Mitigating Post-Spinal Anesthesia Shivering by Exploring Intravenous Ketamine vs. Intravenous Tramadol and Comparison of the Optimal Dose of Ketamine: A Scoping Review of Cohort and Randomized Controlled Trials Studies
-
Siavash Sangi
,
Mehrdad Mesbah Kiaei
,
Maryam Aligholizadeh
,
Alireza Babajani
,
Parisa Akbarpour
,
Maryam Sarkhosh
,
Elnaz Jalalkamali
,
Zahra Karimian
Abstract
Background: Shivering is prevalent in 65% of patients undergoing spinal anesthesia, resulting in adverse outcomes and increased healthcare expenses. Ketamine, an N-methyl-D-aspartate receptor antagonist, and tramadol exhibit analgesic properties, potentially mitigating post-spinal shivering. This scoping review aims to explore the existing literature on the intravenously administered ketamine and tramadol in reducing the incidence of shivering subsequent to spinal anesthesia.
Methods: This scoping review, conducted from April to June 2024, examined studies on intravenous ketamine and tramadol for shivering post-spinal anesthesia. Using MeSH terms, researchers searched Scopus, Web of Science, PubMed, Cochrane, Google Scholar, Iran SID, and Iran ISC. After excluding duplicates and irrelevant studies, six pertinent studies were included.
Results: The search strategy identified 1316 articles, with 1258 remaining after removing 58 duplicates. Title and abstract screening excluded 6 conference papers, 42 systematic reviews, 94 book chapters or animal studies, and 2 theses. Full-text review of 97 studies resulted in excluding 78 unrelated cases, 1 language discrepancy, and 11 without full-text availability. Ultimately, 6 studies (5 randomized controlled trials and 1 prospective cohort) from Iran, Pakistan, India, Egypt, and Ethiopia found ketamine more effective than tramadol in preventing shivering.
Conclusion: Ketamine is more effective than tramadol in preventing post-spinal anesthesia shivering, with fewer adverse effects like nausea, vomiting, and bradycardia. These findings support its use for shivering management. Future research should optimize dosing to reduce hallucinations, explore other side effects, and prioritize diverse study parameters and safety evaluations.
[1] Bafghi NN, Bafghi NN, Salagegheh S, Kermani MS, Valeh H, Hakimpour S. Prevalence Of Post Anesthesia Complications And Their Related Factors In Urologic Surgery. J Pharm Negat Results. 2023; 3534-43.
[2] Abid K, Iqbal R, Shah SA, Tariq S. Intravenous Ondansetron Efficacy in Preventing Post Spinal Shivering during Lower Segment Caesarean Section. PAFMJ. 2023; 73(6):1636-9.
[3] Sagir O, Gulhas NU, Toprak HÜ, Yucel AY, Begec ZE, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesth Scand. 2007; 51(1):44-9.
[4] Babajani A, Mohebi T, Ahmadi M, Karimi A. Selection Spinal Anesthesia Against an Unusual Finding: A Case Report Hairy Patch. Arch Anesthesiol Crit Care. 2024.
[5] Babajani A, Feizollahzadeh N, Koohsoltani H. Occurrence of Total Spinal Anesthesia after Caudal Anesthesia in a Newborn Patient: A Case Report of a Challenging Complication. Arch Anesthesiol Crit Care. 2024.
[6] Mullainayaki K, Pushparani A, Sujina A H, Mirunalini G, Ramani CKS. Intravenous Ketamine for Prevention of Post Anesthetic Shivering In Urological Procedures Done Under Spinal Anesthesia: A Randomized Triple Blinded Placebo Controlled Trial. Ann Med Health Sci Res. 2023; 13:425-430.
[7] Botros JM, Mahmoud AMS, Ragab SG, Ahmed MAA, Roushdy HMS, Yassin HM, et al. Comparative study between Dexmedetomidine and Ondansteron for prevention of post spinal shivering. A randomized controlled trial. BMC Anesthesiol. 2018; 18:1-8.
