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BJA Advance Access published online on April 22, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei148
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted April 5, 2005

Clinical Investigation

Efficacy of prophylactic ketamine in preventing postoperative shivering

D. Dal 1*, A. Kose 1, M. Honca 1, S. B. Akinci 1, E. Basgul 1, and U. Aypar 1

1 Hacettepe University School of Medicine Department of Anaesthesiology and Reanimation, Ankara 06100, Turkey

* To whom correspondence should be addressed.
D. Dal, E-mail: didemdal{at}yahoo.com


  Abstract

Background. Treatment with ketamine and pethidine is effective in postoperative shivering. The aim of this study was to compare the efficacy of low-dose prophylactic ketamine with that of pethidine or placebo in preventing postoperative shivering.

Methods. A prospective randomized double-blind study involved 90 ASA I and II patients undergoing general anaesthesia. Patients were randomly allocated to receive normal saline (Group S, n=30), pethidine 20 mg (Group P, n=30) or ketamine 0.5 mg kg-1 (Group K, n=30) intravenously 20 min before completion of surgery. The anaesthesia was induced with propofol 2 mg kg-1, fentanyl 1 µg kg-1 and vecuronium 0.1 mg kg-1. It was maintained with sevoflurane 2-4% and nitrous oxide 60% in oxygen. Tympanic temperature was measured immediately after induction of anaesthesia, 30 min after induction and before administration of the study drug. An investigator, blinded to the treatment group, graded postoperative shivering using a four-point scale and postoperative pain using a visual analogue scale (VAS) ranging between 0 and 10.

Results. The three groups did not differ significantly regarding patient characteristics. The number of patients shivering on arrival in the recovery room, and at 10 and 20 min after operation were significantly less in Groups P and K than in Group S. The time to first analgesic requirement in Group S was shorter than in either Group K or Group P (P<0.005). There was no difference between the three groups regarding VAS pain scores.

Conclusion. Prophylactic low-dose ketamine was found to be effective in preventing postoperative shivering.

Keywords: anaesthetics, i.v., ketamine; analgesics, opioid, pethidine; complications, shivering.
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