| ObjectiveThere are many methods to prevent postanesthetic shivering in clinic. But little about total intravenous anesthesia. This study compare the effect of tramad-ol and different doses fentany for preventing postanesthetic shivering.Methods1. Clinical dateWe studied 80 patients scheduled to undergo prolapse of lumbar interverte-bral disc surgery to under general anesthesia . Patients were randomly allocated to four groups:Group A received 0. 5ug/kg fentanyl ( n = 20);Group B received 1 ug/kg fentanyl ( n = 20);Group C received 1 mg/kg tramadol ( n = 20);Group D received saline as placebo ( n = 20) ( control group) 2. Assay methodGeneral anaesthesia was maintained with intravenous propofol 350 -400mg/h and remifentanil 0.7 - 0. 8 mg/h. When anaesthesia , study drugs were administered intravenously at the end of surgery. Heart rate ( HR) ,mean arterial blood pressure ( MAP) and nasopharynx temperature were measured before induction of anaesthesia ( To ) , and 1 min ( T1) ,5min ( T2 ) , 10min ( T3) and 20min(T4) after extubation. Meanwhile, we observeded the incidence of post-anaesthetic shivering, wrench score, recorded the time of extubation (from end of application of propofol to extubation) , the time of out of PACU (from end of application of propofol to out of PACU) and adverse effect in 24 hours after opera-tion. If the wrench score ^2, 25mg meperidine was given intravenously as rescue medicine and repeated once if necessary.3. Analysis dataAfter background subtraction and decay , apply SPSS 13. 0 software for Stat . and Excel software for histogram. Comparisons between groups were performed with one - way analysis of variance , comparison within group were made by means of paired T - test. Count data was performed with Chi - square test . Non-normal distribution data was performed with Kruskal - Wallis . Probability values less than 0. 05were considered significant.ResultsIncidence of postanaesthetic shivering was significantly decreased in the group A (30% ) xgroup B (5% ) and group C (10% ) compared with group D (75% )( control group). (P < 0.05) Furthermore , incidence of postanaesthetic shivering was significantly decreased in the group B (5% ) compared with group A (30% ). There were no difference in group B and group C. MAP;At 1 min after extubation there were significant decrease in the group A (100. 7 ±7. 48) >group B (94. 45 ± 6. 05 ) and group C (100. 15 ± 7. 03 ) compared with group D (106. 55 ± 13. 49 ) ( control group) , and group A ( 100. 7 ± 7. 48 ) % group C (100. 15 ±7. 03) were significantly increased to group B (94.45 ±6. 05 ). ( P < 0. 05) . In group A?group C and group D, MAP at 1 min after extubation there was significantly increased compared with baseline, (P < 0.05) but in group B, there was no significant difference. In group A and group D, HR at 1 min after extubation was a significantly increased compared with baseline , ( P < 0. 05 ) But there wereno difference in group B and group C. The time of extubation (19. 9 ± 3. 6) and the time of out of PACU (28. 7 ± 5. 2) was significantly delayed in group B. compared with group A N group C and group D. ( P < 0.05).ConclusionFentanyl (1 ug/kg) can prevent postanesthetic shivering and inhibit haemo-dynamic fluctuation during the period of extubation. But fentanyl(lug/kg) will delay analepsia time, the time of extubation and the time of out of PACU . Tra-madol (1 mg/kg) can effectively prevent postanesthetic shivering , But can' t inhibit haemodynamic fluctuation during the period of extubation. So the optimum dose of fentanyl to prevent postanesthetic shivering and decrease postoperation complication should be further investigated. |
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