Prophylactic ondansetron eight milligrams versus four milligrams against post spinal anaesthesia shivering

Authors

  • Ajay Kumar Department of Anaesthesiology and Critical Care, Military Hospital Dehradun, Uttarakhand, India
  • Anuj Singh Departmentt of Anaesthesiology and Critical Care, Military Hospital Jaipur, Rajasthan, India
  • Shamabhu P. Sharma Departmentt of Anaesthesiology and Critical Care, Military Hospital Jaipur, Rajasthan, India
  • Amitava Dutta Department of Public Health, Indian Level II Hospital, South Sudan
  • Amit Kumar Sharma Deptartment of Pharmacology VMMC and SJH, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20211825

Keywords:

Spinal Anesthesia, Shivering, Dysrhythmias

Abstract

Background: Shivering is one of the commonly encountered adverse affect after spinal anaesthesia. Shivering can be very discomforting to the patient and hampers operative maneuvering. Pharmacological therapies have been studied for control and management of shivering. One such drug is ondansetron, a 5-HT3 antagonist. Aim of current study is to evaluate the efficacy of prophylactic administration of ondansetron 8 mg vs. 4 mg for prevention of shivering.

Methods: A prospective, randomized, and double blind study was conducted on 100 patients, from either gender, aged 20-60 years, of the American society of anesthesiologists grade I or II, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 50 each to receive either ondansetron 8 mg (group E) or ondansetron 4 mg, (group F) as slow intravenous infusion prior to spinal anesthesia. The primary end point were intraoperative shivering and secondary outcomes included hypotension, adverse reaction, cardiac dysrhythmia’s.

Results: A total of 10 patients in group E (20%) and 20 (40%) patients in group F experienced shivering (p=0.029). Incidence of nausea was similar in both groups, total of 8 (16%) patients in group E and 5 (10%) in group B had hypotension (p=0.27). 1 (2%) patient in group E experienced bradycardia.

Conclusions: Prophylactic administration of ondansetron 8 mg has better efficacy in prevention of spinal anaesthesia induced shivering with minimal side effects as compared to 4 mg dosage.

References

Alfonsi P. Postanaesthetic shivering: epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesio.l 2003;69:438-42.

Kurz A. Physiology of thermoregulation. Best Pract Res Clin Anaesthesiol. 2008;22:627-44.

Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26:465-9.

Sajedi P, Yaraghi A, Moseli HA. Efficacy of granisetron in preventing postanesthetic shivering. Acta Anaesthesiol Taiwan. 2008;46:166-70.

Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anest Pain Med. 2008;33:241-52.

Glosten B, Hynson J, Sessler DI, McGuire J. Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg. 1993;77:488-93.

Ponte J, Collett BJ, Walmsley A. Anaesthetic temperature and shivering in epidural anaesthesia. Acta Anaesthesiol Scand. 1986;30:584-7.

Shehabi Y, Gatt S, Buckman T, Isert P. Effect of adrenaline, fentanyl and warming of injectate on shivering following extradural analgesia in labour. Anaesth Intensive Care. 1990;18:31-7.

Kranke P, Eberhart LH, Roewer N, Tramer MR: Postoperative shivering in children: a review on pharmacologic prevention and treatment. Paediatr Drugs. 2003;5:373-83.

Dawson NJ, Malcolm JL. Initiation and inhibition of shivering in the rat: interaction between peripheral and central factors. Clin Exp Pharmaco Physiol. 1982;9:89-93.

Feldberg W, Myers RD. A new concept of temperature regulation by amines in the hypothalamus. Nature. 1963;200:1325.

Abdollahi MH, Forouzannia SK, Bagherinasab M, Barzegar K, Fekri A, Sarebanhassanabadi M, et al. The effect of ondansetron and meperedin on preventing shivering after off-pump coronary artery bypass graft. Acta Med Iran. 2012;50:395-8.

Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study. Int J Obstet Anesth. 2012;21(1):24-8.

Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology. 2003;98(5): 1250-60.

Martinek RM. Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report. Can J Anaesth. 2004;51(3):226-30.

Veeser M, Hofmann T, Roth R, Klöhr S, Rossaint R, Heesen M. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012;56(7):810-6.

Powell RM, Buggy DJ. Ondansetron given before induction ofanesthesia reduces shivering after general anesthesia. Anesth Analg. 2000;90:1423-7

Shah SA, Nallam SR, Cherukuru K, Sateesh G. Efficacy of Intravenous Ondansetron for Prevention of Postspinal Shivering during Lower Segment Cesarean Section: A Double-Blinded Randomized Trial. Anesth Essays Res. 2010;5(9):87-92.

Marashi SM, Soltani-Omid S, Soltani Mohammadi S, Aghajani Y, Movafegh A. Comparing Two Different Doses of Intravenous Ondansetron With Placebo on Attenuation of Spinal-induced Hypotension and Shivering. Anesth Pain Med. 2014;4(2):e12055.

Downloads

Published

2021-04-28

Issue

Section

Original Research Articles