and Effects of Dexamethasone
Yared JP, Starr NJ, Hoffman HoggL, et al
Dexamethasone Decreases the Incidence of Shivering After Cardiac Surgery : A Randomized, Double Blind, Placebo Controlled Study
Anesth Analg 87: 795-799, 1998
Many patients undergoing cardiac surgery experience shivering in the immediate postoperative period. A possible cause of this problem is fever and chills resulting from activation of the inflammatory response and release of cytokines by cardiopulmonary bypass [CPB]. Because Dexamethasone [DEX] can modify the inflammatory response to CPB, prevent fever, and improve peripheral circulation, the drug has been recommended for use in cardiac surgery.
The double blind study randomized 236 patients to DEX or placebo, administered after the induction of anesthesia but before skin incision. After surgery, ICU nurses unaware of the patients treatment group, recorded visible shivering. Skin temperatures and central blood temperature were monitored continuously and 02 consumption and CO2 production were randomly minitored to confirm the nurses measurements.
DEX significantly decreased the incidence of shivering from 33% to 13% in the 205 evaluable patients. The two treatment groups did not differ significantly in duration of anesthesia, CPB cross-clamp time, lowest bladder temperature on CPB, or central blood temperature on admission to ICU. The incidence of shivering was significantly lower in the DEX group, irrespective of whether CPB was with normothermia or hypothermia. Significantly 34 patients were women and none of them experienced any shivering.