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Background: This study aimed to investigate the impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery. Methods: A prospective observational study was conducted based on inclusion and exclusion criteria. A total of 384 elderly patients undergoing abdominal surgery under general anesthesia were enrolled in a grade A tertiary hospital in Chengdu, Sichuan Province from October 2021 and October 2022. After anesthesia induction, inflatable warming blankets were routinely used for active heat preservation, and nasopharyngeal temperature was monitored to observe the occurrence of intraoperative hypothermia. Patients were divided into hypothermia group and nonhypothermia group according to whether hypothermia occurred during the operation. Anesthesia recovery time and the incidence of adverse events or unwanted events during anesthesia recovery between the two groups were compared. Results: The numbers (percentage) of 384 patients who underwent abdominal surgery developed intraoperative hypothermia occurred in 240 (62.5%) patients, all of whom had mild hypothermia. There were statistically significant differences between mild hypothermia after active warming and nonhypothermia in the occurrence of shivering (χ2 = 5.197, P = 0.023) and anesthesia recovery time (Z = -2.269, P = 0.02) in elderly patients undergoing abdominal surgery during anesthesia recovery, and there were no statistically significant differences in hypoxemia, nausea or vomiting, hypertension, hypokalemia, hypocalcemia, analgesic drug use,postoperative wound infection or postoperative hospitalization days. Conclusions: The incidence of intraoperative mild hypothermia after active warming was high in elderly patients who underwent abdominal surgery. Mild hypothermia increased the incidence of shivering and prolonged anesthesia recovery time in elderly patients undergoing abdominal surgery. [ABSTRACT FROM AUTHOR]

Few cases of transcatheter aortic valve implantation (TAVI) following infective endocarditis (IE) have been reported. In this presentation, we discuss the feasibility of TAVI in a degenerated bioprosthetic valve affected by IE. We examine a rare case involving an elderly man with a degenerated bioprosthetic aortic valve complicated by IE 6 months after a COVID-19 infection. The patient was successfully treated with valve-in-valve intervention following antibiotic therapy for the acute phase of the infection. This resulted in excellent outcomes with no complications in the early postprocedural period and during follow-up visits. For patients with a destructed bioprosthetic aortic valve due to IE and residual dysfunction after healing, valve-in-valve intervention can be a safe and effective treatment option, particularly for those at high risk for surgery. [ABSTRACT FROM AUTHOR]

We present an extremely rare case of multivalvular endocarditis in an immunocompetent host which is not observed in routine clinical practice. Multivalvular endocarditis is extremely rare to find in today's era due to the widespread use of broad-spectrum antibiotics to treat pyrexia of unknown origin (PUO). Multivalvular involvement is usually encountered in immunocompromised individuals and is most often due to staphylococcal in origin. It is scarce to find our case of a 73-year-old elderly nondiabetic female with PUO who was diagnosed to be having endocarditis of both aortic and mitral valves showing large friable vegetations. In contrast, her urine and blood culture both had grown Enterococcus species. We successfully treated the patient with parenteral ampicillin and gentamycin for eight weeks, which made the patient afebrile and resolved the vegetation. [ABSTRACT FROM AUTHOR]

Background: Vaccines during the pandemic COVID-19 were the best solution to overcome the pandemic. The aim of this study was to evaluate and compare Sputnik V, Sinopharm, and AstraZeneca vaccins' side effects. Material and Methods: A cross-sectional study was designed among healthcare workers in a teaching hospital. The checklist was prepared for collecting data of demographic variables, respondents' medical history, and vaccines side effects. Results: More than half of participants received Sinopharm, while the development of COVID-19 following AstraZeneca was significantly among smaller proportion of respondents than other vaccines (P< 0.0001). There was no significant difference between age group and general side effects. The prevalence of serious side effects was higher in healthcare workers younger than 40 years old (P< 0.0001). The emergence of oral side effects was higher in participants who received two doses of vaccines in comparison to individuals who received one dose (P< 0.0001). Conclusion: The prevalence of serious side effects was higher in sputnik V in comparison to the other vaccines. The vaccines serious side effects were linked to the age of vaccinated people and immune system responses. [ABSTRACT FROM AUTHOR]

Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P

Background and Aims: Dexmedetomidine has been used as an anti-shivering agent in the perioperative period in pregnant patients undergoing caesarean section (CS), but its effectiveness remains inconclusive. This systematic review and meta-analysis aimed to assess the efficacy of intravenous Dexmedetomidine in the management of shivering. Methods: PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were explored for the randomised controlled trials (RCTs), which compared intravenous administration of Dexmedetomidine with normal saline (placebo) or other anti-shivering agents for the prevention or treatment of shivering in pregnant patients undergoing CS under central neuraxial blockade. The primary outcome was either incidence and/or severity (for prevention) and duration and/or success rate (for treatment) of shivering between the two groups. The secondary outcome measures were adverse effects (bradycardia, hypotension, sedation, nausea and vomiting, and effect on the APGAR scores of the baby) if observed. Data were synthesised using a random effect model. We calculated the odds ratio (95% CI) for presenting the categorical outcome and standardized mean difference (95% CI) for continuous outcomes. Heterogeneity was assessed using I2 statistics and was investigated using sensitivity analysis. Results: A total of 15 RCTs were included in the present systematic review and data from 10 RCTs comparing Dexmedetomidine with normal saline were pooled into the meta-analysis for primary outcome measure. The incidence and severity of shivering at 30 and 60 minutes weresignificantly less in the Dexmedetomidine group compared to the normal saline group [OR = 0.30, 95% CI: 0.19 to 0.47, P < 0.0001; MD = -0.54, 95% CI: -0.81 to -0.26, Z = 3.78, P = 0.0002 and MD = -1.06, 95% CI: -1.46 to -0.66, Z = 5.23, P < 0.0001 respectively]. Similarly, the time to reduce shivering was significantly lower and the success rate of treatment was higher in the Dexmedetomidine group compared to the normal saline group [MD = -13.55, 95% CI: −17.78 to -9.12, Z = 6.0, P < 0.0001 and OR = 0.03, 95% CI: 0.02 to 0.07, P < 0.0001 respectively]. There was no heterogeneity among the studies for incidence, severity at 60 minutes, and success rate of treatment outcome, while the severity of shivering at 30 minutes and time to reduce shivering demonstrated moderate heterogeneity. The side effect profile was comparable between the Dexmedetomidine and control (active and passive) group. Conclusion: This meta-analysis shows that intravenous administration of Dexmedetomidine for both prophylaxis and treatment is superior to normal saline in the management of perioperative shivering during CS, but is comparable to other most commonly used anti-shivering agents. There is no statistically significant difference in the incidence of side effects between the two groups.

The article presents a case study of a 34-year-old patient with autoimmune Glial Fibrillary Acidic Protein (GFAP) astrocytopathy, a rare central nervous system inflammatory disorder. Topics discussed include the diagnostic challenges and imaging findings related to autoimmune GFAP astrocytopathy, the impact of the condition on neurological and functional abilities, and the effectiveness of a multidisciplinary rehabilitation approach in improving patient outcomes.

