Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Singh, Prince Kumar; Dimitriou, V.; Mahajan, Ravi; Crossley, A. W. A.

doi:10.1093/bja/71.5.685

Cited by 80 publications

(51 citation statements)

References 32 publications

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“…Finally, a little known role for doxapram in terminating post-operative shivering was found in 1993 (48). The effectiveness of doxapram to prevent shivering on emergence from general anesthesia was compared to that of demerol.…”

Section: Prevention Of Shiveringmentioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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A number of life-threatening clinical disorders may be amenable to treatment with a drug that can stimulate respiratory drive. These include acute respiratory failure secondary to chronic obstructive pulmonary disease, post-anesthetic respiratory depression, and apnea of prematurity. Doxapram has been available for over forty years for the treatment of these conditions and it has a low side effect profile compared to other available agents. Generally though, the use of doxapram has been limited to these clinical niches involving patients in the intensive care, post-anesthesia care and neonatal intensive care units. Recent basic science studies have made considerable progress in understanding the molecular mechanism of doxapram's respiratory stimulant action. Although it is unlikely that doxapram will undergo a clinical renaissance based on this new understanding, it represents a significant advance in our knowledge of the control of breathing.

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Section: Prevention Of Shiveringmentioning

confidence: 99%

A New Look at the Respiratory Stimulant Doxapram

2006

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“…Although doxapram stimulates release of dopamine from carotid bodies in rats (6), it is known to have central effects (7) that are probably, at least in part, similarly mediated. As might thus be expected, doxapram is a useful treatment for postanesthetic shivering (8). Doxapram produces a dose-dependent and substantial reduction in the shivering threshold in rabbits (9).…”

Section: Introductionmentioning

confidence: 65%

Doxapram Only Slightly Reduces the Shivering Threshold in Healthy Volunteers

Komatsu

Sengupta

Cherynak

et al. 2005

Anesthesia & Analgesia

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We determined the effects of doxapram on the major autonomic thermoregulatory responses in humans. Nine healthy volunteers were studied on two days: Control and Doxapram (intravenous infusion to a plasma concentration of 2.4 ±0.8 μg/mL, 2.5 ±0.9 μg/mL, and 2.6 ±1.1 μg/mL at the sweating, vasoconstriction, and shivering thresholds, respectively). Each day, skin and core temperatures were increased to provoke sweating, then reduced to elicit peripheral vasoconstriction and shivering. We determined the sweating, vasoconstriction, and shivering thresholds with compensation for changes in skin temperature. Data were analyzed with paired t tests and presented as means ± SDs; P < 0.05 was considered statistically significant. Doxapram did not change the sweating (Control: 37.5±0.4°C, Doxapram: 37.3±0.4°C, P=0.290) or the vasoconstriction threshold (36.8±0.7 vs. 36.4±0.5°C; P=0.110). However, it significantly reduced the shivering threshold from 36.2±0.5 to 35.7±0.7°C (P=0.012). No sedation or symptoms of panic were observed on either study day. The observed reduction in the shivering threshold explains the drug's efficacy for treatment of postoperative shivering; however, a reduction of only 0.5°C is unlikely to markedly facilitate induction of therapeutic hypothermia as a sole agent. Implications:The observed reduction of only 0.5°C in the shivering threshold explains the drug's efficacy for treatment of postoperative shivering. However, such a reduction is unlikely to markedly facilitate induction of therapeutic hypothermia as a sole agent.

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“…17 In contrast, Figure 3 ondansetron effectively relieves postoperative nausea and vomiting. Although meperidine in the doses effective in treating post-anesthetic shivering (0.33-0.4 mg/kg) rarely produces untoward cardiovascular effect, 22,23,24,25,17 it may potentially cause respiratory depression, especially if it or other opioids have been given intraoperatively.…”

Section: Resultsmentioning

confidence: 99%