of > or =3 was significantly higher in Group C compared with Groups M, K, and KM (8 vs 4, 1, and 0, respectively, P=0.040). CONCLUSIONS: Prophylactic use of ketamine 0.25 mg kg(-1)+midazolam 37.5 microg kg(-1) i.v. was more effective than ketamine 0.5 mg kg(-1) i.v. or midazolam 75 microg kg(-1) i.v. in preventing shivering developed during regional anaesthesia. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/18621986/Comparison_of_prophylactic_use_of_midazolam_ketamine_and_ketamine_plus_midazolam_for_prevention_of_shivering_during_regional_anaesthesia:_a_randomized_double_blind_placebo_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)34172-7 DB - PRIME DP - Unbound Medicine ER -