This study compared the efficacy of ketamine, clonidine, and a combination of ketamine-clonidine in preventing shivering following general anesthesia. 120 patients were divided into 4 groups receiving intravenous ketamine, clonidine, ketamine-clonidine combination, or placebo. Hemodynamic parameters, temperature, and shivering were monitored and compared intraoperatively and postoperatively. The results showed that the ketamine-clonidine combination had the most stable vital signs and lowest incidence of side effects like tachycardia, hypertension, hypotension, and nausea compared to the other groups. Therefore, the combination of ketamine and clonidine was recommended as the best treatment to prevent postoperative shivering.

1. A COMPARATIVE
STUDY ON KETAMINE,
CLONIDINE & A
COMBINATION OF
KETAMINE-CLONIDINE
FOR PREVENTION OF
SHIVERING
FOLLOWING GENERAL
ANAESTHESIA
Presented by:
Amarjeet Singh
Ankush Roy
Ashitha VS
Koushik Rakshit
Namita Pandey
Roma Agrawal

2. BACKGROUND
OBJECTIVE OF THE STUDY
 To compare the efficacy of single dose intravenous ketamine
(0.5mg/kg) and intravenous clonidine (1.5mcg/kg) and combination
of intravenous ketamine(0.25mg/kg) plus clonidine(0.75mcg/kg) in
the prevention of shivering following general anesthesia.
Total Size of Sample: 120 patients
Randomly allocated in following four equal groups:
 Group K – will receive intravenous ketamine(0.5mg/kg).
 Group C - will receive intravenous clonidine(1.5mcg/kg).
 Group KC– will receive combination of intravenous
ketamine(0.25mg/kg) and intravenous clonidine(0.75mcg/kg).
 Group P - will receive intravenous normal saline(placebo).

3. ANALYSIS & OBSERVATIONS
 Average Age, Weight & Height are symmetrical across
all groups.
 Average duration of surgery is also similar across all
groups.
 Each group has a similar sex ratio.
 Hence, we can infer that all the four groups are identical
in nature.

4. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Heart Rate (HR) across Groups: Pre operative HR was same across
all the groups. After that, as p<0.0001 at every time stamp, HR is
fluctuating. Group C has exceptionally low HR.

5. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Systolic Blood Pressure (SBP) across Groups: Pre operative value is
same, after that values are different across the groups at different time
stamps and exceptionally low for Group C.

6. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Diastolic Blood Pressure (DBP) across Groups: Mean DBP, just like
HR and SBP, has showed similar pattern in all the groups. However,
DBP for group C is relatively lower as compared to other groups. Mean
DBP across groups are the same for all the groups at pre-op stage.

7. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Mean Arterial Pressure (MAP) across Groups: MAP also follows the
same pattern - same for groups K, KC and P and slightly lower for
group C.

8. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Peripheral Oxygen Saturation (SPO2) across Groups: As p-value is
significantly high at every time stamps, therefore, null hypothesis is
true, hence there is symmetry between all four groups with reference
to SPO2.

9. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Capnography (ETCO2) across Groups: All 4 groups have similar type
of fluctuations and mean ETCO2 is almost same across groups at all
time stamps.

10. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Surface Temperature (ST) across Groups: Mean ST is similar across
all four groups.

11. ANALYSIS & OBSERVATIONS
Intra Operative Comparison
Core Temperature (CT) across Groups: Mean CT remain same across
all groups. Variations in first 3 groups are same, but group P has
constant CT.

12. ANALYSIS & OBSERVATIONS
Post Operative Comparison
Heart Rate (HR) across Groups: It is similar in Groups K, KC, P but
slightly low in group C.

13. ANALYSIS & OBSERVATIONS
Post Operative Comparison
Systolic Blood Pressure (SBP) across Groups: It is similar in Groups K,
KC, P but slightly low in group C.

14. ANALYSIS & OBSERVATIONS
Post Operative Comparison
Diastolic Blood Pressure (DBP) across Groups: It is similar in Groups
K, KC, P but slightly low in group C.

