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Prevention of post spinal anesthesia shivering during cesarean section with its associated discomfort, distress, aggravation of pain, increased metabolic demands, and increased oxygen consumption
Shivering is one of the most important periperative complications seen in clinical practice. Several mechanisms have been postulated for its pathogenesis. Anesthetic-induced inhibition of thermoregulation resulting in hypothermia is an important cause of post anesthesia shivering, uncontrolled spinal reflexes, and cutaneous vasodilation are the other suggested mechanisms involved in the pathogenesis of shivering. Opioid receptors, α2 receptors, and serotonergic receptors also are involved of shivering.
Various drugs were studied for their potential role in prevention of peri-operative shivering such as tramadol, dexmedetomidine, ondansetron, ketamine, and pethidine.
We decided to perform a well-designed study to compare clonidine and granisetron which has been recently introduced as drugs for prevention and control of shivering after spinal anesthesia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group Cl (clonidine group) | Active Comparator | will be given intravenous Clonidine 0.5 µg/kg diluted in 10ml normal saline 20 minutes before spinal anesthesia |
|
| Group G (granisetron group) | Active Comparator | will be given intravenous 1mg of granisetron 20 minutes before spinal anesthesia. |
|
| Group C (control group) | Placebo Comparator | will be given intravenous10ml normal saline 20 minutes before spinal anesthesia |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clonidine Injection | Drug | intravenous Clonidine 0.5 µg/kg diluted in 10ml normal saline 20 minutes before spinal anesthesia |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Shivering | • Shivering will be graded according to Tsai and Chu scale (10): 0 = no shivering, 1 = piloerection or peripheral vasoconstriction but no visible shivering, 2 = muscular activity in only one muscle group, 3 = muscular activity in more than one muscle group but not generalized shivering, 4 =shivering involving the whole body | Procedure (through out the period of spinal anesthesia) |
| Measure | Description | Time Frame |
|---|---|---|
| core body temperature | Core body temperature was detected by measuring tympanic membrane temperature using digital infrared ear thermometer (thermoscan KFT-10; Grnzia, genova, Italy). | Procedure (preoperative as base and through out the period of spinal anesthesia) |
| Maternal Heart rate |
| Measure | Description | Time Frame |
|---|---|---|
| maternal oxygen saturation | Procedure (preoperative as base and through out the period of spinal anesthesia) |
Inclusion Criteria: Patient acceptance.,Aged between 21-40 years old, BMI: 18- 30 kg/m2, ASA: I and II., Scheduled for elective cesarean section under spinal anesthesia.
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Exclusion Criteria:
History of hypersensitivity to drugs used in this study,Patients with history of chronic pain and taking analgesics, Patients with sepsis and Significant cardiac, liver or renal diseases, Uncooperative patients or with psychiatric disorders that prevent surgery under spinal anesthesia, Atrio-ventricular block in any degree, cardiac arrhythmias, valvular heart disease, kidney or liver diseases, neuromuscular disorders and diabetes mellitus
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parturients undergoing cesarean section
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Heba M Fathi, M.D | Contact | 00201000143938 | heba_elgendi@yahoo.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Heba M Fathi | Recruiting | Zagazig | 44519 | Egypt |
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| ID | Term |
|---|---|
| D003000 | Clonidine |
| D017829 | Granisetron |
| D000077330 | Saline Solution |
| D007267 | Injections |
| ID | Term |
|---|---|
| D048288 | Imidazolines |
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
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triple blinded
| Granisetron Injection | Drug | intravenous 1mg of granisetron diluted in 10ml normal saline 20 minutes before spinal anesthesia. |
|
| Normal Saline 10 mL Injection | Drug | intravenous 10 ml normal saline 20 minutes before spinal anesthesia |
|
beats/minute |
| Procedure (preoperative as base and through out the period of spinal anesthesia) |
| baby APGAR score | 1 minutes and 5 minutes post natal |
| maternal blood presure | mmhg | Procedure (preoperative as base and through out the period of spinal anesthesia) |
| D006571 |
| Heterocyclic Compounds |
| D053961 | Azabicyclo Compounds |
| D001372 | Aza Compounds |
| D009930 | Organic Chemicals |
| D007191 | Indazoles |
| D011720 | Pyrazoles |
| D019086 | Bridged Bicyclo Compounds, Heterocyclic |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |