Comparison of optimal doses of prophylactic dexmedetomidine for preventing post-operative shivering in patients undergoing elective laparoscopic cholecystectomy

Abstract

Introduction: Postoperative shivering is an involuntary, oscillatory muscular activity during early recovery after anaesthesia. Postoperative shivering is a frequent complication of anaesthesia; it has been reported to range from 20 to 70% in general anaesthesia.Shivering is believed to increase oxygen consumption and increase the risk of hypoxemia; it might also increase postoperative complications. dexmedetomidine might provide a simple pharmacological intervention to suppress shivering and improve comfort without producing respiratory compromise in patients.
Methods: The study was conducted in department of anaesthesiology at Pt. B. D. Sharma PGIMS, Rohtak. Total one hundred thirty-two patients of either sex between 18- 60 years of age having physical status of grade I and II according to American Society of Anaesthesiologists (ASA) scheduled for elective laproscopic cholecystectomy under general anaesthesia were included in this study. It was a prospective, randomized and double blinded
study. All the patients were randomly divided into four groups of 33 each.
Group-I(DN)(n=33) Administration of 20 ml of normal saline over 10 min.
Group-II(D0.5)(n=33) Administration of 0.5 mcg kg-1 dexmedetomidine over 10 min.
Group-III(D0.75)(n=33) Administration of 0.75 mcg kg-1dexmedetomidine over 10 min.
Group-IV(D1.0)(n=33) Administration of 1.0 mcg kg-1 dexmedetomidine over 10 min.
Results: After studying various factors, we found from our study that i.v dexmedetomidine in the dose range of 0.5 mcgkg-1 , 0.75 mcgkg-1 and 1.0 mcgkg-1reduces the rise in heart rate, systolic blood pressure, diastolic blood pressure during general anaesthesia. Thus, dexmedetomidine provides better perioperative haemodynamic stability in ASA I and II grade patients during general anaesthesia as dexmedetomidine has sedative, anxiolytic and sympatholytic properties. The decrease in pain and shivering was greater in dexmedetomidine dose 0.75 mcgkg-1 and 1.0 mcgkg-1 than dexmedetomidine dose 0.5 mcgkg-1 and placebo and time of first rescue analgesic was more in dexmedetomidine dose 0.75 mcgkg-1 and 1.0 mcgkg-1 than dexmedetomidine dose 0.5 mcgkg-1 and placebo.
Conclusion: we recommend dexmedetomidinedose 0.75mcgkg-1 as an anaesthetic adjuvant can be used during general anaesthesia as an optimal dose to reduce post operative shivering in patients undergoing laproscopic cholecystectomy, because it significantly attenuates heart rate and blood pressures, it decreases pain and shivering and it facilitates smooth emergence from anaesthesia and the sedation and complication rate of dexmedetomidinedose 0.75mcgkg-1 is lower than other doses.