Pethidine and Skin Warming to Prevent Shivering during Endovascular Cooling

We tested the efficacy of pethidine and cutaneous warming to prevent shivering during percutaneous cooling in unanaesthetized patients. Ten patients scheduled for cranial neurosurgery received pethidine infusion and skin warming. The Setpoint™ internal heat-exchanging catheter was inserted and cooling to 33.5°C was started. Clonidine and chlorpromazine were given as “rescue medication” to treat shivering. General anaesthesia was planned to be induced after cooling was complete. Rewarming was initiated at dural closure. Three patients successfully completed the protocol, cooling to 33.8°C at a median rate of 3.6 (range: 3.4-3.8) °C/h. Two patients cooled to 33.8°C but required treatment for shivering (cooling rate: 2.9 [2.8-3.1] °C/h). Four patients failed to cool adequately because of refractory shivering (cooling rate: 2.0 [1.5-2.9] °C/h). One patient did not shiver and yet failed to cool adequately (cooling rate: 0.76 °C/h). Rewarming was at a rate of 2.6 (1.2-4.3) °C/h. There were no significant complications arising from catheter placement. The combination of skin warming and pethidine was not reliable enough to be recommended for use during endovascular cooling in unanaesthetized patients.

[1]  D. Sessler,et al.  Initial Experience with a Novel Heat-Exchanging Catheter in Neurosurgical Patients , 2002, Anesthesia and analgesia.

[2]  Karen Smith,et al.  Treatment of Comatose Survivors of Out-of-hospital Cardiac Arrest With Induced Hypothermia , 2003 .

[3]  S. Bernard,et al.  Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. , 2002, The New England journal of medicine.

[4]  A. Bjorksten,et al.  Buspirone and Meperidine Synergistically Reduce the Shivering Threshold , 2001, Anesthesia and analgesia.

[5]  D. Krieger,et al.  Cooling for Acute Ischemic Brain Damage (COOL AID): An Open Pilot Study of Induced Hypothermia in Acute Ischemic Stroke , 2001, Stroke.

[6]  H. Nordeng,et al.  Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors , 2001, Acta paediatrica.

[7]  H S Levin,et al.  Lack of effect of induction of hypothermia after acute brain injury. , 2001, The New England journal of medicine.

[8]  B. Hindman,et al.  Mild hypothermia as a protective therapy during intracranial aneurysm surgery: a randomized prospective pilot trial. , 1999, Neurosurgery.

[9]  Christian F. Bulcao,et al.  Relative contribution of core and cutaneous temperatures to thermal comfort and autonomic responses in humans. , 1999, Journal of applied physiology.

[10]  W. Hacke,et al.  Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. , 1998, Stroke.

[11]  P. Neuvonen,et al.  Effects of verapamil and diltiazem on the pharmacokinetics and pharmacodynamics of buspirone , 1998, Clinical pharmacology and therapeutics.

[12]  A. Bjorksten,et al.  Meperidine and Alfentanil Do Not Reduce the Gain or Maximum Intensity of Shivering , 1998, Anesthesiology.

[13]  V. Steelman.  Perioperative Maintenance of Normothermia Reduces the Incidence of Morbid Cardiac Events , 1998 .

[14]  D. Sessler,et al.  Physostigmine Prevents Postanesthetic Shivering As Does Meperidine or Clonidine , 1998, Anesthesiology.

[15]  D. Warner.  Treatment of traumatic brain injury with moderate hypothermia , 1997 .

[16]  A. Bjorksten,et al.  Meperidine Decreases the Shivering Threshold Twice as Much as the Vasoconstriction Threshold , 1997, Anesthesiology.

[17]  L. Fleisher,et al.  Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. , 1997, JAMA.

[18]  D. Sessler,et al.  Thermoregulatory vasococonstriction and shivering impede therapeutic hypothermia in acute ischemic stroke patients. , 1996, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[19]  A. Kurz,et al.  Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. , 1996, The New England journal of medicine.

[20]  D. Sessler,et al.  Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty , 1996, The Lancet.

[21]  D. Sessler,et al.  Heat Balance and Distribution during the Core-Temperature Plateau in Anesthetized Humans , 1995, Anesthesiology.

[22]  Hank Lin,et al.  Increasing Mean Skin Temperature Linearly Reduces the Core‐ temperature Thresholds for Vasoconstriction and Shivering in Humans , 1995, Anesthesiology.

[23]  L. Fleisher,et al.  The Catecholamine, Cortisol, and Hemodynamic Responses to Mild Perioperative Hypothermia: A Randomized Clinical Trial , 1995, Anesthesiology.

[24]  U. Illievich,et al.  Effects of Hypothermia or Anesthetics on Hippocampal Glutamate and Glycine Concentrations after Repeated Transient Global Cerebral Ischemia , 1994, Anesthesiology.

[25]  D. Sessler,et al.  Naloxone, Meperidine, and Shivering , 1993, Anesthesiology.

[26]  C J Baker,et al.  Deliberate Mild Intraoperative Hypothermia for Craniotomy , 1993, Anesthesiology.

[27]  L. Beydon,et al.  Clonidine Comparably Decreases the Thermoregulatory Thresholds for Vasoconstriction and Shivering in Humans , 1993, Anesthesiology.

[28]  M. Lamy,et al.  Clonidine and Ketanserin Both Are Effective Treatment for Postanesthetic Shivering , 1993, Anesthesiology.

[29]  A M Sessler,et al.  Leg Heat Content Continues to Decrease during the Core Temperature Plateau in Humans Anesthetized with Isoflurane , 1993, Anesthesiology.

[30]  D. Chernik,et al.  Validity and Reliability of the Observer's: Assessment of Alertness/Sedation Scale Study with Intravenous Midazolam , 1990, Journal of clinical psychopharmacology.

[31]  D. Sessler,et al.  The thermoregulatory threshold is inversely proportional to isoflurane concentration. , 1990, Anesthesiology.

[32]  M D Ginsberg,et al.  Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. , 1989, Stroke.

[33]  W. Dalton Dietrich,et al.  Small Differences in Intraischemic Brain Temperature Critically Determine the Extent of Ischemic Neuronal Injury , 1987, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[34]  G. Boschi,et al.  Neuroleptic‐induced hypothermia in mice: lack of evidence for a central mechanism , 1987, British journal of pharmacology.

[35]  D R Stanski,et al.  EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. , 1985, Anesthesiology.

[36]  J. Calvanese,et al.  Hyperthermia from a near hanging. , 1982, Annals of emergency medicine.

[37]  N. Ramanathan,et al.  A NEW WEIGHTING SYSTEM FOR MEAN SURFACE TEMPERATURE OF THE HUMAN BODY. , 1964, Journal of applied physiology.

[38]  D. Morgan,et al.  Evaluation of infusion regimens for thiopentone as a primary anaesthetic agent , 2004, European Journal of Clinical Pharmacology.

[39]  Aniel,et al.  PERIOPERATIVE NORMOTHERMIA TO REDUCE THE INCIDENCE OF SURGICAL-WOUND INFECTION AND SHORTEN HOSPITALIZATION , 2000 .

[40]  M. Dereski,et al.  Mild hypothermic intervention after graded ischemic stress in rats. , 1991, Stroke.