ABSTRACTBackground Shivering occurs in 40–60% of patients under spinal anesthesia. Prophylaxis with intravenous tramadol produces a dose-dependent reduction in the incidence of shivering. Intrathecal Tramadol is used safely as an adjuvant in a dose up to 20 mg. Few studies tested the anti-shivering efficacy of intrathecal tramadol. However, no study compared the anti-shivering effect of the two different routes of tramadol. The aim is to compare the anti-shivering effect of intrathecal versus intravenous tramadol. This study was a randomized, triple-blinded parallel-design clinical trial, conducted in orthopedic operating room in our university hospitalMaterial and Methods The study included 86 patients of ASA I & II aged 18 years or more who underwent lower limb orthopedic surgery that lasted less than 2 hours under spinal anesthesia. Patients were randomly allocated into two equal groups: control intravenous (IV) group and interventional intrathecal (IT) group. We used Amadol ampoules 100 mg/2 ml (Adwia company).Intervention The control group received IT 15 mg bupivacaine and then IV tramadol 0.25 mg/kg in 5 ml normal saline. The interventional group received 20 mg IT tramadol added to 15 mg bupivacaine then IV 5 ml normal saline. The patients were observed for intraoperative shivering, the primary outcome. Intraoperative hemodynamics, postoperative shivering, and its score were all recorded. Postoperative complications such as nausea, vomiting, and hypotension were documented.Results Intraoperative shivering was observed in 18.6% of the patients in IV group compared to 4.6% of patients in the IT group with a P-value of 0.047.Conclusions IT tramadol is more efficient in preventing post-spinal shivering compared to IV tramadol.

Surgical emergencies in patients with hemophilia A represent a major risk of mortality without proper multidisciplinary management and require prompt and effective treatment to prevent complications and improve patient outcomes. We present a short number of cases that were hospitalized in the I–II Surgery Clinic of the Emergency County Hospital "St. Spiridon" from Iasi, Romania, with hemophilia A requiring surgical emergencies. The timing of surgical intervention is very important, so the indication for surgical intervention must be made judiciously and without delay. Consequently, it is vital to ensure access to hemostatic support so surgery can be performed on these patients, ultimately saving their lives. [ABSTRACT FROM AUTHOR]

Postoperative shivering is one of the most common complications of surgeries. The current research compared the effects of ketamine, granisetron, and dexmedetomidine on reducing postoperative shivering after general anesthesia. This double-blind clinical trial enrolled 148 patients (39.08 ± 5.99 years old) who had been admitted to Vali-Asr Hospital of Arak, Iran in 2019–2021. The study drugs, including dexmedetomidine, ketamine, granisetron and normal saline, were administered in corresponding groups 30 minutes before the end of surgery. The results showed that dexmedetomidine reduced mean arterial pressure and heart rate in patients. The lowest incidence of shivering was observed in the dexmedetomidine group and it increased the duration of recovery. Overall, dexmedetomidine is recommended to reduce postoperative shivering after general anesthesia, but the increase in duration of recovery should be considered. [ABSTRACT FROM AUTHOR]

Background: Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering. Aims and Objectives: In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering. Materials and Methods: Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted. Results: The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P<0.001). The additional tramadol requirement was significantly lower in Group T versus I and in Group T versus C but comparable among Group I versus C. Conclusion: The addition of 25 mg tramadol to IT 0.5% bupivacaine heavy is effective in preventing intraoperative shivering in patients undergoing urological surgeries like URSL. [ABSTRACT FROM AUTHOR]

Headache is a common symptom of influenza infection; however, its causes and consequences remain uncertain. In this manuscript, we analyzed which demographic and clinical factors were associated with the presence of headache during the course of influenza infection and whether patients with headache had a different prognosis, evaluated by need of hospitalization, sick leave or school absenteeism. The influence study (NCT05704335) was an observational study that analyzed data routinely collected from the Health Sentinel Network between 2010 and 2020. During the study period, 7832 cases were considered, among which, 5275 (67.4%) reported headache. The presence of headache was independently associated with myalgia (2.753; 95%CI: 2.456–3.087, P < 0.001), asthenia (OR: 1.958; 95%CI: 1.732–2.214, P < 0.001), shivering (OR: 1.925; 95%CI: 1.718–2.156, P < 0.001), nasopharyngeal erythema (OR: 1.505; 95%CI: 1.293–1.753, P < 0.001), fever (OR: 1.469; 95%CI: 1.159–1.861; P = 0.001), sudden onset of symptoms (OR: 1.380; 95%CI: 1.120–1.702, p = 0.004), female sex (OR: 1.134; 95%CI: 1.023–1.257, P = 0.018), and gastrointestinal symptoms (OR: 1.169; 95%CI: 1.039–1.315; P = 0.01). Patients with headache had a sex and age adjusted lower odds of being referred to the hospital (OR: 0.463; 95%CI: 0.264–0.812, P = 0.007) and a higher odd of having a sick leave and/or school absenteeism (absenteeism (OR: 1.342; 95%CI: 1.190–1.514, P < 0.001). In conclusion, the presence of headache seems associated with symptoms caused by the innate immune response. These findings support a headache pathophysiology linked with the innate immune response. Due to the potential negative consequences and its treatable nature, clinicians should systematically evaluate it and, whenever necessary, treat it too. [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening hypersensitivity reaction with cutaneous presentation and internal organ involvement. We herein present a case of phenytoin induced DRESS syndrome in a 56- year-old male who presented with high-grade fever and chills, cough with expectoration and generalized maculopapular rash. Laboratory findings revealed eosinophilia, leukocytosis, thrombocytopenia, transaminitis and elevated inflammatory markers. Further clinical, radiological and histopathological assessments confirmed the diagnosis. Phenytoin was discontinued, and patient was started on intravenous dexamethasone, which was later switched to oral prednisone. Rapid resolution of fever, eosinophilia and progressive improvement in skin rash and liver dysfunction was observed. Our report highlights the importance of prompt recognition of DRESS syndrome and the need for a guideline directed therapy for the management of this adverse drug reaction. [ABSTRACT FROM AUTHOR]

Shivering occurs more frequently for women having caesarean section under neuraxial anaesthesia compared to other patient groups and causes an increase in pain and interrupts bonding with her newborn. This study aimed to report the evidence on non-pharmacological methods to treat shivering, defined as uncontrollable shaking, because of being cold, frightened, or excited, post neuraxial anaesthesia; the use of local anaesthesia inserted around the nerves of the central nervous system such as spinal anaesthesia and epidural in women having a caesarean section. A scoping review was conducted using six electronic health databases that were searched with no restrictions placed on language, date, or study type. Of the 1399 studies identified, following screenings only one study was deemed suitable for inclusion. The study, a randomised controlled trial, compared forced air warming blankets (intervention) with the usual care of warmed cotton blankets (control) and its impact on maternal and newborn outcomes. The only statistically significant difference found was the perceived thermal comfort of the mother. Non-pharmacological treatments for shivering are underrepresented in the literature; only one study identified where the impact of active warming was compared to warmed cotton blankets (usual care) for the measures of: oral temperature; degree of shivering; and thermal comfort pain scores. There was a decline in temperature in both groups at odds with some women reporting feeling too warm such that they asked for the active warmer to be turned down. Social engagement strategies are interventions that send a signal of safety to the nervous system leading to a sense of calm and wellbeing and have biological plausibility and warrant evaluation. Recommendations for further research: design a robust study to test the effectiveness of social engagement strategies on shivering for women having caesarean section under neuraxial anaesthesia. [ABSTRACT FROM AUTHOR]

