Meperidine and Alfentanil Do Not Reduce the Gain or Maximum Intensity of Shivering

Ikeda, Takehiko; Sessler, Daniel I.; Tayefeh, Farzin; Negishi, Chiharu; Turakhia, Minang; Marder, Danielle; Bjorksten, Andrew R.; Larson, Merlín D.

doi:10.1097/00000542-199804000-00003

Cited by 57 publications

(23 citation statements)

References 25 publications

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“…In agreement with our results, Ikeda et al 22 did not detect any changes in the maximum intensity of shivering after meperidine and also alfentanil application. However, both drugs proved to decrease the thermoregulatory threshold.…”

supporting

confidence: 94%

Differential Effects of α2-adrenoceptors in the Modulation of the Thermoregulatory Response in Mice Induced by Meperidine

et al. 2008

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Background: Meperidine proved to be more effective in treatment of shivering than equianalgesic doses of other opioids, especially pure -agonists. Further, meperidine has well known nonopioid actions including agonistic effects at ␣ 2 -adrenoceptors in vitro. Accordingly, the authors investigated nonopioid receptor-mediated effects of meperidine on thermoregulation using a mice model of nonshivering thermogenesis. To differentiate conceivable ␣ 2 -adrenoceptor subtype specific interactions the authors analyzed wild-type mice and knock-out mice with deletion of the ␣ 2A -, ␣ 2B -, or ␣ 2C -adrenoceptor.Methods: Ten mice per group (n ‫؍‬ 60) were injected with saline, meperidine (20 mg/kg), saline plus naloxone (125 g/ kg), meperidine plus naloxone, fentanyl (50 g/kg) plus naloxone, or meperidine plus atipamezole (2 mg/kg) intraperitoneally. Each mouse was subjected to the six different treatments. Then they were positioned into a plexiglas chamber where rectal temperature and mixed expired carbon dioxide were measured while whole body cooling was performed. Maximum response intensity and thermoregulatory threshold temperature of nonshivering thermogenesis were analyzed.Results: Meperidine decreased the thermoregulatory threshold temperature in wild-type mice and ␣ 2B -and ␣ 2C -adrenoceptor knock-out mice. This effect ended after injection of the ␣ 2 -adrenoceptor antagonist atipamezole. In wild-type and ␣ 2B -adrenoceptor knock-out mice, the decrease of thermoregulatory threshold was not reversible by administration of the opioid receptor antagonist naloxone. In contrast, in ␣ 2A -adrenoceptor knock-out mice, no decline of thermoregulatory threshold following meperidine injection was detectable. Maximum response intensity of nonshivering thermogenesis was comparable in all groups.Conclusions: The authors' results suggest a major role of ␣ 2 -adrenoceptors, especially the ␣ 2A subtype, in the mediation of thermoregulatory effects caused by meperidine in mice.

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supporting

confidence: 94%

Differential Effects of α2-adrenoceptors in the Modulation of the Thermoregulatory Response in Mice Induced by Meperidine

et al. 2008

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“…Gain and maximum shivering intensity remain normal during both meperidine and alfentanil administration 147. Gain also remains nearly intact during nitrous oxide administration, although maximum intensity is reduced 148.…”

Section: Thermoregulation During General Anesthesiamentioning

confidence: 93%

Temperature Monitoring and Perioperative Thermoregulation

2008

Self Cite

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Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature measuring sites are completely non-invasive and easy to use — especially in patients not having general anesthesia. Nonetheless, temperature can be reliably measured in most patients. Body temperature should be measured in patients having general anesthesia exceeding 30 minutes in duration, and in patients having major operations under neuraxial anesthesia. Core body temperature is normally tightly regulated. All general anesthetics produce a profound dose-dependent reduction in the core temperature triggering cold defenses including arterio-venous shunt vasoconstriction and shivering. Anesthetic-induced impairment of normal thermoregulatory control, and the resulting core-to-peripheral redistribution of body heat, is the primary cause of hypothermia in most patients. Neuraxial anesthesia also impairs thermoregulatory control, although to a lesser extant than general anesthesia. Prolonged epidural analgesia is associated with hyperthermia whose cause remains unknown.

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“…(Once triggered, the gain and maximum intensity of shivering remains normal during opioid administration. 30 ) Meperidine differs from other drugs in disproportionately reducing the shivering threshold; that is, producing a dose-dependent reduction in Figure 3. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and heart rate (HR) before and after vasoconstriction.…”

Section: Nonanesthetic Drugsmentioning

confidence: 97%

“…30,31 While causing much less inhibition than intravenous anesthetics such as propofol, 29 the pattern of impairment is similar: they only slightly increase the sweating threshold, but linearly and synchronously reduce the vasoconstriction and shivering thresholds. (Once triggered, the gain and maximum intensity of shivering remains normal during opioid administration.…”

Section: Nonanesthetic Drugsmentioning

confidence: 99%

Defeating Normal Thermoregulatory Defenses

Sessler

2009

Stroke

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Abstract-Therapeutic hypothermia may be useful in various circumstances including stroke. However, core body temperature is normally tightly regulated. Even mild hypothermia in conscious subjects thus provokes vigorous thermoregulatory defenses which are potentially harmful in fragile patients. Furthermore, thermoregulatory responses are effective, which reduces the rate at which hypothermia can be induced. Drugs are thus often given to blunt normal thermoregulatory defenses. General anesthetics profoundly impair thermoregulatory control, but prolonged general anesthesia is rarely practical or appropriate. A variety of other drugs have therefore been evaluated. Most opioids only slightly impair thermoregulatory defenses, but meperidine is considerably more effective than equipotent doses of other opioids. The central ␣-2 agonists clonidine and dexmedetomidine are also useful. However, the best overall approach to inducing thermal tolerance appears to be a combination of buspirone and meperidine, which reduces the core temperature triggering shivering to about 33.5°C in doses that maintain adequate ventilation. (Stroke. 2009;40:e614-e621.)

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Meperidine and Alfentanil Do Not Reduce the Gain or Maximum Intensity of Shivering

Abstract: The authors could not confirm the hypothesis that meperidine reduces the gain or maximum intensity of shivering more than alfentanil does. These results suggest that meperidine's special antishivering effect is primarily mediated by a disproportionate reduction in the shivering threshold.

Cited by 57 publications

References 25 publications

Differential Effects of α2-adrenoceptors in the Modulation of the Thermoregulatory Response in Mice Induced by Meperidine

Differential Effects of α2-adrenoceptors in the Modulation of the Thermoregulatory Response in Mice Induced by Meperidine

Temperature Monitoring and Perioperative Thermoregulation

Defeating Normal Thermoregulatory Defenses

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