Opioid |
Mu and Kappa receptor agonism, anticholinergic action, monoamine reuptake inhibition |
Effective at reducing the incidence and severity of perioperative shivering |
Meperidine 10 mg ITFentanyl 20 – 25 μg ITTramadol 10 mg IT |
5-HT3 Antagonist |
Inhibit serotonin reuptake at the pre-optic anterior hypothalamic region |
May be effective when compared to inactive placebo but not when compared to intrathecal fentanyl |
Ondansetron 8 mg IV |
NMDA Antagonist |
Modulate noradrenergic and serotonergic neurons in the locus coeruleus |
Ketamine appears effective while evidence on magnesium is limited |
Ketamine 0.25 – 0.5 mg/kg IVMagnesium Sulphate 50 mg Epid |
Alpha-2 Agonist |
Alpha-2 receptor stimulation decreases the thermoregulatory threshold for shivering at the hypothalamus level, and modulate cutaneous thermal inputs via descending inhibition, thus inhibiting shivering at the spinal cord level |
Dexmedetomidine is effective at reducing shivering but can lead to bradycardia |
Dexmedetomidine 5 – 10 μg ITDexmedetomidine 1 μg/kg EpidDexmedetomidine 30 mcg IV |