Alfentanil Slightly Increases the Sweating Threshold and Markedly Reduces the Vasoconstriction and Shivering Thresholds

Kurz, Andrea; Go, Janice; Sessler, Daniel I.; Kaer, Klaus; Larson, Merlín D.; Bjorksten, Andrew R.

doi:10.1097/00000542-199508000-00009

Cited by 177 publications

(77 citation statements)

References 35 publications

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“…This physiological response was most probably blunted by morphine or sedation with midazolam, or both. [9][10][11][12] This possibility is fully supported by the fact that patient No. 17 was excluded because he developed a shiveringequivalent reaction with increased EE while not receiving opioids as he required close neurological surveillance.…”

Section: Discussionmentioning

confidence: 87%

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Poblete¹,

Romand²,

Pichard³

et al. 1997

British Journal of Anaesthesia

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SummaryWe have measured the metabolic response to sequential administration of propacetamol, metamizol and/or external cooling in 20 febrile patients under sedation and analgesia and during mechanical ventilation. There was no change in temperature (TЊ) after propacetamol therapy, whereas after metamizol only a small decrease was noted (from 38.9 (SEM 0.2) to 38.5 (0.3) ЊC; P:0.02). External cooling produced a significant decrease in TЊ (39.1 (0.2) to 37.1 (0.2) ЊC; P:0.0001) accompanied by a decrease in energy expenditure (EE) (2034 (73) to 1791 (88) kcal day 91 ; P:0.004). Heart rate and minute ventilation decreased significantly in parallel. There were no other changes in haemodynamics or pulmonary gas exchanges. We conclude that propacetamol and metamizol did not produce a clinically significant decrease in TЊ in febrile ICU patients whereas external cooling decreased both TЊ and EE. The parallel decrease in body temperature and EE seemed to be related to opioid administration or sedation, or both. (Br. J. Anaesth. 1997; 78: 23-127 Fever in critically ill patients is related frequently to either the systemic inflammatory response syndrome (SIRS) or infection. Usually fever is treated with antipyretic drugs, often paracetamol or metamizol. External cooling by different methods, such as sponging the body surface with ice-cooled water, is also used. 1 Even if reducing fever is still controversial from an immunological point of view, there is little doubt that patient comfort and metabolic demand can be improved by this procedure. 2 Indeed, a previous study in critically ill patients demonstrated diminished oxygen consumption related to decreased body temperature improving the oxygen demand-delivery ratio. 3 However, body cooling in healthy humans results in shivering which increases energy expenditure (EE).The aim of this study was to measure EE as an integrated indicator of body metabolic activity after reduction in temperature. Our hypothesis was that external cooling may induce an increase in EE, in contrast with drugs which, by resetting the thermoregulatory set point, decrease EE. Therefore, we designed a prospective, unblinded, crossover study to evaluate the respective effects of centrally acting drugs (propacetamol or metamizol) or external physical cooling in febrile ICU patients. Patients and methodsThe study was approved by the Ethics Committee of our institution. The requirement for informed consent was waived by the committee who judged that the therapies were applied independently by the attending physician and were accepted in clinical practice, and no invasive measurements were made. We studied 20 patients undergoing mechanical ventilation via a tracheal tube, with a rectal temperature greater than 38.5 ЊC and in whom the physician in charge wished to decrease fever. No patient had an inspired oxygen fraction greater than 0.6, a pneumothorax or a broncho-pleural fistula. Patients' lungs were ventilated with a Veolar-Hamilton (Hamilton Bonaduz, Switzerland) or Engström-Erica ventilator (Engström,...

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Section: Discussionmentioning

confidence: 87%

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Poblete¹,

Romand²,

Pichard³

et al. 1997

British Journal of Anaesthesia

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“…None of the patients from either group shivered in the PACU; this may be because of propofol [26], fentanyl [27] and tramadol [28] that have residual effects on the thermoregulatory control centre, including reduced shivering. Besides, the postoperative forced-air warming over the skin could also have prevented shivering.…”

