A COMPARISON BETWEEN KETAMINE,CLONIDINE AND COMBINATION OF

KETAMINE-CLONIDINE FOR THE PREVENTION OF POSTANAESTHETIC

SHIVERING :

AIMS AND OBJECTIVES

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

Each of these parameters are being measured for Intra-operative periods
Prior Induction (Pre Operative)
Immediately after intubation
After 5 Mins
After 10 Mins
After 15 Mins
After 30 Mins
After 40 Mins
After 50 Mins
After 60 Mins
End of Surgery
Analysis
Heart Rate (HR)
Systolic Blood Pressure(SBP)
Diastolic Blood Pressure(DBP)
Mean Arterial Pressure(MAP) = DBP+1/3(SBP-DBP)
Peripheral oxygen saturation (SPO
2
)
Capnography (ETCO
2
)
Need to compare their variation across groups and from baseline separately
for each group. Adverse events are also to be compared across groups.
They are

Tachycardia happens when intra-operative Heart Rate rises above 100
Bradycardia happens when intra-operative Heart Rate falls below 60Hypertension
happens when the Intra-operative MAP rises 20% or more from Baseline level
Hypotension happens when the Intra-operative MAP falls 20% or more from Baseline
level (Pre-operative)
Nausea and Vomiting (N_V)


Also check the impact on Shivering and Sedation Score.
a. Need to compare Heart rate, Systolic blood pressure, diastolic blood pressure,
mean arterial pressure, peripheral oxygen saturation variation across groups.
ANS: Oneway anova was used to compare the variation of heart rate, systolic
blood pressure, diastolic blood pressure, mean arterial pressure, peripheral oxygen
saturation across groups. From the analysis, heartrate after 5, 10, 15, 30, 40, 50,
60, HR_EOS, HR_IND have significant variance across the groups. Therefore,the
medicines which are given across the group has a significant effect on the heart
rate of the patient.
From the above analysis, diastolic blood pressure after 5, 10, 15, 30, 40, 50, 60,
DBP_EOS, DBP_IND have significant variance across the groups. Therefore,the
medicines which are given across the group has a significant effect on the heart
rate of the patient.
Again from the analysis, mean arterial pressure(MAP) after 5, 10, 15, 30, 40, 50,
60, MAP_EOS, MAP_IND have significant variance across the groups. Therefore,the
medicines which are given across the group has a significant effect on the heart
rate of the patient.
Again from the analysis, SPO2(peripheral oxygen saturation) after 5, 10, 15, 30,
40, 50, 60 , SPO2_EOS, SPO2_IND dont have significant variance across the
groups. Therefore,the medicines which are given across the group has no
significant effect on the heart rate of the patient.
Again from the analysis, we can see that ETCO2, after 5, 10, 15, 30, 40, 50, 60 ,
ETCO2_EOS, ETCO2_IND dont have significant variance across the groups.
Therefore,the medicines which are given across the group has no significant effect
on the heart rate of the patient.
b. To compare the variation of HEART RATE, systolic pressure, diastolic pressure,
mean arterial pressure, peripheral oxygen saturation with their baseline
separately from each group.
From the paired sample test, we have found that :
SBP_IND-SBP_PREOP, SBP_5-SBP_PREOP. SBP_10-SBP_PREOP, SBP_15-SBP_PREOP,
SBP_30-SBP_PREOP, SBP_40-SBP_PREOP, SBP_60-SBP_PREOP,DBP_EOS-
DBP_PREOP,MAP_30-MAP_PREOP, MAP_EOS-MAP_PREOP have significant variation
with their baseline separately from each group.
HR_5-HR_PREOP, HR_10-HR_PREOP, HR_15-HR_PREOP, HR_30-HR_PREOP, HR_40-
HR_PREOP, HR_50_HR_PREOP, HR_60_HR_PREOP, HR_EOS-HR_PREOP,SBP_50-
SBP_PREOP,DBP_5-DBP_PREOP, DB_10-DBP_PREOP, DBP_15-DBP_PREOP, DBP30-
DBP_PREOP, DBP_40-DBP_PREOP, DBP_50-DBP_PREOP,DBP_60-DBP_PREOP, MAP_5-
MAP_PREOP,MAP_10-MAP_PREOP,MAP_15-MAP_PREOP,MAP_40-MAP_PREOP,
MAP_50-MAP_PREOP,MAP_60_MAP_PREOP have insignificant variation with their
baseline separately from each group.
2. Comparison of adverse events across group.
a.TACHYCARDIA AND BRADYCARDIA.


Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
GR * HEARTDESEASE 56 46.7% 64 53.3% 120 100.0%














GR * HEARTDESEASE Crosstabulation
Count
HEARTDESEASE Total
1.00 2.00
GR
1 16 1 17
2 2 15 17
3 4 4 8
4 9 5 14
Total 31 25 56








Chi-Square Tests


Value df Asymp. Sig. (2-
sided)
Pearson Chi-Square 23.951
a
3 .000
Likelihood Ratio 27.727 3 .000
Linear-by-Linear Association 1.088 1 .297
N of Valid Cases 56

a. 2 cells (25.0%) have expected count less than 5. The minimum
expected count is 3.57.
Heartdesease has significant variance across. groups. Therefore
bradycardia and tachycardia has sigificant variance across groups.
Hence the combination of medicines has significant variance on the
heartdesease.



b. Comparsion of adverse events across the group.
Hypertension and hypotension

Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
GR * TENSION 120 100.0% 0 0.0% 120 100.0%


GR * TENSION Crosstabulation
Count
TENSION Total
HYPERTENSIO
N
HYPOTENSION
GR
1 21 9 0 30
2 15 0 15 30
3 26 0 4 30
4 15 10 5 30
Total 77 19 24 120



Chi-Square Tests
Value df Asymp. Sig. (2-
sided)
Pearson Chi-Square 43.841
a
6 .000
Likelihood Ratio 53.131 6 .000
N of Valid Cases 120

a. 4 cells (33.3%) have expected count less than 5. The
minimum expected count is 4.75.
MAP has significant variance across group. Therefore
hypertension and hypotension has significant variance across
group. Therefore the effect of medicines on the adverse effect
has significant variance.


C. COMPARISON OF ADVERSE EVENTS ACROSS GROUP.
NAUSEA AND VOMMITING.


Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
GR * NAUSEAVOMITTING 120 100.0% 0 0.0% 120 100.0%


GR * NAUSEAVOMITTING Crosstabulation
Count
NAUSEAVOMITTING Total
1.00 2.00
GR
1 1 29 30
2 8 22 30
3 2 28 30
4 4 26 30
Total 15 105 120


Chi-Square Tests
Value df Asymp. Sig. (2-
sided)
Pearson Chi-Square 8.762
a
3 .033
Likelihood Ratio 8.605 3 .035
Linear-by-Linear Association .136 1 .712
N of Valid Cases 120

a. 4 cells (50.0%) have expected count less than 5. The minimum
expected count is 3.75.
Combination of medicines has a significant effect on the physical
condition on the patients. Patients having nausea vomiting is denoted by
N_V and who dont have are denoted by NO.




d. Comparison of adverse events across groups.
Shivering and sedation

Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
GR * SED_SCORE 120 100.0% 0 0.0% 120 100.0%



GR * SED_SCORE Crosstabulation
Count
SED_SCORE Total
1 2 3 4
GR
1 24 6 0 0 30
2 8 15 6 1 30
3 16 14 0 0 30
4 25 5 0 0 30
Total 73 40 6 1 120




Chi-Square Tests
Value df Asymp. Sig. (2-
sided)
Pearson Chi-Square 39.542
a
9 .000
Likelihood Ratio 39.408 9 .000
Linear-by-Linear Association 1.498 1 .221
N of Valid Cases 120

a. 8 cells (50.0%) have expected count less than 5. The minimum
expected count is .25.

Case Processing Summary

Cases
Valid Missing Total
N Percent N Percent N Percent
GR * SHIVERING 120 100.0% 0 0.0% 120 100.0%



GR * SHIVERING Crosstabulation
Count
SHIVERING Total
0 1 2 3 4
GR
1 3 5 15 6 1 30
2 10 13 5 2 0 30
3 15 7 4 4 0 30
4 1 4 5 20 0 30
Total 29 29 29 32 1 120


Chi-Square Tests
Value df Asymp. Sig. (2-
sided)
Pearson Chi-Square 63.069
a
12 .000
Likelihood Ratio 59.709 12 .000
Linear-by-Linear Association 3.022 1 .082
N of Valid Cases 120

a. 4 cells (20.0%) have expected count less than 5. The minimum
expected count is .25.

Here the combination of medicines has a significant effect on the physical condition like
shivering of the patients and significant variance was found. Also sedation has a significant
variance across group.