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Year : 2012  |  Volume : 28  |  Issue : 1  |  Page : 86-91

Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study

Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India

Date of Web Publication31-Jan-2012

Correspondence Address:
Sukhminder Jit Singh Bajwa
Department of Anaesthesiology and Intensive Care, House No-27-A, Ratan Nagar, Tripuri, Patiala, Punjab - 147 001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9185.92452

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Background and Aims: Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been employed to abolish the occurrence of shivering. The present study aims to explore the effectiveness of dexmedetomidine in suppressing the postanesthetic shivering in patients undergoing general anesthesia.
Materials and Methods: The present study was carried out on 80 patients, in American Society of Anesthesiologists I and
II, aged 22-59 years, who underwent general anesthesia for laparoscopic surgical procedures. Patients were allocated randomly into two groups: group N (n = 40) and group D (n = 40). Group D were administered 1 ΅g/kg of dexmedetomidine intravenously, while group N received similar volume of saline during peri-op period. Cardiorespiratory parameters were observed and recorded during the preop, intraop, and postop periods. Any incidence of postop shivering was observed and recorded as per 4 point scale. Side effects were also observed, recorded, and treated symptomatically. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni's correction.
Results: The two groups were comparable regarding demographic profile (P> 0.05). Incidence of shivering in group N was 42.5%, which was statistically highly significant (P = 0.014). Heart rate and mean arterial pressure also showed significant variation clinically and statistically in group D patients during the postop period (P = 0.008 and 0.012). A high incidence of sedation (P = 0.000) and dry mouth (P = 0.000) was observed in group D, whereas the incidence of nausea and vomiting was higher in group N (P = 0.011 and 0.034).
Conclusions: Dexmedetomidine seems to possess antishivering properties and was found to reduce the occurrence of shivering in patients undergoing general anesthesia.

Keywords: Dexmedetomidine, hypothermia, shivering, tramadol

How to cite this article:
Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S S. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. J Anaesthesiol Clin Pharmacol 2012;28:86-91

How to cite this URL:
Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S S. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2022 Sep 30];28:86-91. Available from:

  Introduction Top

Shivering is a protective mechanism by virtue of which heat production occurs, by vigorous involuntary muscle activity, to compensate for the decreased core temperature in a normal healthy living body. At molecular level, the reflex protective mechanism against cold gets kick started on perception of lower temperature by the preoptic nucleus of hypothalamus.­ [1] The neurological mechanism of shivering is mediated by the spinal α-motor neurons and their axons. [2]

Shivering is commonly encountered both after regional and general anesthesia (GA) with a little higher incidence in patients receiving GA. [3] It is distressing and uncomfortable and is perceived by many as equivalent to the postop surgical pain. It can hamper the normal smooth recovery and can be quite detrimental in certain group of patients, e.g., patients with raised intraocular pressure, raised intracranial tension, and with limited cardiorespiratory reserves such as elderly patients. [4],[5] Excessive shivering creates an imbalance between body's oxygen demand and supply ratio. The resultant increased demand, sometimes up to six times than normal, and relative deficit of oxygen supply can lead to various metabolic derangements such as hypoxemia, lactic acidosis, and hypercarbia, thereby hampering a smooth recovery from anesthesia. [3]

Various drugs, techniques, and measures have been used in the past to prevent incidence of shivering but the search for an ideal drug or drug combination is still on. [3],[6],[7] The desired properties for a drug to prevent shivering include easy availability and minimal side effects. Dexmedetomidine seems to have great potential for its usage in anesthesia and intensive care practice. It has been successfully used as adjunct to local anesthetics in neuraxial anesthesia and peripheral nerve blockade, as sedative agent during surgery and in ICU, as well as supplementation of postoperative analgesia. [8],[9],[12] It is also postulated that dexmedetomidine exhibits antishivering effects through its centrally mediated actions. [13],[14] We had tried to find out the effectiveness of dexmedetomidine in prevention of postoperative shivering in patients who underwent GA for laparoscopic surgical procedures.

  Materials and Methods Top

After the approval from the hospital ethics committee, a prospective double blind randomized study was performed in our institute after obtaining a written informed consent from 80 ASA I and II patients of both genders aged 22-59 years. Patient with heart diseases, respiratory insufficiency, diabetes mellitus, psychiatric disorders, neuromuscular disorders, history of convulsions, thyroid disorders, multiple allergies, and patients with preoperative temperature >38 °C or <36.5 °C were excluded from the study.

The patients were randomly allocated by computer coded envelopes into two groups D and N of 40 patients each. Group D patients were administered a diluted solution of 2 ml of normal saline containing 1μg/kg of dexmedetomidine, while group N patients were given a 2 ml of normal saline solution 30 minutes before the anticipated completion of surgery over 10 minutes. The treatment drugs were prepared by an anesthesia technician who was given a written set of instructions and was totally unaware of the study design. All the patients were premedicated with alprazolam 0.25 mg and ranitidine 150 mg orally with a sip of water a night before surgery and 2 hours before the proposed surgical procedure.

