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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 190-197

Treatment of postoperative shivering after laparoscopic cholecystectomy under general anesthesia: a comparative clinical study


Anesthesia and Intensive Care Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt

Correspondence Address:
Saeed M Abdallah
Anesthesia and Intensive Care Department, Faculty of Medicine, Al Azhar University, Cairo, 11111
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AZMJ.AZMJ_67_19

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Background Postanesthesia shivering is one of the common harmful hazards following general anesthesia, especially with laparoscopic surgery. Postoperative shivering may lead to multiple complications, which may happen owing to increased oxygen demands, precipitating in cardiac and neurological ischemia. Aim This study aims to compare the therapeutic effects of pethidine, ondansetron, and ketamine in preventing postoperative shivering in laparoscopic cholecystectomy under general anesthesia. Patients and methods In this prospective study, patients aged from 26 to 55 years scheduled for elective laparoscopic cholecystectomy under general anesthesia were included. Patients who developed shivering in the recovery room were randomly divided into three groups: the first group [pethidine (P)] received intravenous pethidine (0.5 mg/kg), the second group [ondansetron (O)] received intravenous ondansetron 8 mg, and the third group [ketamine (K)] received intravenous ketamine (0.25 mg/kg). The frequency and degree of shivering was determined immediately after surgery, 15 min after study drugs administration, and 30 min after study drugs administration. Moreover, hemodynamic changes before and after drug administration and adverse effects of the study drugs were examined. Results A total of 95 patients who developed postoperative shivering after laparoscopic cholecystectomy were included in this study. No significant difference was found among the groups regarding treatment and grading of shivering in recovery room 15 min after the study drug administration. No significant difference was found among the groups regarding the recurrence of shivering in recovery room 30 min after study drug administration. There is a significant difference in heart rate changes among the three groups and between group K and group O at 10 and 20 min after the administration of study drugs (P<0.05), and heart rate was higher in group K. There is a significant difference in mean arterial blood pressure among the three groups and between group K and group O at 10, 20, and 30 min after the administration of study drugs (P<0.05), and Mean arterial blood pressure (MAP) was higher in group K. There was no significant difference in oxygen saturation and axillary temperature changes among the three groups at all time before and after administration of study drugs (P>0.05). There was a significant difference among groups P, O, and K regarding sedation, hallucination, and nystagmus, being more in group K, but there was no difference among the groups regarding vomiting and itching. Conclusion The result of this study showed that ondansetron and ketamine effectively managed postoperative shivering with decreased incidence of recurrence of shivering. Ondansetron seems to be the drug to least affect hemodynamics, with less adverse effects than ketamine in comparison with pethidine.


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