We investigated how young people comprehend stories of trauma through their immediate expressions after listening to personal testimonies of Holocaust survivors. The material included 747 drawings and 182 texts by 10–16-year-old Swedish pupils from 14 schools. Qualitative analyses and cross-tabulations showed that the testimonies elicited complex patterns of emotions and cognitive processing. Personal testimonies can thus be a powerful way of teaching about historical trauma, although complex cognitive meaning making might often require additional time and adult-facilitated conversation. Also, as the testimonies aroused strong emotions, they should be used in a well-informed way. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative shivering is an involuntary, oscillatory muscular activity during early recovery after anaesthesia. Postoperative shivering is a frequent complication of anaesthesia; it has been reported to range from 20 to 70% in general anaesthesia. Shivering is believed to increase oxygen consumption and increase the risk of hypoxemia; it might also increase postoperative complications. dexmedetomidine might provide a simple pharmacological intervention to suppress shivering and improve comfort without producing respiratory compromise in patients. Methods: The study was conducted in department of anaesthesiology at Pt. B. D. Sharma PGIMS, Rohtak. Total one hundred thirty-two patients of either sex between 18-60 years of age having physical status of grade I and II according to American Society of Anaesthesiologists (ASA) scheduled for elective laproscopic cholecystectomy under general anaesthesia were included in this study. It was a prospective, randomized and double blinded study. All the patients were randomly divided into four groups of 33 each. Group-I(DN)(n=33) Administration of 20 ml of normal saline over 10 min. Group-II(D0.5)(n=33) Administration of 0.5 mcg kg-1 dexmedetomidine over 10 min. Group-III(D0.75)(n=33) Administration of 0.75 mcg kg-1dexmedetomidine over 10 min. Group-IV(D1.0)(n=33) Administration of 1.0 mcg kg-1 dexmedetomidine over 10 min. Results: After studying various factors, we found from our study that i.v dexmedetomidine in the dose range of 0.5 mcgkg-1, 0.75 mcgkg-1 and 1.0 mcgkg-1reduces the rise in heart rate, systolic blood pressure, diastolic blood pressure during general anaesthesia. Thus, dexmedetomidine provides better perioperative haemodynamic stability in ASA I and II grade patients during general anaesthesia as dexmedetomidine has sedative, anxiolytic and sympatholytic properties. The decrease in pain and shivering was greater in dexmedetomidine dose 0.75 mcgkg-1 and 1.0 mcgkg-1 than dexmedetomidine dose 0.5 mcgkg-1 and placebo and time of first rescue analgesic was more in dexmedetomidine dose 0.75 mcgkg-1 and 1.0 mcgkg-1 than dexmedetomidine dose 0.5 mcgkg-1 and placebo. Conclusion: we recommend dexmedetomidinedose 0.75mcgkg-1 as an anaesthetic adjuvant can be used during general anaesthesia as an optimal dose to reduce post operative shivering in patients undergoing laproscopic cholecystectomy, because it significantly attenuates heart rate and blood pressures, it decreases pain and shivering and it facilitates smooth emergence from anaesthesia and the sedation and complication rate of dexmedetomidinedose 0.75mcgkg-1 is lower than other doses. [ABSTRACT FROM AUTHOR]

Background: Post-spinal anesthesia shivering is a common complication during cesarean deliveries, affecting maternal comfort and potentially impacting neonatal outcomes. Various preventive measures exist, but their efficacy remains uncertain, prompting exploration of alternative strategies such as tramadol. Objective: This study aims to evaluate the effectiveness of tramadol in preventing postspinal anesthesia shivering during cesarean deliveries compared to standard methods. Methods: A randomized controlled trial was conducted involving 150 of parturients scheduled for elective cesarean sections under spinal anesthesia. Participants were randomized into two groups: tramadol and placebo. Shivering incidence, severity, and duration were assessed using a standardized scale. Maternal and neonatal parameters were secondary outcome measures. Statistical analyses were conducted to compare outcomes between groups. Results: Tramadol significantly reduced post-spinal anesthesia shivering incidence (12% vs. 30% placebo) and severity scores (0.8 vs. 1.5 immediately post-delivery). Maternal vital signs remained stable. Neonatal Apgar scores (1 & 5 mins) showed no significant differences, indicating tramadol's efficacy without adverse neonatal effects. Conclusion: Tramadol showed efficacy in reducing post-spinal anesthesia shivering during cesarean deliveries without significant adverse effects on mothers or newborns. These findings suggest tramadol could serve as a potential preventive measure in this clinical setting, although further studies are warranted to validate its long-term safety and costeffectiveness. [ABSTRACT FROM AUTHOR]

Postoperative hypothermia followed by shivering is a common phenomenon in patients undergoing surgery under anesthesia, and should be prevented and treated in postoperative patient care units. This study was conducted to investigate the effect of warmed serum injection on postoperative shivering and recovery period of patients operated under general and spinal anesthesia. In this clinical trial, patients to be operated on under general and spinal anesthesia were randomly assigned into two groups of test and control. In the test group, patients received warmed intravenous fluids and blood products. All patients were monitored to record vital signs, incidences of hypothermia and shivering, and recovery period. The collected data were analyzed with repeated measures analysis of variance to detect significant differences between groups and significant changes within groups over time. The incidence of nausea, vomiting, and shivering in the intervention and control groups was (4.7%, 42%), (2.8%, 16.8%), and (6.6%, 43%), respectively. Patients in the intervention group had higher body temperature than the control group (<0.001). Also, patients under spinal anesthesia had higher body temperature than patients under general anesthesia (<0.001). Blood pressure reduction was also significantly higher in the control group than in the intervention group. The patients who received warm intravenous serum, and especially those who had received spinal anesthesia spent less time in the recovery room (<0.001). The use of warmed intravenous serum increased the patients' core temperature, reduced their postoperative shivering, and shortened their recovery period. Considering the potential risks associated with hypothermia, using such methods for hypothermia prevention can be highly effective in preventing shivering and prolongation of the recovery period and other potential complications. Anesthesia specialists and technicians are therefore encouraged to use this method as a preventive measure. [ABSTRACT FROM AUTHOR]

Dexamethasone is routinely used in anesthesia practice and has been regarded as one of the ideal perioperative agents. It is a synthetic glucocorticoid with potent antiinflammatory action. It reduces postoperative nausea and vomiting, pain, postoperative opioid requirements after general anaesthesia as well as spinal anaesthesia. It has been used via intravenous, epidural and perineural routes. It has been used successfully in fascial blocks. It significantly decreases fatigue, shivering and postoperative sore throat and improves quality of recovery. [ABSTRACT FROM AUTHOR]

Background: Objective: This study aims to compare the effectiveness and safety of ketamine, tramadol, and dexmedetomidine in the prophylactic treatment of shivering after spinal anesthesia. Methods: A randomized controlled trial was conducted involving 200 patients undergoing surgeries requiring spinal anesthesia. The participants were equally divided into three groups to receive either ketamine, tramadol, or dexmedetomidine as a prophylactic measure against shivering. The primary outcome measured was the incidence of shivering, while secondary outcomes included monitoring hemodynamic parameters and noting any adverse effects. Results: The incidence of shivering was significantly lower in the dexmedetomidine group compared to the ketamine and tramadol groups. Hemodynamic parameters remained stable across all groups, with minimal and manageable side effects. Tramadol and ketamine were effective to a lesser extent but were associated with more side effects compared to dexmedetomidine. Conclusion: Dexmedetomidine demonstrates a higher efficacy and better safety profile in preventing shivering after spinal anesthesia compared to ketamine and tramadol. These findings suggest that dexmedetomidine can be considered a preferred choice for preventing shivering in patients undergoing surgeries with spinal anesthesia. Further studies are recommended to confirm these findings and explore long-term outcomes. [ABSTRACT FROM AUTHOR]