In the preop room, all the vitals including axillary temperature were observed and recorded into the performa by a staff nurse. In the operation theatre, all the baseline parameters such as heart rate (HR), electrocardiography (ECG), noninvasive blood pressure (NIBP), pulse oximetry (SpO 2 ), and end tidal carbon dioxide (EtCO 2 ) were recorded and an intravenous (IV) access was secured with an 18G cannula. Anesthetic management was standardized. Anesthesia was induced with propofol (2 mg/kg), fentanyl (1.5 mcg/kg), midazolam (1 mg), and vecuronium (0.1 mg/kg). Endotracheal intubation was achieved with an appropriate-sized endotracheal tube. Axillary temperature was measured again after induction of anesthesia and thereafter every 20 minutes and also just before the administration of study drugs. All the patients were provided adequate covering of the body and operation room temperature was maintained at 24-25°C. Anesthesia was maintained with 60% nitrous oxide in oxygen, isoflurane 1-1.5% and vecuronium bromide 0.03-0.05mg/kg as and when required. Palonosetron was also administered in a dose of 75 μg IV to all patients of both the groups 20-25 minutes before the anticipated completion of the surgical procedure. Neostigmine 2.5 mg and glycopyrrolate 0.5 mg was given to antagonize any residual neuromuscular blockade. Trachea was extubated after establishing the adequate return of protective airway reflexes and rhythmic breathing pattern with adequate tidal volume. All the vital parameters were duly observed and recorded into the performa.

In the recovery room, all the patients were covered with a warm blanket and were administered oxygen @ 3 L/min in a slightly propped-up position. Any episode of shivering, fever, pain, hallucination, dry mouth, postoperative nausea, and vomiting (PONV) and other complications were recorded by a Senior Anesthesia resident. Vital parameters HR, NIBP, ECG, and SpO 2 were recorded at intervals of 5, 10, 20, 30, 45, and 60 minutes and half hourly thereafter for next 2 hours. Patients with any episode of PONV were treated with ondansetron 4 mg IV. Shivering was measured as per 4 point scale and any episode of shivering, of grade ≥2, was treated with IV tramadol in a rescue dose of 25 mg [Table 1]. Sedation was graded as: 0 = no sedation/widely awake/slightly restless, 1 = calm and compose, 2 = opening eyes on verbal command, 3 = opening eyes on gentle shaking, 4 = opening eyes on vigorous shaking, and 5 = unarousable.
Table 1: Grades of shivering

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Statistical analyses were performed using statistical package for social sciences (SPSS) version 15.0 for windows. Mean differences between the two groups regarding age, weight, and height were calculated using analysis of variance (ANOVA). The chi-square test was used to analyze the difference between the gender, ASA class, the number of patients who developed shivering, and the number of patients who had other complications. Value of P< 0.05 was considered as significant and P< 0.01 as highly significant. Post-hoc comparisons were performed using the Bonferroni's correction of the significance levels. Power analysis was carried out and for a detection of difference in the number of shivering patients; a sample size of 34 was calculated to achieve a power of 87% in the chi-square test with a significance level of 0.01 at group proportions of 0.6 and 0.1.

  Results Top

Both the groups were comparable regarding distribution of age, weight, height, gender, ASA grade, duration of anesthesia, and duration of surgery and were nonsignificant on statistical comparison [Table 2]. Patients administered dexmedetomidine had a more stable hemodynamic course during extubation and the recovery period. The pre-op mean HR and MAP were comparable in both the groups and did not reveal any statistical significance (P> 0.05). Postoperatively, however, there was significant difference between the two groups as group D patients had a lower mean HR and MAP as compared to group N patients. HR and NIBP fluctuations were minimal in the group D as compared to group N during the period ranging from extubation to recovery in the postanesthesia care unit (PACU). These clinical parameters revealed a significant difference on statistical analysis [Table 3]. The other vital parameters such as respiratory rate, SpO 2 , EtCO 2 , general consciousness level, and alertness were almost similar in both the groups (P> 0.05). However, sedation scores were observed to be higher in group D patients as 45% of the patients had a sedation score of 2 or higher measured on a subjective scale [Table 5].
Table 2: Demographic characteristics of Group N and Group D

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Table 3: Comparisons of vital parameters in both the groups

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The preoperative axillary temperature in both the groups was very much comparable (36.8°C in group D and 36.9 °C in group N) and not significant during statistical comparison. Perioperatively, no major differences were observed between the two groups on repeated measurement of the temperature. Similarly, the average axillary temperature during the first 30 minutes in the postoperative period was measured to be 36.2 °C in the group N as compared to 36.4 °C in group D [Figure 1]. On statistical comparison, the difference in the axillary temperature between the two groups turned out to be nonsignificant (P> 0.05).
Figure 1: Response rate

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There were 17 patients in the group N who had to be treated with rescue injection of tramadol for control of shivering in PACU as compared to just 2 patients in the D group. The demographic composition of the patients who had suffered from an episode of shivering in group N consisted of 7 females and 10 males with an average age of 36.84 ± 9.28 years and an average weight of 66.8 kg. Out of these 17 patients, 11 suffered grade 2 shivering, 4 reached grade 3, and only 2 had vigorous shivering of grade 4 in the first 1 hour of postoperative period. None of these patients suffered any second attack of shivering after the injection of tramadol during the recovery period. The most striking statistics during recovery period pertained to the absence of any shivering in 95% of the patients who were administered intra-op dexmedetomidine as compared to only 57.5% of the patients in group N (P = 0.002). The comparison of shivering statistics revealed a significant to highly significant difference on comparison between the patients of both the groups. [Table 4]
Table 4: Comparative incidence of grade of shivering in both the groups

