Pethidine and Skin Warming to Prevent Shivering during Endovascular Cooling

Leslie, Kate; Di, Williams; Irwin, Kathleen L.; Bjorksten, Andrew R.; Sessler, Daniel I.

doi:10.1177/0310057x0403200310

Cited by 8 publications

(4 citation statements)

References 40 publications

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“…However, whatever the reason, meperidine is one of the most effective antishivering drugs known and is frequently used for treatment of postoperative shivering (65). Nonetheless, meperidine alone is not usually sufficient for induction of therapeutic hypothermia (66).…”

Section: Opioidsmentioning

confidence: 99%

Thermoregulatory defense mechanisms

Sessler

2009

Critical Care Medicine

161

114

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Core body temperature is normally tightly regulated by an effective thermoregulatory system. Thermoregulatory control is sometimes impaired by serious illness, but more typically remains intact. The primary autonomic defenses against heat are sweating and active precapillary vasodilation; the primary autonomic defenses against cold are arteriovenous shunt vasoconstriction and shivering. The core temperature triggering each response defines its activation threshold. Temperatures between the sweating and vasoconstriction thresholds define the inter-threshold range. The shivering threshold is usually a full 1 degrees C below the vasoconstriction threshold and is therefore a "last resort" response. Both vasoconstriction and shivering are associated with autonomic and hemodynamic activation; and each response is effective, thus impeding induction of therapeutic hypothermia. It is thus helpful to accompany core cooling with drugs that pharmacologically induce a degree of thermal tolerance. No perfect drug or drug combination has been identified. Anesthetics, for example, induce considerable tolerance, but are rarely suitable. Meperidine-especially in combination with buspirone-is especially effective while provoking only modest toxicity. The combination of buspirone and dexmedetomidine is comparably effective while avoiding the respiratory depression association with opioid administration.

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Section: Opioidsmentioning

confidence: 99%

Thermoregulatory defense mechanisms

Sessler

2009

Critical Care Medicine

161

114

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“…They reported good feasibility with mild shivering in nine patients. Leslie and colleagues [ 36 ] reported that a combination of a low level of meperidine (target plasma level: 0.4 mg/ml) and skin warming in 10 patients scheduled for neurosurgery was insufficient to prevent shivering. However, study results have also shown a large range of meperidine levels (0.1 to 0.9 μg/ml) and therefore have to be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

“…However, only in the study by Leslie and colleagues [ 36 ] were meperidine levels measured and sedation assessed with a validated scale; in none of the aforementioned studies was the interaction between meperidine and skin warming examined. In contrast, by means of an approach described by Slinker [ 29 ], our present volunteer study is able to demonstrate an additive interaction between meperidine and skin warming.…”

Section: Discussionmentioning

confidence: 99%

Meperidine and skin surface warming additively reduce the shivering threshold: a volunteer study

et al. 2007

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Introduction Mild therapeutic hypothermia has been shown to improve outcome for patients after cardiac arrest and may be beneficial for ischaemic stroke and myocardial ischaemia patients. However, in the awake patient, even a small decrease of core temperature provokes vigorous autonomic reactionsvasoconstriction and shivering-which both inhibit efficient core cooling. Meperidine and skin warming each linearly lower vasoconstriction and shivering thresholds. We tested whether a combination of skin warming and a medium dose of meperidine additively would reduce the shivering threshold to below 34°C without producing significant sedation or respiratory depression.

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“…For example, meperidine was frequently used for the treatment of perioperative shiver because of its beneficial and characteristic therapeutic profile (Burks et al, 1980). The administration of opioids inhibits the motor (shiver) thermal response at twice the rate as the vasoconstrictive response, at any given dose (Leslie et al, 2004). The antishivering action of meperidine is already present at blood levels that do not lead to any observable respiratory depression or sedation, for example, a relatively small dose (25 mg, iv) of meperidine decreases the shivering threshold by 2°C (Alfonsi et al, 1998).…”

Section: Induction Of Therapeutic Hypothermiamentioning

confidence: 99%

Induction of Therapeutic Hypothermia Requires Modulation of Thermoregulatory Defenses

Bandschapp

Iaizzo²

2011

Therapeutic Hypothermia and Temperature Management

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Hypothermia has been linked to beneficial neurologic outcomes in different clinical situations and its therapeutic value is considered important. For example, in asphyctic neonates and in patients with out-of-hospital cardiac arrest (with ventricular fibrillation as the initial cardiac rhythm), rapid installation of hypothermia has been reported to add substantial therapeutic benefits over nonthermal standard treatments. Yet, in other groups of patients in which the application of therapeutic hypothermia may be applied with clinical benefits, the optimization of therapy remains less straightforward, as the body possesses vigorous defense mechanisms to protect it from inducing hypothermia, that is, especially in conscious patients and/or in those in which the hypothalamus remains intact, such as stroke patients or patients who suffer a myocardial infarction or spinal cord injury. This overview summarizes the body's primary reactions to hypothermia and the defense mechanisms available or evoked. Then, clinically applicable ways to overcome these forceful cold defenses of the body are described to ensure both an optimal induction process for therapeutic hypothermia and maximal subjective comfort for these conscious patients.

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Pethidine and Skin Warming to Prevent Shivering during Endovascular Cooling

Cited by 8 publications

References 40 publications

Thermoregulatory defense mechanisms

Thermoregulatory defense mechanisms

Meperidine and skin surface warming additively reduce the shivering threshold: a volunteer study

Induction of Therapeutic Hypothermia Requires Modulation of Thermoregulatory Defenses

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