Section: Discussionmentioning

confidence: 99%

Comparison of peri‐operative core temperature in obese and non‐obese patients*

et al. 2012

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SummaryOur aim was to compare peri-operative core temperatures and the incidence of hypothermia in obese and non-obese women with active forced-air warming. Twenty female patients scheduled for abdominal surgery were allocated to two groups according to body mass index. Ten obese (30.0-34.9 kg.m )2) and 10 non-obese (18.5-24.9 kg.m ) women received forced-air warming on their lower limbs. At the end of surgery, the mean (SD) core temperatures were 36.7 (0.5)°C in the obese group and 36.0 (0.6)°C in the non-obese group (p < 0.001). Only in the non-obese group was there a significant decrease in the intra-operative core temperature values (p < 0.001). The incidences of intra-operative hypothermia were lower in the obese group (10%) compared with non-obese group (60%; p = 0.019). In the postoperative recovery phase, the mean (SD) core temperature data were higher in the obese group than in the nonobese group (36.2 (0.4) vs 35.6 (0.5)°C, respectively (p < 0.001)). In conclusion, obese female patients have higher perioperative core temperature and a lower incidence of hypothermia compared with non-obese female patients during abdominal surgery with active forced-air warming. Accepted: 21 August 2012Unintentional peri-operative hypothermia (core temperatures between 34.5 and 35.9°C) often leads to adverse outcomes, including cardiac events secondary to sympathetic nervous system activation [1], surgicalwound infections and prolonged hospitalisation [2], coagulopathy and increased blood loss [3], impaired drug metabolism, delayed postoperative recovery period [4,5] and shivering [6]. Therefore, maintaining perioperative normothermia reduces morbidity [1][2][3] and the use of peri-operative warming devices has become routine.The prevalence of obesity has increased markedly worldwide in recent years [7]. In clinical practice, body mass index (BMI) is used to estimate the degree of obesity, which is classified in three levels: grade 1 (BMI from 30.0 to 34.9 kg.m ) [8]. The prevalence of grade-1 obesity is higher among both female and male obese populations than are the other grades [8]. Obese patients are more likely to vasoconstrict in cooler environments [9], have reduced heat redistribution from core to peripheral tissue after

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“…Em nosso estudo, não houve diferença significativa entre as doses totais de propofol para os dois grupos estudados (1251 mg ± 596 em G1 e 1341 mg ± 478 em G2). Algumas das principais complicações observadas (Tabela IV) em G1 na SO podem ser atribuídas ao opióide e foram broncoespasmo 25 , hipotensão arterial 11 e bradicardia 12 e na SRPA, depressão respiratória recorrente 26,27 , náuseas e vô-mitos 28 , tremores 29 e retenção urinária 30 . Como conseqüên-cia, o tempo de permanência na SRPA para G1 foi significativamente maior do que para G2 19 (Figura 4).…”

Section: Resultsunclassified

“…Some G1 complications observed (Table IV) in the OR may be attributed to the opioid and included: bronchospasm 25 , arterial hypotension 11 and bradycardia 12 . In the PACU were seen recurrent respiratory depression 26,27 , nausea and vomiting 28 , shivering 29 and urinary retention 30 . As a consequence, PACU stay for G1 was significantly longer compared to G2 19 ( Figure 4).…”

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confidence: 99%

Dexmedetomidina e sufentanil como analgésicos per-operatórios: estudo comparativo

Curtis

Castiglia²,

Stolf³

et al. 2002

Rev. Bras. Anestesiol.

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, Paulo do Nascimento Junior, TSA 6 RESUMO Curtis FG, Castiglia YMM, Stolf AA, Ronzella E, Vanni SMD, Nascimento Jr P -Dexmedetomidina e Sufentanil como Analgé-sicos Per-Operatórios. Estudo Comparativo Justificativa e Objetivos -A utilização das drogas agonistas dos a 2 -adrenoceptores para controlar a pressão arterial e f r e q ü ê n c i a c a r d í a c a , p r o p i c i a r m e n o r e s r e s p o s t a s hemodinâmicas à intubação

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Alfentanil Slightly Increases the Sweating Threshold and Markedly Reduces the Vasoconstriction and Shivering Thresholds

Abstract: The observed pattern of thermoregulatory impairment is similar to that produced by most general anesthetics: a slight increase in the sweating threshold and a substantial, linear decrease in the vasoconstriction and shivering thresholds.

Cited by 177 publications

References 35 publications

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

Comparison of peri‐operative core temperature in obese and non‐obese patients*

Dexmedetomidina e sufentanil como analgésicos per-operatórios: estudo comparativo

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