Menşure KAYA, Oğuz SARIYILDIZ, Devrim KARAKUŞ, Gülçin ÖZALP, Nihal KADIOĞULLARI

Genel anestezi sonrası titreme tedavisinde tramadolün etkinliği

Bu çalışmada; üç farklı dozda kullanılan tramadolün titremeye karşı etkinliği ve yan etkileri değerlendirildi. Çift-kör ve rasgele üç grup olarak planlanan çalışmaya ASA I-III grubundan, genel anestezi sonrası şiddetli titremesi olan 96 hasta alındı. I. Gruba (n=32) 0.25 mg/kg, II. Gruba (n=32) 0.5 mg/kg, III. Gruba (n=32) l mg/kg tramadol İV olarak verildi. Enjeksiyondan .5 dk sonra ilaç etkinliği değerlendirildi ve etki başlama süresi kaydedildi. Enjeksiyon öncesinde, 5, 10, ve 15. dk da sistemik arter basıncı, kalp atım hızı ve sedasyon skorları kaydedildi. Bulantı ve kusma varlığı ile antiemetik gereksinimi değerlendirildi. Titremede belirgin düzelme oranının II. (% 97) ve III. (% 97) Gruplarda, L Gruba (% 59) göre anlamlı olarak daha yüksek olduğu saptandı (p

The effectiveness of tramadol in the treatment of shivering after general anaesthesia

In this study, the effectiveness and side effects of three different doses of tramadol in the treatment of shivering were evaluated. Ninety six ASA I-III patients who developed severe shivering after general anaesthesia were randomly assigned to three groups in a double blind study. Group I (n=32) was given 0.25 mg/kg, Group II (n=32) 0.5 mg/kg and Group III (n=32) 1 mg/kg of tramadol intravenously. 5 min after the injection the effectiveness of the drug was assessed and the onset of the effect was recorded. Arterial blood pressure, heart rate and sedation scores were recorded before and 5, 10, 15 min after the injection. Presence of nausea and vomiting and antiemetic require ments were assessed. Rates of marked improvement in Group II (% 97) and Group III (% 97) were found significantly higher than Group I (% 59). The onset of the effect was found to be significantly different among the groups. (Group I: 180±74 sec, Group II: 94±65 sec, Group llI: 57±38 sec, p

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1. Goold JE: Postoperative spasticity and shivering. Anaesthesia 1984; 39:35-8.
2. Piper SN, Suttner SW, Schmidt CC, et al: Nefopam and clonidine in the prevention of postanaesthetic shivering. Anaesthesia 1999; 54(7):695-9.
3. Guffin A, Girard D, Kaplan JA: Shivering following cardiac surgery: hemodynamic changes and reversal. J Cardiothorac Anesth 1987; 1:24-8.
4. Mahajan RP, Grover VK, Sharma SL: Intraocular pressure changes during muscular hyperactivity after general anesthesia. Anesthesiology 1987; 66:419-21.
5. Ciofolo MJ, Clergue F, Devilliers C, et al: Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70:737-41.
6. De Witte J, Deloof T, De Veylder J, et al: Tramadol in the treatment of postanesthetic shivering. Acta Anaesthesiol Scand 1997; 41:506-10.
7. Pausawasdi S, Jirasirithum S, Phanarai C: The use of tramadol hydrochloride in the treatment of postanesthetic shivering. J Med Assoc Thai 1990; 73:16-20.
8. Svetlov VA, Kozlov SP, Sarkisova NG, et al: Shivering and rigor during the awakening period. Anesteziol Reanimatol 1994; s.12-6.
9. Holtzclaw BJ: Postoperative shivering after cardiac surgery: a review. Heart and Lung 1986; 15:292-300.
10. Chan MH, Ng FJ, Tong WN, et al: Control of shivering under regional anesthesia in obstetric patients with tramadol. Can J Anesthesiol 1999; 46:253-8.
11. Kaya M, Sarıyıldız O, Karakuş D, et al: Control of shivering under spinal anaesthesia with tramadol (abstract). The International Monitor 2000; 12:150.
12. Raffa RB, Friderichs E, Reimann W, et al: Opioid and nonopiyoid components independently contribute to the mechanism of action of tramadol, an ‘atypical’ opiyoid analgesic. J Pharmacol Exp Ther 1992; 260:275-85.
13. Pauca AL, Savage RT, Simpson S, et al: Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand 1984; 28:138-43.
14. Kurz M, Belani KG, Sessler DI, et al: Naloxone, meperidine and shivering. Anesthesiology 1993; 79:1193-201.
15. Wrench IJ, Singh P, Dennis AR, et al: The minimum effective doses of pethidine and doxapram in the treatment of post-anaesthetic shivering. Anaesthesia 1997; 52:32-6.
16. Eggers KA, Power I. Editorial: tramadol. Br J Anaesth 1995; 74(3):247-9.
17. Brück K, Hinckel P: Thermoafferent networks and their adaptive modifications. In: Schönbaum E, Lomax P, eds. Thermoregulation: Physiology and Biochemistry. New York: Pergamon Press,1990; p.129-152.
18. Vickers MD, O’Flaherty D, Szekely SM, et al: Tramadol: Pain relief by an opiyoid without depression of respiration. Anaesthesia 1992; 47:291-6.
19. Vickers MD, Paravicini D: Comparison of tramadol with morphine for post-operative pain following abdominal surgery. Eur J Anaesthesiol 1995; 12:265-71.