Title : The effects of remimazolam comapred to propofol on postoperative shivering in patients undergoing cesearen section under spinal anesthesia sedation
Abstract:
Introduction:
Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%
Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found.
This study compared the effects of remimazolam with propofol on postoperative shivering(PS) in patients undergoing cesarean section under spinal anesthesia.
Methods:
Seventy patients were allocated into one of two groups. After delivery, group A received propofol and group B received remimazolam for sedation.
Results:
The incidence and severity of postoperative shivering, core body temperature, and the association of PS with hypothermia, MAP, or HR in the post-anesthesia care unit (PACU) were measured. Group B had significantly lower rates of perioperative hypothermia (50.1 vs. 28.0%, p = 0.04) and postoperative shivering (40.2 vs. 20.1%, p = 0.042).
The severity of PS was also lower in group B than in group A (p = 0.032). Core body temperature was significantly higher in group B than in group A from 10 min after induction (p = 0.046) to the PACU (p = 0.02).
MAP and HR were more stable in group B than in group A.
In group A, the correlation between the severity of PS and the incidence of hypothermia was moderate but not significant.
In group B, the correlation between PS severity and hypothermia was moderate and significant.
Discussion:
PS is an important complication in hypothermic patients and is one of the most common discomforts in the post-anesthesia care unit (PACU) after receiving general anesthesia.
Remimazolam showed better results than propofol in anesthesia maintenance regarding hypothermia.
The mechanism of remimazolam for thermoregulation is reducing the vasoconstriction threshold to a lesser extent than propofol and had an earlier onset of vasoconstriction, resulting in superior thermoregulatory control. In addition, remimazolam showed more stable hemodynamic parameters than propofol, including MAP and HR.
Consequently, if patients are at risk of hypothermia, remimazolam would be better choice than propofol for sedation.
