The document compares ketamine, clonidine, and a combination of ketamine-clonidine for preventing post-anesthetic shivering in 120 patients. It finds that a combination of intravenous ketamine (0.25mg/kg) and clonidine (0.75mcg/kg) is most effective at stabilizing vital parameters with the fewest adverse effects like shivering, sedation, and tachycardia. Single doses of ketamine or clonidine showed more fluctuations in vital parameters and higher rates of side effects like bradycardia, hypertension, and nausea. The combination treatment provided the best balance of preventing shivering while maintaining stable hemodynamics and low side effect rates.

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

2. Agenda
• Introduction
• Objective
• Demographical Analysis
• Intra-operative Analysis
• Post-operative Analysis
• Adverse Effects
• 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)

4. 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.
Total Sample Size(120)
Group-K(30) Group-C(30) Group-KC(30) Group-P(30)

5. Demographic Analysis
• Average age, height, weight and duration of
surgery are almost same across groups.
• Male-female ratio in Group-P is almost same.

6. Intra-operative and Post-operative Analysis
• Across groups, the average values of Heart Rate(HR),
Systolic Blood Pressure(SBP), Diastolic Blood
Pressure(DBP), Mean Arterial Pressure(MAP),Peripheral
oxygen saturation (SPO2) are compared using ANOVA
test.
• Across groups, the mean difference values of all the
above variables are compared with the baseline value
using Paired t-test.
• These variables are tested using the values measured
during intra-operative and post-operative periods.
• Body temperatures(Core and Surface) and Capnography
(ETCO2 ) are measured only during Intra-operative periods.

7. Intra-operative Analysis
• Heart Rate(HR) has shown variations across all groups
after induction. Group-C has shown the highest variation.
• When compared with base line value, Group-K is raising
the HR, Group-C is lowering the HR and Group-KC has
fewer variations and more stability.
• Systolic Blood Pressure(SBP) has shown variations
across all groups. Group-KC has shown the less
variations (values lies between 120-139 with less
fluctuations).
• When compared with base line value, Group-KC is more
stable and there is a sudden increase at EOS in Group-K
and Group-P

8. Intra-operative Analysis
• Diastolic Blood Pressure(DBP) is stable across Group-
C, Group-KC and Group-P and near to normal value of
being less than 80. Group-K is slightly increasing DBP.
• When compared from baseline, Group-K and Group-C
has high fluctuations, Group-P seems more stable at all
intervals except at 15 min and EOS intervals. Group-KC
is more stable.
• Mean Arterial Pressure shows variations across groups
with highest variation in Group-C and more stable in
Group-KC.
• When compared from baseline, SBP is increasing in
Group-K and decreasing in Group-C and more stable in
Group-KC.

9. Intra-operative Analysis
• Peripheral oxygen saturation (SPO2 ) has very less
fluctuations and almost similar across groups.
• When compared from baseline, it seems same across
groups and values at 50 min and 30 min in Group-KC
and Group-P are the same values as the baseline(mean
difference=0).
• Capnography (ETCO2 ) has very less fluctuations and
almost similar across groups.
• When compared from baseline, it seems same across
groups. However, Group-KC is decreasing very slightly
from baseline, Group-P is increasing from baseline.

10. Intra-operative Analysis
• Core temperature has very less fluctuations and almost
similar across groups.
• When compared from base line, it shows variations in
Group-K, C and KC except at Induction interval and
Group-P don’t have any variations.
• Surface temperature has very less fluctuations and
almost similar across groups.
• When compared from baseline, it shows variations in all
groups except in three intervals in Group-P.

11. Post-operative Analysis
• Heart Rate(HR) is more stable across all groups except
Group-C has shown decrease in HR.
• When compared with base line value(EOS), all groups
patients HR is coming to normal values.
• Systolic Blood Pressure(SBP) has shown variations by
being higher the normal value(120-139) across all
groups except Group-C. Group-K has shown higher
variations.
• When compared with base line value, all groups have
shown variations, Group-K, C and P values are
decreasing.

12. Post-operative Analysis
• Diastolic Blood Pressure(DBP) is stable across Group-
K, Group-KC and Group-P and near to normal value of
being less than 80. Group-C DBP values are decreasing.
• When compared from baseline, all groups DBP values
are getting decreased. Hence, Group-C patients need
attention.
• Mean Arterial Pressure shows variations across groups
with highest variation in Group-C and Group-KC.
• When compared from baseline, MAP values in all groups
are decreasing and very high variation at 30 min.

13. Post-operative Analysis
• Peripheral oxygen saturation (SPO2 ) has very less
fluctuations and almost similar across groups.
• When compared from baseline, it seems same across
groups and values at 30 min in Group-KC is the same
values as the baseline(mean difference=0).

14. Adverse Effects
• Tachycardia (Intra-op HR >100)
 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
• Bradycardia (Intra-op HR <60)
 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

15. Adverse Effects
• Hypertension (Intra-op MAP > 20%or more from Baseline)
 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
• Hypotension (Intra-op MAP < 20%or more from Baseline)
 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

16. Adverse Effects
• 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 & Group C has shivering levels between 1 and 2.

17. Adverse Effects
• 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.

18. Adverse Effects

19. Final Results
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
Post operative
Heart rate NE NE NE NE
Systolic BP NE E NE 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

20. Final Results
Variables Group-K Group-C Group-KC 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 HYPERTENSION
LOWEST LOWEST SHIVERING SCORE ACROSS GROUPS LOWEST LOWEST SHIVERING SCORE ACROSS GROUPS
HIGHEST HIGHEST SHIVERING SCORE ACROSS GROUPS HIGHEST HIGHEST SHIVERING SCORE ACROSS GROUPS
NORMAL ALL VALS IN BETWEEN NORMAL ALL VALS IN BETWEEN
SEDATION TACHYCARDIA
LOWEST LOWEST SED SCORE ACROSS GROUPS LOWEST LOWEST SED SCORE ACROSS GROUPS
HIGHEST HIGHEST SED SCORE ACROSS GROUPS HIGHEST HIGHEST SED SCORE ACROSS GROUPS
NORMAL ALL VALS IN BETWEEN NORMAL ALL VALS IN BETWEEN
HYPOTENSION BRADYCHARDIA
LOWEST LOWEST HYPOTENSION ACROSS GROUPS LOWEST LOWEST HYPOTENSION ACROSS GROUPS
HIGHEST HIGHEST HYPOTENSION ACROSS GROUPS HIGHEST HIGHEST HYPOTENSION ACROSS GROUPS
NORMAL ALL VALS IN BETWEEN NORMAL ALL VALS IN BETWEEN

21. Conclusion
Based on the comparisons of vital parameters and adverse
effects across all groups, we conclude that
Intravenous ketamine (0.25mg/kg) and clonidine
(0.75mcg/kg)) combination works the best for most vital
parameters with least adverse effects.
•We need to check with the other adverse effects like
sedation score, shivering, tachycardia etc., caused to
patients due to this drug.