Nefopam, a Nonsedative Benzoxazocine Analgesic, Selectively Reduces the Shivering Threshold in Unanesthetized Subjects

Alfonsi, Pascal; Adam, Frédéric; Passard, Andréa; Guignard, B.; Sessler, Daniel I.; Chauvin, M.

doi:10.1097/00000542-200401000-00010

Cited by 69 publications

(64 citation statements)

References 53 publications

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“…Most drugs with antishivering action such as clonidine and dexmedetomidine (partial a2-adrenoceptor agonists), alfentanil (selective l opioid receptor agonist), propofol and volatile anaesthetics, all reduce the vasoconstriction and shivering thresholds, leading to greater heat loss and more pronounced hypotension. In contrast, nefopam reduces the shivering threshold without vascular effects, thus minimising heat loss and hypotension [13]. Of the 37 patients in our study who shivered, 18 (49%) shivered at the end of the procedure after flumazenil administration.…”

Section: Discussionmentioning

confidence: 74%

“…Pharmacological prevention minimises the increase in metabolic activity and cardiac work [5]. Nefopam (3,4,5,6-tetrahydro-5-methyl-l-phenyl-1H-2.5-benoxazocine hydrochloride) is a non-opioid analgesic drug that is safe and effective in preventing shivering after general and neuraxial anaesthesia with little effect on the sweating and vasoconstriction thresholds [2,[4][5][6]13]. Unlike clonidine, nefopam has no sedative or hypotensive effects.…”

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confidence: 99%

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Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology

Bilotta¹,

Ferri²,

Giovannini³

et al. 2005

Anaesthesia

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SummaryThe aim of this randomised, double-blind study was to investigate the usefulness of intravenous nefopam, clonidine or placebo in preventing shivering in patients undergoing conscious sedation for interventional neuroradiological procedures. A total of 101 patients were prospectively enrolled and assigned to one of three groups to receive nefopam, clonidine or placebo. The overall incidence of intra-operative shivering was significantly lower in patients treated with nefopam than in those treated with clonidine or placebo (2 ⁄ 32 (6%) vs. 11 ⁄ 38 (29%), p < 0.02; 2 ⁄ 32 (6%) vs. 24 ⁄ 31 (77%), p < 0.0001, respectively). The number of patients who required ephedrine infusions to maintain a mean arterial pressure of 100 mm Hg was higher in the clonidine group than in the nefopam and placebo groups (18 ⁄ 38 (47%) vs. 5 ⁄ 32 (17%), p < 0.05; 18 ⁄ 38 (47%) vs. 6 ⁄ 31 (19%), p < 0.05, respectively). We found that both nefopam and clonidine significantly lowered the rate and severity of shivering during interventional neuroradiological procedures. Fewer patients in the nefopam group than in the other two groups required vasoactive drugs.

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Section: Discussionmentioning

confidence: 74%

mentioning

confidence: 99%

Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology

Bilotta¹,

Ferri²,

Giovannini³

et al. 2005

Anaesthesia

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“…Nefopam is a central-acting analgesic benzoxacin that reduces tremors without affecting ventilation, with minimal sedation, and proven efficacy. Contrary to other drugs, it does not cause vasoconstriction, working only in the tremor pathway 78 .…”

Section: Treatment Of Postoperative Tremorsmentioning

confidence: 91%

“…O nefopam é uma benzoxacina analgésica de ação central que reduz os tremores sem comprometer a ventilação, com mínimos efeitos sedativos e com eficiência comprovada. Ao contrário dos outros fármacos, não atua como vasoconstritor, apenas na via do tremor 78 .…”

Section: Tratamento Dos Tremores Pós-operatóriosunclassified

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Albergaria

Lorentz²,

Lima³

2007

Rev. Bras. Anestesiol.

