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[Comparative study of pethidine and clonidine for prevention of postoperative shivering. A prospective, randomized, placebo-controlled double-blind study].

Abstract

OBJECTIVE

Patients with ischaemic heart disease and cardiac failure are endangered by an increase in oxygen consumption caused by postoperative shivering. The purpose of this study was to evaluate if pethidine and clonidine, which are well known for their effectiveness in the treatment of this undesirable side effect, can also prevent postoperative shivering if administered at the end of surgery. In addition it was investigated whether their intraoperative application influences the time of extubation and analgesics demand in the early postoperative period.

METHODS

60 patients (ASA I-II) scheduled for elective microsurgical vertebral disc resection were included in the study. After standardised induction of anaesthesia (5 mg x kg-1 thiopental, 2 micrograms x kg-1 fentanyl, 0.1 mg x kg-1 vecuronium) lungs were ventilated with isoflurane vaporized in 66% N2O and 33% O2. The concentration of the inhalation anaesthetic was adjusted to maintain a surgical plane of anaesthesia without supplementary doses of opioids. Patients were randomly allocated in a double-blind fashion to one of three groups (each n = 20) to receive either pethidine (0.3 mg x kg-1) or clonidine (2 micrograms x kg-1) or 0.9% saline (control) 5 minutes prior to the end of surgery. Heart rate, arterial blood pressure and rectal temperature were measured at defined times, as well as the recovery time between the end of anaesthesia and extubation, incidence of postoperative shivering, and the pain level of the patients with a visual analog scale. The frequency and total demand of analgesics were determined using patient controlled analgesia and recorded for two hours postoperatively.

RESULTS

The incidence of postoperative shivering in the clonidine group (5%) was less than in the pethidine group (25%) and significantly less than in the saline group (55%). Heart rate and blood pressure values after the administration of clonidine were lower than after pethidine and significantly lower than after saline. The time between end of surgery and extubation was similar in all groups with an average of 18 minutes. No significant differences among the pain scores and the analgesics demand were noted among any of the groups, including the saline control-group.

CONCLUSION

Intraoperative administration of clonidine (2 micrograms x kg-1) is suitable for prevention of postoperative shivering. Despite its sedative effects the recovery time until extubation was not prolonged. 0.3 mg x kg-1 pethidine proved to be less beneficial.

Authors+Show Affiliations

Klinik für Anaästhesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
English Abstract
Journal Article
Randomized Controlled Trial

Language

ger

PubMed ID

9138543

Citation

Grundmann, U, et al. "[Comparative Study of Pethidine and Clonidine for Prevention of Postoperative Shivering. a Prospective, Randomized, Placebo-controlled Double-blind Study]." Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS, vol. 32, no. 1, 1997, pp. 36-42.
Grundmann U, Berg K, Stamminger U, et al. [Comparative study of pethidine and clonidine for prevention of postoperative shivering. A prospective, randomized, placebo-controlled double-blind study]. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32(1):36-42.
Grundmann, U., Berg, K., Stamminger, U., Juckenhöfel, S., & Wilhelm, W. (1997). [Comparative study of pethidine and clonidine for prevention of postoperative shivering. A prospective, randomized, placebo-controlled double-blind study]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS, 32(1), 36-42.
Grundmann U, et al. [Comparative Study of Pethidine and Clonidine for Prevention of Postoperative Shivering. a Prospective, Randomized, Placebo-controlled Double-blind Study]. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32(1):36-42. PubMed PMID: 9138543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Comparative study of pethidine and clonidine for prevention of postoperative shivering. A prospective, randomized, placebo-controlled double-blind study]. AU - Grundmann,U, AU - Berg,K, AU - Stamminger,U, AU - Juckenhöfel,S, AU - Wilhelm,W, PY - 1997/1/1/pubmed PY - 1997/1/1/medline PY - 1997/1/1/entrez SP - 36 EP - 42 JF - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS JO - Anasthesiol Intensivmed Notfallmed Schmerzther VL - 32 IS - 1 N2 - OBJECTIVE: Patients with ischaemic heart disease and cardiac failure are endangered by an increase in oxygen consumption caused by postoperative shivering. The purpose of this study was to evaluate if pethidine and clonidine, which are well known for their effectiveness in the treatment of this undesirable side effect, can also prevent postoperative shivering if administered at the end of surgery. In addition it was investigated whether their intraoperative application influences the time of extubation and analgesics demand in the early postoperative period. METHODS: 60 patients (ASA I-II) scheduled for elective microsurgical vertebral disc resection were included in the study. After standardised induction of anaesthesia (5 mg x kg-1 thiopental, 2 micrograms x kg-1 fentanyl, 0.1 mg x kg-1 vecuronium) lungs were ventilated with isoflurane vaporized in 66% N2O and 33% O2. The concentration of the inhalation anaesthetic was adjusted to maintain a surgical plane of anaesthesia without supplementary doses of opioids. Patients were randomly allocated in a double-blind fashion to one of three groups (each n = 20) to receive either pethidine (0.3 mg x kg-1) or clonidine (2 micrograms x kg-1) or 0.9% saline (control) 5 minutes prior to the end of surgery. Heart rate, arterial blood pressure and rectal temperature were measured at defined times, as well as the recovery time between the end of anaesthesia and extubation, incidence of postoperative shivering, and the pain level of the patients with a visual analog scale. The frequency and total demand of analgesics were determined using patient controlled analgesia and recorded for two hours postoperatively. RESULTS: The incidence of postoperative shivering in the clonidine group (5%) was less than in the pethidine group (25%) and significantly less than in the saline group (55%). Heart rate and blood pressure values after the administration of clonidine were lower than after pethidine and significantly lower than after saline. The time between end of surgery and extubation was similar in all groups with an average of 18 minutes. No significant differences among the pain scores and the analgesics demand were noted among any of the groups, including the saline control-group. CONCLUSION: Intraoperative administration of clonidine (2 micrograms x kg-1) is suitable for prevention of postoperative shivering. Despite its sedative effects the recovery time until extubation was not prolonged. 0.3 mg x kg-1 pethidine proved to be less beneficial. SN - 0939-2661 UR - https://www.unboundmedicine.com/medline/citation/9138543/[Comparative_study_of_pethidine_and_clonidine_for_prevention_of_postoperative_shivering__A_prospective_randomized_placebo_controlled_double_blind_study]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-995005 DB - PRIME DP - Unbound Medicine ER -