title: The effects of tramadol on postoperative shivering after sevoflurane and remifentanil anesthesia.
abstract: BACKGROUND
  Remifentanil has been reported to cause post-anesthetic shivering (PAS). Higher doses of remifentanil reportedly induce more intense PAS. Tramadol, a synthetic opioid that acts at multiple sites, is considered to be an effective treatment for PAS, but the evidence for its therapeutic benefit after remifentanil anesthesia is limited. We investigated the effect of tramadol on the incidence of PAS after remifentanil anesthesia.
  
  
  METHODS
  Sixty-three patients who had undergone upper abdominal surgery under general anesthesia were studied retrospectively. Tramadol was administered at induction of anesthesia. The patients were divided into four groups: HT(+), high dose remifentanil (1-1.5 μg/kg/min) with tramadol; HT(-), high dose remifentanil without tramadol; LT(+), low dose remifentanil (0.15-0.25 μg/kg/min) with tramadol; and LT(-), low dose remifentanil without tramadol. We recorded perioperative changes in nasopharyngeal temperature and episodes of PAS on emergence from anesthesia.
  
  
  RESULTS
  The incidences of PAS in both tramadol treatment groups were significantly lower than the groups that did not receive tramadol. Nasopharyngeal temperature after surgery fell significantly more from baseline in the tramadol treatment groups compared with the non-treatment groups.
  
  
  CONCLUSIONS
  Tramadol administered at induction of anesthesia appears to suppress PAS following remifentanil anesthesia.
authors.affiliation: Department of Anesthesiology, Hachinohe city Hospital, Aomori, Japan.|Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Anesthesiology, Hachinohe city Hospital, Aomori, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Anesthesiology, Hachinohe city Hospital, Aomori, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. shiron@kuaccm.med.kyushu-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shirozu
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Sumio
authors.initials: S
authors.lastname: Hoka
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D001831:Body Temperature / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects* / Q000037:antagonists & inhibitors*; D000077208:Remifentanil; D012189:Retrospective Studies; D000077149:Sevoflurane; D012768:Shivering / Q000187:drug effects*; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D014147:Tramadol; D000077208:Remifentanil
keywords: Remifentanil; Shivering; Tramadol