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Intravenous dexmedetomidine for the treatment of shivering during Cesarean delivery under neuraxial anesthesia: a randomized-controlled trial

  • Christina LamontagneEmail author
  • Sandra Lesage
  • Edith Villeneuve
  • Elsa Lidzborski
  • Alex Derstenfeld
  • Chantal Crochetière
Reports of Original Investigations
  • 83 Downloads

Abstract

Purpose

About 55% of patients undergoing a Cesarean delivery under spinal or epidural anesthesia will experience shivering, which may interfere with the monitoring of vital signs. Recent studies have shown that dexmedetomidine could potentially help to alleviate shivering associated with anesthesia. We investigated whether dexmedetomidine, an alpha 2-adrenergic agonist, reduces the duration of shivering associated with neuraxial anesthesia during Cesarean delivery.

Methods

Eighty parturients undergoing Cesarean delivery under neuraxial anesthesia and experiencing shivering were enlisted in this prospective, randomized, double-blind trial. After childbirth, the intervention group (n = 40) received a single intravenous bolus of dexmedetomidine (30 µg) while the control group (n = 40) received saline. Randomization and allocation were based on a computer-generated list. The primary outcome measure was the time required for an observable decrease in shivering after the intervention.

Results

One hundred fifty-five patients were recruited, 80 of whom presented with shivering and were randomized. Our study showed that dexmedetomidine reduced the mean (standard deviation) duration of shivering after a single intravenous bolus to 2.6 (2.1) min after dexmedetomidine from 17.9 (12.6) min after saline (difference in means, -15.3 min; 95% confidence interval [CI], -11.2 to -19.4). The effect of dexmedetomidine persisted 15 min after the bolus was administered, as shivering had completely stopped in 90% of the patients in the intervention group vs 22.5% in the control group (relative risk, 4.0; 95% CI, 2.2 to 7.2). No adverse effects, including bradycardia, were observed.

Conclusion

A single intravenous bolus of dexmedetomidine decreased the duration of shivering for up to 15 min during Cesarean delivery under neuraxial anesthesia.

Trial registration

www.clinicaltrials.gov (NCT02384343); registered 10 March, 2015.

Administration de dexmédétomidine intraveineuse pour le traitement des frissons pendant un accouchement par césarienne sous anesthésie neuraxiale : une étude randomisée contrôlée

Résumé

Objectif

Environ 55 % des patientes subissant un accouchement par césarienne sous anesthésie rachidienne ou épidurale vont manifester des frissons, lesquels peuvent interférer avec la mesure des signes vitaux. Des études récentes ont démontré que la dexmédétomidine a le potentiel de réduire les frissons associés à l’anesthésie. Nous avons cherché à démontrer si la dexmédétomidine, un agoniste des récepteurs alpha-2-adrénergiques, peut réduire la durée des frissons associés à l’anesthésie neuraxiale lors d’un accouchement par césarienne.

Méthode

Quatre-vingts parturientes subissant un accouchement par césarienne sous anesthésie neuraxiale et manifestant des frissons ont été recrutées pour cette étude prospective, randomisée et à double insu. Après la naissance, le groupe intervention (n = 40) a reçu un bolus intraveineux unique de dexmédétomidine (30 µg) alors que le groupe témoin (n = 40) a reçu une solution saline. La randomisation et l’attribution ont suivi une liste générée par ordinateur. Le critère d’évaluation principal était le temps nécessaire avant d’observer une réduction des frissons après l’intervention.

Résultats

Cent cinquante-cinq patientes ont été recrutées, dont 80 ont présenté des frissons et ont été randomisées. Notre étude a montré que la dexmédétomidine réduisait la durée moyenne (écart type) des frissons après un bolus intraveineux unique à 2,6 (2,1) min après l’administration de dexmédétomidine par rapport à une durée moyenne de 17,9 (12,6) min après la solution saline (différence de moyennes, -15,3 min; intervalle de confiance [IC] 95 %, -11,2 à -19,4). L’effet de la dexmédétomidine persistait 15 min après l’administration du bolus, où les frissons avaient complètement cessé chez 90 % des patientes du groupe intervention vs 22,5 % du groupe témoin (risque relatif, 4,0; IC 95 %, 2,2 à 7,2). Aucun effet secondaire néfaste, y compris la bradycardie, n’a été observé.

Conclusion

Un bolus intraveineux unique de dexmédétomidine réduit la durée des frissons jusqu’à 15 min lors d’un accouchement par césarienne sous anesthésie neuraxiale.

Enregistrement de l’étude

www.clinicaltrials.gov (NCT02384343); enregistrée le 10 mars 2015.

Notes

Funding

CHU Sainte-Justine Department of Anesthesiology Research Fund.

Author contributions

Christina Lamontagne contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data, and drafting the article. Sandra Lesage contributed to the analysis and interpretation of data. Edith Villeneuve contributed to the conception and design of the study, and the analysis and interpretation of data. Elsa Lidzborski contributed to the acquisition, analysis, and interpretation of data. Alex Derstenfeld contributed to drafting the article.

Conflict of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.CHU Sainte-JustineMontréalCanada
  2. 2.Faculty of MedicineMcGill UniversityMontrealCanada

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