Effect of Pethidine, Fentanyl and Morphine on Post‐Operative Shivering in Man

Pauca, Alfredo L.; Savage, R; Simpson, SL; Roy, Raymond C.

doi:10.1111/j.1399-6576.1984.tb02029.x

Cited by 118 publications

(47 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This physiological response was most probably blunted by morphine or sedation with midazolam, or both. [9][10][11][12] This possibility is fully supported by the fact that patient No. 17 was excluded because he developed a shiveringequivalent reaction with increased EE while not receiving opioids as he required close neurological surveillance.…”

Section: Discussionsupporting

confidence: 51%

“…3 Indeed, shivering is suppressed by general anaesthetics, centrally acting agents such as clonidine and especially by opioids such as pethidine, morphine and fentanyl. 10 In clinical practice, although controversial, antipyretic therapy is often prescribed to combat temperatures greater than 38.5 ЊC. Indeed, fever complements the host immunological defence against invasion by micro-organisms.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Poblete¹,

Romand²,

Pichard³

et al. 1997

British Journal of Anaesthesia

View full text Add to dashboard Cite

SummaryWe have measured the metabolic response to sequential administration of propacetamol, metamizol and/or external cooling in 20 febrile patients under sedation and analgesia and during mechanical ventilation. There was no change in temperature (TЊ) after propacetamol therapy, whereas after metamizol only a small decrease was noted (from 38.9 (SEM 0.2) to 38.5 (0.3) ЊC; P:0.02). External cooling produced a significant decrease in TЊ (39.1 (0.2) to 37.1 (0.2) ЊC; P:0.0001) accompanied by a decrease in energy expenditure (EE) (2034 (73) to 1791 (88) kcal day 91 ; P:0.004). Heart rate and minute ventilation decreased significantly in parallel. There were no other changes in haemodynamics or pulmonary gas exchanges. We conclude that propacetamol and metamizol did not produce a clinically significant decrease in TЊ in febrile ICU patients whereas external cooling decreased both TЊ and EE. The parallel decrease in body temperature and EE seemed to be related to opioid administration or sedation, or both. (Br. J. Anaesth. 1997; 78: 23-127 Fever in critically ill patients is related frequently to either the systemic inflammatory response syndrome (SIRS) or infection. Usually fever is treated with antipyretic drugs, often paracetamol or metamizol. External cooling by different methods, such as sponging the body surface with ice-cooled water, is also used. 1 Even if reducing fever is still controversial from an immunological point of view, there is little doubt that patient comfort and metabolic demand can be improved by this procedure. 2 Indeed, a previous study in critically ill patients demonstrated diminished oxygen consumption related to decreased body temperature improving the oxygen demand-delivery ratio. 3 However, body cooling in healthy humans results in shivering which increases energy expenditure (EE).The aim of this study was to measure EE as an integrated indicator of body metabolic activity after reduction in temperature. Our hypothesis was that external cooling may induce an increase in EE, in contrast with drugs which, by resetting the thermoregulatory set point, decrease EE. Therefore, we designed a prospective, unblinded, crossover study to evaluate the respective effects of centrally acting drugs (propacetamol or metamizol) or external physical cooling in febrile ICU patients. Patients and methodsThe study was approved by the Ethics Committee of our institution. The requirement for informed consent was waived by the committee who judged that the therapies were applied independently by the attending physician and were accepted in clinical practice, and no invasive measurements were made. We studied 20 patients undergoing mechanical ventilation via a tracheal tube, with a rectal temperature greater than 38.5 ЊC and in whom the physician in charge wished to decrease fever. No patient had an inspired oxygen fraction greater than 0.6, a pneumothorax or a broncho-pleural fistula. Patients' lungs were ventilated with a Veolar-Hamilton (Hamilton Bonaduz, Switzerland) or Engström-Erica ventilator (Engström,...

show abstract

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Poblete¹,

Romand²,

Pichard³

et al. 1997

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…15 We also recorded rectal temperature in the patients who underwent hypothermia and found full correlation between rectal and tympanic temperature readings. Compensatory shivering was treated with intravenous administration of pethidine in doses of 25 to 50 mg, 16 given when the patient reported shivering or the investigator (L.P.K. or B.H.R.)…”