[8] Sangi S, Alipour N, Manouchehrian N, Aligholizadeh M. Comparative Efficacy of Intravenous Midazolam, Midazolam-Ketamine, and Ketamine in Reducing the Prevalence of Post-Spinal Shivering: A Double-Blind Clinical Trial. Bulletin of Pharmaceutical Sciences Assiut University. 2024.
[9] Shakya B, Chaturvedi A, Sah B. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010; 26(4):465-9.
[10] Khan T, Yadav M, Geetha S, Gopinath R, Durga P, Chowdary H. Comparison between Dexmedetomidine, Ketamine and Tramadol for Prevention of Perioperative Shivering under Spinal Anaesthesia: A Randomised Clinical Trial. J Clin Diagn Res. 2022; 16(12):32-36.
[11] Fenta E, Kibret S, Hunie M, Tamire T, Fentie Y, Seid S, et al. The effects of intravenous tramadol vs. intravenous ketamine in the prevention of shivering during spinal anesthesia: A meta-analysis of randomized controlled trials. Front Med. 2022; 9:1011953.
[12] Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008; 33(3):241-52.
[13] Neaton K, Voldanova L, Kiely T, Nagle C. Non-pharmacological treatments for shivering post neuraxial anaesthesia for caesarean section: a scoping review. Contemp Nurse. 2024; 60(1):42-53.
[14] Seyam SH. Prevention of post-spinal anesthesia shivering: Low dose ketamine vs tramadol. Al-Azhar Int Med J. 2020; 1(4):108-15.
[15] Nirala DK, Prakash J, Ram B, Kumar V, Bhattacharya PK, Priye S. Randomized double-blinded comparative study of intravenous nalbuphine and tramadol for the treatment of postspinal anesthesia shivering. Anesth Essays Res. 2020; 14(3):510-514.
[16] Yimer HT, Hailekiros AG, Tadesse YD. Magnitude and associated factors of postanaesthesia shivering among patients who operated under general and regional anesthesia, Northwest Ethiopia: a cross sectional study. Anesth Clin Res. 2015; 6(11):1-5.
[17] Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P. Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J. 2005; 73(1):47.
[18] Lema GF, Gebremedhn EG, Gebregzi AH, Desta YT, Kassa AA. Efficacy of intravenous tramadol and low-dose ketamine in the prevention of post-spinal anesthesia shivering following cesarean section: a double-blinded, randomized control trial. Int J Womens Health. 2017; 681-8.
[19] Sadeh SS, Hashemi E, Aminnejad R, Bastanhagh E. The impact of optimal dose of ketamine on shivering following elective abdominal hysterectomy: a randomised comparative study. Anesth Pain Med. 2020; 10(5).
[20] Pardo M. Miller’s Basics of anesthesia: Elsevier Health Sciences; 2022.
[21] Jabalameli M, Radmanesh A. Comparing the efficacy of prophylactic intravenous dexamethasone and pethidine on postoperative shivering in elective cesarean section under spinal anaesthesia. J Isfahan Med Sch. 2014; 32(285):678-89.
[22] Neaton K, Voldanova L, Kiely T, Nagle C. Non-pharmacological treatments for shivering post neuraxial anaesthesia for caesarean section: a scoping review. Contemp Nurse. 2024; 60(1):42-53.
[23] Norouzi M, Doroodian M, Salajegheh S. Optimum dose of ketamine for prevention of postanesthetic shivering; a randomized double-blind placebo-controlled clinical trial. Acta anaesthesiologica belgica. 2011; 62(1):33-6.
[24] Gholami H, Moradi Y, Khazaei Z, Tehrani S. A comparison of the effect of dexamethasone and pethidine for prevention of shivering after spinal anesthesia in caesarean section: randomization clinical trial. Biomed Res Ther. 2018; 5(9):2646-50.
[25] Maroufi SS, Kiaei MM, Aligholizadeh M, Saei A, Sangi S, Akbarpour P. The Effect of Ketamine Administration on the Incidence of Delirium After Coronary Artery Bypass Graft Surgery: A Scoping Review. J Cell Mol Anesth. 2024(In Press).
