Propofol Linearly Reduces the Vasoconstriction and Shivering Thresholds

Matsukawa, Takashi; Kurz, Andrea; Sessler, Daniel I.; Bjorksten, Andrew R.; Merrifield, Benjamin; Cheng, Christi

doi:10.1097/00000542-199505000-00012

Cited by 308 publications

(99 citation statements)

References 50 publications

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“…None of the patients from either group shivered in the PACU; this may be because of propofol [26], fentanyl [27] and tramadol [28] that have residual effects on the thermoregulatory control centre, including reduced shivering. Besides, the postoperative forced-air warming over the skin could also have prevented shivering.…”

Section: Discussionmentioning

confidence: 99%

Comparison of peri‐operative core temperature in obese and non‐obese patients*

et al. 2012

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SummaryOur aim was to compare peri-operative core temperatures and the incidence of hypothermia in obese and non-obese women with active forced-air warming. Twenty female patients scheduled for abdominal surgery were allocated to two groups according to body mass index. Ten obese (30.0-34.9 kg.m )2) and 10 non-obese (18.5-24.9 kg.m ) women received forced-air warming on their lower limbs. At the end of surgery, the mean (SD) core temperatures were 36.7 (0.5)°C in the obese group and 36.0 (0.6)°C in the non-obese group (p < 0.001). Only in the non-obese group was there a significant decrease in the intra-operative core temperature values (p < 0.001). The incidences of intra-operative hypothermia were lower in the obese group (10%) compared with non-obese group (60%; p = 0.019). In the postoperative recovery phase, the mean (SD) core temperature data were higher in the obese group than in the nonobese group (36.2 (0.4) vs 35.6 (0.5)°C, respectively (p < 0.001)). In conclusion, obese female patients have higher perioperative core temperature and a lower incidence of hypothermia compared with non-obese female patients during abdominal surgery with active forced-air warming. Accepted: 21 August 2012Unintentional peri-operative hypothermia (core temperatures between 34.5 and 35.9°C) often leads to adverse outcomes, including cardiac events secondary to sympathetic nervous system activation [1], surgicalwound infections and prolonged hospitalisation [2], coagulopathy and increased blood loss [3], impaired drug metabolism, delayed postoperative recovery period [4,5] and shivering [6]. Therefore, maintaining perioperative normothermia reduces morbidity [1][2][3] and the use of peri-operative warming devices has become routine.The prevalence of obesity has increased markedly worldwide in recent years [7]. In clinical practice, body mass index (BMI) is used to estimate the degree of obesity, which is classified in three levels: grade 1 (BMI from 30.0 to 34.9 kg.m ) [8]. The prevalence of grade-1 obesity is higher among both female and male obese populations than are the other grades [8]. Obese patients are more likely to vasoconstrict in cooler environments [9], have reduced heat redistribution from core to peripheral tissue after

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Section: Discussionmentioning

confidence: 99%

Comparison of peri‐operative core temperature in obese and non‐obese patients*

et al. 2012

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“…Numerous pharmacological agents 7,10,[16][17][18][19][20][21][22][23][24][25] (Table 2) that reduce the vasoconstriction and shivering thresholds have been used to manage shivering during therapeutic hypothermia. According to the ILCOR, 3 sedative and hypnotic agents are often used to decrease metabolic demand and facilitate mechanical ventilation in comatose patients who lack signs of awakening within the first 5 to 10 minutes after return of spontaneous circulation.…”

Section: Pharmacological Methodsmentioning

confidence: 99%

“…Doses of 2.5 to 10 mg of midazolam are moderately effective in reducing shivering, although the drug also has a high sedative effect and a low risk of hypotension. 27 Matsukawa et al 25 reported that propofol linearly reduced the shivering threshold by 0.7ºC (SD, 0.1ºC) per microgram per milliliter, to a shivering threshold of 34.4ºC to 31.5ºC with doses of 2 to 8 µg/mL, respectively. However, a limitation in the use of propofol is the risk of hypotension.…”

Section: Pharmacological Methodsmentioning

confidence: 99%

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Logan

Sangkachand²,

Funk

2011

Critical Care Nurse

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Both pharmacological and nonpharmacological methods are used to control shivering in therapeutic hypothermia. An evidence-based protocol based on the most current research has been developed for the management of shivering during therapeutic hypothermia. Meperidine is the drug of choice and provides the greatest reduction in the shivering threshold. Other effective pharmacological agents recommended for reducing the threshold include dexmedetomidine, midazolam, fentanyl, and magnesium sulfate. In addition, skin counterwarming techniques, such as use of an air-circulating blanket, are effective nonpharmacological methods for reducing shivering when used in conjunction with medication. As a last resort, neuromuscular blocking agents are considered appropriate therapy for management of refractory shivering.