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During the corresponding period, the pain scores were comparable on VAS scale and none of the patient in either of the group complained of any major pain episode except for mild discomfort which was very much tolerable. Four patients in the group N had episode of vomiting and a total of 7 patients suffered from nausea including these four as compared to just 1 and 2 patients in group D who suffered from similar episodes of PONV. This comparison was significant on statistical analysis (P< 0.05). Dryness of oral mucosa is an established side effect of α-2 agonists and the incidence was observed in 35% of the patients who were administered dexmedetomidine as compared to only 5% patients in the control group. The statistical comparison of the incidence of dry mouth turned out to be highly significant among the two groups (P = 0.000) [Table 5].
Table 5: Comparison of side effect profile of both the groups

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  Discussion Top

Post-op shivering is as distressing to the patient as is pain and PONV though more stress is laid on the prevention of post-op pain and PONV. Its incidence is estimated to be as high as 50-60% in normal population undergoing GA. [4],[15],[16],[17] The events like post-op shivering are often neglected and no universal protocols are established for its prevention. Though numerous research articles have laid emphasis on various pharmacological methods of prevention of shivering but nothing concrete has been incorporated into routine practice to prevent its occurrence.

The comparability of the demographic factors such as age, weight, height, gender distribution, duration of anesthesia, and surgery in the present study has ruled out any visible or confounding bias which could have affected the results of the study. Physical factors such as operating room temperature (24-25 °C), temperature of the recovery room, and temperature of the infused fluids are considered potential risk factors of shivering, [18] but these factors were very well controlled in the present study.

Thermoregulatory mechanisms get impaired during GA. As a result, hypothermia is one of the commonest complications during GA. [19],[20],[21] Though, shivering is a protective mechanism to preserve body heat but no definite linear relationship exists between body temperature and occurrence of shivering. [22] In the present study, nasopharyngeal temperature corelated well with the axillary temperature after applying a correction factor. A higher incidence of shivering in the control group defies the logic of hypothermia associated shivering as the mean differences of temperature in both the groups was comparable and statistically nonsignificant during the post-op period. These observations suggest that there must be some other factors also influencing the shivering mechanism and not just the presence of hypothermia alone.

Alpha-2 adrenergic agonists are widely used nowadays in clinical practice of anesthesiology and intensive care. Antishivering mechanism of dexmedetomidine has been studied but not adequately. In the present study, we obtained satisfactory results in the prevention of shivering in patients who were administered with dexmedetomidine as only 2 patients out of total 40 suffered an episode of shivering. The α-2 receptor agonists are known to prevent shivering to a moderate extent without any associated respiratory depression as with other antishivering drugs like meperidine.­ [13],[23] Dexmedetomidine reduces shivering by lowering vasoconstriction and shivering thresholds. [13],[24] The findings of the present study provide an indirect support to the fact that antishivering action of dexmedetomidine is mediated by its central α-2 activity. [25] The clinically significant effect at this dose includes mild sedation post-operatively which did not have any apparent effect on the ventilatory drive. [13],[26] The difference in sedation scores between the two groups was statistically significant, but the mild sedation induced by dexmedetomidine did not produce any other clinical side effect.

Alpha-2 adrenergic agonists decrease the central thermo sensitivity by suppressing the neuronal conductance. [27] This is mediated by the increased potassium conductance through Gi-coupled proteins which causes hyper polarization of neurons. [28],[29],[30],[31] Augmentation of neural suppression response is further mediated by restriction of calcium entry into nerve cells which causes inhibition of neurotransmitter release. [31],[32] The increased accumulation of calcium ions on the neuron's surface in the posterior hypothalamus lowers the firing rate of heat gain units by stabilizing the cell membrane. [33]α-2 adrenergic agonists suppress the spontaneous firing rate of neurons in the locus coeruleus and neurotransmitter mediated firing of neurons in the dorsal raphe nucleus when administered intravenously. [34] All these central actions of α-2 agonists are possible due to a high density of α-2 adrenoceptors in the hypothalamus and activation of these receptors produces hypothermia by reduction of heat generated by metabolic activity. [14]

The incidence of shivering was 42.5% (n = 17) in the control group as compared to a merely 5% in the study group. The incidence of shivering in the control group is relatively lower than that of observed incidence in other studies. [4],[15],[16],[35] This may be due to the use of 75 μg of 5HT3 antagonist palonosetron for the prophylaxis of PONV. These 5HT3 antagonists are being regularly used to prevent incidence of PONV in laparoscopic surgeries. [36] They have been used with moderate success in prevention of postoperative shivering as well as they can influence both metabolic heat production and heat loss pathways. [4],[18],[37]

The occurrence of dry mouth is an established fact with α-2 adrenergic agonist and the incidence of 35% was observed in the present study. Patients had to be administered 5-10 ml of distilled water to wet the lips to overcome this discomforting side effect. Till date, there is no prophylactic treatment to counter this side effect as far as our knowledge is concerned.

