Dexmedetomidina para la prevención de tremor durante raquianestesia
Dexmedetomidine for the prevention of shivering during spinal anesthesia.
Usta B, Gozdemir M, Demircioglu RI, Muslu B, Sert H, Yaldiz A.
Department of Anesthesiology, School of Medicine, Fatih University, Ankara, Turkey.
Clinics (Sao Paulo). 2011;66(7):1187-91.
Abstract
PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection.RESULTS: Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207). CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148462/pdf/cln-66-07-1187.pdf
El calentamiento de la parte inferior del cuerpo imita la reducción normal inducida por bloqueo epidural en el umbral del tremor
Lower-body warming mimics the normal epidural-induced reduction in the shivering threshold.
Doufas AG, Morioka N, Maghoub AN, Mascha E, Sessler DI.
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.agdoufas@stanford.edu
Anesth Analg. 2008 Jan;106(1):252-6
Abstract
BACKGROUND: Neuraxial anesthesia reduces the shivering threshold approximately 0.6 degrees C. This effect might be mediated by an apparent (as opposed to actual) increase in lower body temperature. Accordingly, sufficient lower body warming should result in thermoregulatory inhibition comparable to that exerted by epidural anesthesia. We tested the hypothesis that increasing leg skin temperature to 38 degrees C mimics the normal approximately 0.6 degrees C reduction in the shivering threshold during epidural anesthesia. METHODS: Shivering threshold during internal body cooling was determined in nine female volunteers on two separate days: one unanesthetized control day, and one day with a T10-11 epidural block. On each study day, lower body skin temperature was maintained near 38 degrees C and upper body skin temperature near 33 degrees C. We assessed equivalency of the shivering thresholds on the control and epidural days using the two one-sided tests method. RESULTS: The thresholds on the control (35.8 degrees C +/- 0.5 degrees C; mean +/- sd) and epidural (35.8 degrees C +/- 0.5 degrees C) days were shown to be equivalent because the 95% CI for the difference in means, 0.0 (-0.4, 0.4), was within our prespecified limits of -0.6 degrees C to +0.6 degrees C (P < 0.025 for both one-sided equivalency tests). CONCLUSIONS: Lower body warming mimics the normal epidural-induced reduction in the shivering threshold. Our results support a mechanism based on increased apparent lower body skin temperature during neuraxial anesthesia.
http://www.anesthesia-analgesia.org/content/106/1/252.full.pdf
Tremor postanestésico. Epidemiología, patofisiología, y abordajes para prevención y manejo
Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management.
Alfonsi P.
Département of Anesthesia and Resuscitation, Hôpital A. Paré, Boulogne, France. pascal.alfonsi@apr.ap-hop-paris.fr
Minerva Anestesiol. 2003 May;69(5):438-42.
Abstract
Postanaesthetic shivering is one of the leading causes of discomfort for patients recovering from general anesthesia. During EMG records, the distinguishing factor from shivering in fully awake patients is the existence of clonus similar to that recorded in patients with spinal cord transection. They coexist with the classic waxing and waning signals associated with cutaneous vasoconstriction (thermoregulatory shivering). The causes responsible for their appearance primarily include hypothermia, which sets in due to thermoregulation inhibition by anesthetics. However, we also note the existence of shivering associated with cutaneous vasodilatation (non-thermoregulatory shivering) one of the origins of which is postoperative pain. Apart from the discomfort and aggravated pain, postanaesthetic shivering raises metabolic demand proportionally to the solicited muscle mass and the patient's cardiac capacities. No link has been demonstrated between their occurrence and an increase in cardiac morbidity but it is preferable to avoid postanaesthetic shivering since it is oxygen draining. Prevention mainly entails preventing hypothermia by actively rewarming the patient. Postoperative skin surface rewarming is a way of obtaining the threshold shivering temperature while raising the skin temperature and improving the patient's comfort. However, it is less efficient than certain drugs such as meperidine, nefopam or tramadol, which act by reducing the shivering threshold temperature.
http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.
php?cod=R02Y2003N05A0438
http://www.minervamedica.it/en/getfreepdf/UuE%252BHPTphQ5mhoHwxNqFjqx3FsWwsTt9bK
WheROcUSkiL0RUW4VuGGKseN23n1srLxm22RuaBTXXXs8YP4lU9Q%253D%253D/R02Y2003N05A0438.pdf
Temblor postanestésico: Prevención y manejo
Mario Quintero, Jaime Ortega, Elisa Rionda, Alejandro Jiménez, Marcela Berrocal, Pastor Luna
An Med (Mex) 2008; 53 (4): 195-201
RESUMEN
El temblor postanestésico es una de las principales causas de molestia en las aéreas de recuperación en las pacientes que recibieron anestesia general. Ocurre en 40% de los casos, la mayoría de las veces es precedido de un fenómeno de hipotermia perioperatoria. En este artículo se revisa la fisiopatología del temblor postanestésico, así como la prevención y el manejo por medios físicos y farmacológicos. Palabras clave: Hipotermia, temblor postanestésico, anestesia.
http://www.medigraphic.com/pdfs/abc/bc-2008/bc084e.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Dexmedetomidine for the prevention of shivering during spinal anesthesia.
Usta B, Gozdemir M, Demircioglu RI, Muslu B, Sert H, Yaldiz A.
Department of Anesthesiology, School of Medicine, Fatih University, Ankara, Turkey.