Shivering is known to be a frequent complication, reported in 40 to 70 % of patients undergoing surgery under regional anesthesia. Post-anesthetic shivering is spontaneous involuntary, rhythmic, oscillating, tremor-like muscle hyperactivity that increases metabolic heat production up to 600% after general or regional anesthesia. Post anesthetic shivering may cause discomfort to patients, and aggravate wound pain by stretching incisions and increase intracranial and intraocular pressure. Various methods are available for control of shivering; these may be non pharmacological or pharmacological methods using drugs which have antishivering properties. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of prophylactic intravenous tramadol alone versus a combination of tramadol and ketamine in preventing shivering during spinal anesthesia for lower segment caesarean section. Methods: This double-blind randomized controlled trial was conducted at Ziauddin Hospital, North Nazimabad, Karachi, Pakistan from August 2023 to October 2023. Pregnant women aged between 18 to 40 years meeting American Society of Anesthesiologist physical status I and II admitted in hospital for lower segment caesarian section were enrolled. One group received an injection tramadol 0.5mg/kg whereas the other group received an injection of tramadol 0.25mg/Kg plus an injection ketamine 0.25 mg/Kg. The primary outcomes were incidence of shivering and severity of shivering. Time to shiver and complications were secondary outcomes. Results: Of total 190 patients, the mean age was 25.95 ±3.63 years. Shivering was reported in 96 (50.5%) patients. The incidence of shivering was found significantly lower in tramadol plus ketamine group as compared to tramadol group i.e., 18 (18.7%) vs. 78 (81.3%) (p-value <0.001). Severity of shivering was found significantly lower in tramadol plus ketamine group as compared to tramadol group (p-value <0.001). Mean duration of shivering found significantly lower in tramadol plus ketamine group as compared to tramadol group i.e., 4.78 ±0.73 minutes vs. 8.46 ±1.02 minutes (p-value <0.001) respectively. Conclusion: The incidence of shivering was significantly lower in the group receiving the combination therapy compared to those receiving tramadol alone. Notably, the severity and duration of shivering were also markedly reduced in the tramadol plus ketamine group. [ABSTRACT FROM AUTHOR]

Typhoid fever is a systemic infectious disease caused by the bacterium Salmonella Typhi and is rare in the United States. In April 2022, a case of typhoid was confirmed by positive blood cultures in Orleans County, New York among a 40-year-old Hispanic male who recently traveled from Mexico. He was employed as a seasonal farmworker and resided in migrant housing in Orleans County. Sixteen household contacts were identified and tested for possible typhoid infection. Because the migrant workers had not yet identified primary care providers in the area, the Orleans County Health Department coordinated testing services for the case and contacts. Salmonella Typhi was not detected in any of the case or contacts' stool samples, indicating the case was not a carrier and no transmission occurred to contacts. This report is intended to encourage local health agencies to consistently prioritize the health of the migrant worker population. [ABSTRACT FROM AUTHOR]

Background and Aims: Dexmedetomidine has been used as an anti-shivering agent in the perioperative period in pregnant patients undergoing caesarean section (CS), but its effectiveness remains inconclusive. This systematic review and meta-analysis aimed to assess the efficacy of intravenous Dexmedetomidine in the management of shivering. Methods: PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were explored for the randomised controlled trials (RCTs), which compared intravenous administration of Dexmedetomidine with normal saline (placebo) or other anti-shivering agents for the prevention or treatment of shivering in pregnant patients undergoing CS under central neuraxial blockade. The primary outcome was either incidence and/or severity (for prevention) and duration and/or success rate (for treatment) of shivering between the two groups. The secondary outcome measures were adverse effects (bradycardia, hypotension, sedation, nausea and vomiting, and effect on the APGAR scores of the baby) if observed. Data were synthesised using a random effect model. We calculated the odds ratio (95% CI) for presenting the categorical outcome and standardized mean difference (95% CI) for continuous outcomes. Heterogeneity was assessed using I2 statistics and was investigated using sensitivity analysis. Results: A total of 15 RCTs were included in the present systematic review and data from 10 RCTs comparing Dexmedetomidine with normal saline were pooled into the meta-analysis for primary outcome measure. The incidence and severity of shivering at 30 and 60 minutes weresignificantly less in the Dexmedetomidine group compared to the normal saline group [OR = 0.30, 95% CI: 0.19 to 0.47, P < 0.0001; MD = -0.54, 95% CI: -0.81 to -0.26, Z = 3.78, P = 0.0002 and MD = -1.06, 95% CI: -1.46 to -0.66, Z = 5.23, P < 0.0001 respectively]. Similarly, the time to reduce shivering was significantly lower and the success rate of treatment was higher in the Dexmedetomidine group compared to the normal saline group [MD = -13.55, 95% CI: −17.78 to -9.12, Z = 6.0, P < 0.0001 and OR = 0.03, 95% CI: 0.02 to 0.07, P < 0.0001 respectively]. There was no heterogeneity among the studies for incidence, severity at 60 minutes, and success rate of treatment outcome, while the severity of shivering at 30 minutes and time to reduce shivering demonstrated moderate heterogeneity. The side effect profile was comparable between the Dexmedetomidine and control (active and passive) group. Conclusion: This meta-analysis shows that intravenous administration of Dexmedetomidine for both prophylaxis and treatment is superior to normal saline in the management of perioperative shivering during CS, but is comparable to other most commonly used anti-shivering agents. There is no statistically significant difference in the incidence of side effects between the two groups. [ABSTRACT FROM AUTHOR]

Background The shivering effect after spinal anesthesia in total knee arthroplasty (TKA) is challenging for anesthesiologists. This study aimed to compare two administration routes of dexmedetomidine as a post-neuraxial shivering prevention measure and an adjunctive analgesic and sedative agent. Methods Fifty-six patients were randomly allocated into two equal groups. The intravenous dexmedetomidine (IV dex) group received an IV infusion of 0.5 µg/kg dexmedetomidine diluted in 20 ml saline and an adductor canal block (ACB) consisting of 20 ml of 0.25% levobupivacaine and 1 ml saline. The adductor canal block dexmedetomidine (ACB dex) group received a 20 ml IV infusion of saline and an ACB consisting of 20 ml 0.25% levobupivacaine and 1 ml of 0.5 µg/kg dexmedetomidine. Results The incidence of shivering 1 h post spinal anesthesia was equal in both groups (50%); however, the shivering grade was significantly lower in the IV dex group 1 h postoperatively. The onset of sensory block was significantly later in the IV dex group (22.14 ± 2.52 min) than in the ACB dex group (12 ± 3.31 min). Postoperative analgesic duration (h) was significantly longer in the ACB dex group (12.28 ± 4.47) compared to the IV dex group (9.28 ± 1.90). The sedation scores were also significantly higher in the IV dex group in the preoperative, intraoperative, and immediate postoperative periods. Conclusions While perineural ACB dexmedetomidine had similar intraoperative anti-shivering with less sedative effects as IV dexmedetomidine, it was associated with both less shivering control and superior analgesia post-TKA under spinal anesthesia.

shivering is one of common causes of maternal discomfort during cesarean section. This paper reviewed the studies on shivering during elective cesarean section in perspectives of its mechanism, risk factors, comprehensive heat-preservation and Traditional Chinese Medicine nursing interventions, and provided reference for prevention and control of shivering during elective cesarean section. (寒战是剖宫产手术中引起产妇不适的常见原因之一。本研究就剖宫产术中寒战发生机制、发生的危险因素、术中寒战的综合保温护理、中医特色护理干预措施进行综述, 皆在为剖宫产产妇术中寒战的防治提供可靠参考。)

