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Physostigmine prevents postanesthetic shivering as does meperidine or clonidine.
Anesthesiology. 1998 Jan; 88(1):108-13.A

Abstract

BACKGROUND

Postanesthetic shivering develops in as many as one half of patients recovering from isoflurane anesthesia. Cholinergic stimulation of the hypothalamic-pituitary-adrenal axis and adrenal medulla by physostigmine enhances secretion of arginine vasopressin, epinephrine, and norepinephrine. Because the hypothalamus is the dominant thermoregulatory controller in mammals, and these neurotransmitters may be involved in body temperature control, physostigmine administration may influence the incidence of shivering. Accordingly, the authors tested the hypothesis that physostigmine administration inhibits postanesthetic shivering. Its efficacy was compared with that of saline (negative control) and meperidine and clonidine (positive controls).

METHODS

Sixty patients having surgery of the ear or nose were tested. General anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 1.5 microg/kg fentanyl and maintained with isoflurane (1.5 +/- 0.4%) in 70% nitrous oxide. At the end of surgery, the patients were randomly assigned to receive an intravenous bolus of 0.04 mg/kg physostigmine, isotonic saline, 0.5 mg/kg meperidine, or 1.5 microg/kg clonidine. Heart rate, mean arterial blood pressure, oxygen saturation, visual analog pain score, temperature, and postanesthetic shivering were measured during recovery.

RESULTS

Postanesthetic shivering occurred in 6 of 15 (40%) patients given saline. In contrast, postanesthetic shivering was significantly reduced in physostigmine-treated patients (1 of 15, or 7%) and was absent in patients given clonidine or meperidine.

CONCLUSIONS

Physostigmine inhibited shivering as well as did two established treatments, meperidine and clonidine. These data suggest that cholinergic systems contribute to the genesis and control of postanesthetic shivering.

Authors+Show Affiliations

Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany. EPHORN@CompuServe.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9447863

Citation

Horn, E P., et al. "Physostigmine Prevents Postanesthetic Shivering as Does Meperidine or Clonidine." Anesthesiology, vol. 88, no. 1, 1998, pp. 108-13.
Horn EP, Standl T, Sessler DI, et al. Physostigmine prevents postanesthetic shivering as does meperidine or clonidine. Anesthesiology. 1998;88(1):108-13.
Horn, E. P., Standl, T., Sessler, D. I., von Knobelsdorff, G., Büchs, C., & Schulte am Esch, J. (1998). Physostigmine prevents postanesthetic shivering as does meperidine or clonidine. Anesthesiology, 88(1), 108-13.
Horn EP, et al. Physostigmine Prevents Postanesthetic Shivering as Does Meperidine or Clonidine. Anesthesiology. 1998;88(1):108-13. PubMed PMID: 9447863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physostigmine prevents postanesthetic shivering as does meperidine or clonidine. AU - Horn,E P, AU - Standl,T, AU - Sessler,D I, AU - von Knobelsdorff,G, AU - Büchs,C, AU - Schulte am Esch,J, PY - 1998/2/3/pubmed PY - 1998/2/3/medline PY - 1998/2/3/entrez SP - 108 EP - 13 JF - Anesthesiology JO - Anesthesiology VL - 88 IS - 1 N2 - BACKGROUND: Postanesthetic shivering develops in as many as one half of patients recovering from isoflurane anesthesia. Cholinergic stimulation of the hypothalamic-pituitary-adrenal axis and adrenal medulla by physostigmine enhances secretion of arginine vasopressin, epinephrine, and norepinephrine. Because the hypothalamus is the dominant thermoregulatory controller in mammals, and these neurotransmitters may be involved in body temperature control, physostigmine administration may influence the incidence of shivering. Accordingly, the authors tested the hypothesis that physostigmine administration inhibits postanesthetic shivering. Its efficacy was compared with that of saline (negative control) and meperidine and clonidine (positive controls). METHODS: Sixty patients having surgery of the ear or nose were tested. General anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 1.5 microg/kg fentanyl and maintained with isoflurane (1.5 +/- 0.4%) in 70% nitrous oxide. At the end of surgery, the patients were randomly assigned to receive an intravenous bolus of 0.04 mg/kg physostigmine, isotonic saline, 0.5 mg/kg meperidine, or 1.5 microg/kg clonidine. Heart rate, mean arterial blood pressure, oxygen saturation, visual analog pain score, temperature, and postanesthetic shivering were measured during recovery. RESULTS: Postanesthetic shivering occurred in 6 of 15 (40%) patients given saline. In contrast, postanesthetic shivering was significantly reduced in physostigmine-treated patients (1 of 15, or 7%) and was absent in patients given clonidine or meperidine. CONCLUSIONS: Physostigmine inhibited shivering as well as did two established treatments, meperidine and clonidine. These data suggest that cholinergic systems contribute to the genesis and control of postanesthetic shivering. SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/9447863/Physostigmine_prevents_postanesthetic_shivering_as_does_meperidine_or_clonidine_ L2 - http://anesthesiology.pubs.asahq.org/article.aspx?volume=88&page=108 DB - PRIME DP - Unbound Medicine ER -