Clinics (Sao Paulo). 2011;66(7):1187-91.
Abstract
PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years), scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30) or dexmedetomidine (group D, n = 30). Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection.RESULTS: Hypothermia was observed in 21 patients (70%) in group D and in 20 patients (66.7%) in group C (p = 0.781). Three patients (10%) in group D and 17 patients (56.7%) in group C experienced shivering (p = 0.001). The intensity of shivering was lower in group D than in group C (p = 0.001). Time from baseline to onset of shivering was 10 (5-15) min in group D and 15 (5-45) min in group C (p = 0.207). CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148462/pdf/cln-66-07-1187.pdf
El calentamiento de la parte inferior del cuerpo imita la reducción normal inducida por bloqueo epidural en el umbral del tremor
Lower-body warming mimics the normal epidural-induced reduction in the shivering threshold.
Doufas AG, Morioka N, Maghoub AN, Mascha E, Sessler DI.
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.agdoufas@stanford.edu
Anesth Analg. 2008 Jan;106(1):252-6
Abstract
BACKGROUND: Neuraxial anesthesia reduces the shivering threshold approximately 0.6 degrees C. This effect might be mediated by an apparent (as opposed to actual) increase in lower body temperature. Accordingly, sufficient lower body warming should result in thermoregulatory inhibition comparable to that exerted by epidural anesthesia. We tested the hypothesis that increasing leg skin temperature to 38 degrees C mimics the normal approximately 0.6 degrees C reduction in the shivering threshold during epidural anesthesia. METHODS: Shivering threshold during internal body cooling was determined in nine female volunteers on two separate days: one unanesthetized control day, and one day with a T10-11 epidural block. On each study day, lower body skin temperature was maintained near 38 degrees C and upper body skin temperature near 33 degrees C. We assessed equivalency of the shivering thresholds on the control and epidural days using the two one-sided tests method. RESULTS: The thresholds on the control (35.8 degrees C +/- 0.5 degrees C; mean +/- sd) and epidural (35.8 degrees C +/- 0.5 degrees C) days were shown to be equivalent because the 95% CI for the difference in means, 0.0 (-0.4, 0.4), was within our prespecified limits of -0.6 degrees C to +0.6 degrees C (P < 0.025 for both one-sided equivalency tests). CONCLUSIONS: Lower body warming mimics the normal epidural-induced reduction in the shivering threshold. Our results support a mechanism based on increased apparent lower body skin temperature during neuraxial anesthesia.
http://www.anesthesia-analgesia.org/content/106/1/252.full.pdf
Tremor postanestésico. Epidemiología, patofisiología, y abordajes para prevención y manejo
Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management.
Alfonsi P.
Département of Anesthesia and Resuscitation, Hôpital A. Paré, Boulogne, France. pascal.alfonsi@apr.ap-hop-paris.fr
Minerva Anestesiol. 2003 May;69(5):438-42.
Abstract
Postanaesthetic shivering is one of the leading causes of discomfort for patients recovering from general anesthesia. During EMG records, the distinguishing factor from shivering in fully awake patients is the existence of clonus similar to that recorded in patients with spinal cord transection. They coexist with the classic waxing and waning signals associated with cutaneous vasoconstriction (thermoregulatory shivering). The causes responsible for their appearance primarily include hypothermia, which sets in due to thermoregulation inhibition by anesthetics. However, we also note the existence of shivering associated with cutaneous vasodilatation (non-thermoregulatory shivering) one of the origins of which is postoperative pain. Apart from the discomfort and aggravated pain, postanaesthetic shivering raises metabolic demand proportionally to the solicited muscle mass and the patient's cardiac capacities. No link has been demonstrated between their occurrence and an increase in cardiac morbidity but it is preferable to avoid postanaesthetic shivering since it is oxygen draining. Prevention mainly entails preventing hypothermia by actively rewarming the patient. Postoperative skin surface rewarming is a way of obtaining the threshold shivering temperature while raising the skin temperature and improving the patient's comfort. However, it is less efficient than certain drugs such as meperidine, nefopam or tramadol, which act by reducing the shivering threshold temperature.
http://www.minervamedica.it/en/journals/minerva-anestesiologica/article.
php?cod=R02Y2003N05A0438
http://www.minervamedica.it/en/getfreepdf/UuE%252BHPTphQ5mhoHwxNqFjqx3FsWwsTt9bK
WheROcUSkiL0RUW4VuGGKseN23n1srLxm22RuaBTXXXs8YP4lU9Q%253D%253D/R02Y2003N05A0438.pdf
Temblor postanestésico: Prevención y manejo
Mario Quintero, Jaime Ortega, Elisa Rionda, Alejandro Jiménez, Marcela Berrocal, Pastor Luna
An Med (Mex) 2008; 53 (4): 195-201
RESUMEN
El temblor postanestésico es una de las principales causas de molestia en las aéreas de recuperación en las pacientes que recibieron anestesia general. Ocurre en 40% de los casos, la mayoría de las veces es precedido de un fenómeno de hipotermia perioperatoria. En este artículo se revisa la fisiopatología del temblor postanestésico, así como la prevención y el manejo por medios físicos y farmacológicos. Palabras clave: Hipotermia, temblor postanestésico, anestesia.
http://www.medigraphic.com/pdfs/abc/bc-2008/bc084e.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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