title: Hydrocortisone reduces postoperative shivering following day care knee arthroscopy.
abstract: OBJECTIVE
  Postoperative shivering is commonly observed in patients after general anesthesia. A double-blind randomized controlled trial was conducted in patients undergoing day care knee arthroscopy to test the hypothesis that a single intraoperative dose of hydrocortisone would prevent or attenuate postoperative shivering.
  
  
  METHODS
  One hundred and twenty patients were given a nitrous oxide-isoflurane-remifentanil anesthetic. Approximately ten minutes before the end of anesthesia, they were randomized to receive normal saline (Control group; n = 40); hydrocortisone 1 mg·kg(-1) iv (Hydrocortisone-1 group; n = 40), or hydrocortisone 2 mg·kg(-1) iv (Hydrocortisone-2 group; n = 40). Postoperative shivering was graded by a blinded observer using a five-point scale: Grade 0: none; Grade 1: one or more areas of piloerection but without visible muscular activity; Grade 2: visible muscular activity confined to one muscle group; Grade 3: same as Grade 2 but in more than one muscle group; and Grade 4: gross muscular activity involving the entire body.
  
  
  RESULTS
  Shivering (Grades 1-4) was observed in 33 patients (82%) in the Control group, 13 patients (32%) in the Hydrocortisone-1 group (P < 0.001 compared with the Control group), and eight patients (20%) in the Hydrocortisone-2 group (P < 0.001 compared with the Control group). The overall incidence of shivering was similar in the Hydrocortisone-1 and Hydrocortisone-2 groups.
  
  
  CONCLUSIONS
  This study shows that hydrocortisone (1-2 mg·kg(-1) iv) provides effective prophylaxis against postoperative shivering in patients undergoing day care knee arthroscopy under general anesthesia.
authors.affiliation: Department of Anaesthesia and ICU, National Trauma Center, Khoula Hospital, Muscat, Sultanate of Oman. manjitshimla@hotmail.com
authors.forename: Manjeet Singh
authors.initials: MS
authors.lastname: Pawar
authors.forename: Neelam
authors.initials: N
authors.lastname: Suri
authors.forename: Naresh
authors.initials: N
authors.lastname: Kaul
authors.forename: Shobha
authors.initials: S
authors.lastname: Lad
authors.forename: Rashid Manzoor
authors.initials: RM
authors.lastname: Khan
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D018681:Anesthetics, General / Q000008:administration & dosage / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012768:Shivering / Q000187:drug effects*; D055815:Young Adult
chemical_list: D018681:Anesthetics, General; D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone