MAGNESIUM SULPHATE INFUSION PREVENTS SHIVERING DURING SPINAL ANAESTHESIA: A RANDOMISED DOUBLE BLINDED CONTROLLED STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2016, Vol 5, Issue 65
Abstract
Spinal anaesthesia is the most common form of anaesthesia in our hospital. Shivering is a very common complication in patients undergoing surgery under spinal anaesthesia. Shivering increases expenditure of cardiac and systemic energy resulting in increased oxygen consumption and carbon dioxide production, lactic acidosis and raises intraocular and intracranial pressure. It also interferes with haemodynamic monitoring intraoperatively. Regional anaesthesia produces vasodilatation, which facilitates core to peripheral distribution of heat. It also increases sweating threshold and decreases vasoconstriction and shivering threshold. Intra- and postoperative management of shivering is usually done by external heating (Forced air warming, warming blankets), warmed fluids or pharmacological intervention. Prevention and treatment of established shivering should be regarded as clinically relevant intervention in the perioperative period. Therefore, a randomized double-blind control study was done using magnesium sulphate infusion in the prevention of shivering in our hospital. The aim of our study is to assess the efficacy of magnesium sulphate when used for prevention of shivering following spinal anaesthesia. METHODS Institutional Ethical Committee approval and informed consent were obtained from all patients. INCLUSION CRITERIA 80 patients of ASA 1 and 2 belonging to either sex, aged between 18-65 years undergoing lower abdominal and lower limb surgeries were included in the study. EXCLUSION CRITERIA Patients suffering from neuromuscular disease, hyperthyroidism, cardiopulmonary disease, psychological disease, refusal to participate or temperature more than 38*C or less than 36.5*C. The patients were randomized into 2 groups namely Group M and Group C. Group M - Each of Group M patients were designated to receive 2 gms (4 mL) of magnesium sulphate in the preloading fluid over a period of 20-30 minutes. Group C – Each of Group C patients were designated to receive 4 mL of normal saline as control in the preloading fluid over a period of 20-30 minutes. Following a detailed pre-anaesthetic checkup along with relevant investigations, patients were brought to the operation theatre and connected to monitors. Then the vital signs of the patients including heart rate, temperature, non-invasive blood pressure, respiratory rate and SpO2 were continuously monitored and recorded. Both group of patients were pre-loaded with 15 mL/kg of Ringer lactate before giving spinal anaesthesia. GROUP M The study drug of 4 mL of Inj. Magnesium Sulphate was coded and presented to the anaesthetist not involved in the management of the patient and administered by intravenous infusion by adding it in the preloading fluid before spinal anaesthesia over a period of 20-30 minutes. GROUP C The control drug of 4 mL of normal saline was coded and presented to the anaesthetist not involved in the management of the patient and administered by intravenous infusion by adding it in the preloading fluid before spinal anaesthesia over a period of 20-30 minutes. The temperature of the operation theatre was maintained at 22-24*C. After preloading, all patients were administered intrathecal injection of 12.5 mg of 0.5% preservative free heavy Bupivacaine. Intraoperative patients were monitored for shivering along with other vital parameters. Adequacy of subarachnoid block was ensured. Core and skin temperatures were also recorded. MAIN RESULTS Total incidence of shivering grade 3/4 was 5% in Group M and 30% in Group C (p < 0.01). Magnesium sulphate significantly reduced the incidence and intensity of shivering. The use of rescue drug Inj. Pethidine was more in Group C (30%) compared to 5% in Group C (p < 0.01). CONCLUSION For patients undergoing spinal anaesthesia, prophylactic Inj. Magnesium Sulphate infusion lowered incidence of shivering. When shivering did occur, rescue drug Inj. Pethidine proved to be an effective treatment with minimal side effects
Authors and Affiliations
Mariappan , Raju
Keywords
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- EP ID EP144275
- DOI 10.14260/jemds/2016/1052
- Views 96
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