Intravenous paracetamol for fever control in acute brain-injured patients: cerebral and hemodynamic effects

Picetti, Edoardo; Rossi, Ilaria; Ceccarelli, Patrizia; Risolo, S.; Schiavi, Paolo; Donelli, Valentina; Crocamo, Antonio; Antonini, Marta Velia; Caspani, Maria Luisa

doi:10.1186/cc12267

Cited by 4 publications

(8 citation statements)

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“…Recently, in the context of critical illness, clinical studies have suggested that i.v. paracetamol may cause hypotension [1][2][3][4][5][6][7][8]. Most of these studies did not report on the possible mechanism for the hypotension observed [1,3,[5][6][7].…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

“…In addition, all studies identified in our literature search were non-randomized, non-blinded and uncontrolled, making it difficult to draw firm conclusions about this potential effect of paracetamol. One study reported anecdotal data [1] and others used small patient numbers [5,6,8]. Moreover, use of vasopressors could have also masked the magnitude of the adverse haemodynamic effects of paracetamol observed [2,3,[5][6][7].…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

“…One study reported anecdotal data [1] and others used small patient numbers [5,6,8]. Moreover, use of vasopressors could have also masked the magnitude of the adverse haemodynamic effects of paracetamol observed [2,3,[5][6][7]. Recently, Krajcova et al performed a nonblinded, non-randomized study on six intensive care patients who received 48 paracetamol and 35 control drug administrations [8].…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

“…However, with growing use, concerns have developed in critical care literature, which suggest that i.v. formulations may be associated with transient hypotension [1][2][3][4][5][6][7][8]. Additionally, studies examining the haemodynamic effects of i.v.…”

Section: Introductionmentioning

confidence: 99%

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The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double‐blind, randomized, triple crossover trial

Chiam

Weinberg

Bailey

et al. 2016

Brit J Clinical Pharma

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Aim The haemodynamic effects of intravenous paracetamol have not been systematically investigated. We compared the physiological effects of intravenous mannitol‐containing paracetamol, and an equivalent dosage of mannitol, and normal saline 0.9% in healthy volunteers. Methods We performed a blinded, triple crossover, randomized trial of 24 adult healthy volunteers. Participants received i.v. paracetamol (1 g paracetamol +3.91 g mannitol 100 ml–1), i.v. mannitol (3.91 g mannitol 100 ml–1) and i.v. normal saline (100 ml). Composite primary end points were changes in mean arterial pressure (MAP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured pre‐infusion, during a 15 min infusion period and over a 45 min observation period. Systemic vascular resistance index (SVRI) and cardiac index were measured at the same time points. Results Infusion of paracetamol induced a transient yet significant decrease in blood pressures from pre‐infusion values (MAP –1.85 mmHg, 95% CI –2.6, –1.1, SBP –0.54 mmHg, 95% CI –1.7, 0.6 and DBP −1.92 mmHg, 95% CI –2.6, –1.2, P < 0.0001), associated with a transient reduction in SVRI and an increase in cardiac index. Changes were observed, but to a lesser extent with normal saline (MAP –0.15 mmHg, SBP +1.44 mmHg, DBP −–0.73 mmHg, P < 0.0001), but not with mannitol (MAP +1.47 mmHg, SBP +4.03 mmHg, DBP +0.48 mmHg, P < 0.0001). Conclusions I.v. paracetamol caused a transient decrease in blood pressure immediately after infusion. These effects were not seen with mannitol or normal saline. The physiological mechanism was consistent with vasodilatation. This study provides plausible physiological data in a healthy volunteer setting, supporting transient changes in haemodynamic variables with i.v. paracetamol and justifies controlled studies in the peri‐operative and critical care setting.

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Section: Relationship To Previous Studiesmentioning

confidence: 99%

Section: Relationship To Previous Studiesmentioning

confidence: 99%

Section: Relationship To Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double‐blind, randomized, triple crossover trial

Chiam

Weinberg

Bailey

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

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“…Intravenous paracetamol-induced hypotension maybe clinically important, especially in the setting of critical illness where it is most frequently reported [5][6][7][10][11][12][13][14] . Boyle et al 6 .…”

Section: Discussionmentioning

confidence: 99%

Paracetamol infusion-related severe hypotension and cardiac arrest in a child

et al. 2016

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Paracetamol (also known as Acetaminophen) is an antipyretic, non-opioid analgesic, and non-steroidal anti-inflammatory drug (NSAID), and is one of the most commonly used medications worldwide. In recent years, IV paracetamol has been frequently used in hospitalized patients to reduce fever and pain. Significant adverse reactions associated with intravenous paracetamol are extremely rare. Typically reported adverse events include hypotension, malaise, hypersensitivity reaction, liver enzyme elevation, and thrombocytopenia. We present herein a case of IV paracetamol infusion-related severe hypotension and cardiac arrest.

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The hemodynamic effects of intravenous paracetamol (acetaminophen) in patients with chronic liver disease undergoing liver transplantation: a pilot study

et al. 2021

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Objective We performed a single-center double-blinded, randomized trial to investigate the hemodynamic effects of IV paracetamol in patients with chronic liver disease (CLD) undergoing liver transplantation surgery. Patients with CLD are particularly susceptible to hemodynamic derangements given their low systemic vascular resistance state. Accordingly, hypotension is common in this setting. The hemodynamic effects of IV paracetamol in patients undergoing elective liver transplantation are unknown, therefore we evaluated whether the intraoperative administration of IV paracetamol in patients with chronic liver disease undergoing liver transplantation results in adverse hemodynamic effects. The primary end point was a change in systolic blood pressure 30-min after the preoperative infusion. Results Twenty-four participants undergoing liver transplantation surgery were randomly assigned to receive a single bolus of IV paracetamol (1 g paracetamol + 3.91 g mannitol per 100 mL) (n = 12) or placebo (0.9% Saline 100 mL) (n = 12). All participants completed their study intervention, and there were no breaches or violations of the trial protocol. Baseline characteristics were similar in both groups. There were no significant differences regarding surgical duration, intraoperative use of fluids, and intraoperative noradrenaline use. After the administration of paracetamol there were no significant differences observed in blood pressure or other hemodynamic parameters when compared to placebo.

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Intravenous paracetamol for fever control in acute brain-injured patients: cerebral and hemodynamic effects

Cited by 4 publications

References 1 publication

The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double‐blind, randomized, triple crossover trial

The haemodynamic effects of intravenous paracetamol (acetaminophen) in healthy volunteers: a double‐blind, randomized, triple crossover trial

Paracetamol infusion-related severe hypotension and cardiac arrest in a child

The hemodynamic effects of intravenous paracetamol (acetaminophen) in patients with chronic liver disease undergoing liver transplantation: a pilot study

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