The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Bolus administration versus continuous infusion of intravenous magnesium sulfate in prevention of shivering following cesarean section under spinal anesthesia: a single-blind randomized clinical trial study

Document Type : Original Article

Authors
Seyed Hossein Hamidi 1
Ebrahim Alijanpour 2
Nadia Banihashem 2
Meysam Ghorbanpour 3
Kourosh Jafar Kazemi 1
1 Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
2 Associate Professor, Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
3 Anesthesiologist and Resident of Intensive Care, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
10.22038/ijogi.2022.20038
Abstract
Introduction: Shivering following spinal anesthesia is caused by a disturbance in body temperature regulation that increases tissue oxygen consumption and cardiopulmonary activity. So far, various methods have been used to reduce and treat it. Magnesium sulfate is a common drug used in pregnant women that also has anti-shivering properties. This study was performed with aim to compare the effectiveness of intravenous magnesium sulfate with bolus infusion in the prevention of shivering after cesarean section.
Methods: This interventional clinical trial study was performed in 2017 on 300 pregnant women with term pregnancy, singleton pregnancy, and ASA class I clinical anesthesia in the United States who underwent elective cesarean section at Ayatollah Rouhani Hospital in Babol. The subjects were divided into 3 groups who immediately after spinal anesthesia received 30-minute infusion of magnesium sulfate, bolus injection of magnesium sulfate and normal saline, respectively. P< 0.05 was considered statistically significant.
Results: Overall, shivering in 30, 60, 75 and 90 minutes were significantly lower in the magnesium sulfate infusion group than the bolus and control injection groups, (p=0.018) for the infusion group and (p=0.038) for the bolus group.
Conclusion: The prevalence of shivering significantly reduced by injection of magnesium sulfate. Compared to the method of administration of magnesium sulfate, administration of the drug by infusion within 30 minutes to reduce the incidence of shivering was significantly superior to the bolus administration of the drug and is recommended in patients with a previous history of intraoperative shivering.
Keywords
Cesarean section
Magnesium sulfate
Shivering
Spinal anesthesia
  1. Luggya TS, Kabuye RN, Mijumbi C, Tindimwebwa JB, Kintu A. Prevalence, associated factors and treatment of post spinal shivering in a Sub-Saharan tertiary hospital: a prospective observational study. BMC anesthesiology 2016; 16(1):1-5.
  2. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesilogy. 5nd NewYork: McGraw-Hill; 2013.
  3. Chattopadhyay S, Goswami S, Rudra A. Efficacy of prophylactic clonidine in preventing postanesthetic shivering in laparoscopic-assisted vaginal hysterectomy. J South Asian Feder Obst Gynae 2013; 5:120-3.
  4. Kranke P, Eberhart LH, Roewer N, Tramèr MR. Single-dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesthesia & Analgesia 2004; 99(3):718-27.
  5. Mathew S, Al Mulla A, Varghes PK. Post anesthetic shivering–a new look at tramadol. Anesthesia 2002; 57:394-8.
  6. Zhang Y, Wong KC. Anesthesia and postoperative shivering: its etiology, treatment and prevention. Acta Anaesthesiologica Sinica 1999; 37(3):115-20.
  7. Schwarzkopf KR, Hoff H, Hartmann M, Fritz HG. A comparison between meperidine, clonidine and urapidil in the treatment of postanesthetic shivering. Anesthesia & Analgesia 2001; 92(1):257-60.
  8. Faiz SH, Rahimzadeh P, Imani F, Bakhtiari A. Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study. Korean journal of anesthesiology 2013; 65(4):293-8.
  9. Bock M, Sinner B, Göttlicher M, Simon E, Martin E, Motsch J. Involvement of serotonergic pathways in postanaesthetic cold defence: dolasetron prevents shivering. Journal of thermal biology 2002; 27(2):159-66.
  10. Elvan EG, Öç B, Uzun ŞE, Karabulut ER, Coşkun F, Aypar Ü. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy. European journal of anaesthesiology 2008; 25(5):357-64.
  11. Gropper MA, Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, et al. Miller's Anesthesia, 2-Volume Set E-Book. Elsevier Health Sciences; 2019.
  12. Javaherforoosh F, Pipelzadeh M, Bagherybarma F. Comparison of clonidin, pethedin and fentanyl for post-spinal anesthesia shivering in elective caesarian sections. Armaghane danesh 2006; 11(3):59-67.
  13. Sahebanmaleki M, Ebrahimi B, Eshaghi S, Amiri M, Moavensaiedi M. Comparison of Different Doses of Magnesium Sulfate in Prevention of Postoperative Shivering in Patients Undergoing Spinal Anesthesia. Quarterly of Horizon of Medical Sciences 2019; 25(2):127-33.
  14. Davoudi M, Tahmasebi R, Zolhavareih SM. Evaluation of the effect of intravenous magnesium sulfate on postoperative pain after cesarean section under spinal anesthesia. Avicenna Journal of Clinical Medicine (Scientific Journal of Hamadan University of Medical Sciences and Health Services 2013; 19(4):20-26.
  15. Oddo M, Frangos S, Maloney-Wilensky E, Kofke WA, Le Roux PD, Levine JM. Effect of shivering on brain tissue oxygenation during induced normothermia in patients with severe brain injury. Neurocritical care 2010; 12(1):10-6.
  16. Ibrahim IT, Megalla SA, Khalifa OS, salah El Deen HM. Prophylactic vs. therapeutic magnesium sulfate for shivering during spinal anesthesia. Egyptian Journal of Anaesthesia 2014; 30(1):31-7.
  17. Akhtar MI, Ullah H, Hamid M. Magnesium, a drug of diverse use. Journal of the Pakistan Medical Association 2011; 61(12):1220-5.
  18. Alipour M, Sharifian A, Dastkhosh A. Effects of magnesium sulfate on prevention of shivering during spinal anesthesia in cesarean section. Iran J Obstet Gynecol Infertil 2013; 16(79):1-9.
  19. Rahnama O, Hadadi S, Marzban Sh, Khorramnia S. Comparison of the effect of magnesium sulfate, ondansetron and calcium gluconate in preventing shivering after general anesthesia " Journal of Rafsanjan University of Medical Sciences. Eleventh period 2011: 187-196. (Persian).
  20. Miyakawa H, Matsumoto K, Matsumoto S, Mori M, Yoshitake S, Noguchi T, et al. A comparison of three drugs (pethidine, magnesium sulfate and droperidol) in patients with post-anesthesia shivering. Masui. The Japanese journal of anesthesiology 1991; 40(10):1503-6.
  21. Modir H, Norouzi A, Pazoki S. Comparing the efficacy of different classes of drugs for the prevention of shivering after general anesthesia. Journal of Arak University of Medical Sciences. 2013; 16(3):73-78.
  22. Safavi MR, Honarmand A. Magnesium sulfate pretreatment to alleviate pain on propofol injection: a comparison with ketamine or lidocaine. Journal of Mazandaran University of Medical Sciences 2007; 17(60):30-8.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 24, Issue 13
February 2022
Pages 9-16