Abstract Background Shivers in horses is characterized by abnormal hindlimb movement when walking backward and is proposed to be caused by a Purkinje cell (PC) axonopathy based on histopathology. Objectives Define region‐specific differences in gene expression within the lateral cerebellar hemisphere and compare cerebellar protein expression between Shivers horses and controls. Animals Case‐control study of 5 Shivers and 4 control geldings ≥16.2 hands in height. Methods Using spatial transcriptomics, gene expression was compared between Shivers and control horses in PC soma and lateral cerebellar hemisphere white matter, consisting primarily of axons. Tandem‐mass‐tag (TMT‐11) proteomic analysis was performed on lateral cerebellar hemisphere homogenates. Results Differences in gene expression between Shivers and control horses were evident in principal component analysis of axon‐containing white matter but not PC soma. In white matter, there were 455/1846 differentially expressed genes (DEG; 350 ↓DEG, 105 ↑DEG) between Shivers and controls, with significant gene set enrichment of the Toll‐Like Receptor 4 (TLR4) cascade, highlighting neuroinflammation. There were 50/936 differentially expressed proteins (DEP). The 27 ↓DEP highlighted loss of axonal proteins including intermediate filaments (5), myelin (3), cytoskeleton (2), neurite outgrowth (2), and Na/K ATPase (1). The 23 ↑DEP were involved in the extracellular matrix (7), cytoskeleton (7), redox balance (2), neurite outgrowth (1), signal transduction (1), and others. Conclusion and Clinical Importance Our findings support axonal degeneration as a characteristic feature of Shivers. Combined with histopathology, these findings are consistent with the known distinctive response of PC to injury where axonal changes occur without a substantial impact on PC soma.

Post-anaesthesia shivering is a common complication and has multiple deleterious effects. Sometimes multiple non-pharmacological interventions applied together may not control post-anaesthesia shivering adequately, necessitating the use of drugs in some cases. Hand warming is commonly used to warm up the body since time immemorial but its role in preventing post-anaesthesia shivering has not been evaluated. This case series describes the application of this simple and safe method of focal hand warming along with other non-pharmacological measures to suppress post-anaesthesia shivering, whereby possible use of drugs could be avoided.

Objective: To assess the effectiveness of prophylactic intravenous tramadol alone versus a combination of tramadol and ketamine in preventing shivering during spinal anesthesia for lower segment caesarean section. Methods: This double-blind randomized controlled trial was conducted at Ziauddin Hospital, North Nazimabad, Karachi, Pakistan from August 2023 to October 2023. Pregnant women aged between 18 to 40 years meeting American Society of Anesthesiologist physical status I and II admitted in hospital for lower segment caesarian section were enrolled. One group received an injection tramadol 0.5mg/kg whereas the other group received an injection of tramadol 0.25mg/Kg plus an injection ketamine 0.25 mg/Kg. The primary outcomes were incidence of shivering and severity of shivering. Time to shiver and complications were secondary outcomes. Results: Of total 190 patients, the mean age was 25.95 ±3.63 years. Shivering was reported in 96 (50.5%) patients. The incidence of shivering was found significantly lower in tramadol plus ketamine group as compared to tramadol group i.e., 18 (18.7%) vs. 78 (81.3%) (p-value

Pancreatic cancer is often diagnosed at an advanced stage and is frequently associated with severe pain. Traditional pain management in this condition may be improved with the use of topical diclofenac. A 39-year-old man with advanced pancreatic fibrosarcoma metastatic to the thoracic spine presented to the hospital with severe abdominal pain refractory to escalating doses of opioids. A celiac plexus block produced significant, yet inadequate, pain reduction. Satisfactory pain control and opioid de-escalation were ultimately achieved with the application of topical diclofenac gel to an area of bony metastasis. This case illustrates the potential for pain control using topical diclofenac in patients with pancreatic soft tissue tumors and vertebral metastases. Topical diclofenac may exert antitumoral effects and targeted application may improve absorption, leading to improved pain control. The use of topical diclofenac for pain management in metastatic pancreatic cancer presents an interesting tool that should be considered in similar cases. [ABSTRACT FROM AUTHOR]

Introduction: Nalbuphine and magnesium sulfate are commonly used drugs for the treatment of Perioperative Shivering (POS), but there is a paucity of comparative studies on their intrathecal use in Lower Segment Caesarean Section (LSCS) patients. LSCS is the most commonly performed obstetric surgery, and Spinal Anaesthesia (SA) is advantageous in LSCS. However, shivering has been found to be the most common side-effect of SA. Aim: To compare the effect of intrathecal injection of nalbuphine and magnesium sulfate on the prevention of postspinal anaesthesia shivering during LSCS. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, Government Medical College, Kathua, Jammu and Kashmir, India on 60 parturients between the ages of 20-40 years from September 2021 to January 2023. The participants had full-term gestation and an American Society of Anaesthesiologists (ASA) status of I or II, and were scheduled for LSCS under SA. The total sample was divided into two groups of 30 patients each. Group N (n=30) received 0.7 mg nalbuphine intrathecally, while Group M (n=30) received 25 mg of magnesium sulfate intrathecally, both with 0.5% bupivacaine (10 mg). Characteristics of spinal blockade, time to onset of shivering, severity of shivering, and side-effects such as nausea, vomiting, sedation, and hypotension were noted. Student’s t-test, Chi-square test, and Fisher’s exact test were used for data analysis. A p-value of <0.05 was considered statistically significant. Results: Both study groups were comparable in terms of age (p-value=0.081), height, weight (p-value=0.079), ASA grade (p-value=0.072), and duration of surgery (p-value=0.077). In group N, 5 patients (16.67%) had POS, while in Group M, 6 patients (20%) had POS, but the difference was not statistically significant. In Group N, 3 patients (10%) had a shivering score of 3 and 2 patients (6.67%) had a shivering score of 4, while in group M, 3 patients (10%) had a shivering score of 3 and 3 patients (10%) had a shivering score of 4. The difference was statistically insignificant. Perioperative complications (sedation, hypotension, nausea, and vomiting) were comparable in both groups with no statistically significant difference. Conclusion: Intrathecal injection of preservative-free 0.7 mg nalbuphine and 25 mg magnesium sulfate were both effective in reducing the incidence of postspinal shivering. Both drugs had comparable minimum perioperative complications. The intrathecal use of nalbuphine and magnesium sulfate for the prevention of postspinal shivering is encouraged, as both drugs are less expensive and readily available in the operation theaters. [ABSTRACT FROM AUTHOR]

Background & objective: Postoperative shivering is a source of much discomfort to the patients following spinal anesthesia (SA), especially in patients undergoing cesarean delivery. The anesthetists have employed various medications and a variety of measures to prevent shivering in their patients. The objective of this study was to investigate the efficacy and safety of intravenous (IV) dexmedetomidine in preventing shivering in patients undergoing cesarean delivery under SA. Methodology: This prospective, double-blind, randomized trial involved 62 parturients undergoing cesarean delivery under SA. They were randomly divided into two groups; patients in dexmedetomidine group (Group D, n = 31) received dexmedetomidine 0.5 µg/kg IV over 10 min followed by infusion of 0.4 µg/kg/h until the end of surgery; whilst patients in the control group (Group C, n = 31) received equivalent loading and infusion volume of 0.9% saline. Both groups were operated upon by a standardized spinal anesthesia technique. The occurrence of shivering, sedation score and hemodynamic parameters were recorded intraoperatively. The recording anesthetist was blinded regarding the study or the control groups. Results: The occurrence of shivering was significantly reduced in Group D as compared to Group C (3.2% vs 64.5%, P < 0.001). Patients in Group D were more sedated as compared to Group C (51.6% vs 0%, P < 0.001). There was no statistically significant difference in systolic and diastolic blood pressure readings between both of the groups. Heart rates in Group D were significantly lower than the Group C but still were within normal physiological range. Conclusion: IV dexmedetomidine was effective in reducing the occurrence of shivering but with significant sedative effect and lowering of heart rate than the placebo. Although the heart rates remained within normal range in both groups [ABSTRACT FROM AUTHOR]