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“…Isso não foi surpresa porque a resposta de regulação térmica é diminuída em idosos 15 . É difícil determinar fatores de risco independentes para tremores antes da intervenção cirúrgica, já que numerosas variáveis influenciam a regulação térmica no pós-operatório resultante dos anestésicos voláteis 32 ou venosos e dos sedativos 33 . Além disso, quase todos os fármacos usados regularmente pelos pacientes (anti-hipertensivos e antidiabéticos, derivados cumarínicos) parecem oferecer proteção significativa para tremores.…”

Section: Fisiopatologiaunclassified

“…This was not surprising, because thermal regulation response is decreased in the elderly 15 . It is difficult to determine independent risk factors for tremors before surgery, since several variables influence postoperative thermal regulation in the case of volatile 32 or intravenous anesthetics, and sedatives 33 . Besides, almost every drug used regularly by patients (antihypertensives, those used in the treatment of diabetes, and coumarin derivatives) seems to offer significant protection against tremors.…”

Section: Physiopathologymentioning

confidence: 99%

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Albergaria

Lorentz²,

Lima³

2007

Rev. Bras. Anestesiol.

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RESUMOAlbergaria VF, Lorentz MN, Lima FAS -Tremores Intra e Pós-Operatório: Prevenção e Tratamento Farmacológico. JUSTIFICATIVA E OBJETIVOS:Os tremores podem ocorrer como um efeito adverso da intervenção cirúrgica e anestesia. A incidência de tremores pós-operatórios varia entre 6,3% e 66%. Pacientes jovens, sexo masculino, uso de agentes anestésicos halogenados e tempo prolongado de anestesia ou procedimento cirúrgico estão relacionados com tremores. Os tremores são involuntários e apresentam-se como atividade muscular oscilatória com finalidade de aumentar a produção de calor. Tremor pós-operatório é uma desagradável complicação que está relacionada com o aumento de morbidade. O tremor aumenta o metabolismo, resultando em um acréscimo de 200% a 500% no consumo de oxigênio. CONTEÚDO:Discute as causas, a prevenção e o tratamento dos tremores intra-e pós-operatório em pacientes adultos e pediátri-cos submetidos à intervenção cirúrgica sob anestesia geral ou do neuroeixo. CONCLUSÕES:Os tremores são, juntamente com náuseas e vô-mitos, causas de intenso desconforto na sala de recuperação pós-anestésica, além de potencialmente prejudiciais por gerarem aumento da demanda metabólica. Embora a presença de tremores não tenha sido diretamente relacionada com a morbidade cardía-ca, a prevenção tem se tornado tema de debate e de vários artigos científicos. A prevenção e o tratamento de tremores devem ser implementados. Pacientes com reserva cardiopulmorar limitada podem sofrer com acidose láctica, dessaturação venosa mista e hipoxemia.Unitermos: ANESTESIA: Geral, Locorregional; COMPLICAÇÕES: hipotermia, tremor; TREMOR: prevenção, tratamento. SUMMARYAlbergaria VF, Lorentz MN, Lima FAS -Intra-and Postoperative Tremors: Prevention and Pharmacological Treatment. BACKGROUND AND OBJECTIVES:Tremors can be an adverse effect of the surgical intervention and anesthesia. The incidence of postoperative tremors varies from 6.3% to 66%. Young age, male gender, the use of halogenated anesthetics, and prolonged anesthesia or surgical procedure are related with tremors. Tremors are involuntary and present as oscillating muscular activity aiming at increasing heat production. Postoperative tremors are a disagreeable complication related with increased morbidity. Tremors increase the metabolism, resulting in a 200% to 500% increase in oxygen consumption. CONTENTS:The objective of this paper was to discuss the causes, prevention, and treatment of intra-and postoperative tremors in adults and children undergoing general anesthesia or neuroaxis anesthesia for surgical interventions. CONCLUSIONS:Tremors, along with nausea and vomiting, cause severe discomfort in the recovery room, besides being highly prejudicial because they generate an increase in the metabolism. Although the presence of tremors has not been directly related with cardiac morbidity, its prevention has become the subject of discussion and several scientific reports. Prevention and treatment of tremors should be implemented. Patients with limited cardiovascular reserve could devel...

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Propofol Linearly Reduces the Vasoconstriction and Shivering Thresholds

Cited by 308 publications

References 50 publications

Comparison of peri‐operative core temperature in obese and non‐obese patients*

Comparison of peri‐operative core temperature in obese and non‐obese patients*

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

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