Effects of Dexmedetomidine On the Postoperative Shivering, Nausea, and Vomiting Among Opium User Patients Undergoing Elective Supratentorial Brain Tumor Surgery: A Randomized, Placebo, Controlled Clinical trials
DOI:
https://doi.org/10.31661/gmj.v10i.2146Keywords:
Dexmedetomidine; General Anesthesia; Nausea; Vomiting; ShiveringAbstract
Background: Postoperative nausea and vomiting (PONV), and shivering are common general anesthesia complications. Hence, this study evaluates the effect of dexmedetomidine, given as a premedication, on PONV and shivering in patients with opium use who underwent elective supratentorial brain tumor surgeries. Materials and Methods: In a randomized clinical trial, 100 opium user patients who were candidates for elective supra-tentorial brain tumor surgery under general anesthesia were studied in two groups of 50 patients. The intervention group received dexmedetomidine (within 10 and 30 minutes infusion) before the anesthesia induction. Group placebo that received normal saline as a group. PONV and shivering rates were compared between the two groups. Results: Both groups did not differ in hemodynamic parameters during operation, including pulse rate, systolic and diastolic blood pressure, and anesthesia duration. In the dexmedetomidine group, patients suffered less from PONV and shivering rather than controls, and these differences were both significant (P=0.001 and P=0.027, respectively). Discussion: Dexmedetomidine administration before major surgeries might reduce post-operative nausea and vomiting and the occurrence of shivering, particularly in opium-addicted patients.[GMJ.2021;10:e2146]
References
Moghaddam MJ, Ommi D, Mirkheshti A, Dabbagh A, Memary E, Sadeghi A et al. Effects of clonidine premedication upon postoperative shivering and recovery time in patients with and without opium addiction after elective leg fracture surgeries. Anesth Pain Med. 2013;2(3):107. https://doi.org/10.5812/aapm.7143PMID: 24244918 PMCID: PMC3821124 Giesbrecht GG, Sessler DI, Mekjavic IB, Schroeder M, Bristow GK. Treatment of mild immersion hypothermia by direct body-to-body contact. J Appl Physiol1994;76(6):2373-9. https://doi.org/10.1152/jappl.1994.76.6.2373PMID: 7928860 Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg. 2000;90(6):1423-7. https://doi.org/10.1097/00000539-200006000-00032PMID: 10825334 Mathews S, Al Mulla A, Varghese P, Radim K, Mumtaz S. Postanaesthetic shivering a new look at tramadol. Anaesthesia. 2002;57(4):387-403. https://doi.org/10.1046/j.1365-2044.2002.2457_3.xPMID: 11949644 Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology. 2003;98(1):46-52. https://doi.org/10.1097/00000542-200301000-00011PMID: 12502978 Cao X, White PF, Ma H. An update on the management of postoperative nausea and vomiting. J Anesth. 2017;31(4):617-26. https://doi.org/10.1007/s00540-017-2363-xPMID: 28455599 Lin CJ, Williams BA. Postoperative nausea and vomiting in ambulatory regional anesthesia. J Appl Physiol. 2011;49(4):134-43. https://doi.org/10.1097/aia.0b013e318216bf9cPMID: 21956083 Domino KB, Anderson EA, Polissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg. 1999;88(6):1370-9. https://doi.org/10.1213/00000539-199906000-00032PMID: 10357347 Jin S, Liang DD, Chen C, Zhang M, Wang J. Dexmedetomidine prevent postoperative nausea and vomiting on patients during general anesthesia: A PRISMA-compliant meta analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(1):1-7. https://doi.org/10.1097/MD.0000000000005770PMID: 28072722 PMCID: PMC5228682 Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30(12):1537-41. PMID: 19936416 Keating GM, Hoy SM, Lyseng-Williamson KA. Dexmedetomidine: a guide to its use for sedation in the US. Clin. Drug Investig. 2012;32(8):561-7. https://doi.org/10.1007/bf03261910PMID: 22741747 Salimi A, Sharifi G, Bahrani H, Mohajerani SA, Jafari A, Safari F et al. Dexmedetomidine could enhance surgical satisfaction in Trans-sphenoidal resection of pituitary adenoma. J Neurosurg Sci. 2017;61(1):46-52. https://doi.org/10.23736/s0390-5616.16.02792-2PMID: 24866894 Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H et al. [Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study]. Rev Bras Anestesiol. 2015;65(3):191-9. https://doi.org/10.1016/j.bjan.2014.05.006PMID: 25990496 Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. J Anaesthesiol Clin Pharmacol. 2012;28(1):86-91. https://doi.org/10.4103/0970-9185.92452PMID: 22345953 PMCID: PMC3275980 Moghadam MJ, Ommi D, Mirkheshti A, Shadnoush M, Dabbagh A. The effect of pretreatment with clonidine on propofol consumption in opium abuser and non-abuser patients undergoing elective leg surgery. J Res Med Sci. 2012;17(8):728. PMID: 23798938 PMCID: PMC3687878 Ommi D, Teymourian H, Zali A, Ashrafi F, Moghaddam MJ, Mirkheshti A. Effects of clonidine premedication on intraoperative blood loss in patients with and without opium addiction during elective femoral fracture surgeries. Anesth Pain Med. 2015;5(4):1-6. https://doi.org/10.5812/aapm.23626PMID: 26473101 PMCID: PMC4602228 Panzer O, Ghazanfari N, Sessler DI, Yucel Y, Greher M, Akca O et al. Shivering and shivering-like tremor during labor with and without epidural analgesia. Anesthesiology. 1999;90(6):1609-16. https://doi.org/10.1097/00000542-199906000-00017PMID: 10360859 Bicer C, Esmaoglu A, Akin A, Boyaci A. Dexmedetomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesthesiol. 2006;23(2):149-53. https://doi.org/10.1017/S0265021505002061PMID: 16426470 Liu ZX, Xu FY, Liang X, Zhou M, Wu L, Wu JR et al. Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials. Can J Anaesth. 2015;62(7):816-29. https://doi.org/10.1007/s12630-015-0368-1PMID: 25851018 Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003;97(1):62-71 https://doi.org/10.1213/01.ANE.0000068580.00245.95PMID: 12818945 Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77(1):162-84. PMID: 1609990 Lee SJ, Lee SM, Kim SI, Ok SY, Kim SH, Park SY et al. The effect of aprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery with intravenous patient controlled analgesia using fentanyl: aprepitant plus ramosetron vs ramosetron alone. Korean J Anesthesiol. 2012;63(3):221-6. https://doi.org/10.4097/kjae.2012.63.3.221PMID: 23060978 PMCID: PMC3460150 Riley TJ, McKenzie R, Trantisira BR, Hamilton DL. Droperidol-ondansetron combination versus droperidol alone for postoperative control of emesis after total abdominal hysterectomy. J Clin Anesth. 1998;10(1):6-12. https://doi.org/10.1016/S0952-8180(97)00188-8PMID: 9526930 Scuderi PE, James RL, Harris L, Mims GR, 3rd. Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg. 2000;91(6):1408-14. https://doi.org/10.1097/00000539-200012000-00020PMID: 11093990 Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008;25(1):22-8. https://doi.org/10.1017/S0265021507001317PMID: 17666131 Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30(12):1537-41. PMID: 19936416 Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116(6):1312-22. https://doi.org/10.1097/ALN.0b013e31825681cbPMID: 22546966
