The effect of neuromuscular agent on postoperative shivering in patients undergoing retrograde intrarenal surgery: A randomized controlled clinical trial

Abstract

Objective: Shivering, and active movements, are very effective mechanisms for heat generation and warming in ambulatory mobile patients with open conscious. This study aimed to test the hypothesis that intraoperative hypothermia and postoperative shivering may be present in adults for whom neuromuscular blocker (NMB) was used during general anesthesia. Method: Eighty patients who underwent retrograde intrarenal surgery (RIRS) were randomly divided into two groups as those receiving or not receiving neuromuscular blocking agent (NMB) [Group R (NMB+), N=40; Group K (control), N=40)]. Laryngeal mask (LMA) was used for airway control in all patients and a standard anesthetic protocol was performed except for NMB administration. Data obtained from the monitoring of skin and internal temperatures and shivering tests were performed prior to anesthesia induction (t0), when NMB was delivered (t1), intraoperative 15 (t2), 30 (t3), and 60 (t4) and postoperative 0 (t5), 10 (t6), 15 (T7), 30 (t8), and 60 (t9) minutes. Results: In group R, at t0, t1, t2, t3 and t5 skin temperatures were significantly higher than group K, but there was no difference between the groups in terms of internal temperatures (t5, t6 and t7 in those who have tremors in group R were significantly higher than group K (Chi-Square p<0.05). In both groups, there is a statistically significant difference in skin temperature compared to t0. Accordingly, there was a significant difference in t7,8,9 in Group K and t1 in group R relative to t0. In Group R, the internal temperature was significantly lower in t3 than in t2, and t3, while in group K was significantly lower than t1 and t2. Conclusion: An understanding of postoperative shivering and the mechanisms that cause it is an important issue. A possible association with the use of neuromuscular blocker over hypothermia is worth investigating for patients with intraoperative heat management and low respiratory and cardiac reserve. The data obtained from this study did not support a relationship between NMB use and intraoperative hypothermia, but clearly showed a relationship with postoperative shivering. However, there is a need to study the possible effects of neuromuscular blockers on body temperature and peripheral defense mechanisms perhaps also on central mechanisms in adults.