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A Comparison between Intravenous Ketamine and Magnesium Sulphate for Prevention of Intraoperative Shivering in Patients Undergoing Spinal Anesthesia
Abstract Background Post-anesthetic shivering is a frequent complication of spinal and epidural anesthesia causing many complications intra and post operatively. This randomized controlled study aimed to compare Ketamine versus Magnesium sulphate in prevention of intraoperative shivering after spina...
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| Published in: | QJM : An International Journal of Medicine 2023-08, Vol.116 (Supplement_1) |
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| Main Authors: | , , , |
| Format: | Article |
| Language: | English |
| Online Access: | Get full text |
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| Summary: | Abstract
Background
Post-anesthetic shivering is a frequent complication of spinal and epidural anesthesia causing many complications intra and post operatively. This randomized controlled study aimed to compare Ketamine versus Magnesium sulphate in prevention of intraoperative shivering after spinal anesthesia.
Aim of Work
To compare the efficacy and safety of low doses of ketamine versus magnesium sulphate as preventive agents of shivering in patients undergoing spinal anesthesia for surgery.
Patients and Methods
The current randomized double-blinded clinical trial was conducted in Ain Shams university hospitals. It included 75 patients who underwent diabetic foot debridement surgeries under spinal anesthesia and met the selection criteria. After intrathecal injection, the patients were classified into three groups: Group K who received ketamine 0,5 mg/kg. diluted in a 100 ml of normal saline and given over 15 minutes, prophylactically. Group M received Magnesium sulphate 30 mg/kg. diluted in a 100 ml of normal saline and given over 15 minutes prophylactically. Group P received a 100 ml bolus of physiological solution given over 15 minutes.
Results
Both Ketamine and Magnesium sulphate showed better results in the control of shivering than the control group (p = 0.035), reduced requirement of pethidine (p = 0.022) and both showed significant effect in delaying the onset of shivering (p = 0.001). The ketamine group had less incidence of shivering, more delayed onset and lesser dose of pethidine required than the Magnesium group but not enough to be statistically significant.
Ketamine also showed less incidence of hypotension following spinal anesthesia (p = 0.03) but much more incidence of heavy sedation and hallucinations (p = 0.000)
Conclusion
Both ketamine and Magnesium sulphate are effective agents in controlling shivering after spinal anesthesia. They reduce the incidence of shivering, delay the onset of shivering if it occurs and reduces the required dose of pethidine to resolve shivering with minimal side effects. Ketamine has a probable protective effect against hypotension after spinal anesthesia. |
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| ISSN: | 1460-2725 1460-2393 |
| DOI: | 10.1093/qjmed/hcad069.089 |