Case Study Analysis For A Comparison Between Ketamine, Clonidine And Combination Of Ketamine-clonidine For The 

Prevention Of Post Anesthetic Shivering

Presented by:Ankur KhandelwalAnurag ShandilyaPullabhatla ApuroopSrikanth MallayaShekhar Sinha

Objective

To compare the efficacy of single dose intravenous ketamine(0.5mg/kg) and intravenous clonidine (1.5mcg/kg) and combination of intravenous ketamine(0.25mg/kg) plus clonidine(0.75mcg/kg) in the prevention of shivering following general anesthesia.

Introduction 

120 Patients

Group K=30

Intravenous ketamine (0.5mg/kg)

Group C=30

Intravenous Clonidine(0.25mg/

kg)

Group KC=30

Intravenous ketamine 

& clonidine(0.75mcg/kg)

Group P=30

Normal saline(plac

ebo) 

Analysis of Demographic

Age Height Weight DOS0

20

40

60

80

100

120

140

160

180

39.8

161.46

64.7

76.63

42.7

163.06

61.46

74.26

40.06

163.36

64.1

77.23

43.26

161.7

64.7

73.93

Group K

Group C

Group KC

Group P

Analysis of Intra-operative measures:

• Group C, which has been given clonidine, is lowering the heart rate while other 3 groups have more or less similar heart rate near normal range.

• Group C is better among the four as it keeps the systolic blood pressure near the normal range while others (ketamine, ketamine and clonidine and placebo) increases the SBP among the patients of the respective groups.

• Diastolic blood pressure (DBP) is within ideal range for Group C, KC and P. Ketamine slightly raises DBP, reaching a maximum of 82.9.

Analysis of Intra-operative measures:

• Ketamine is raising the MAP of patients in group K which is not good for them. Also group K and P patients have values maximum at end of surgery.

• Drugs have no effects on SPO2, ETCO2, ST, and CT. All these remain same for all groups.

Post Operative Analysis:• HR of all patients in Group K, KC and P are absolutely normal, but Group C

has decreased too much.

• Systolic blood pressure (SBP) is higher than the normal range i.e. <=120. Group C, KC and P are better, but group K patients’ needs attention.

• Diastolic blood pressure (DBP) is low for patients in group C and KC, other two are absolutely fine.

• Ketamine is raising the MAP of patients in group K, which is not good for them. Also group P patients have values towards the higher end of range. Group C and KC patients have normal MAP.

• Drugs have no effects on SPO2, it remain same for all groups.

Analysis with baselines: Preop• Ketamine is raising the HR and clonidine is lowering the HR significantly

from its baseline value.

• Clonidine is decreasing the SBP significantly from its baseline value.• Ketamine is raising the DBP and MAP and clonidine is lowering both the

pressures significantly from its baseline value. • SPO2 remains same across all four groups. • All the four groups have patients with increased ST compared to baseline

values. Changes in ST are considerable in all the groups.

Analysis with baselines: End of Surgery

• HR, SBP, DBP and MAP has decreased from its pre-operative value. HR is decreasing to gain stabilization. So this is good that patients are tending towards normal values.

• SPO2 remains same across all four groups.

Comparison of adverse effect:

Tachycardia(%) Bradicardia(%) Hypotension(%) Hyper(%) N_V(%)0

10

20

30

40

50

6060

6.67

0

50

3.33

10

50 50

0

26.67

20

13.33

16.67

13.33

6.67

33.33

16.67 16.67

46.67

13.33

K

C

KC

P

Comparison of adverse effect:

• As Ketamine makes Heart rate and Mean Arterial Pressure raise during Intra operative period which is the cause for maximum patients of this group suffering from Tachycardia and hypertension.

• Similarly, clonidine is lowering down the Heart rate and Mean Arterial Pressure that’s why patients of group C are suffering from Bradycardia, Hypotension.

• Nausea Vomiting are seen maximum within group C patients.

• Group KC has almost equally distributed patients among all 5 side-effects.

Sedation Score:

K C KC P0

5

10

15

20

25 24

8

16

25

6

15

14

5

0

6

0 00

1

0 0

1

2

3

4

Sedation Score:

• Alround 80 - 84% patients in Group K and P are having low sedation score which is good (Sed_score >=3 is not good for patients). Group C, which has been given clonidine, has maximum sedation score.

• Group P has received saline and has lowest sedation score (83.33% has Sed_score of 1).

Shivering :

0 1 2 3 40

2

4

6

8

10

12

14

16

18

20

3

5

15

6

1

10

13

5

2

0

15

7

4 4

0

1

4

5

20

0

K

C

KC

P

Shivering:• All the group’s patients have shivering side effect.

• Maximum in group P followed by K.

• Group P was given saline and 66.67% are having post anesthetic shivering.

• Group KC has minimum shivering (50% patients are not shivering).

Conclusion

• Group KC is the most stable at all stages, during preop, postop and baselines as it has shown the most desired results.

• Group P seems to be the least effective.

• Group KC also scores over other groups in the adverse effects, sedation and shivering.

• Hence it seems to be the most stable drug for prevention of post anesthetic shivering.