Pethidine is considered the most effective antishivering drug in a dose of 25 mg. [38],[39] We however, preferred tramadol in a dose of 25 mg as rescue drug to control post-op shivering as the latter is not associated with respiratory depression. [40],[41] Tramadol exerts its antishivering mechanism by inhibiting the reuptake of 5HT, nor-epinephrine, and dopamine and at the same time facilitating the release of 5HT. [42],[43],[44]

Limitations of the present study include the short duration of surgery as the mean duration of surgical period was calculated to be approximately 1 hour in both the groups. The antishivering effect of dexmedetomidine needs to be seen in surgeries of longer duration where chances of developing hypothermia are more. We did not measure tympanic membrane temperature to measure the core temperature but applied a correction factor to the measured axillary temperature.

We conclude that dexmedetomidine seems to possess anti-shivering properties in a dose of 1 μg/kg. Though few of the side effects such as sedation and dry mouth with dexmedetomidine are discomforting to the patient but they did not have any major clinical impact on the overall recovery from anesthesia.

  References Top

1.Giesbrecht GG, Sessler DI, Mekjavic IB, Schroeder M, Bristow GW. Treatment of immersion hypothermia by direct body-to-body contact. J Appl Physiol 1994;76:2373-9.  Back to cited text no. 1
2.Henneman E. Organization of the motoneuron pool: The size principle, Medical Physiology. 14 th ed. Mountcastle VB, editor. St. Louis: CV Mosby; 1980. p. 718-41.  Back to cited text no. 2
3.Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharma­cological treatment of postoperative shivering a quan­titative systemic review of randomized controlled trials. Anesth Analg 2002;94:453-60.  Back to cited text no. 3
4.Powell R, Buggy D. Ondansetron given before induc­tion of anesthesia reduces shivering after general anes­thesia. Anesth Analg 2000;90:1413-7.  Back to cited text no. 4
5.Ciofolo MJ, Clergue F, Devilliers C, Ben Ammar M, Viars P. Changes in ven­tilation, oxygen uptake and carbon dioxide output dur­ing recovery from isoflurane anesthesia. Anesthesiol­ogy 1989;70:737-41.  Back to cited text no. 5
6.Piper SN, Maleck WH, Boldt J, suttner SW, Schmidt CC, Reich DG. A comparison of clonidine, meperidine and placebo in preventing postanesthetic shivering. Anesth Analg 2000;90:954-7.   Back to cited text no. 6
7.Alfonsi P. Postanesthetic shivering epidemiology, patho­physiology and approaches to prevention and manage­ment. Drugs 2001;61:2193-205.  Back to cited text no. 7
8.Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth 2011;55:116-21.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Linde H e Mo. The clinical use of dexmedetomidine. Rev Bras Anestesiol 2004;54:1-4.  Back to cited text no. 9
10.Ribeiro RN, Nascimento JP. The use of dexmedetomidine in anesthesiology. Rev Bras Anestesiol 2003;53:97-113.  Back to cited text no. 10
11.Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnesic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705.  Back to cited text no. 11
12.Kamibayashi T, Maze M. Clinical uses of alpha-2 adrenergic agonists. Anaesthesiology 2000;93:1345-9.  Back to cited text no. 12
13.Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology 1997; 87:835-41.  Back to cited text no. 13
14.Quan N, Xin L, Ungar AL, Blatteis CM. Preoptic norepinephrine-induced hypothermia is mediated by α2-adrenoceptors. Am J Physiol 1992;262:R407-11.  Back to cited text no. 14
15.Buggy D, Higgens P, Moran C, O'Donovan F, Mc Carroll M. Clonidine at induction reduces shivering after gen­eral anesthesia. Can J Anaesth 1997;44:263-7.  Back to cited text no. 15
16.Piper SN, Rohm KD, Suttner SW, Maleck WH, Kranke P, Boldt J. A comparison of nefopam and clonidine for the prevention of postanesthetic shivering: A comparative, double blind and placebo controlled dose ranging study. Anaesthesia 2004;59:559-64.  Back to cited text no. 16
17.Kranke P, Eberhart LH, Roewer N, Tramer MR. Single dose parenteral pharmacological interventions for the prevention of postoperative shivering: A quantitative systematic review of randomized controlled trials. Anesth Analg 2004;99:718-27.  Back to cited text no. 17
18.Witte JD, Sessler DI. Perioperative shivering physi­ology and pharmacology. Anesthesiology 2002;96:467-84.  Back to cited text no. 18
19.Katyal S, Tewari A. Shivering: Anesthetic Considerations. J Anaesth Clin Pharmacol 2002; 18(4): 363-76.  Back to cited text no. 19
20.Sessler DI. Temperature Monitoring. Textbook of Anaesthesia. Miller RD, editor. 5 th ed. Philadelphia: Churchill Livingstone Inc.; 1994. p. 1367-89.  Back to cited text no. 20
