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

1. A COMPARISON BETWEEN KETAMINE,CLONIDINE AND
COMBINATION OF KETAMINE-CLONIDINE FOR THE
PREVENTION OF POSTANAESTHETIC SHIVERING
By-
Asim Abinash
Krishna Bollojula
Shubham Sharma
Soham Mukhopadhyay
Suddhasheel Bhattacharya
Swapnasis Mohanty

2. AGENDA
• Introduction
 Data Given
 Objective
• Demographical Analysis
• Pre-op and Post-op Analysis
• Final Results
• Conclusion

3. Introduction
• Data Given
 Sample Size (120 Patients)
• Groups(4)
 Group-K(Single dose of Intravenous Ketamine [0.5mg/kg])
 Group-C(Single dose of Intravenous Clonidine [1.5mg/kg])
 Group-KC(Combination of Intravenous Ketamine
[0.25mg/kg]and Clonidine [o.75mcg/kg])
 Group-P(Placebo)
• Objective
 To compare the efficacy of single dose intravenous ketamine
and intravenous clonidine and combination of intravenous
ketamine plus clonidine in the prevention of shivering
following general anesthesia.

4. DEMOGRAPHICAL ANALYSIS
After comparing the demographical data such as age, weight, height,
date of surgery(dos) of patients across all four groups we have found
that there was no significant statistical difference across the four
groups. This result was concluded using anova test where the
p – value for all the four groups was >0.05 (i.e. null hypothesis was
accepted)

5. Pre-op and Post-op analysis
Parameters
• Heart Rate
• Systolic Blood
Pressure
Post-operative
• As there is significant
difference in the
mean value of all four
groups i.e. all groups
are equally unstable
• As there no significant
difference in the
mean value of group-
KC, so Group –P is the
most stable .
As there no significant
difference in the mean
value of group-KC, so
Group -KC is the most
stable .
As there no significant
difference in the mean
value of group-KC and
Group-P , so Group -KC &
Group-P are most
stable .
Pre-operative

6. Parameters
• Diastolic Blood
Pressure(DBP)
• Mean Arterial
Pressure(MAP)
Post-operative
• As there is significant
difference in the
mean value of all four
groups i.e. all groups
are equally unstable.
• As there is significant
difference in the
mean value of all four
groups i.e. all groups
are equally unstable.
• As there no
significant difference in
the mean value of
group-KC, so Group -KC
is the most stable .
• Group-KC and Group-
KC are having equally
stable.
Pre-operative

7. Parameters
• Peripheral
oxygen
saturation (SPO2)
• Capnography
(ETCO2 )
Post-operative
• As there no significant
difference in the
mean value of all four
groups i.e. all groups
are equally effective.
• As there no
significant difference
in the mean value of
all four groups i.e. all
groups are equally
effective.
• As there no
significant difference
in the mean value of
all four groups i.e. all
groups are equally
effective.
Pre-operative

8. Parameters
• Body temperatures-
Surface
• Body temperatures-
Surface -Core
Post-operative
• As there no significant
difference in the
mean value of all four
groups i.e. all groups
are equally effective.
• Only Group-P has no
significant difference,
the rest three group
has significant
difference.
Pre-operative

9. Adverse Effects
• Hypotension
 Group – K has no event of hypotension
 50% of people in Group – P has hypotension
 Group-KC and Group –P has 17% event of hypotension
• Hypertension
 50% of people in Group-K has hypertension
 Group- C has no event of hypertension
 47% of people in Group-P has hypertension
 In Group-KC has more than 85% event of no hypertension

10. • Bradycardia
 50% of people have bradycardia in Group-C
 More than 90% of people have no event of bradycardia in
Group-K
 More than 85% of people have no event of bradycardia in
Group-KC and Group-P
• Tachycardia
 60% of people have tachycardia in Group- K
 80% of people do not have tachycardia in Group-C & Group-KC
 More than 65% of people do not have tachycardia in Group-C

11. • Nausea and Vomiting
 90 % of the people in Group-K, Group-P & Group-KC has no
event of nausea and vomiting.
 Group-C has highest events of nausea and vomiting.
• Shivering
 50 % of the people in Group KC has no Shivering.
 Group P has highest event of Shivering(Shiv>=3).
 Group K and Group C has shivering levels between 1 and 2.

12. • Sedation Score
 High Variation of sedation Score in Group C (sed_score>=3).
 More than 80% of people in Group K & Group P has score of 1.
 More than 50% of people in Group KC has score of 1.
 General Sedation Score scale.

13. Parameters Group-K Group-K Group-K&C Group-P
Pre-operative
Heart rate NE NE E NE
Systolic BP NE NE E NE
Diastolic BP NE NE E NE
Mean Artrial pressure NE NE E NE
Core temprature NE NE NE E
Post operative
Heart rate NE NE NE NE
Systolic BP NE NE E NE
Diastolic BP NE NE NE NE
Mean Artrial pressure NE NE NE NE
If there is less number of fluctuations from Base Line we have termed it as effective for that parcticular parameter
If there is high number of fluctuations from Base Line we have termed it as Not effective for that parcticular parameter
Overall Efficacy Of Drugs

14. Parameters Group-K Group-C Group-K&C Group-P
SHIVERING NORMAL NORMAL LOWEST HIGHEST
SEDATION LOWEST HIGHEST NORMAL LOWEST
HYPOTENSION LOWEST HIGHEST NORMAL NORMAL
HYPERTENSION HIGHEST LOWEST NORMAL HIGHEST
BRADYCARDIA NORMAL HIGHEST NORMAL NORMAL
TACHYCARDIA HIGHEST NORMAL NORMAL NORMAL
NAUSEA & VOMITING LOWEST HIGHEST NORMAL NORMAL
SHIVERING
LOWEST LOWEST SHIVERINGSCORE ACROSS GROUPS
HIGHEST HIGHEST SHIVERINGSCORE ACROSS GROUPS
NORMAL ALL VALS IN BETWEEN
SEDATION
LOWEST LOWEST SED SCORE ACROSS GROUPS
HIGHEST HIGHEST SED SCORE ACROSS GROUPS
NORMAL ALL VALS IN BETWEEN
HYPOTENSION
LOWEST LOWEST HYPOTENSION ACROSS GROUPS
HIGHEST HIGHEST HYPOTENSION ACROSS GROUPS
NORMAL ALL VALS IN BETWEEN
Adverse Effects Of Drugs

15. Conclusion
From the tables it could be concluded that:
• Intravenous ketamine (0.25mg/kg) and clonidine(0.75mcg/kg))
combination works the best for most vital parameters with least
adverse effects

16. Thank You