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Intravenous dexmedetomidine for the treatment of shivering during cesarean delivery under neuraxial anesthesia : a randomized placebo-controlled trial.
Abstract Number: SA-25
Abstract Type: Original Research
Trial design: Monocentric, randomized, prospective, double-blind, placebo-controlled, parallel-group study.
Background: Neuraxial anesthesia is the preferred technique for cesarean delivery. In about 55% of these patients, spinal or epidural anesthesia may be associated with shivering which may be very distressing (1) and interfere with the monitoring of vital signs. Recent studies have shown that dexmedetomidine could help to alleviate shivering associated with neuraxial anesthesia (2).
Objective: To test whether dexmedetomidine, an alpha 2-adrenergic agonist, reduces the duration of shivering episodes associated with neuraxial anesthesia during cesarean delivery.
Methods: Eighty healthy parturients, 18 years of age or more, undergoing cesarean delivery under neuraxial anesthesia at the CHU Sainte-Justine were enlisted in this prospective, randomized, double-blind trial. We obtained the approval of Health Canada to use dexmedetomidine for this application. After childbirth, when shivering occurred, the intervention group (n = 40) received a single intravenous bolus of dexmedetomidine (30 mcg) while the control group (n = 40) received a single intravenous bolus of normal saline. Randomization and allocation were based on a computer generated list. The primary outcome measure was the time lapse for an observable decrease in shivering after the intervention.
Findings: A preliminary analysis was performed after 7 months. 201 patients undergoing a cesarean section under neuraxial anesthesia were recruited, of whom 70 presented shivering and were randomized. Our study shows that dexmedetomidine reduces the duration of shivering: mean time to decrease chills after the bolus is 2.3 minutes (CI 95% 1.7-3.0min) with dexmedetomidine, and 20.3 minutes (CI 95% 16.2- 24.5min) with saline. At 5 minutes, chills had stopped in 77% of the patients in the intervention group versus 11% in the control group. Chills significantly decreased at 5, 10 and 15 minutes after the administration of a 30 mcg IV bolus of dexmedetomidine. No adverse effects, including bradycardia, have been observed. In cases where slower heart rates were noticed, no medical intervention was needed.
Conclusions: This study demonstrates that an intravenous bolus of dexmedetomidine is an effective treatment to decrease the duration of shivering during cesarean delivery under neuraxial anesthesia. More patients are needed to fully assess safety.
(1) Crowley, L. J., & Buggy, D. J. (2008). Shivering and neuraxial anesthesia. Regional Anesthesia and Pain Medicine, 33(3), 241–252.
(2) Mittal, G., Gupta, K., Katyal, S., & Kaushal, S. (2014). Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering. Indian Journal of Anaesthesia, 58(3), 257–262.