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Titolo:
NALOXONE, MEPERIDINE, AND SHIVERING
Autore:
KURZ M; BELANI KG; SESSLER DI; KURZ A; LARSON MD; SCHROEDER M; BLANCHARD D;
Indirizzi:
UNIV CALIF SAN FRANCISCO,SCH MED,DEPT ANESTHESIA,THERMOREGULAT RES LAB,3RD & PARNASSUS AVE SAN FRANCISCO CA 94143 UNIV CALIF SAN FRANCISCO,SCH MED,DEPT ANESTHESIA,THERMOREGULAT RES LAB,3RD & PARNASSUS AVE SAN FRANCISCO CA 94143 WAEHRINGER GUERTEL,DEPT TRANSFUS MED VIENNA AUSTRIA UNIV VIENNA,DEPT ANESTHESIA & INTENS CARE A-1010 VIENNA AUSTRIA UNIV MINNESOTA,DEPT ANESTHESIA MINNEAPOLIS MN 55455
Titolo Testata:
Anesthesiology
fascicolo: 6, volume: 79, anno: 1993,
pagine: 1193 - 1201
SICI:
0003-3022(1993)79:6<1193:NMAS>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
PUPILLARY LIGHT REFLEX; NITROUS-OXIDE; CEREBRAL-ISCHEMIA; MILD HYPOTHERMIA; HUMANS; ISOFLURANE; RESPONSES; RAT; BUPRENORPHINE; HYPERTHERMIA;
Keywords:
ANALGESICS, OPIOIDS, MEPERIDINE; ANTAGONISTS, OPIOID, NALOXONE; BRAIN, HYPOTHALAMUS; TEMPERATURE, HYPOTHERMIA; THERMOREGULATION, SETPOINT; SHIVERING; THRESHOLD;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
55
Recensione:
Indirizzi per estratti:
Citazione:
M. Kurz et al., "NALOXONE, MEPERIDINE, AND SHIVERING", Anesthesiology, 79(6), 1993, pp. 1193-1201

Abstract

Background: Meperidine, which binds both mu and kappa opioid receptors, is reportedly more effective in treating shivering than are equianalgesic doses of morphine (a nearly pure mu-receptor agonist). Furthermore, butorphanol, a kappa-receptor agonist/antagonist, treats shivering better than does fentanyl, which mostly binds mu receptors. These data indicate that much of meperidine's special antishivering activity may be mediated by its kappa activity. Accordingly, the authors tested the hypothesis that the antishivering activity of meperidine will be minimally impaired by low-dose naloxone (blocking most mu-receptors), but largely prevented by high-dose naloxone (blocking all mu and most kappa receptors). Methods. Twelve volunteers each participated on 2 days. On both days, shivering was induced by central venous infusion of cold fluid. Twenty minutes later, six volunteers were given a placebo infusion of saline on one day, or an infusion of 0.5 mug . kg-1 . min-1naloxone hydrochloride (''low-dose,'' designed to block mu receptors)on the other. The second group of six volunteers was given a saline bolus and infusion on one day, or a bolus of 11.5 mug/kg naloxone hydrochloride followed by an infusion of naloxone at 5 mug . kg-1 . min-1 (''high-dose,'' designed to block both mu and kappa receptors) on the other day. The infusions were continued for the duration of the study. The order of the treatment days (saline vs. naloxone) was randomly assigned, and the study was double blinded. Fifteen minutes after the test infusion was started, all 12 volunteers were given an intravenous bolus of 1 mg/kg meperidine hydrochloride. Pupillary diameter and light reflex amplitude were used to quantify opioid-receptor agonist activity; shivering intensity was evaluated using oxygen consumption. Results. Administration of naloxone alone did not alter oxygen consumption, pupil size, or the pupillary light reflex. No pupillary constriction was detected in either group when naloxone and meperidine were combined;in contrast, meperidine alone decreased pupil size and amplitude of the light reflex 30%. The meperidine bolus decreased oxygen consumptionnearly to control values when the volunteers were given saline placebo. Combined administration of meperidine and low-dose naloxone also significantly reduced oxygen consumption, but the reduction and the duration of the reduction was less than during saline. When the volunteerswere given high-dose naloxone, meperidine only slightly reduced oxygen consumption, and the values rapidly returned to premeperidine levels. Conclusions. These data indicate that the antishivering property of meperidine is not fully mediated by mu-receptors. Although meperidine has well-known nonopioid actions, stimulation Of kappa receptors seemsa likely alternative explanation for much of the drug's antishiveringaction.

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Documento generato il 15/07/20 alle ore 08:30:07