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*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 ResearchTM 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.
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