| Introduction and purposePostoperative shivering(POS)is one of the common postoperative complications in patients with gynecological laparoscopic surgery,with an incidence of up to 65%.Shivering refers to the rapid and rhythmic contraction of skeletal muscles to increase heat production,which is a compensatory response of the body to hypothermia.The etiology and mechanism of shivering are still unclear.Hypothermia,age,anesthesia,operation time,fluid infusion and other factors are influencing POS.POS not only increased cardiac output and peripheral vascular resistance,aggravated the burden of the heart,but also may lead to lactic acidosis,increased intraocular and intracranial pressure,and prolonged anesthesia recovery time and other adverse reactions,so it is very important for the prevention and treatment of POS.Studies have shown that esketamine(Ket)or the ondansetron(Ond)all have the effect of the prevention of postoperative shivering,but esketamine will increase postoperative illusion,the incidence of nausea and vomiting,and Ondansetron was not as effective as esketamine in preventing POS.At present,there are few reports on the efficacy and safety of the combined use of the two drugs to prevent POS.The purpose of this study was to compare the clinical effects of conventional dose of esketamine,ondansetron or small dose of esketamine combined with ondansetron on the prevention of postoperative shivering in patients undergoing gynecological laparoscopic surgery.MethodsThis study was a randomized,parallel and controlled study approved by the Clinical Research Ethics Committee of Shandong Provincial Hospital affiliated to Shandong University,and enrolled patients signed informed consent.A total of 120 patients undergoing gynecological laparoscopic surgery were selected and divided into three groups according to random block method:esketamine group(Ket group,n=40),ondansetron group(Ond group,n=40),and low-dose esticketamine combined with ondansetron group(KO group,n=40).The Ket group was given 0.5mg/kg esticketamine intravenously half an hour before the end of surgery,the Ond group was given 8mg ondansetron intravenously half an hour before the end of surgery,and the KO group was given 0.25mg/kg esticketamine combined with 4mg ondansetron intravenously half an hour before the end of surgery.After admission to the operating room,all patients’ upper limb veins were opened and electrocardiogram(ECG),noninvasive blood pressure(NIBP),and blood oxygen saturation(SpO2)were monitored using a standard noninvasive monitor.The main outcome was postoperative shivering.Secondary indicators included changes in peripheral body temperature and core body temperature and the occurrence of postoperative adverse reactions.Logistic regression was used to analyze the independent risk factors of POS.ResultsIn this study,The incidence of postoperative shivering was 22.5%(9/40)in Ket group,25%(10/40)in Ond group and 5%(2/40)in KO group.KO group was significantly lower than Ket group(OR=0.417,95%CI(0.242-0.675),P<0.05),AND KO group was also significantly lower than Ond group(OR=0.357,95%CI(0.162-0.575),P<0.05).The incidence of postoperative nausea and vomiting was 20%(8/40)in Ket group,significantly higher than 2.5%(1/40)in Ond group and 5%(2/40)in KO group(P<0.05).The incidence of postoperative hallucinations in Ket group was 12.5%(5/40)significantly higher than that in KO group 0%(0/40)and KO group 2.5%(1/40)(P<0.05).Logistic regression analysis showed that intraoperative fluid volume and operative time were independent risk factors for postoperative shivering.Conclusions1.The effect of small dose of esketamine combined with ondansetron on postoperative shivering is better than that of esketamine or ondansetron alone;2.Low dose of esketamine combined with ondansetron can also reduce the incidence of adverse reactions of nausea,vomiting and hallucinations caused by esketamine alone;3.Intraoperative fluid volume and operative time were independent risk factors for postoperative shivering. |
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