Background and Aims: Paracetamol (PCM) has an anti-shivering effect and may also exacerbate intraoperative hypothermia. This study compares the incidence of shivering as the primary outcome and the incidence of perioperative hypothermia (<36°C) and the time to the analgesic requirement as secondary outcomes when PCM was administered after induction of anaesthesia or towards the end of surgery. Methods: In this randomised study, 225 adult patients of either gender undergoing elective surgical procedures under general anaesthesia with an expected duration of surgery of 1–4 h were studied. They received intravenous (IV) PCM 15 mg/kg (maximum 1 g) immediately after anaesthesia induction (Early PCM group), 30 min before completion of surgery (Late PCM group) or no PCM (Control group). IV morphine 0.1 mg/kg was administered for analgesia in all three groups. The Chi-square test and repeated measures analysis of variance followed by Tukey's test were used for statistical analysis. Results: The incidence of shivering was lower in Late PCM (12%) than in Early PCM (29.3%) (P = 0.009) and Control groups (30.6%) (P = 0.005). The incidence of postoperative hypothermia was also significantly lower in the Late PCM group than in the Early PCM (P = 0.002) and Control groups (P = 0.016). Early PCM and Control groups did not significantly differ. The number of patients requiring postoperative analgesia was smaller, and the time to the analgesic requirement was longer in Late PCM compared to other groups. Conclusion: Administration of IV PCM 30 min before completion of surgery results in a lower incidence of postoperative shivering and hypothermia when compared to PCM administered after induction of anaesthesia or no PCM. [ABSTRACT FROM AUTHOR]

Background: Shivering is a common adverse effect of achieving and maintaining normothermia in neurocritical care patients. We compared the burden of shivering and shivering-related interventions between a novel transnasal temperature-modulating device (tnTMD) and surface cooling temperature-modulating devices (sTMDs) during the first 24 h of targeted normothermia in mechanically ventilated febrile neurocritical care patients. Methods: This is a case–control study controlling for factors that impact shiver burden: age, sex, body surface area. All patients underwent transnasal cooling (CoolStat, KeyTech, Inc.) as part of an ongoing multicenter clinical trial (NCT03360656). Patients undergoing treatment with sTMDs were selected from consecutively treated patients during the same time period. Data collected included the following: core body temperature (every 2 h), bedside shivering assessment scale (BSAS) score (every 2 h), and administration of antishivering medication for a BSAS score > 1. Time to normothermia (≤ 37.5 °C), as well as temperature burden > 37.5 °C (°C × h), were compared between groups using Student's t-test for mean differences. The proportion of patients requiring interventions, as well as the number of interventions per patient, was compared using the χ2 test. Significance was determined based on a p value < 0.05. Results: There were 10 tnTMD patients and 30 sTMD patients included in the analysis (mean age: 62 ± 4, 30% women, body surface area = 1.97 ± 0.25). There were no differences between groups in temperature at cooling initiation (tnTMD: 38.5 ± 0.2 °C vs. sTMD: 38.7 ± 0.5 °C, p = 0.3), time to ≤ 37.5 °C (tnTMD: 1.8 ± 1.5 h vs. sTMD: 2.9 ± 1.4 h, p = 0.1), or temperature burden > 37.5 (tnTMD: − 0.4 ± 1.13 °C × h vs. sTMD median [IQR]: − 0.57 ± 0.58 °C × h, p = 0.67). The number of tnTMD patients who received pharmacologic shivering interventions was lower than the number of controls (20 vs. 67%, p = 0.01). tnTMD patients also had fewer shivering interventions per patient (0 [range: 0–3] vs. 4 [range: 0–23], p < 0.001). Conclusions: A transnasal cooling approach achieved similar time to normothermia and temperature burden with less shivering than surface cooling. This approach may be a feasible option to consider for mechanically ventilated febrile neurocritical care patients. [ABSTRACT FROM AUTHOR]

While the cause of altered mentation in the elderly may be multifactorial, infectious etiologies may be missed. This case report aims to detail an account of a patient with dementia, found to have Lyme meningitis in the setting of a normal pressure hydrocephalus (NPH). The patient smelled of urine and presented with ambulatory dysfunction, fitting the "wet, wacky, and wobbly" triad of NPH while also having subjective chills and leukocytosis. Non-contrast brain CT scan showed dilated ventricles. Cerebrospinal fluid (CSF) studies suggested aseptic meningitis. Serum studies using a modified twotiered algorithm confirmed the diagnosis of Lyme disease. Treatment of the underlying condition with a prolonged course of doxycycline improved symptoms and clinical course. Review of the literature on the association between Lyme meningitis and NPH reveals that few cases of Lyme-related NPH have been reported worldwide and further research into the pathophysiology, diagnostic approach, treatment modalities, and management of NPH secondary to Lyme meningitis may be warranted. [ABSTRACT FROM AUTHOR]

Purpose: Perioperative shivering is common and can occur as a result of hypothermia or changes in the threshold of thermoregulation. Droperidol usage for anesthesia is currently limited to its sedative and antiemetic effects. We investigated the effects of high and low doses of droperidol on the shivering threshold in rabbits. Methods: Forty-two male Japanese white rabbits were anesthetized with isoflurane and randomly assigned to the control, high-dose, or low-dose group. Rabbits in the high-dose group received a 5 mg/kg droperidol bolus followed by continuous infusion at 5 mg/kg/h, those in the low-dose group received a 0.5 mg/kg droperidol bolus, and those in the control group received the same volume of saline as the high-dose group. Body temperature was reduced at a rate of 2–3 °C/h, and the shivering threshold was defined as the subject's core temperature (°C) at the onset of shivering. Results: The shivering thresholds in the control, high-dose, and low-dose groups were 38.1 °C ± 1.1 °C, 36.7 °C ± 1.2 °C, and 36.9 °C ± 1.0 °C, respectively. The shivering thresholds were significantly lower in the high-dose and low-dose groups than in the control group (P < 0.01). The thresholds were comparable between the high-dose and low-dose groups. Conclusions: Droperidol in high and low doses effectively reduced the shivering threshold in rabbits. Droperidol has been used in low doses as an antiemetic. Low doses of droperidol can reduce the incidence of shivering perioperatively and during the induction of therapeutic hypothermia. [ABSTRACT FROM AUTHOR]

Background: Shivering occurs in 40-60% of patients under spinal anesthesia. Prophylaxis with intravenous tramadol produces a dose-dependent reduction in the incidence of shivering. Intra thecal Tramadol is used safely as an adjuvant in a dose up to 20 mg. Few studies tested the antishivering efficacy of intrathecal tramadol. However, no study compared the anti-shivering effect of the two different routes of tramadol. The aim is to compare the anti-shivering effect of intrathecal versus intravenous tramadol. This study was a randomized, triple-blinded parallel-design clinical trial, conducted in orthopedic operating room in our university hospital. Material and Methods: The study included 86 patients of ASA I & II aged 18 years or more who underwent lower limb orthopedic surgery that lasted less than 2 hours under spinal anesthesia. Patients were randomly allocated into two equal groups: control intravenous (IV) group and interventional intrathecal (IT) group. We used Amadol ampoules 100 mg/2 ml (Adwia company). Intervention: The control group received IT 15 mg bupivacaine and then IV tramadol 0.25 mg/kg in 5 ml normal saline. The interventional group received 20 mg IT tramadol added to 15 mg bupivacaine then IV 5 ml normal saline. The patients were observed for intraoperative shivering, the primary outcome. Intraoperative hemodynamics, postoperative shivering, and its score were all recorded. Postoperative complications such as nausea, vomiting, and hypotension were documented. Results: Intraoperative shivering was observed in 18.6% of the patients in IV group compared to 4.6% of patients in the IT group with a P-value of 0.047. Results: Intraoperative shivering was observed in 18.6% of the patients in IV group compared to 4.6% of patients in the IT group with a P-value of 0.047. [ABSTRACT FROM AUTHOR]