[26] Osama A, Islam B, Sayed M, Gehan A. Efficacy of dexamethasone on prevention of post-operative spinal shivering in comparison with intravenous ketamine plus midazolam during elective cesarean section. Med J Cairo Univ. 2019; 87(June):2285-94.
[27] Jouryabi AM, Sharami SH, Ghanaie MM, Sedighinejad A, Imantalab V, Sorouri ZR, et al. Comparing the effects of low dose of ketamine, tramadol, and ondansetron in prevention of post spinal anesthesia shivering in cesarean section. Anesth Pain Med. 2021; 11(4).
[28] Gemechu AD, Gebremedhin TD, Andebiku AA, Solomon F, Sorsa A. The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020. BMC Anesthesiol. 2022; 22(1):361.
[29] Nasim S, Shirin P, Alireza K, Houshang T, Mehri J, Hamid RH, et al. Comparison between intrathecal midazolam and tramadol with conventional method for postoperative pain and shivering control after elective cesarean section. 2013; 3(2):67-73.
[30] Hong JH, Kim SJ, Hwang MS. Comparison of effect of electroacupuncture and nefopam for prevention of postanesthetic shivering in patients undergoing urologic operation under spinal anesthesia. Korean journal of anesthesiology. 2016; 69(6):579-86.
[31] Faraz A, Islam H, Jahangir M, Ashfaq F. Comparing the effects of low doses of ketamine and tramadol in the prevention of post-spinal anesthesia shivering in cesarean section. Biol Clin Sci Res J. 2023; 2023(1):50
[32] Sriranganath T, Radhapuram SD, Rao MH, Shameem S, Samantaray A, Dharaniprasad G. Comparison of intravenous tramadol and intravenous ketamine for the prevention of post-anaesthetic shivering. J Clin Sci Res. 2020; 9(2):94-100.
[33] Arksey H, O'malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005; 8(1):19-32.
[34] McGowan J, Straus S, Moher D, Langlois EV, O'Brien KK, Horsley T, et al. Reporting scoping reviews—PRISMA ScR extension. J Clin Epidemiol. 2020; 123:177-9.
[35] Gordon M, Daniel M, Ajiboye A, Uraiby H, Xu NY, Bartlett R, et al. A scoping review of artificial intelligence in medical education: BEME Guide No. 84. Med Teach. 2024; 46(4):446-70.
[36] Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology. 2018; 18:1-7.
[37] Waheed A, Raza S, Saleh M, Zia HA, Jan B, Umair HM. The Effect of Ketamine Versus Tramadol on Prophylactic Post-Spinal Shivering in Those Patients Undergoing Orthopedic Surgery. Pak J Med Health Sci. 2023; 17(1):648.
[38] Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative pain management and opioid stewardship: A practical guide. Healthcare (Switzerland). 2021; 9(3):333.
[39] Kang P, Park SK, Yoo S, Hur MJ, Kim WH, Kim JT, et al. Comparative effectiveness of pharmacologic interventions to prevent shivering after surgery: a network meta-analysis. Minerva Anestesiol. 2019; 85 1:60-70.
[40] Zhou Y, Mannan A, Han Y, Liu H, Guan HL, Gao X, et al. Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis. BMC Anesthesiol. 2019; 19:1-11.
[41] Sadeghi J, Bazzazi S, Fattahi F, Mousavi MA, Tajbakhsh A, Rassouli S, et al. Impact of analgesics on the risk of ovarian cancer; a systematic review and meta-analysis of cohort and case-control studies. Immunopathol Persa. 2023; 40572.
[42] Morsali SF, Movasseghi G, Kiaee MM, Ghorbanloo M, Mohaghegh MR, Morsali A, et al. Clonidine versus tramadol for postanesthetic shivering: A randomized clinical trial study. Biomed Res Ther. 2017; 4(10):1716-32.
[43] Schep LJ, Slaughter RJ, Watts M, Mackenzie E, Gee P. The clinical toxicology of ketamine. Clin Toxicol. 2023; 61(6):415-28.
