A Comparison Between Ketamine,Clonidine and combination of Ketamine-Clonidine for prevention of postanaesthetic shivering

1. A COMPARISON BETWEEN KETAMINE,CLONIDINE
AND COMBINATION OF KETAMINE-CLONIDINE
FOR THE PREVENTION OF
POSTANAESTHETIC SHIVERING
SAS CASE STUDY
Presented by
Arbind Kumar (A13003)
Vaibhav Jain (A13021)
Sunil Kumar (A13020)
Punit Kishore (A13011)
Maruthi Nataraj (A13009)

2. BACKGROUND
OBJECTIVE
To compare the efficacy of single dose intravenous ketamine (0.5mg/kg)
and intravenous clonidine (1.5
mcg/kg) and
combination of
intravenous ketamine(0.25mg/kg) plus clonidine(0.75mcg/kg) in the
prevention of shivering following general anaesthesia.
SAMPLE SIZE
Total = 120 patients
GROUPS
Randomly allocated in following four equal groups (n=30):
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 AND OBSERVATIONS
• Average Age, Weight and Height is same across all the groups.
• Group P has equal mix of males and females.
• Average duration of surgery is almost similar across all groups.
• Heart rate has shown steady variations across all groups after prior
induction with highest variation in group C. When compared to the
baseline, Group KC has fewer variations in the heart rate & shows more
stability.

4. ANALYSIS AND OBSERVATIONS
• When compared with baseline, the fluctuation of systolic blood
pressure is highest in C Group and it is most stable in group KC.
There is sudden spurt in SBP at end of surgery in groups K and P.
• Diastolic blood pressure is most stable in the required intervals
when compared to DBP at prior induction in group KC. In group P
also, there are few variations except a shoot at 15 min interval and
higher fluctuations are observed in groups K and C.

5. ANALYSIS AND OBSERVATIONS
• Mean arterial pressure in comparison to it at prior induction, most
stability is observed in KC group and it has lot of variation in C group.
• Peripheral oxygen saturation, when compared with the same at
prior induction, there is only a marginal variation in few points
where in it can observed that SPO2 was at the same level as it was at
prior induction after 50 min in KC group and after 30 min in P group.

6. ANALYSIS AND OBSERVATIONS
Group K has most number of patients
affected by Tachycardia which is 18 and group
C being the lowest with 3 patients. At the
same time, group C has highest number of
patients who are affected by Bradycardia.

7. ANALYSIS AND OBSERVATIONS
• Hypertension is observed to highest across group K followed by
group P with 16 and 14 patients respectively. It is interesting to
see that there are no patients affected by Hypotension in group K
and it is highest in group C with 16 patients.
• Affect of nausea and vomiting Is highest in group C with 8
patients and lowest in group K with only 1 patient. On an average,
group KC has been consistent wherein patients were exposed to
the adverse events only to a smaller extent.

8. ANALYSIS AND OBSERVATIONS
66.7% of the patients in group P have moderate shivering followed
by group K which is 23.33% which includes low shivering and
moderate shivering. Group KC has 50% of patients with no shivering
and 23.33% with visible shivering which is most favourable. Group C
has 33.33% and 43.33% of the patients with no shivering and visible
shivering respectively.

9. ANALYSIS AND OBSERVATIONS
In group C, the patients become more drowsy followed by
group KC. Also, patients of groups K and P are almost fully
awake which might be an issue during the operation.

10. RECOMMENDATIONS
• Patient can be treated with the drug dose which is
combination of intravenous ketamine (0.25mg/kg) plus
clonidine (0.75mcg/kg)
following
for the prevention of shivering
general anaesthesia
after taking various other
factors into considerations.
• Identify reasons for heart rate and diastolic pressure
dropping below 70 after operation in case of treatment with
above drug.
• Though there is reduction in shivering , monitor
side effects like Hypertension, Hypotension etc.