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RESUMOAlbergaria VF, Lorentz MN, Lima FAS -Tremores Intra e Pós-Operatório: Prevenção e Tratamento Farmacológico. JUSTIFICATIVA E OBJETIVOS:Os tremores podem ocorrer como um efeito adverso da intervenção cirúrgica e anestesia. A incidência de tremores pós-operatórios varia entre 6,3% e 66%. Pacientes jovens, sexo masculino, uso de agentes anestésicos halogenados e tempo prolongado de anestesia ou procedimento cirúrgico estão relacionados com tremores. Os tremores são involuntários e apresentam-se como atividade muscular oscilatória com finalidade de aumentar a produção de calor. Tremor pós-operatório é uma desagradável complicação que está relacionada com o aumento de morbidade. O tremor aumenta o metabolismo, resultando em um acréscimo de 200% a 500% no consumo de oxigênio. CONTEÚDO:Discute as causas, a prevenção e o tratamento dos tremores intra-e pós-operatório em pacientes adultos e pediátri-cos submetidos à intervenção cirúrgica sob anestesia geral ou do neuroeixo. CONCLUSÕES:Os tremores são, juntamente com náuseas e vô-mitos, causas de intenso desconforto na sala de recuperação pós-anestésica, além de potencialmente prejudiciais por gerarem aumento da demanda metabólica. Embora a presença de tremores não tenha sido diretamente relacionada com a morbidade cardía-ca, a prevenção tem se tornado tema de debate e de vários artigos científicos. A prevenção e o tratamento de tremores devem ser implementados. Pacientes com reserva cardiopulmorar limitada podem sofrer com acidose láctica, dessaturação venosa mista e hipoxemia.Unitermos: ANESTESIA: Geral, Locorregional; COMPLICAÇÕES: hipotermia, tremor; TREMOR: prevenção, tratamento. SUMMARYAlbergaria VF, Lorentz MN, Lima FAS -Intra-and Postoperative Tremors: Prevention and Pharmacological Treatment. BACKGROUND AND OBJECTIVES:Tremors can be an adverse effect of the surgical intervention and anesthesia. The incidence of postoperative tremors varies from 6.3% to 66%. Young age, male gender, the use of halogenated anesthetics, and prolonged anesthesia or surgical procedure are related with tremors. Tremors are involuntary and present as oscillating muscular activity aiming at increasing heat production. Postoperative tremors are a disagreeable complication related with increased morbidity. Tremors increase the metabolism, resulting in a 200% to 500% increase in oxygen consumption. CONTENTS:The objective of this paper was to discuss the causes, prevention, and treatment of intra-and postoperative tremors in adults and children undergoing general anesthesia or neuroaxis anesthesia for surgical interventions. CONCLUSIONS:Tremors, along with nausea and vomiting, cause severe discomfort in the recovery room, besides being highly prejudicial because they generate an increase in the metabolism. Although the presence of tremors has not been directly related with cardiac morbidity, its prevention has become the subject of discussion and several scientific reports. Prevention and treatment of tremors should be implemented. Patients with limited cardiovascular reserve could devel...

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“…Hypothermia results initially from a rapid core-to-peripheral redistribution of body heat [14,15] and is followed by a linear reduction in core temperature that results from heat loss exceeding heat production. Even mild perioperative hypothermia has been causally linked to numerous severe complications including increased blood loss [16] and transfusion requirement [17], morbid myocardial outcomes [18], prolonged post-anesthetic recovery [19] and hospitalization [6], negative nitrogen balance [20], post-anesthetic shivering [21][22][23], and thermal discomfort [24]. Hypothermia also increases the risk of surgical wound infection.…”

Section: Maintaining Normothermia Perioperative Thermal Homeostasismentioning

confidence: 99%

Non-pharmacologic Prevention of Surgical Wound Infection

Sessler

2006

Anesthesiology Clinics of North America

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Wound infections are serious and relatively common postoperative complications. They are generally detected five to nine days after surgery and are usually attributed, even by surgeons, to poor surgical technique or failure to maintain sterility. However, it has been known for decades that all wounds become contaminated, often by bacteria from the skin or within the patient, and that it is host defense mechanisms that prevent most contamination from developing into clinical infections. Host defense is especially important during the initial hours following contamination, i.e., the immediate perioperative period.As might thus be expected, factors that improve host defense reduce infection risk. Many of these are under the direct control of anesthesiologists and are at least as important as appropriate use of prophylactic antibiotics, which halve infection risk [1]. This article will review nonpharmacologic methods of reducing infection risk, with special emphasis on methods available to anesthesiologists.

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Nefopam, a Nonsedative Benzoxazocine Analgesic, Selectively Reduces the Shivering Threshold in Unanesthetized Subjects

Cited by 69 publications

References 53 publications

Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology

Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Non-pharmacologic Prevention of Surgical Wound Infection

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