Shivering Management in Spinal Anesthesia: Evaluating the Role of Ketamine: A Narrative Review

Siavash  Sangi; Mehrdad Mesbah  Kiaei; Shahnam Sedigh  Maroufi; Maryam  Aligholizadeh; Parisa  Moradimajd; Azam  Saei

doi:10.18502/aacc.v11i1.17496

Siavash Sangi Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Mehrdad Mesbah Kiaei Department of Anesthesiology and Pain Medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
Shahnam Sedigh Maroufi Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Maryam Aligholizadeh Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Parisa Moradimajd Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Azam Saei Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v11i1.17496

Keywords: Intravenous Ketamine; Shivering; Spinal Anesthesia; Shivering Management

Abstract

Background: Shivering is one of the most prevalent known complications due to dysregulation in the thermoregulatory system following regional anesthesia, with an incidence of 65%, leading to unpleasant outcomes and decreased patient satisfaction. Ketamine, a weak analgesic, affects the thermoregulatory center.

Methods: The authors conducted a search and selection of articles using reputable scientific databases. The search keywords included Shivering, Ketamine, and Spinal Anesthesia. The selected articles summarized the literature findings related to ketamine and shivering after spinal anesthesia.

Results: This narrative review synthesizes findings from multiple studies examining the role of ketamine in managing shivering following spinal anesthesia. Based on the results obtained, 10 areas were examined: Definition of shivering, Epidemiology of postoperative shivering, Pathophysiology of shivering, Risk factors for post-spinal anesthesia shivering, Spinal anesthesia, its benefits, and its impact on shivering, Post-anesthetic shivering (PAS) complications, Risk factors for postoperative shivering, Control and management of post-anesthetic shivering (PAS) dosage, Effective timing and benefits of ketamine administration in postoperative shivering.

Conclusion: The effectiveness of ketamine in preventing shivering after spinal anesthesia is evident from the mixed results of studies. Ketamine, regardless of dosage, can be effective in reducing shivering after spinal anesthesia based on the mentioned criteria. Standardized research with precise methods to determine optimal dosages and ensure safety is necessary.