A Comparison between Intravenous Ketamine and Magnesium Sulphate for Prevention of Intraoperative Shivering in Patients Undergoing Spinal Anesthesia
Omar Ahmed Sameh Mahmoud Ghoraba;
Abstract
Shivering is one of the common problems after spinal anesthesia with an incidence of up to 56.7%. Shivering is defined as an involuntary, repetitive activity of skeletal muscles.
The mechanisms of shivering in patients undergoing surgery are mainly intraoperative heat loss, increased sympathetic tone, pain, and systemic release of pyrogens.
Perioperative shivering not only increases the psychological stress response, but also leads to an increase in oxygen consumption (up to 400%)
Additionally, increased production of carbon dioxide results in accumulation of hypoxia and lactic acid in tissue. This then
affects the process of anesthesia and surgery, causing severe consequences for patients with poor cardiopulmonary function reserve.
At present, there are many clinical treatments available for patients to control shivering after spinal anesthesia, including non-pharmacological methods and pharmacological methods. Nonpharmacological methods using equipment to maintain a normal temperature of the body are
effective, but expensive. However, pharmacological methods using drugs, such as ketamine, magnesium sulphate and pethidine, are easier to carry out. Ketamine and magnesium sulphate have been tried among other pharmacological agents to reduce shivering during anesthesia with good results. Ketamine; a competitive NMDA receptor antagonist
has a role in thermoregulation at various levels. NMDA receptor modulates noradrenergic and serotoninergic neurons in locus ceruleus. It is used as an antishivering agent in the dose of 0.5-
0.75mg/kg. Meanwhile trials showed that there is sufficient data to conclude that intravenous magnesium reduces shivering in perioperative patients. The drug not only exerts a central effect, but is also a mild muscle relaxant and may thus simultaneously reduce the gain of shivering (incremental shivering intensity) with progressing hypothermia.
So, the current study was conducted to evaluate and compare the relative efficacy and safety of
low dose ketamine (0.5mg/kg) and magnesium sulphate (30 mg/kg) in prevention of shivering during/post spinal anesthesia.
Methods:
This study is a randomized clinical trial. Conducted in Ain Shams university hospitals. Seventy five American Society of Anesthesiologist physical status II and III patients undergoing diabetic foot debridement surgeries under spinal anesthesia were included.
After intrathecal injection, the patients were randomly divided to one of the 3 groups of 25 each according to the agent; Group K (ketamine) received ketamine 0,5 mg/ kg. diluted in a 100 ml of normal saline and given over 15 minutes, prophylactically.
Group M (Magnesium sulphate) received Magnesium sulphate 30 mg/kg. diluted in a 100 ml of normal saline and given over 15 minutes prophylactically
Group P received a 100 ml bolus of physiological solution given over 15 minutes
Shivering was graded using Grada scale described by Crossley & Mahajan every five minutes
All IV fluids were given at room temperature, patients were adequately warmed and covered with the exception of surgery site, operating room temperature was kept at 22 Celsius.
When shivering of grade II or higher happens, Pethidine (0.5mg/kg) was
given as rescue medication and repeated within 10 minutes for a maximum dose of 1mg/kg.
Vital data and temperature (Via the axilla) will be recorded every five minutes. Side effects i.e. hypotension, nausea and vomiting, sedation and hallucinations were also recorded.
Cumulative doses of pethidine were noted for each patient and group.
Results
Regarding the demographic data (Age, sex, height, weight) there was no statistically significant difference among the three groups. Also the pre operative vital signs and medical history showed no difference that is statistically significant.
Both Ketamine and Magnesium sulphate showed better results in the control of shivering than the control group (p = 0.035).
There was was a statistically significant decrease in the incidence of shivering (grade II or higher) in both K group (12%) and M group (24%) compared to the incidence of 44% in the P group (p-value 0.035). No statistically
The mechanisms of shivering in patients undergoing surgery are mainly intraoperative heat loss, increased sympathetic tone, pain, and systemic release of pyrogens.