[44] Moreira DD, Gauer LE, Teixeira G, da Silva AC, Cavalcanti S, Quevedo J. Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis. J Affect Disord. 2023; 330:227-38.
[45] Manouchehri A, Nekoukar Z, Malakian A, Zakariaei Z. Tramadol poisoning and its management and complications: a scoping review. Ann Med Surg. 2023; 85(8):3982-9.
[46] Pribish A, Wood N, Kalava A. A review of nonanesthetic uses of ketamine. Anesth Res Pract. 2020; 2020(1):5798285.
[47] Crossley A, Mahajan R. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesth. 1994; 49(3):205-7
[48] Sangi S, Kiaei MM, Maroufi SS, Aligholizadeh M, Moradimajd P, Saei A. Shivering Management in Spinal Anesthesia: Evaluating the Role of Ketamine: A Narrative Review. Archives of Anesthesiology and Critical Care. 2024.
[2] Abid K, Iqbal R, Shah SA, Tariq S. Intravenous Ondansetron Efficacy in Preventing Post Spinal Shivering during Lower Segment Caesarean Section. PAFMJ. 2023; 73(6):1636-9.
[3] Sagir O, Gulhas NU, Toprak HÜ, Yucel AY, Begec ZE, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesth Scand. 2007; 51(1):44-9.
[4] Babajani A, Mohebi T, Ahmadi M, Karimi A. Selection Spinal Anesthesia Against an Unusual Finding: A Case Report Hairy Patch. Arch Anesthesiol Crit Care. 2024.
[5] Babajani A, Feizollahzadeh N, Koohsoltani H. Occurrence of Total Spinal Anesthesia after Caudal Anesthesia in a Newborn Patient: A Case Report of a Challenging Complication. Arch Anesthesiol Crit Care. 2024.
[6] Mullainayaki K, Pushparani A, Sujina A H, Mirunalini G, Ramani CKS. Intravenous Ketamine for Prevention of Post Anesthetic Shivering In Urological Procedures Done Under Spinal Anesthesia: A Randomized Triple Blinded Placebo Controlled Trial. Ann Med Health Sci Res. 2023; 13:425-430.
[7] Botros JM, Mahmoud AMS, Ragab SG, Ahmed MAA, Roushdy HMS, Yassin HM, et al. Comparative study between Dexmedetomidine and Ondansteron for prevention of post spinal shivering. A randomized controlled trial. BMC Anesthesiol. 2018; 18:1-8.
[8] Sangi S, Alipour N, Manouchehrian N, Aligholizadeh M. Comparative Efficacy of Intravenous Midazolam, Midazolam-Ketamine, and Ketamine in Reducing the Prevalence of Post-Spinal Shivering: A Double-Blind Clinical Trial. Bulletin of Pharmaceutical Sciences Assiut University. 2024.
[9] Shakya B, Chaturvedi A, Sah B. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010; 26(4):465-9.
[10] Khan T, Yadav M, Geetha S, Gopinath R, Durga P, Chowdary H. Comparison between Dexmedetomidine, Ketamine and Tramadol for Prevention of Perioperative Shivering under Spinal Anaesthesia: A Randomised Clinical Trial. J Clin Diagn Res. 2022; 16(12):32-36.
[11] Fenta E, Kibret S, Hunie M, Tamire T, Fentie Y, Seid S, et al. The effects of intravenous tramadol vs. intravenous ketamine in the prevention of shivering during spinal anesthesia: A meta-analysis of randomized controlled trials. Front Med. 2022; 9:1011953.
[12] Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008; 33(3):241-52.
[13] Neaton K, Voldanova L, Kiely T, Nagle C. Non-pharmacological treatments for shivering post neuraxial anaesthesia for caesarean section: a scoping review. Contemp Nurse. 2024; 60(1):42-53.
[14] Seyam SH. Prevention of post-spinal anesthesia shivering: Low dose ketamine vs tramadol. Al-Azhar Int Med J. 2020; 1(4):108-15.