Background: Recently, use of HT35 receptor antagonists to prevent postoperative shivering has attracted a great deal of attention. This study was conducted with the aim of investigating the effectiveness of granisetron as an HT35 antagonist when compared with ondansetron and meperidine in preventing postoperative shivering. Material and Methods: In this triple blind random clinical trial study, 90 patients 18-50 years of age with ASA Class I and II undergoing general anesthesia were randomly assigned into one of the three drug groups: O (4-mg ondansetron), G (40 jug/kg of granisetron), and P (25 mg meperidine), immediately before induction of anesthesia. After anesthesia induction, at the end of the surgery, after the entrance and after leaving the recovery state, central temperature, peripheral temperature, heart rate, systolic blood pressure, diastolic blood pressure, and shivering were measured and documented. Two-tailed P < 0.05 was considered significant. Results: In the meperidine, ondansetron, and granisetron groups, 4 (13.3%), 3 (10%), and 10 (33.3%) of patients experienced shivering during recovery, where the difference between the ondansetron and granisetron groups was significant (p-value=0.02). The variations in the mean arterial pressure during the investigation stages only in the ondansetron group were not significant (p>0.05). At the beginning of recovery, the reduction of peripheral temperature significantly was lower in the ondansetron group (p<0.05), while reduction of the central temperature was significantly (p<0.05) higher in the granisetron group. By the end of the recovery, the variations in the peripheral temperature across the three groups were consistent with the changes at the beginning of recovery, but variations of the central temperature across the three groups was not significantly diverse. Conclusion: Granisetron was not found to be much effective in preventing postoperative shivering. Ondansetron and meperidine were equally effective in preventing postoperative shivering. Ondansetron also causes less hemodynamic changes compared to other drugs, while granisetron is more effective in terms of preventing nausea and vomiting. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is a proper treatment for cholecystitis but the Carbon dioxide gas which is used in surgery stimulates the sympathetic system and causes hemodynamic changes and postoperative shivering in patients undergoing operations. This study was conducted to evaluate the effects of clonidine on reducing hemodynamic changes during tracheal intubation and Carbon dioxide gas insufflation and postoperative shivering in patients undergoing laparoscopic cholecystectomy. Material and Methods: This prospective, randomized, triple-blind clinical trial was conducted on 60 patients between the 18-70 years-old age group, who were candidates of laparoscopic cholecystectomy surgery. The patients randomized into two groups (30 patients received 150 µg oral clonidine) and 30 patients received 100 mg oral Vitamin C). Heart rate and mean arterial pressure of patients were recorded before anesthesia, before and after laryngoscopy, before and after Carbon dioxide gas insufflation. Data were analyzed using Chi-2, student t-test, and analysis of variance by repeated measure considering at a significant level less than 0.05. Results: The findings of this study showed that both heart rate and mean arterial pressure in clonidine group after tracheal intubation and Carbon dioxide gas insufflation were lower than patients in the placebo group, but there was not any statistically significant difference between the two groups (p>0.05) and also postoperative shivering was not different in groups. There was no significant statistical difference in postoperative shivering between the two groups (p>0.05). Conclusion: Using 150 µg oral clonidine as a cheap and affordable premedication in patients undergoing laparoscopic cholecystectomy improves hemodynamic stability during operation. [ABSTRACT FROM AUTHOR]

Background: Peri-operative shivering remains a common issue often encounteredduring surgery. Various pharmacological and nonpharmacological methods are employed to control shivering. Nalbuphine and tramadol are shown to possess potent anti-shivering effects. Hence the present study was undertaken to compare the effect of Inj. Nalbuphine Hydrochloride and Inj. Tramadol Hydrochloride for treatment of perioperative shivering in regional anaesthesia. Method: Total 90 patients of either sex, aged 18-65years, ASA I/II, who scheduled for elective surgeries under regional anaesthesia were randomly divided into three groups of 30 patients in each. Group N received 0.08µg/kg Nalbuphine diluted in 5 ml of 0.9% normal saline, Group T received 0.5 mg/kg Tramadol diluted in 5 ml of 0.9% normal saline and Group C (Controlled) received 5ml of 0.9% normal saline. Results: In group T, mean score according to Filos sedation was found to be 1.10±0.31, and in group N it was 1.10±0.31 whilein controls it was 1.10±0.30, (p>0.05). Tramadol shows lesser cessation time of shivering (3.73±1.43min) as compared to nalbuphine (4.08±1.28 min), though the difference was not statistically significant, (p=0.36). Theinsignificant difference found between the response intramadol and nalbuphine groups, (p=0.36) but significant difference was observed between the response of normal saline and tramadol (p<0.0001) and between the response of normal saline and nalbuphine (p<0.0001). The groups were found to be matched regarding recurrence (p=0.120), hypotension(p=0.200), nausea (p=0.133), vomiting (p=0.133) and pruritis (p=0.364). Conclusion: Tramadol administration in dose of 0.5mg/kg or Nalbuphine administration in dose of 0.08mg/kg is recommended to counteract perioperative shivering in subjects undergoing surgery under regional anaesthesia with central neuraxial blockade. [ABSTRACT FROM AUTHOR]

Background: As one of the most common postoperative complications, hypothermia is the main cause of numerous problems during treatment, especially in elderly patients with decreased cardiac reserves. Objectives: The aim of the present study was to compare the effects of forced-air warming system (FAWS), warmed intravenous fluids (WIVFs) and routine method on hemodynamic parameters, arterial blood gases (ABGs), shivering, and time to awakening in elderly patients undergoing open cardiac surgery (OCS). Methods: This clinical randomized controlled trial was conducted on 94 elderly patients who underwent OCS at Ayatollah Rouhani Hospital, Babol, Iran. They were divided into three groups, namely FAWS (n=31), WIVFs (n=31) and routine rewarming method (RRWM, with a blanket) (n=32). The data were then recorded in a checklist. Descriptive and inferential statistics were performed using SPSS 26 at a significance level of less than 0.05. Results: The findings demonstrated that the degree of hypothermia had a significant decreasing trend in the groups receiving FAWS and WIVFs (P=0.002). Additionally, increased respiratory rate (P=0.013), higher bicarbonate (HCO3-) levels on arrival up to 4 hours after surgery (P=0.045), reduced lactate level (P=0.005), normal base excess (BE) and accelerated time to awakening (P=0.004) were observed in patients receiving FAWS. There was no significant difference in the study groups regarding shivering. Conclusion: The results revealed that FAWS could mitigate the degree of hypothermia, increase body temperature and decrease the postoperative serum lactate levels. Moreover, BE as one of the most important parameters for ABGs, could remain at a normal level. Besides, the use of FAWS could lead to early awakening, and thus facilitate weaning and extubation of these patients. [ABSTRACT FROM AUTHOR]

