JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) En Espanol Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (24) Citing Articles via Google Scholar Google Scholar Articles by Powell, R. M. Articles by Buggy, D. J. Search for Related Content PubMed PubMed Citation Articles by Powell, R. M. Articles by Buggy, D. J.

---

GENERAL ARTICLES

Ondansetron Given Before Induction of Anesthesia Reduces Shivering After General Anesthesia

University Department of Anaesthesia, Leicester University, Leicester, United Kingdom

Address correspondence and reprint requests to Donal J. Buggy, MD, MSc, MRCPI, DME, FFARCI, University Department of Anaesthesia, Leicester General Hospital, Leicester LE5 4PW, UK. Address e-mail to dbuggy{at}talk21.com

The neurotransmitter pathways involved in the mechanism of postanesthetic shivering (PAS) are poorly understood. Meperidine, clonidine, and physostigmine are all effective treatments, indicating that opioid, ₂-adrenergic, and anticholinergic systems are probably involved. We investigated the effect of ondansetron, a 5-HT₃ antagonist used to treat postoperative nausea and vomiting, on intraoperative core and peripheral temperatures and PAS. Eighty-two patients (age, 18–60 yr) undergoing orthopedic, general, or urological surgery were randomized into three groups in this double-blinded, placebo-controlled, study: Group O4 (n = 27) received ondansetron 4 mg IV, Group O8 (n = 27) received ondansetron 8 mg IV, and Group C (n = 28) received saline IV immediately before the anesthetic induction. Core (tympanic) and fingertip temperature (dorsum of middle finger) were recorded. Anesthesia was induced with IV fentanyl 1 µg/kg and propofol 2.0–2.5 mg/kg and maintained with 1 minimum alveolar anesthetic concentration isoflurane in 70% nitrous oxide/oxygen. The occurrence of shivering was documented clinically during recovery by nursing staff, who were unaware of the group assignment. PAS occurred in 16 of 28 (57%) patients in Group C, compared with 9 of 27 (33%) in Group O4 (P = 0.13) and 4 of 27 (15%) patients in Group O8 (P = 0.003). Within each group, core temperature decreased and peripheral temperature increased significantly, but there were no significant differences among the groups at any time interval. We conclude that ondansetron 8 mg IV given during the induction of anesthesia prevents PAS without affecting the core-to-peripheral redistribution of heat during general anesthesia. This suggests that serotonergic pathways have a role in the regulation of PAS.

Implications: In a randomized, double-blinded, placebo-controlled, clinical study, ondansetron 8 mg IV, given just before the induction, reduced the incidence of postanesthetic shivering compared with saline. The anticipated core-to-peripheral redistribution of body temperature during general anesthesia was not affected. This implies that ondansetron probably acts by a central inhibitory mechanism, and that 5-hydroxytryptaminergic pathways have a role in regulating postanesthetic shivering.

This article has been cited by other articles:

				A. Honarmand and M. R. Safavi Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial Br. J. Anaesth., October 1, 2008; 101(4): 557 - 562. [Abstract] [Full Text] [PDF]

				R. Komatsu, M. Orhan-Sungur, J. In, T. Podranski, T. Bouillon, R. Lauber, S. Rohrbach, and D. Sessler Ondansetron does not reduce the shivering threshold in healthy volunteers Br. J. Anaesth., June 1, 2006; 96(6): 732 - 737. [Abstract] [Full Text] [PDF]

				A. Paris, C. Ohlendorf, M. Marquardt, B. Bein, J. M. Sonner, J. Scholz, and P. H. Tonner The Effect of Meperidine on Thermoregulation in Mice: Involvement of {alpha}2-Adrenoceptors Anesth. Analg., January 1, 2005; 100(1): 102 - 106. [Abstract] [Full Text] [PDF]

				P. Kranke, L. H. Eberhart, N. Roewer, and M. R. Tramer Single-Dose Parenteral Pharmacological Interventions for the Prevention of Postoperative Shivering: A Quantitative Systematic Review of Randomized Controlled Trials Anesth. Analg., September 1, 2004; 99(3): 718 - 727. [Abstract] [Full Text] [PDF]

				F. Bilotta, G. Rosa, S. N. Piper, W. H. Maleck, and J. Boldt Pharmacological Prevention of Postanesthetic Shivering * Response Anesth. Analg., October 1, 2002; 95(4): 1125 - 1126. [Full Text] [PDF]

				S. N. Piper, K. D. Rohm, W. H. Maleck, M. T. Fent, S. W. Suttner, and J. Boldt Dolasetron for Preventing Postanesthetic Shivering Anesth. Analg., January 1, 2002; 94(1): 106 - 111. [Abstract] [Full Text] [PDF]

				M. Mokhtarani, A. N. Mahgoub, N. Morioka, A. G. Doufas, M. Dae, T. E. Shaughnessy, A. R. Bjorksten, and D. I. Sessler Buspirone and Meperidine Synergistically Reduce the Shivering Threshold Anesth. Analg., November 1, 2001; 93(5): 1233 - 1239. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999