Section: Methodsmentioning

confidence: 99%

Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study

Kammersgaard

Rasmussen

Jørgensen

et al. 2000

Stroke

252

141

View full text Add to dashboard Cite

Background and Purpose-Hypothermia reduces neuronal damage in animal stroke models. Whether hypothermia is neuroprotective in patients with acute stroke remains to be clarified. In this case-control study, we evaluated the feasibility and safety of inducing modest hypothermia by a surface cooling method in awake patients with acute stroke. Methods-We prospectively included 17 patients (cases) with stroke admitted within 12 hours from stoke onset (mean 3.25 hours). They were given hypothermic treatment for 6 hours by the "forced air" method, a surface cooling method that uses a cooling blanket with a flow of cool air (10°C). Pethidine was given to treat compensatory shivering. Cases were compared with 56 patients (controls) from the Copenhagen Stroke Study matched for age, gender, initial stroke severity, body temperature on admission, and time from stroke onset to admission. Blood cytology, biochemistry, ECGs, and body temperature were monitored during hypothermic treatment. Multiple regression analyses on outcome were performed to examine the safety of hypothermic therapy. Results-Body temperature decreased from t 0 ϭ36.8°C to t 6 ϭ35.5°C (PϽ0.001), and hypothermia was present until 4 hours after therapy (t 0 ϭ36.8°C versus t 10 ϭ36.5°C; Pϭ0.01). Mortality at 6 months after stroke was 12% in cases versus 23% in controls (Pϭ0.50). Final neurological impairment (Scandinavian Stroke Scale score at 6 months) was mean 42.4 points in cases versus 47.9 in controls (Pϭ0.21). Hypothermic therapy was not a predictor of poor outcome in the multivariate analyses. Conclusions-Modest hypothermia can be achieved in awake patients with acute stroke by surface cooling with the "forced air" method, in combination with pethidine to treat shivering. It was not associated with a poor outcome. We suggest a large, randomized clinical trial to test the possible beneficial effect of induced modest hypothermia in unselected patients with stroke. (Stroke. 2000;31:2251-2256.)

show abstract

“…As such, hypothermia is undesirable in these patients. A sympathetic blockade during local anesthesia causes heat loss precipitating shivering in these patients (17). Therefore, to avoid hypothermia, patients should be heated pre-and intraoperatively, and solutions should be warmed prior to administration.…”

Section: Discussionmentioning

confidence: 99%

“…Opioids are often used to prevent shivering. However, epidural injection of opioids may lead to respiratory depression, thus, if opioids are to be used by epidural injection, breathing should be monitored more carefully (17).…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for a Patient with Myotonic Dystrophy

Kalaycı¹,

Şen²,

Muslu³

et al. 2016

Haseki

View full text Add to dashboard Cite

Myotonic dystrophy is the most common myotonic syndrome causing abnormalities of the skeletal and smooth muscles as well as problems related to the cardiac, gastrointestinal and endocrine systems. In affected people, reduced functional residual capacity, vital capacity, and peak inspiratory pressure are observed within the respiratory system. As would be expected, anesthetic management of these patients is challenging for anesthesiologists. In addition, delayed recovery from anesthesia and cardiac and pulmonary complications may develop in the intraoperative and early postoperative periods due to sensitivity to sedatives, anesthetic agents, and neuromuscular blocking agents. Myotonic dystrophy can be performed with the use of appropriate anesthesia procedures as well as carefully communication between anesthesiologists and surgeons. In conclusion, myotonic dystrophy has variations, which makes it important to preoperatively determine specific surgical and anesthetic management strategies for each patient. In this article, we present a patient with myotonic dystrophy who underwent laparoscopic cholecystectomy surgery for symptomatic cholelithiasis and to discuss the relevant literature.

show abstract

Effect of Pethidine, Fentanyl and Morphine on Post‐Operative Shivering in Man

Cited by 118 publications

References 13 publications

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study

Anesthesia for a Patient with Myotonic Dystrophy

Contact Info

Product

Resources

About