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Titolo:
MEPERIDINE DECREASES THE SHIVERING THRESHOLD TWICE AS MUCH AS THE VASOCONSTRICTION THRESHOLD
Autore:
KURZ A; IKEDA T; SESSLER DI; LARSON MD; BJORKSTEN AR; DECHERT M; CHRISTENSEN R;
Indirizzi:
UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA,374 PARNASSUS AVE SAN FRANCISCO CA 94143 UNIV CALIF SAN FRANCISCO,DEPT ANESTHESIA SAN FRANCISCO CA 94143 UNIV VIENNA,DEPT ANESTHESIA & INTENS CARE,OUTCOMES RES LAB VIENNA AUSTRIA ROYAL MELBOURNE HOSP,DEPT ANAESTHESIA PARKVILLE VIC 3050 AUSTRALIA
Titolo Testata:
Anesthesiology
fascicolo: 5, volume: 86, anno: 1997,
pagine: 1046 - 1054
SICI:
0003-3022(1997)86:5<1046:MDTSTT>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
PUPILLARY LIGHT REFLEX; THERMOREGULATORY RESPONSES; SLIGHTLY INCREASES; SWEATING THRESHOLD; ANALGESIC RESPONSE; HUMANS; ISOFLURANE; HYPERTHERMIA; ANESTHESIA; PETHIDINE;
Keywords:
ANESTHESIA; OPIOIDS, ALFENTANIL, MEPERIDINE, PETHIDINE; TEMPERATURE; THERMOREGULATION, SHIVERING, SWEATING, VASOCONSTRICTION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
46
Recensione:
Indirizzi per estratti:
Citazione:
A. Kurz et al., "MEPERIDINE DECREASES THE SHIVERING THRESHOLD TWICE AS MUCH AS THE VASOCONSTRICTION THRESHOLD", Anesthesiology, 86(5), 1997, pp. 1046-1054

Abstract

Background: Meperidine administration is a more effective treatment for shivering than equianalgesic doses of other opioids, However, it remains unknown whether meperidine also profoundly impairs other thermoregulatory responses, such as sweating or vasoconstriction. Proportional inhibition of vasoconstriction and shivering suggests that the drug acts much like alfentanil and anesthetics but possesses greater thermoregulatory than analgesic potency, In contrast, disproportionate inhibition would imply a special antishivering mechanism. Accordingly, the authors tested the hypothesis that meperidine administration produces a far greater concentration-dependent reduction in the shivering than vasoconstriction threshold. Methods: Nine volunteers were each studiedon three days: 1) control (no opioid); 2) a target total plasma meperidine concentration of 0.6 mu g/ml (40 mg/h); and 3) a target concentration of 1.8 mu g/ml (120 mg/h). Each day, skin and core temperatures were increased to provoke sweating and then subsequently reduced to elicit vasoconstriction and shivering, Core-temperature thresholds (at adesignated skin temperature of 34 degrees C) were computed using established Linear cutaneous contributions to control sweating (10%) and vasoconstriction and shivering (20%). The dose-dependent effects of unbound meperidine on thermoregulatory response thresholds was then determined using Linear regression, Results are presented as means +/-SDs. Results: The unbound meperidine fraction was approximate to 35%. Meperidine administration slightly increased the sweating threshold (0.5 +/- 0.8 degrees C mu g(-1).ml; r(2) = 0.51 +/- 0.37) and markedly decreased the vasoconstriction threshold (-3.3 +/- 1.5 degrees C.mu g(-1).ml; r(2) = 0.92 +/- 0.08). However, meperidine reduced the shivering threshold nearly twice as much as the vasoconstriction threshold (-6.1 +/- 3.0 degrees C.mu g.ml; r(2) = 0.97 +/- 0.05; P = 0.001). Conclusions: The special antishivering efficacy of meperidine results at least inpart from an uncharacteristically large reduction in the shivering threshold rather than from exaggerated generalized thermoregulatory inhibition, This pattern of thermoregulatory impairment differs from that produced by alfentanil, clonidine, propofol, and the volatile anesthetics, all which reduce the vasoconstriction and shivering thresholds comparably.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 31/03/20 alle ore 05:13:36