This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Greif, R. Articles by Sessler, D. I. Search for Related Content PubMed PubMed Citation Articles by Greif, R. Articles by Sessler, D. I. Related Collections Pharmacology

---

ANESTHETIC PHARMACOLOGY

Neither Nalbuphine nor Atropine Posses Special Antishivering Activity

Robert Greif, MD^*, Sonja Laciny, MD^*, Angela M. Rajek, MD^*, Merlin D. Larson, MD^*, Andrew R. Bjorksten, PhD, Anthony G. Doufas, MD^*, Maryam Bakhshandeh, MD^*, Masoud Mokhtarani, MD^*, and Daniel I. Sessler, MD^||

*Department of Anesthesia and Perioperative Care, University of California–San Francisco, San Francisco, California; Department of Anesthesiology and Intensive Care Medicine, Donauspital/SMZO-Vienna, Austria; Department of Cardiothoracic and Vascular Anesthesia, University of Vienna, Vienna, Austria; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia; and ||Outcomes Research^TM Institute and Department of Anesthesiology, University of Louisville, Kentucky, and Ludwig Boltzmann Institute, University of Vienna, Austria

Address correspondence and reprint requests to Dr. Sessler, University of Louisville, Abell Administration Center, Room 217, 323 East Chestnut St., Louisville, KY 40202-3866. Address e-mail to sessler{at}louisville.edu

The special antishivering action of meperidine may be mediated by its or anticholinergic actions. We therefore tested the hypotheses that nalbuphine or atropine decreases the shivering threshold more than the vasoconstriction threshold. Eight volunteers were each evaluated on four separate study days: 1) control (no drug), 2) small-dose nalbuphine (0.2 µg/mL), 3) large-dose nalbuphine (0.4 µg/mL), and 4) atropine (1-mg bolus and 0.5 mg/h). Body temperature was increased until the patient sweated and then decreased until the patient shivered. Nalbuphine produced concentration-dependent decreases (mean ± SD) in the sweating (-2.5 ± 1.7°C · µg^-1 · mL; r² = 0.75 ± 0.25), vasoconstriction (-2.6 ± 1.7°C · µg^-1 · mL; r² = 0.75 ± 0.25), and shivering (-2.8 ± 1.7°C · µg^-1 · mL; r² = 0.79 ± 0.23) thresholds. Atropine significantly increased the thresholds for sweating (1.0°C ± 0.4°C), vasoconstriction (0.9°C ± 0.3°C), and shivering (0.7°C ± 0.3°C). Nalbuphine reduced the vasoconstriction and shivering thresholds comparably. This differs markedly from meperidine, which impairs shivering twice as much as vasoconstriction. Atropine increased all thresholds and would thus be expected to facilitate shivering. Our results thus fail to support the theory that activation of -opioid or central anticholinergic receptors contribute to meperidine’s special antishivering action.

IMPLICATIONS: The activation of neither -opioid nor central anticholinergic receptors contributes to meperidine’s special antishivering action. Some other aspect of meperidine’s pharmacology is thus responsible for the drug’s special antishivering action.

This article has been cited by other articles:

				D. I. Sessler Defeating Normal Thermoregulatory Defenses: Induction of Therapeutic Hypothermia Stroke, November 1, 2009; 40(11): e614 - e621. [Abstract] [Full Text] [PDF]

				A.-M. Machata, H. Willschke, B. Kabon, D. Prayer, and P. Marhofer Effect of brain magnetic resonance imaging on body core temperature in sedated infants and children Br. J. Anaesth., March 1, 2009; 102(3): 385 - 389. [Abstract] [Full Text] [PDF]

				R. Komatsu, M. Orhan-Sungur, J. In, T. Podranski, T. Bouillon, R. Lauber, S. Rohrbach, and D. Sessler Ondansetron does not reduce the shivering threshold in healthy volunteers Br. J. Anaesth., June 1, 2006; 96(6): 732 - 737. [Abstract] [Full Text] [PDF]

				M. Cabanac Adjustable set point: to honor Harold T. Hammel J Appl Physiol, April 1, 2006; 100(4): 1338 - 1346. [Abstract] [Full Text] [PDF]

				A. A. Romanovsky Do fever and anapyrexia exist? Analysis of set point-based definitions Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2004; 287(4): R992 - R995. [Abstract] [Full Text] [PDF]

				A. G. Doufas, C.-M. Lin, M.-I. Suleman, E. B. Liem, R. Lenhardt, N. Morioka, O. Akca, Y. M. Shah, A. R. Bjorksten, and D. I. Sessler Dexmedetomidine and Meperidine Additively Reduce the Shivering Threshold in Humans Stroke, May 1, 2003; 34(5): 1218 - 1223. [Abstract] [Full Text] [PDF]