21.Mathews S, Al Mulla A, Varghese PK, Radim K, Mumtaz S. Postanaesthetic shivering-a new look at Tramadol. Anaesthesia 2002;57:387-403.  Back to cited text no. 21
22.Vanderstappen I, Vanermeerch E, Vanacker B, Mattheussen M, Herijgers P, Van Aken H. The effect of prophylactic clonidine on postoperative shivering: A large prospective double-blind study. Anaesthesia 1996;51:351-5.  Back to cited text no. 22
23.Kurz A, Ikeda T, Sessler DI, Larson M, Bjorksten AR, Dechert M, et al. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology 1997;86:1046-54.  Back to cited text no. 23
24.Takada K, Clark DJ, Davies MF, Tonner PH, Krause TK, Bertaccini E, et al. Meperidine exerts agonist activity at the a 2B -adrenoceptor subtype. Anesthesiology 2002;96:1420-6.  Back to cited text no. 24
25.Mokhtarani M, Mahgoub AN, Morioka N, Doufas AG, Sessler DI. Buspirone and meperidine synergistically reduce the shivering threshold. Anesth Analg 2001;93:1233-9.  Back to cited text no. 25
26.Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000;93:382-94.  Back to cited text no. 26
27.Boulant JA. The effect of firing rate on preoptic neuronal thermosensitivity. J Physiol 1974;240:661-9.  Back to cited text no. 27
28.Maze M, Tranquilli W. Alpha-2 adrenoceptor agonists: Defining the role in clinical anesthesia. Anesthesiology 1991;74:581-605.  Back to cited text no. 28
29.Surprenant A, North RA. Mechanism of synaptic inhibition by noradrenaline acting at α2-adrenoceptors. Proc R Soc Biol 1988;234:85-114.  Back to cited text no. 29
30.Evans RJ, Surprenant A. Effects of phospholipase A2 inhibitors on coupling of α2-adrenoceptors to inwardly rectifying potassium currents in guinea pig submucosal neurones. Br J Pharmacol 1993;10:591-6.  Back to cited text no. 30
31.Maze M. Clinical uses of alpha-2 agonists, 46 th Annual Refresher Course Lectures. Atlanta: American Society of Anesthesiologists; 1995. p. 125.  Back to cited text no. 31
32.Lipscombe D, Kongsamut S, Tsien RW. α-adrenergic inhibition of sympathetic neurotransmitter release mediated by modulation of N-type calcium-channel gating. Nature 1989;340:639-42.  Back to cited text no. 32
33.Myers RD, Simpson CW, Higgins D, Nattermann RA, Rice JC, Redgrave P, et al. Hypothalamic Na+ and Ca++ ions and temperature set-point: New mechanisms of action of a central or peripheral thermal challenge and intrahypothalamic 5-HT, NE, PGE1, and pyrogen. Brain Res Bull 1976;1:301-27.  Back to cited text no. 33
34.Alojado ME, Ohta Y, Kemmotsu O. The effect of clonidine on the activity of neurons in the rat dorsal raphe nucleus in vitro. Anesth Analg 1994;79:257-60.  Back to cited text no. 34
35.De Witte J, Sessler DI. Perioperative shivering: Physiology and Pharmacology. Anaesthesiology 2002;96:467-84.  Back to cited text no. 35
36.Bajwa SS, Bajwa SK, Kaur J, Sharma V, Singh A, Singh A, et al. Palonosetron: A novel approach to control postoperative nausea and vomiting in day care surgery. Saudi J Anaesth 2011;5:19-24.  Back to cited text no. 36
[PUBMED]  Medknow Journal  
37.Bock M, Sinner B, Gottlicher M, Simon E, Martin E, Motsch J. Involvement of serotonergic pathways in pos­tanesthetic cold defence: Dolasetron prevents shiver­ing. J Thermal Biol 2002;27:159-66.  Back to cited text no. 37
38.Wrench IJ, Cavill G, Ward JE, Crossley AW. Com­parison between alfentanil, pethidine and placebo in the treatment of postanesthetic shivering. Br J Anaesth 1997;79:541-2.  Back to cited text no. 38
39.Terasako K, Yamamoto M. Comparison between pentazo­cine, pethidine and placebo in the treatment of postanes­thetic shivering. Acta Anaesthesiol Scand 2000;44:311-2.  Back to cited text no. 39
40.De Witte J, Deloof T, De Veylder J, Housemans PR. Tramadol is the treatment of postanaesthetic shivering. Acta Anaesthesiol Scandinavica 1997;41:506-10.  Back to cited text no. 40
41.Saha E, Ray M, Mukherjee G. Effect of tramadol in prevention of postanaesthetic shivering following general anaesthesia for cholecystectomy. Indian J Anaesth 2005;49:208-12.  Back to cited text no. 41
  Medknow Journal  
42.Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an "atypical" opioid analgesic. J Pharmacol Exp Ther 1992;260:275-85.  Back to cited text no. 42
43.Frink MC, Hennies HH, Englberger W, Haurand M, Wilffert B. Influence of tramadol on neurotransmitter systems of the rat brain. Arzneimittelforschung 1996;46:1029-36.  Back to cited text no. 43
44.De Witte JL, Kim JS, Sessler DI, Bastanmehr H, Bjorksten AR. Tramadol reduces the shivering, vasoconstriction, and sweating thresholds. Anesth Analg 1998;87:173-9.  Back to cited text no. 44