Perioperative shivering not only increases the psychological stress response, but also leads to an increase in oxygen consumption (up to 400%)
Additionally, increased production of carbon dioxide results in accumulation of hypoxia and lactic acid in tissue. This then
affects the process of anesthesia and surgery, causing severe consequences for patients with poor cardiopulmonary function reserve.
At present, there are many clinical treatments available for patients to control shivering after spinal anesthesia, including non-pharmacological methods and pharmacological methods. Nonpharmacological methods using equipment to maintain a normal temperature of the body are
effective, but expensive. However, pharmacological methods using drugs, such as ketamine, magnesium sulphate and pethidine, are easier to carry out. Ketamine and magnesium sulphate have been tried among other pharmacological agents to reduce shivering during anesthesia with good results. Ketamine; a competitive NMDA receptor antagonist
has a role in thermoregulation at various levels. NMDA receptor modulates noradrenergic and serotoninergic neurons in locus ceruleus. It is used as an antishivering agent in the dose of 0.5-
0.75mg/kg. Meanwhile trials showed that there is sufficient data to conclude that intravenous magnesium reduces shivering in perioperative patients. The drug not only exerts a central effect, but is also a mild muscle relaxant and may thus simultaneously reduce the gain of shivering (incremental shivering intensity) with progressing hypothermia.
So, the current study was conducted to evaluate and compare the relative efficacy and safety of
low dose ketamine (0.5mg/kg) and magnesium sulphate (30 mg/kg) in prevention of shivering during/post spinal anesthesia.
Methods:
This study is a randomized clinical trial. Conducted in Ain Shams university hospitals. Seventy five American Society of Anesthesiologist physical status II and III patients undergoing diabetic foot debridement surgeries under spinal anesthesia were included.
After intrathecal injection, the patients were randomly divided to one of the 3 groups of 25 each according to the agent; Group K (ketamine) received ketamine 0,5 mg/ kg. diluted in a 100 ml of normal saline and given over 15 minutes, prophylactically.
Group M (Magnesium sulphate) received Magnesium sulphate 30 mg/kg. diluted in a 100 ml of normal saline and given over 15 minutes prophylactically
Group P received a 100 ml bolus of physiological solution given over 15 minutes
Shivering was graded using Grada scale described by Crossley & Mahajan every five minutes
All IV fluids were given at room temperature, patients were adequately warmed and covered with the exception of surgery site, operating room temperature was kept at 22 Celsius.
When shivering of grade II or higher happens, Pethidine (0.5mg/kg) was
given as rescue medication and repeated within 10 minutes for a maximum dose of 1mg/kg.
Vital data and temperature (Via the axilla) will be recorded every five minutes. Side effects i.e. hypotension, nausea and vomiting, sedation and hallucinations were also recorded.
Cumulative doses of pethidine were noted for each patient and group.
Results
Regarding the demographic data (Age, sex, height, weight) there was no statistically significant difference among the three groups. Also the pre operative vital signs and medical history showed no difference that is statistically significant.
Both Ketamine and Magnesium sulphate showed better results in the control of shivering than the control group (p = 0.035).
There was was a statistically significant decrease in the incidence of shivering (grade II or higher) in both K group (12%) and M group (24%) compared to the incidence of 44% in the P group (p-value 0.035). No statistically
Other data
| Title | A Comparison between Intravenous Ketamine and Magnesium Sulphate for Prevention of Intraoperative Shivering in Patients Undergoing Spinal Anesthesia | Other Titles | دراسة مقارنة بين عقاري الكيتامين وسلفات الماغنسيوم عن طريق الوريد للوقاية من الرجفة اثناء التخدير النصفي | Authors | Omar Ahmed Sameh Mahmoud Ghoraba | Issue Date | 2022 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| BB12682.pdf | 480.76 kB | Adobe PDF | View/Open |
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