Analysis of Various Drugs :Prevention of shivering during regional anaesthesia

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A comparison between ketamine, clonidine and combination of ketamine-clonidine for the prevention of post anaesthetic shivering

A comparison between ketamine, clonidine and combination of ketamine-clonidine for the prevention of post anaesthetic shivering

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  • 1. A COMPARISON BETWEEN KETAMINE, CLONIDINE AND COMBINATION OF KETAMINE-CLONIDINE FOR THE PREVENTION OF POST ANAESTHETIC SHIVERING PRESENTED BY: SUDHANSHU RANJAN SANTOSH KOPADA ROHIT KUMAR SUMIT KUMAR PANKAJ KUMAR SINGH
  • 2. Agenda  Introduction  Demographical  Pre-op Analysis & Post-op Analysis with Ideal Range  Adverse Events & Shivering Analysis  Result  Conclusion
  • 3. Introduction   Shivering is distressing for the patients undergoing surgery. Causes for shivering intra/post-operative  Temperature loss  Decreased sympathetic tone  Systemic release of pyrogens  Sample Size (120)  Total Groups(4)  Analysis on various factors  Evaluation of effectiveness of intravenous ketamine and clonidine and combination of both, in control of shivering and to note the side effects of drug used.
  • 4. Demographic Analysis  After comparing the demographic data such as age, weight, height and sex of patients across all the four groups, we have found that there was no significant statistical difference across the groups.  The result was found using the anova test where the ‘p’ value of all the variables was >0.05 DEMOGRAPHIC ANALYSIS 300.00 AVERAGE 250.00 200.00 150.00 100.00 50.00 0.00 64.70 61.47 64.10 64.70 161.47 163.07 163.37 161.70 39.80 42.70 40.07 43.27 Group K Group C Group KC GROUP WEIGHT HEIGHT Group P
  • 5. Pre-op & Post-op Analysis With Ideal Range Normal Range Pre-Operative Normal range of Heart Rate is 60-80 BPM Group K & P was constantly high and crossed above 85 immediately after intubation Normal range for SBP is 120-140 Sharp increase in SBP in group K (145.2) immediately after mmHg administration of ketamine and after surgery(150) Post-Operative After EOS HR was reported high for group K&P (80) and came down to 70 after 30 min of surgery. Group C shows considerable lower heart rate Group K still above 140 even after 30 min of EOS whereas other group was under range. Group K & P show fluctuations Normal range for DBP IS 60-90 with it being high at some point during the surgery and at the mmHg end of surgery, compare to other groups KC & C. Overall the DBP of each group was within the range Group K,KC& P stable after 30 min of EOS whereas group C reported major fall after 30 min of EOS & touches 60 Fluctuation occurred but within Normal Range for MAP is 70- the normal range, Major 110 mmHg fluctuation reported in Group K &C All group stables after 30 min of EOS
  • 6. Adverse Events & Shivering Analysis  Among the four groups, we have found that Tachycardia happens to 60% of the patients in Group K and is least in Group C. Bradycardia occurs to almost 50% of the patients in Group C and is least in Group K.  From the analysis we also see that Group K and Group P has a high percentage of patients where hypertension occurs. And Group C has an extremely high percentage of patients where hypotension occurs.  Group KC, as we can see from the below graphical representation is the least effected.  Higher shivering occurred in group P . SHIVERING >=3 46.67 16.67 Group P 20 3.33 53.33 6.67 53.33 0 T AC H Y C AR D I A B R AD Y C AR D I A H Y P E R T E N SI ON H Y P O T E N S I O N ADVERSE EFFECT Group KC Group C Group K Group P 66.67 46.67 Group KC 13.33 60 13.33 6.67 20 10 16.67 16.67 Group C 23.33 33.33 Group K NUMBER OF PATIENTS(IN %) NUMBER OF PATIENTS (IN %) ADVERSE EFFECT(IN %) S H I VE R I N G (> = 3 )
  • 7. RESULT  During the surgery we found that the incidence of shivering was lowest in Group C, low in group KC, high in group K and extremely high in group P. But in Group C it was found that side-effects like Bradycardia, Nausea and Vomiting and Hypotension was high.  Group K was found to have high occurrences of hypertension and tachycardia.  Among all the four groups, it was found that group KC has the lowest occurrence of shivering and other side effects.
  • 8. CONCLUSION  Combination of ketamine and Clonidine in the dose of 0.5 mg/kg and 1.5mg/kg respectively i.v. during regional anaesthesia significantly decreased the incidence of shivering without causing any major side effects.  Even combination of these drugs decreased the Nausea & Vomiting Number Of Patients ( In %) Adverse_Effect & N_V 100% 80% 60% 40% 20% 0% Tachycardia Bradycardia Group K Group C Hypertension Group KC Hypotension Group P N_V
  • 9. Thank You