Prophylactic paracetamol for intraoperative shivering prevention for patients undergoing gynecological procedures under spinal anesthesia: A randomized clinical trial

Introduction@#Shivering is defined as an involuntary, repetitive activity of skeletal muscles. Mechanisms of shivering for patients undergoing surgical operation include intraoperative heat loss, increase sympathetic tone, pain, and systemic release of pyrogens. Regional anesthesia, particularly spinal anesthesia causes redistribution of core heat to the peripheral tissues this in turn predisposes patient to shivering and hypothermia. The median incidence of shivering related to regional anesthesia observed in a review of 21 studies is 55%. Paracetamol is one of the most commonly used analgesic and antipyretic drugs around the world, available without a prescription, it has analgesic and antipyretic property similar to NSAIDs it also affects core body temperature through the hypothalamus. Though different modalities have been established for shivering prevention, the search for a cost-effective drug with lesser side effects and improvement of patient satisfaction still continues. @*Objective@#The aim of this study was to evaluate the effect of prophylactic dose of Paracetamol on postanesthesia shivering on patients undergoing, gynecological procedures under spinal anesthesia as compared to patients not given Paracetamol.@*Methodology@#This is a Double blind, Randomized, Placebo Controlled conducted in patients scheduled for benign gynecological procedures such as Hysterectomy with or without adnexectomy. Using simple random sampling through fishbowl method and a sample size of 42, all patients who consented to participate in the study was randomly assigned to receive Paracetamol 900 mg IV or Placebo 0.9% Saline intravenously 30 minutes prior to induction of spinal anesthesia. Incidence and severity of Shivering was documented using shivering five point scale outlined by Crossley and Mahajan, while patient satisfaction was also evaluated using the Likert Scale, possible side effects was also assessed.

Elimination of viruses, bacteria and protozoan oocysts by slow sand filtration.

The decimal elimination capacity (DEC) of slow sand filters (SSF) for viruses, bacteria and oocysts of Cryptosporidium has been assessed from full-scale data and pilot plant and laboratory experiments. DEC for viruses calculated from experimental data with MS2-bacteriophages in the pilot plant filters was 1.5-2 log10. E. coli and thermotolerant coliforms (Coli44) were removed at full-scale and in the pilot plant with 2-3 log10. At full-scale, Campylobacter bacteria removal was 1 log10 more than removal of Coli44, which indicated that Coli44 was a conservative surrogate for these pathogenic bacteria. Laboratory experiments with sand columns showed 2-3 and >5-6 log10 removal of spiked spores of sulphite-reducing clostridia (SSRC; C. perfringens) and oocysts of Cryptosporidium respectively. Consequently, SSRC was not a good surrogate to quantify oocyst removal by SSF. Removal of indigenous SSRC by full-scale filters was less efficient than observed in the laboratory columns, probably due to continuous loading of these filter beds with spores, accumulation and retarded transport. It remains to be investigated if this also applies to oocyst removal by SSF. The results additionally showed that the schmutzdecke and accumulation of (in)organic charged compounds in the sand increased the elimination of microorganisms. Removal of the schmutzdecke reduced DEC for bacteria by +/-2 log10, but did not affect removal of phages. This clearly indicated that, besides biological activity, both straining and adsorption were important removal mechanisms in the filter bed for microorganisms larger than viruses.