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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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10 Magnesium sulfate intravenous infusion versus intrathecal injection for prevention of post-spinal shivering during lower limb fracture surgery: a randomized controlled study
Sherif Abdullah Mohamed,Nevan Mohamed El Mekawy,Raed Mohamed Abdelfattah,Ahmed Ibrahim Abdelkhalik Elsonbaty,Mohamed Ibrahim Abdelkhalik Elsonbaty
Ain-Shams Journal of Anesthesiology. 2021; 13(1)
[Pubmed] | [DOI]
11 The Effect of Early Sedation With Dexmedetomidine on Body Temperature in Critically Ill Patients
Kim E. Grayson, Michael Bailey, Mayurathan Balachandran, Piyusha P. Banneheke, Alessandro Belletti, Rinaldo Bellomo, Thummaporn Naorungroj, Ary Serpa-Neto, Jason D. Wright, Fumitaka Yanase, Paul J. Young, Yahya Shehabi
Critical Care Medicine. 2021; Publish Ah
[Pubmed] | [DOI]
12 CONSORT the effect of a bolus dose of dexmedetomidine on postoperative pain, agitation, and quality of recovery after laparoscopic cholecystectomy
Jung Ju Choi,Kyungmi Kim,Hee Yeon Park,Young Jin Chang,Kyung Cheon Lee,Kwan Yeong Kim,Hyun Jeong Kwak
Medicine. 2021; 100(3): e24353
[Pubmed] | [DOI]
13 Effect of 5-µg Dose of Dexmedetomidine in Combination With Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis
Shuyan Liu,Peng Zhao,Yunfeng Cui,Chang Lu,Mingxin Ji,Wenhua Liu,Wei Jiang,Zhuo Zhu,Qianchuang Sun
Clinical Therapeutics. 2020;
[Pubmed] | [DOI]
14 Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials
Jinguo Wang,Zaitang Wang,Junyan Liu,Na Wang
BMC Anesthesiology. 2020; 20(1)
[Pubmed] | [DOI]
15 A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section
Mohamed Abdul Mohsen Abdul Naiem Ismaiel,Omar Mohamed Taha El Safty,Ashraf El Sayed El-Agamy,Omar Mohamed Zafer Mohamed,Mohamed Mourad Mohsen Mohamed Ali
Ain-Shams Journal of Anesthesiology. 2020; 12(1)
[Pubmed] | [DOI]
16 5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials
Qi-Hong Shen,Hui-Fang Li,Xuyan Zhou,Yaping Lu,Xiao-Zong Yuan
BMJ Open. 2020; 10(10): e038293
[Pubmed] | [DOI]

A Comparison of Dexmedetomidine and Midazolam for the Prevention of Postoperative Nausea and Vomiting Caused by Hemabate in Cesarean Delivery: A Randomized Controlled Trial