Background:Shivering is one of the most common side effects after cesarean section under neuraxial anesthesia due to inhibition of thermoregulatory control. However, it is often not treated. Aims & Objectives: This study aimed to evaluate the effect of low dose Dexmedetomidine on shivering in patients undergoing C-sections after spinal anesthesia. Materials & Methods: This randomized placebo controlled clinical study included 128 patients of ASA group II undergoing lower segment cesarean section under spinal anesthesia. They were randomly divided two groups as Group D received dexmedetomidine 20µg in 1ml normal saline intravenously and Group P received 1 ml of normal saline intravenously to all parturients after the clamping of umbilical cord. All patients were evaluated during and after surgery for hemodynamic changes, incidence of shivering, sedation score and any other side effects. Results: The incidence of shivering in group P (56.7%) was significantly higher than in group D (10%). The mean sedation score and hemodynamic changes were not significantly different between the two groups (P < 0.05). No significant adverse effects were noted. Conclusion: The administration of prophylactic intravenous low dose dexmedetomidine effectively reduces the incidence of perioperative shivering in patients undergoing lower segment cesarean section under spinal anesthesia without causing any remarkable side effects. [ABSTRACT FROM AUTHOR]

Background and Aims: Post-anaesthesia shivering is distressing and is observed after spinal and general anaesthesia. Nalbuphine, a partial mu-opioid receptor antagonist with kappa-opioid receptor agonist properties, has been successfully used to manage post-anaesthesia shivering. Methods: After registering the review with the International Prospective Register of Systematic Reviews (PROSPERO), we searched PubMed/Medline, Scopus, Ovid, Cochrane Library and clinicaltrials.gov with keywords for randomised controlled trials. The risk of bias-2 (RoB-2) scale was used to assess the quality of evidence. We also used Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines to evaluate the strength of evidence and trial sequential analysis to validate the conclusions. Results: Of the 240 articles, 10 were considered eligible for review (700 patients, 350- nalbuphine, 350- control or placebo). When compared to placebo, the success rate of nalbuphine controlling shivering was significantly better (risk ratio [RR]: 2.37, 95% confidence interval [CI]:1.91, 2.94; P = 0.04, I2 = 94%), but comparable to the control group drugs (opioids, dexmedetomidine, ondansetron, pethidine). Compared to placebo, shivering recurrence was significantly less with nalbuphine than with placebo (RR: 0.47, 95% CI: 0.26, 0.83; P = 0.01, I2 = 61%), but comparable with the control group. The incidence of postoperative nausea/vomiting (PONV) was significantly less with nalbuphine when compared to the control group (RR: 0.67, 95% CI: 0.47, 0.95; P = 0.02, I2 = 37%), but PONV in the nalbuphine group was comparable to placebo (RR: 1.20, 95% CI: 0.68, 2.12; P = 0.54, I2 = 0%). Other outcomes, like the grade of shivering and hypotension, were comparable between the nalbuphine and control groups. Conclusion: Nalbuphine successfully controls post-anaesthesia shivering and reduces the recurrence of shivering. [ABSTRACT FROM AUTHOR]

Malignant myeloid sarcoma (chloroma) is a rare extramedullary solid tumor that consists of immature myeloid precursor cells, constantly associated with acute myeloid leukemia (AML). Here, we report the case of a 35-year-old male who developed an acute paraplegia secondary to paraspinal chloroma associated with AML. A careful review of the patient's history, blood smear, and bone marrow findings will decrease the chance of missing the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Shivering is one of the most common adverse outcomes associated with the administration of spinal anaesthesia, which, when clinically relevant, leads to numerous detrimental effects on the human body. Hence, its management becomes imperative. Meperidine, an opioid analgesic, is the drug of choice for this condition. However, the use of meperidine is controversial, as it carries the devastating adverse effect of respiratory depression. We explored the role of granisetron, a 5HT3 antagonist and a commonly used antiemetic premedication, in minimising the incidence of post-spinal shivering and decreasing the use of meperidine as a rescue drug. Methods: Overall, 160 parturient patients, between the ages 18-50, undergoing uncomplicated, elective caesarean section, were enrolled in the study, and randomized into two groups with 80 participants each: Group A received 3ml of normal saline, and Group B was administered 3 mg granisetron, 15 minutes before spinal anaesthesia institution. Incidence of clinically relevant shivering (score of 3 or more) was noted, and it was recorded whether meperidine was used or not. Results: 67.5% of participants in Group A, and 32.5% of patients in Group B, experienced clinically relevant shivering, with 62.5% of patients in Group A and 28.75% in Group B warranting the use of meperidine. There was a statistically significant difference between the two groups in terms of incidence of clinically relevant shivering, and meperidine consumption (p-value <0.001). Conclusion: Premedication with 3 mg granisetron effectively attenuates the occurrence of post-spinal shivering and, hence, lowers the requirement of meperidine as rescue medication. [ABSTRACT FROM AUTHOR]

Objective:Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia.Methods:One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects.Results:The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value

Introduction: Regional anaesthesia is widely used and safe anaesthetic technique. It leads to Intra/ post-operative shivering. There are various methods available to control. Tramadol is one of the most widely used to control shivering, however it is also associated with nausea and vomiting. Objective: To compare the efficacy of dexmedetomidine and tramadol in the treatment of post‑spinal anesthesia (SA) shivering as well as to compare their side‑effect profile. Methodology: This hospital based, prospective, randomized, double blinded, Superiority type of interventional study included 60 patients undergoing elective spinal anesthesia aged 20-60 years, ASA grade I and II, weighing 40-80 kilograms. Subjects were randomly allocated into two groups, to receive either 0.5 mcg/kg Dexmedetomidine (Group D) or 05 mg/kg Tramadol (or grpup T). The grade of shivering was assessed as per wrench (Grade 0: no shivering, Grade 1: One or more of the following: piloerection, peripheral vasoconstriction, peripheral cyanosis, but without visible muscles activity, Grade 2: Visible muscle activity confined to one muscle group, Grade 3: Visible muscle activity in more than one muscle group and Grade 4: Gross muscle activity involving the whole body). Result: Shivering was eliminated in all the patients who received either dexmedetomidine or tramadol. Time for unset of shivering and grade of shivering is quite similar in both study groups. Time to cessation of shivering was significantly earlier with dexmedetomidine (174.3±12.5) as compare with tramadol (279.6±15.9). Nausea and vomiting is found significantly higher (P value = 0.024) with tramadol.

Abstract Background Inadvertent perioperative hypothermia (IPH) defined as core temperature below 36.0 °C is a common complication of general anesthesia with prevalence up to 70%. Warming of peripheral tissues prior to induction of anesthesia reduces the central to peripheral temperature gradient, thereby minimizing central heat loss due to heat redistribution, after induction of anesthesia. This study aimed to evaluate the effect of prewarming on post-induction core temperature and incidence of perioperative inadvertent hypothermia leading to postanesthetic shivering (PAS) in patients undergoing general anesthesia. This is a single-arm study performed after authorization from the scientific review committee (IRB no.:10/2015/05) in a cohort of patients between the ages of 18 and 65 years in ASA I and II physical status, undergoing GA for elective surgeries lasting less than 3 h. Rates of IPH and PAS in 60 patients who were warmed before anesthesia over a 30-min period with a forced-air warmer set at 38.0 °C were compared with existing data from an equal number of cohorts who received only intraoperative warming, during similar surgical procedures according to routine GA. Comparisons between the two groups were made using the Student’s t-test and chi-square test. A paired t-test or Wilcoxon’s signed rank test was applied for pairwise comparisons. The results were considered statistically significant when the P-value was