Dexmedetomidine for the treatment of postanesthesia shivering in children

Summary Background:  Shivering is a common postanesthesia adverse event with multiple etiologies and multiple suggested prophylactic and abortive treatment regimens. Dexmedetomidine, a centrally acting α 2 ‐adrenergic agonist, has been used as a sedative agent and is known to reduce the shivering threshold. We hypothesized that children with postanesthesia shivering would reduce shivering behavior following a single bolus dose of dexmedetomidine. Methods:  Dexmedetomidine was administered in a prospective, open‐label fashion. The anesthesia management was uniform consisting of maintenance inhaled anesthesia (sevoflurane) and the intraoperative administration of fentanyl (1–2  μ g·kg −1 ) plus a regional anesthetic technique (either a neuraxial or peripheral block) for postoperative analgesia. Criteria for treatment included: (i) shivering, (ii) successful extubation, and (iii) no other complaint/indication of pain. All children who met the criteria were treated with a single intravenous bolus dose of dexmedetomidine (0.5  μ g·kg −1 ) over 3–5 min. Following the completion of drug administration, shivering activity was recorded every minute (up to 10 min) with any adverse effects or complaints. The efficacy of shivering reduction at 5 min in this cohort is compared with previous reports from the literature of the efficacy of clonidine and meperidine. Results:  Twenty‐four children ranging in age from 7 to 16 years (11.5 ± 2.5 years) were treated. All children had a cessation of shivering behavior within 5 min following the completion of dexmedetomidine administration. The onset of effect was 3.5 ± 0.9 min. No adverse effects were observed. No shivering behavior recurred. Conclusions: This study demonstrates the efficacy of dexmedetomidine in the treatment of postanesthesia shivering.