Bailong Hu,Haiyan Zhou,Xiaohua Zou,Jing Shi,Xingyu Li,Li Tan
Drug Design, Development and Therapy. 2020; Volume 14: 2127
[Pubmed] | [DOI]
K.K. Arora,Neetu Gupta,Nidhi Sharma
[Pubmed] | [DOI]
19 Comparing the efficacy of two warming methods on physiological indices of patients undergoing laparoscopic cholecystectomy
Fereshteh Baradaranfard,Ahmad Ghadami,Mitra Jabalameli,Akram Aarabi
Koomesh Journal. 2020; 22(1): 50
[Pubmed] | [DOI]
20 Retrograd Intrarenal Cerrahi Esnasinda Olusan Vücut Sicaklik Degisikliklerini Etkileyen Faktörler
Yeni Üroloji Dergisi. 2020;
[Pubmed] | [DOI]
21 Comparison of dexmedetomidine and benzodiazepine for intraoperative sedation in elderly patients: a randomized clinical trial
João Manoel Silva-Jr,Henrique T Katayama,Fernando A M Nogueira,Tatiane B Moura,Thiago L Alves,Barbara W de Oliveira
Regional Anesthesia & Pain Medicine. 2019; 44(3): 319
[Pubmed] | [DOI]
22 The comparison of dexmedetomidine and midazolam premedication on postoperative anxiety in children for hernia repair surgery: A randomized controlled trial
Zhen Du,Xi-Ying Zhang,Shuang-Quan Qu,Zong-Bing Song,Si-Wei Wei,Zhen Xiang,Qu-Lian Guo,Joseph Cravero
Pediatric Anesthesia. 2019;
[Pubmed] | [DOI]
23 Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis
Xin Liu,Xiongjie Zhang,Xujian Wang,Jinyan Wang,Hao Wang
Journal of International Medical Research. 2019; 47(7): 2785
[Pubmed] | [DOI]
24 Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT)
Heba Omar,Wessam Adel Aboella,Mohammed Mahmoud Hassan,Amany Hassan,Passaint Hassan,Ahmed Elshall,Dalia Khaled,Maha Mostafa,Pierre Zarif Tawadros,Mona Hossam Eldin,Mai Wedad,Bassant Mohamed Abdelhamid
BMC Anesthesiology. 2019; 19(1)
[Pubmed] | [DOI]
25 Perioperative adverse events attributed to a2-adrenoceptor agonists in patients not at risk of cardiovascular events: systematic review and meta-analysis
Migena Demiri,Tiago Antunes,Dominique Fletcher,Valeria Martinez
British Journal of Anaesthesia. 2019;
[Pubmed] | [DOI]
26 Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery
Dallas Duncan,Ashwin Sankar,W Scott Beattie,Duminda N Wijeysundera
Cochrane Database of Systematic Reviews. 2018;
[Pubmed] | [DOI]
27 Prophylactic Granisetron for post-spinal anesthesia shivering in Caesarean Section: a randomized controlled clinical study
H. S. Abdel-Ghaffar,S. M. Moeen
Acta Anaesthesiologica Scandinavica. 2018;
[Pubmed] | [DOI]
28 Comparative study between Dexmedetomidine and Ondansteron for prevention of post spinal shivering. A randomized controlled trial
Joseph Makram Botros,Atef Mohamed Sayed Mahmoud,Safaa Gaber Ragab,Mohammed Awad Alsaeid Ahmed,Hany Maher Salib Roushdy,Hany Mahmoud Yassin,Maged Labib Bolus,Abeer Shaban Goda
BMC Anesthesiology. 2018; 18(1)
[Pubmed] | [DOI]
29 The Effect of Dexmedetomidine Prescription on Shivering during Operation in the Spinal Anesthesia Procedures of Selective Orthopedic Surgery of the Lower Limb in Addicted Patients
Mahshid Ghasemi,Faranak Behnaz,Habibollah Hajian
Anesthesiology and Pain Medicine. 2018; In Press(In Press)
[Pubmed] | [DOI]
30 Antishivering Effect of Dexmedetomidine on Patients Undergoing Video-Assisted Thoracoscopic Wedge Resection
Youn Yi Jo,Kyung Cheon Lee,Hee Yeon Park,Ju Ho Kim,Ji Yeon Lee
Iranian Red Crescent Medical Journal. 2018; In Press(In Press)
[Pubmed] | [DOI]
31 The influence of dexmedetomidine on remifentanil-induced hyperalgesia and the sex differences
Haidi Qiu,Zhe Sun,Fathima Shadhiya,Renuka Arulthas,Gita Priya,Pariyatha Christopher,Zulaihat Muhammad,Yonghao Yu
Experimental and Therapeutic Medicine. 2018;
[Pubmed] | [DOI]
32 Dexmedetomidine-Associated Hyperthermia: A Retrospective Cohort Study of Intensive Care Unit Admissions between 2009 and 2016
K. E. D. Grayson,A. E. Tobin,D. T. K. Lim,D. E. Reid,M. Ghani
Anaesthesia and Intensive Care. 2017; 45(6): 727
[Pubmed] | [DOI]
33 Dexmedetomidine prevent postoperative nausea and vomiting on patients during general anesthesia
Shenhui Jin,Dong Dong Liang,Chengyu Chen,Minyuan Zhang,Junlu Wang
Medicine. 2017; 96(1): e5770
[Pubmed] | [DOI]
34 Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia
Liang He,Jun-Mei Xu,Su-Mei Liu,Zhi-Jun Chen,Xin Li,Rong Zhu
Biological & Pharmaceutical Bulletin. 2017; 40(2): 169
[Pubmed] | [DOI]
35 Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials
Jian Zhang,Xuena Zhang,Hui Wang,Haibin Zhou,Tian Tian,Anshi Wu,JianJun Yang
PLOS ONE. 2017; 12(8): e0183154
[Pubmed] | [DOI]
Swati Singh,Vinod Kumar Verma,Chandrakant Prasad,Jay Prakash
Journal of Evolution of Medical and Dental Sciences. 2016; 5(13): 572
[Pubmed] | [DOI]
37 Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery
Guoqi Wang,Licheng Zhang,Shenghan Lou,Yuxiang Chen,Yanxiang Cao,Ruirui Wang,Lihai Zhang,Peifu Tang
Medicine. 2016; 95(10): e2927
[Pubmed] | [DOI]
38 Protective effects of dexmedetomidine combined with flurbiprofen axetil on remifentanil-induced hyperalgesia: A randomized controlled trial
Zenggui Yu,Weilan Wu,Xiaodan Wu,Hongyi Lei,Cansheng Gong,Shiyuan Xu
Experimental and Therapeutic Medicine. 2016; 12(4): 2622
[Pubmed] | [DOI]
39 Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation
SukhminderJit Singh Bajwa, Jasleen Kaur, Ashish Kulshrestha, Rudrashish Haldar, Rakesh Sethi, Amarjit Singh
Journal of Anaesthesiology Clinical Pharmacology. 2016; 32(2): 192
[Pubmed] | [DOI]
40 Dexmedetomidine versus midazolam as adjuvants to intrathecal bupivacaine: A clinical comparison
Usha Shukla, Tallamraju Prabhakar, Kiran Malhotra, Dheeraj Srivastava
Journal of Anaesthesiology Clinical Pharmacology. 2016; 32(2): 214
[Pubmed] | [DOI]
41 Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report
Bill W. S. Kim,Robert M. Peskin
Anesthesia Progress. 2015; 62(1): 25
[Pubmed] | [DOI]
Priti Kolarkar,Gunjan Badwaik,Ajay Watve,Kumar Abhishek,Nupur Bhangale,Amol Bhalerao,Gopalji Gupta,Anurag Giri
Journal of Evidence Based Medicine and Healthcare. 2015; 2(9): 1235
[Pubmed] | [DOI]
43 Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: A randomized controlled trial
Hazem El Sayed Moawad,Mohamed M. Elawdy
Egyptian Journal of Anaesthesia. 2015;
[Pubmed] | [DOI]
44 Dexmedetomidine versus Nefopam for the management of post-spinal anesthesia shivering: A randomized double-blind controlled study
Hatem Saber Mohamed
Egyptian Journal of Anaesthesia. 2015; 31(4): 315
[Pubmed] | [DOI]
45 Pharmacological Management of Perioperative Shivering
Julie Golembiewski
Journal of PeriAnesthesia Nursing. 2015; 30(4): 357
[Pubmed] | [DOI]
46 Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia
Sharon R Lewis,Amanda Nicholson,Andrew F Smith,Phil Alderson
Cochrane Database of Systematic Reviews. 2015;
[Pubmed] | [DOI]
47 Effectiveness of dexmedetomidine use in general anesthesia to prevent postoperative shivering: a systematic review
Jeffrey Hoffman,Casi Hamner
JBI Database of Systematic Reviews and Implementation Reports. 2015; 13(12): 287
[Pubmed] | [DOI]
48 A prospective randomized double-blind study on the effects of the temperature of irrigation solutions on thermoregulation and postoperative complications in percutaneous nephrolithotomy
Zeki Tuncel Tekgul,Sinan Pektas,Umit Yildirim,Yücel Karaman,Meltem Cakmak,Huseyin Ozkarakas,Mustafa Gonullu
Journal of Anesthesia. 2014;
[Pubmed] | [DOI]
49 Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering
Geeta Mittal, Kanchan Gupta, Sunil Katyal, Sandeep Kaushal
Indian Journal of Anaesthesia. 2014; 58(3): 257
[Pubmed] | [DOI]
50 A comparative evaluation of epidural and general anaesthetic technique for renal surgeries: A randomised prospective study
SukhminderJit Singh Bajwa, Jasleen Kaur, Amarjit Singh
Indian Journal of Anaesthesia. 2014; 58(4): 410
[Pubmed] | [DOI]
51 Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia
Cheol Lee,Yeon-Dong Kim,Ji-Na Kim
Korean Journal of Anesthesiology. 2013; 64(4): 301
[Pubmed] | [DOI]
52 Author's reply
Sukhminder JitSingh Bajwa, Jasbir Kaur
Indian Journal of Anaesthesia. 2013; 57(1): 93
[Pubmed] | [DOI]
53 Anaesthesia considerations and implications during oncologic and non-oncologic surgery in cancer patients
Sukhminder Jit Singh Bajwa,Ashish Kulshrestha
Apollo Medicine. 2013;
[Pubmed] | [DOI]
54 Use of dexmedetomidine in patients undergoing esophagoscopy
Zhou, W.-S. and Liu, D.-G.
World Chinese Journal of Digestology. 2013; 21(18): 1750-1754
55 Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia
Lee, C. and Kim, Y.-D. and Kim, J.-N.
Korean Journal of Anesthesiology. 2013; 64(4): 301-307
56 Novamin infusion: a new method to cure postoperative shivering with hypothermia
PeiWen Zhou,ShengJin Ge,YaDi Wang,WanXia Xiong,TingTing Wang,ZhangGang Xue
Journal of Surgical Research. 2013;
[Pubmed] | [DOI]
57 Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo
E. Celis-Rodríguez,C. Birchenall,M.Á. de la Cal,G. Castorena Arellano,A. Hernández,D. Ceraso,J.C. Díaz Cortés,C. Dueñas Castell,E.J. Jimenez,J.C. Meza,T. Muñoz Martínez,J.O. Sosa García,C. Pacheco Tovar,F. Pálizas,J.M. Pardo Oviedo,D-I. Pinilla,F. Raffán-Sanabria,N. Raimondi,C. Righy Shinotsuka,M. Suárez,S. Ugarte,S. Rubiano
Medicina Intensiva. 2013; 37(8): 519
[Pubmed] | [DOI]
58 Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients
E. Celis-Rodríguez,C. Birchenall,M.Á. de la Cal,G. Castorena Arellano,A. Hernández,D. Ceraso,J.C. Díaz Cortés,C. Dueñas Castell,E.J. Jimenez,J.C. Meza,T. Muñoz Martínez,J.O. Sosa García,C. Pacheco Tovar,F. Pálizas,J.M. Pardo Oviedo,D.-I. Pinilla,F. Raffán-Sanabria,N. Raimondi,C. Righy Shinotsuka,M. Suárez,S. Ugarte,S. Rubiano
Medicina Intensiva (English Edition). 2013; 37(8): 519
[Pubmed] | [DOI]
59 Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine
Bajwa, S.J.S. and Kaur, J. and Singh, A. and Parmar, S.S. and Singh, G. and Kulshrestha, A. and Gupta, S. and Sharma, V. and Panda, A.
Indian Journal of Anaesthesia. 2012; 56(2): 123-128
60 Anaesthesia considerations and challenges during renal transplantation: Current perspectives
Sukhminder Jit Singh Bajwa,Ashish Kulshrestha
Apollo Medicine. 2012; 9(2): 126
[Pubmed] | [DOI]
61 Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine
Sukhminder JitSingh Bajwa, Jasbir Kaur, Amarjit Singh, SS Parmar, Gurpreet Singh, Ashish Kulshrestha, Sachin Gupta, Veenita Sharma, Aparajita Panda
Indian Journal of Anaesthesia. 2012; 56(2): 123
[Pubmed] | [DOI]


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