Effectiveness of Dexmedetomidine versus Ketamine for Control of Shivering and Hemodynamic Stability in Vaginal Hysterectomy under Spinal Anesthesia

Abstract

Abstract: Background: Shivering is an attempt by the body to increase the generation of heat through metabolism in response to core hypothermia. Ketamine and dexmedetomidine have been used to prevent shivering during anesthesia with variable findings.

Objective: To determine effectiveness of dexmedetomidine versus ketamine for control of shivering and comparing hemodynamic stability in vaginal hysterectomy under spinal anesthesia.

Materials and Methods: This double blinded randomized control trial was performed in Hamdard University Hospital during January to October, 2023. Before commencing the study, formal permission was taken from Ethics Committee of Hamdard University Hospital (Ref#HCM&D/20/2022). Patients of age 45-55 years undergoing vaginal hysterectomy with ASA grade of I-II were enlisted. Group D was given a prophylactic dose of dexmedetomidine (1mcg/kg) and Group K was given a prophylactic low dosage of ketamine (0.25 mg/kg). Blood pressure (mmHg), heart rate (bpm), oxygen saturation (%) and mean arterial pressure (mmHg) were recorded after every 15 minutes throughout the procedure.

Result: Total 104 patients were enrolled into the study with equal allocation in both the groups. In dexmedetomidine group, only 2 (3.8%) patients experienced shivering whereas in Ketamine group shivering was seen among 9 (17.3%). Among dexmedetomidine group, both of the patients developed shivering at 98 minutes. In ketamine group, average shivering onset time was 84 ± 29.8 minutes with range of 60-105 minutes. Average duration of shivering in dexmedetomidine group was 20±2.1 minutes whereas average duration of shivering for ketamine group was 26.1 ± 9.6 minutes.

Conclusion: The present study demonstrated that dexmedetomidine is superior to ketamine in shivering prevention and control following spinal anesthesia. This study also found that dexmedetomidine is also effective in maintaining hemodynamic stability throughout the procedure.