Dexmedetomidine for the treatment of postanesthesia shivering in children.
BACKGROUND
Shivering is a common postanesthesia adverse event with multiple etiologies and multiple suggested prophylactic and abortive treatment regimens. Dexmedetomidine, a centrally acting alpha(2)-adrenergic agonist, has been used as a sedative agent and is known to reduce the shivering threshold. We hypothesized that children with postanesthesia shivering would reduce shivering behavior following a single bolus dose of dexmedetomidine.


METHODS
Dexmedetomidine was administered in a prospective, open-label fashion. The anesthesia management was uniform consisting of maintenance inhaled anesthesia (sevoflurane) and the intraoperative administration of fentanyl (1-2 microg.kg(-1)) plus a regional anesthetic technique (either a neuraxial or peripheral block) for postoperative analgesia. Criteria for treatment included: (i) shivering, (ii) successful extubation, and (iii) no other complaint/indication of pain. All children who met the criteria were treated with a single intravenous bolus dose of dexmedetomidine (0.5 microg.kg(-1)) over 3-5 min. Following the completion of drug administration, shivering activity was recorded every minute (up to 10 min) with any adverse effects or complaints. The efficacy of shivering reduction at 5 min in this cohort is compared with previous reports from the literature of the efficacy of clonidine and meperidine.


RESULTS
Twenty-four children ranging in age from 7 to 16 years (11.5 +/- 2.5 years) were treated. All children had a cessation of shivering behavior within 5 min following the completion of dexmedetomidine administration. The onset of effect was 3.5 +/- 0.9 min. No adverse effects were observed. No shivering behavior recurred.


CONCLUSIONS
This study demonstrates the efficacy of dexmedetomidine in the treatment of postanesthesia shivering.
Blaine Easley
R
R
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA.
Brady
Kenneth M
KM
Tobias
Joseph D
JD
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000758:Anesthesia / Q000009:adverse effects*; D000762:Anesthesia Recovery Period; D000765:Anesthesia, Conduction / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002648:Child; D015331:Cohort Studies; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D011446:Prospective Studies; D000077149:Sevoflurane; D012768:Shivering / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D020927:Dexmedetomidine; D005283:Fentanyl