Dexmedetomidine for the treatment of postanesthesia shivering in children

Background: Shivering is a common postanesthesia adverse event with multiple etiologies and multiple suggested prophylactic and abortive treatment regimens. Dexmedetomidine, a centrally acting α₂-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 μg·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 μg·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.