[15] Nirala DK, Prakash J, Ram B, Kumar V, Bhattacharya PK, Priye S. Randomized double-blinded comparative study of intravenous nalbuphine and tramadol for the treatment of postspinal anesthesia shivering. Anesth Essays Res. 2020; 14(3):510-514.
[16] Yimer HT, Hailekiros AG, Tadesse YD. Magnitude and associated factors of postanaesthesia shivering among patients who operated under general and regional anesthesia, Northwest Ethiopia: a cross sectional study. Anesth Clin Res. 2015; 6(11):1-5.
[17] Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P. Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J. 2005; 73(1):47.
[18] Lema GF, Gebremedhn EG, Gebregzi AH, Desta YT, Kassa AA. Efficacy of intravenous tramadol and low-dose ketamine in the prevention of post-spinal anesthesia shivering following cesarean section: a double-blinded, randomized control trial. Int J Womens Health. 2017; 681-8.
[19] Sadeh SS, Hashemi E, Aminnejad R, Bastanhagh E. The impact of optimal dose of ketamine on shivering following elective abdominal hysterectomy: a randomised comparative study. Anesth Pain Med. 2020; 10(5).
[20] Pardo M. Miller’s Basics of anesthesia: Elsevier Health Sciences; 2022.
[21] Jabalameli M, Radmanesh A. Comparing the efficacy of prophylactic intravenous dexamethasone and pethidine on postoperative shivering in elective cesarean section under spinal anaesthesia. J Isfahan Med Sch. 2014; 32(285):678-89.
[22] Neaton K, Voldanova L, Kiely T, Nagle C. Non-pharmacological treatments for shivering post neuraxial anaesthesia for caesarean section: a scoping review. Contemp Nurse. 2024; 60(1):42-53.
[23] Norouzi M, Doroodian M, Salajegheh S. Optimum dose of ketamine for prevention of postanesthetic shivering; a randomized double-blind placebo-controlled clinical trial. Acta anaesthesiologica belgica. 2011; 62(1):33-6.
[24] Gholami H, Moradi Y, Khazaei Z, Tehrani S. A comparison of the effect of dexamethasone and pethidine for prevention of shivering after spinal anesthesia in caesarean section: randomization clinical trial. Biomed Res Ther. 2018; 5(9):2646-50.
[25] Maroufi SS, Kiaei MM, Aligholizadeh M, Saei A, Sangi S, Akbarpour P. The Effect of Ketamine Administration on the Incidence of Delirium After Coronary Artery Bypass Graft Surgery: A Scoping Review. J Cell Mol Anesth. 2024(In Press).
[26] Osama A, Islam B, Sayed M, Gehan A. Efficacy of dexamethasone on prevention of post-operative spinal shivering in comparison with intravenous ketamine plus midazolam during elective cesarean section. Med J Cairo Univ. 2019; 87(June):2285-94.
[27] Jouryabi AM, Sharami SH, Ghanaie MM, Sedighinejad A, Imantalab V, Sorouri ZR, et al. Comparing the effects of low dose of ketamine, tramadol, and ondansetron in prevention of post spinal anesthesia shivering in cesarean section. Anesth Pain Med. 2021; 11(4).
[28] Gemechu AD, Gebremedhin TD, Andebiku AA, Solomon F, Sorsa A. The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020. BMC Anesthesiol. 2022; 22(1):361.
[29] Nasim S, Shirin P, Alireza K, Houshang T, Mehri J, Hamid RH, et al. Comparison between intrathecal midazolam and tramadol with conventional method for postoperative pain and shivering control after elective cesarean section. 2013; 3(2):67-73.
[30] Hong JH, Kim SJ, Hwang MS. Comparison of effect of electroacupuncture and nefopam for prevention of postanesthetic shivering in patients undergoing urologic operation under spinal anesthesia. Korean journal of anesthesiology. 2016; 69(6):579-86.
