Intravenous Ketamine For Prevention Of Post Anesthetic Shivering In Urological Procedures Done Under Spinal Anesthesia: A Randomized Triple-Blinded Placebo-Controlled Trial
Description
After obtaining the scientific committee and ethical committee clearance, informed consent written in their own language will be obtained from all the patients. Patients between the age of 18-65 years of age, ASA grade I-II, scheduled for elective urological surgeries under spinal anaesthesia will be selected. Preoperative evaluation will be done the day before surgery for all the patients. Fasting will be advised for 6 hours. Baseline vitals will be recorded. All the patients will be monitored with electrocardiography, pulse oximetry (SpO2) and non invasive blood pressure (NIBP). IV line is secured with 18 G IV cannula and crystalloids on flow. Axillary temperature will be recorded using an axillary thermometer before SA block at 10 min intervals during the perioperative period. Patients will be randomly divided into two groups- ketamine 0.3 mg/kg in the study group (Group K) and 0.9% saline in the control group (Group P). One of the study drugs will be given as i.v. Bolus by an anaesthetist who is not involved in the management of patients. Study drugs will be prepared and diluted to a volume of 5 ml and were presented as coded syringes. Under aseptic precautions, sub arachnoid block will be administered using 25 gauge Quincke’s needle at L3- L4 intervertebral space by midline approach. All patients will be under close observation by a blinded anaesthesiologist continuously for the incidence and intensity of shivering. Following the study drug administration, any side-effects such as nausea, vomiting, hypotension, bradycardia, tachycardia, hallucinations, sedation, and nystagmus will be recorded in 15 min intervals. Time from SA to the beginning of shivering, maximal heights of sensory block, and duration of surgery (duration from skin incision to dressing), will be recorded. At the end of the surgery, patients will be transferred to postoperative ward/ PACU. Patients will be covered with one cotton blanket and no active warming will be used. If patients develop shivering, they will be treated with Inj. Tramadol 100 mg slow IV, preceeded by Inj. Emeset 4 mg IV. Assessment of side effects and other study outcome variables will be continued until an adequate Aldrete score for discharge from the PACU was achieved. The ambient temperature of the operating room and post-anesthesia care unit (PACU) was measured using a digital wall thermometer and maintained at 24 to 28° C during surgery.
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Shivering control in postoperative patients thereby maintaining hemodynamic stability