15. ANALYSIS & OBSERVATIONS
Post Operative Comparison
Mean Arterial Pressure (MAP) across Groups across Groups: It is
similar in Groups K, KC, P but slightly low in group C.

16. ANALYSIS & OBSERVATIONS
Post Operative Comparison
Peripheral Oxygen Saturation (SPO2) across Groups: As p-value is
high, therefore, all 4 groups have similar values of SPO2.

17. ANALYSIS & OBSERVATIONS
Comparison with Baseline values (Intra-Operative)
 Heart Rate (baseline value is HR_PREOP): Behaviors of
Group K and C are same, where p-value is significantly less.
Therefore null hypothesis is rejected and, hence, HR for these
two groups are different at different time points. Groups KC
and P have P>0.5 at most of the time stamp. Hence, for these
two groups null hypothesis is accepted. Thus, they have same
HR at different time points.
 Peripheral Oxygen Saturation (SPO2) (baseline values is
SPO2_PI): P-value is significantly high for all 4 groups. The
null hypothesis is accepted and, hence, SPO2 is same across
all groups.

18. ANALYSIS & OBSERVATIONS
Comparison with Baseline values (Intra-Operative)
 Systolic Blood Pressure, Diastolic Blood Pressure and
Mean Arterial Pressure (baseline value is SBP_PREOP,
DBP_PREOP and MAP_PREOP respectively):
Behaviors of Group K and C are same, P value is
significantly less. Therefore, null hypothesis is rejected
and, hence, these 3 variables for these two groups are
different at different time points. Groups K,C and P have
P>0.5 at most of the time stamp. Hence, for these two
groups null hypothesis is accepted. Thus, they have
same SBP, DBP and MAP at different time points.

19. ANALYSIS & OBSERVATIONS
Comparison with Baseline values (Post-Operative)
 Heart Rate (baseline value is HR_EOS): P<0. Thus,
alternative hypothesis accepted, i.e., all groups have different
HR at different time interval.
 Systolic Blood Pressure, Diastolic Blood Pressure and Mean
Arterial Pressure (baseline value is SBP_EOS, DBP_EOS
and MAP_EOS respectively): P<0. Therefore, alternative
hypothesis is accepted, i.e., all groups have different SBP,
DBP and MAP at different time interval.
 Peripheral Oxygen Saturation (SPO2) (baseline value is
SPO2_EOS): SPO2 is stable as p is significantly high. Null
hypothesis is true.

20. ANALYSIS & OBSERVATIONS
• Group K has highest cases of Tachycardia and Hypertension in
group K while Bradycardia.
• Hypotension and Nausea Vomiting are mainly reported within group
C patients.
• Group KC has lesser side-affects among all 4 groups

21. ANALYSIS & OBSERVATIONS
 Maximum patients from Group K suffered both from
Tachycardia & Hypertension immediately followed by Group
P in both the cases.
 No case of hypertension reported in Group C.
 Group C reported with highest cases of Hypotension while
no cases is seen in Group K.
 Affect of nausea & vomiting is highest in Group C with 8
patients.
 Interestingly, Group KC has lesser side-affects among all 4
groups.

22. ANALYSIS & OBSERVATIONS
Sedation is the most in group C , followed by group KC. Almost
80-85% patients of group K & P, remain fully awake, which is a
serious issue during operation.

23. ANALYSIS & OBSERVATIONS
Shivering was more or less noticed amongst all groups but
maximum in group P followed by K and KC.
.

24. RECOMMENDATIONS
From the analysis, it is clear that patients who were given dose
of combination of intravenous ketamine (0.25mg/kg) and
clonidine (0.75mcg/kg)) have normal variation for almost all
parameters and also less side-effects.
So, this will be the best way for the prevention of Post-anesthetic
Shivering.
Scope for further medical research
Causes for side-effects should be determined:
 Tachycardia and hypertension in group K
 Bradycardia, Hypotension and Nausea Vomiting in group C

25. Thank You