DEXAMETHASONE DECREASES THE INCIDENCE OF SHIVERING AFTER CARDIAC-SURGERY - A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

Shivering after cardiac surgery is common, and may be a result of intr aoperative hypothermia. Another possible etiology is fever and chills secondary to activation of the inflammatory response and release of cy tokines by cardiopulmonary bypass. Dexamethasone decreases the gradien t between core and skin temperature and modifies the inflammatory resp onse. The goal of this study was to determine whether dexamethasone ca n reduce the incidence of shivering. Two hundred thirty-six patients s cheduled for elective coronary and/or valvular surgery were randomly a ssigned to receive either dexamethasone 0.6 mg/kg or placebo after the induction of anesthesia. Al patients received standard monitoring and anesthetic management After arrival in the intensive care unit (ICU), nurses unaware of the treatment groups recorded visible shivering, as well as skin and pulmonary artery temperatures. Analysis of shivering rates was performed by using chi(2) tests and logistic regression ana lysis. Compared with placebo, dexamethasone decreased the incidence of shivering (33.0% vs 13.1%; P = 0.001). It was an independent predicto r of reduced incidence of shivering and was also associated with a hig her skin temperature on ICU admission and a lower central temperature in the early postoperative period. Implications: Dexamethasone is effe ctive in decreasing the incidence of shivering. The effectiveness of d examethasone is independent of temperature and duration of cardiopulmo nary bypass. Shivering after cardiac surgery may be part of the febril e response that occurs after release of cytokines during cardiopulmona ry bypass.