[31] Faraz A, Islam H, Jahangir M, Ashfaq F. Comparing the effects of low doses of ketamine and tramadol in the prevention of post-spinal anesthesia shivering in cesarean section. Biol Clin Sci Res J. 2023; 2023(1):50
[32] Sriranganath T, Radhapuram SD, Rao MH, Shameem S, Samantaray A, Dharaniprasad G. Comparison of intravenous tramadol and intravenous ketamine for the prevention of post-anaesthetic shivering. J Clin Sci Res. 2020; 9(2):94-100.
[33] Arksey H, O'malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005; 8(1):19-32.
[34] McGowan J, Straus S, Moher D, Langlois EV, O'Brien KK, Horsley T, et al. Reporting scoping reviews—PRISMA ScR extension. J Clin Epidemiol. 2020; 123:177-9.
[35] Gordon M, Daniel M, Ajiboye A, Uraiby H, Xu NY, Bartlett R, et al. A scoping review of artificial intelligence in medical education: BEME Guide No. 84. Med Teach. 2024; 46(4):446-70.
[36] Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology. 2018; 18:1-7.
[37] Waheed A, Raza S, Saleh M, Zia HA, Jan B, Umair HM. The Effect of Ketamine Versus Tramadol on Prophylactic Post-Spinal Shivering in Those Patients Undergoing Orthopedic Surgery. Pak J Med Health Sci. 2023; 17(1):648.
[38] Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative pain management and opioid stewardship: A practical guide. Healthcare (Switzerland). 2021; 9(3):333.
[39] Kang P, Park SK, Yoo S, Hur MJ, Kim WH, Kim JT, et al. Comparative effectiveness of pharmacologic interventions to prevent shivering after surgery: a network meta-analysis. Minerva Anestesiol. 2019; 85 1:60-70.
[40] Zhou Y, Mannan A, Han Y, Liu H, Guan HL, Gao X, et al. Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis. BMC Anesthesiol. 2019; 19:1-11.
[41] Sadeghi J, Bazzazi S, Fattahi F, Mousavi MA, Tajbakhsh A, Rassouli S, et al. Impact of analgesics on the risk of ovarian cancer; a systematic review and meta-analysis of cohort and case-control studies. Immunopathol Persa. 2023; 40572.
[42] Morsali SF, Movasseghi G, Kiaee MM, Ghorbanloo M, Mohaghegh MR, Morsali A, et al. Clonidine versus tramadol for postanesthetic shivering: A randomized clinical trial study. Biomed Res Ther. 2017; 4(10):1716-32.
[43] Schep LJ, Slaughter RJ, Watts M, Mackenzie E, Gee P. The clinical toxicology of ketamine. Clin Toxicol. 2023; 61(6):415-28.
[44] Moreira DD, Gauer LE, Teixeira G, da Silva AC, Cavalcanti S, Quevedo J. Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis. J Affect Disord. 2023; 330:227-38.
[45] Manouchehri A, Nekoukar Z, Malakian A, Zakariaei Z. Tramadol poisoning and its management and complications: a scoping review. Ann Med Surg. 2023; 85(8):3982-9.
[46] Pribish A, Wood N, Kalava A. A review of nonanesthetic uses of ketamine. Anesth Res Pract. 2020; 2020(1):5798285.
[47] Crossley A, Mahajan R. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesth. 1994; 49(3):205-7
[48] Sangi S, Kiaei MM, Maroufi SS, Aligholizadeh M, Moradimajd P, Saei A. Shivering Management in Spinal Anesthesia: Evaluating the Role of Ketamine: A Narrative Review. Archives of Anesthesiology and Critical Care. 2024.
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How to Cite
1.
Sangi S, Mesbah Kiaei M, Aligholizadeh M, Babajani A, Akbarpour P, Sarkhosh M, Jalalkamali E, Karimian Z. Mitigating Post-Spinal Anesthesia Shivering by Exploring Intravenous Ketamine vs. Intravenous Tramadol and Comparison of the Optimal Dose of Ketamine: A Scoping Review of Cohort and Randomized Controlled Trials Studies. Arch Anesth & Crit Care. 2024;.
