Suppression of Shivering during Hypothermia Using a Novel Drug Combination in Healthy Volunteers

Lenhardt, Rainer; Orhan-Sungur, Mukadder; Komatsu, Ryu; Govinda, Raghavendra; Kasuya, Yuko; Sessler, Daniel I.; Wadhwa, Anupama

doi:10.1097/aln.0b013e3181a979a3

Cited by 45 publications

(25 citation statements)

References 43 publications

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“…Numerous pharmacological agents 7,10,[16][17][18][19][20][21][22][23][24][25] (Table 2) that reduce the vasoconstriction and shivering thresholds have been used to manage shivering during therapeutic hypothermia. According to the ILCOR, 3 sedative and hypnotic agents are often used to decrease metabolic demand and facilitate mechanical ventilation in comatose patients who lack signs of awakening within the first 5 to 10 minutes after return of spontaneous circulation.…”

Section: Pharmacological Methodsmentioning

confidence: 99%

“…Because prolonged use of meperidine has adverse effects, such as respiratory depression and increased seizure risk, in a recent study, Lenhardt et al 18 examined novel combination therapies to achieve the same suppression of the shivering threshold. A combination of buspirone (0.7ºC) and dexmedetomidine (2ºC) additively reduced the shivering threshold by 2.5ºC, to 34.1ºC, with only minimal sedation.…”

Section: Conclusion and Implications For Practicementioning

confidence: 99%

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Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Logan

Sangkachand²,

Funk

2011

Critical Care Nurse

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Both pharmacological and nonpharmacological methods are used to control shivering in therapeutic hypothermia. An evidence-based protocol based on the most current research has been developed for the management of shivering during therapeutic hypothermia. Meperidine is the drug of choice and provides the greatest reduction in the shivering threshold. Other effective pharmacological agents recommended for reducing the threshold include dexmedetomidine, midazolam, fentanyl, and magnesium sulfate. In addition, skin counterwarming techniques, such as use of an air-circulating blanket, are effective nonpharmacological methods for reducing shivering when used in conjunction with medication. As a last resort, neuromuscular blocking agents are considered appropriate therapy for management of refractory shivering.

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Section: Pharmacological Methodsmentioning

confidence: 99%

Section: Conclusion and Implications For Practicementioning

confidence: 99%

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Logan

Sangkachand²,

Funk

2011

Critical Care Nurse

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show abstract

“…However, we encounter difficulties in preventing shivering, especially in relatively conscious patients with well-maintained and normal thermoregulatory responses versus those who are comatose. In such cases, the most efficient drug combinations reported to induce thermal tolerance without respiratory depression or severe toxicity are a combination of buspirone and meperidine, and a combination of dexmedetomidine and either meperidine or buspirone [21][22][23].…”

Section: Therapeutic Hypothermia Clinical Relevance Of Hypothermiamentioning

confidence: 98%

Controversies in the temperature management of critically ill patients

Nakajima

2016

J Anesth

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Although body temperature is a classic primary vital sign, its value has received little attention compared with the others (blood pressure, heart rate, and respiratory rate). This may result from the fact that unlike the other primary vital signs, aging and diseases rarely affect the thermoregulatory system. Despite this, when humans are exposed to various anesthetics and analgesics and acute etiologies of non-infectious and infectious diseases in perioperative and intensive care settings, abnormalities may occur that shift body temperature up and down. A recent upsurge in clinical evidence in the perioperative and critical care field resulted in many clinical trials in temperature management. The results of these clinical trials suggest that aggressive body temperature modifications in comatose survivors after resuscitation from shockable rhythm, and permissive fever in critically ill patients, are carried out in critical care settings to improve patient outcomes; however, its efficacy remains to be elucidated. A recent, large multicenter randomized controlled trial demonstrated contradictory results, which may disrupt the trends in clinical practice. Thus, updated information concerning thermoregulatory interventions is essential for anesthesiologists and intensivists. Here, recent controversies in therapeutic hypothermia and fever management are summarized, and their relevance to the physiology of human thermoregulation is discussed.

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“…However, limitations in generalizability of this study include that most patients (n = 44) underwent normothermia using surface cooling, only five patients were cooled intravascularly, direct skin temperature measurement was not assessed, and the effect of CW on core temperature was not discussed. Lenhardt et al (2009) investigated the use of medications to reduce the shivering threshold in young, healthy volunteers to assess the possibility of applying hypothermia in awake patients with minimal sedation. The study investigated the combination use of buspirone, which reduced the shivering threshold by 0.7-C, from 36.6-C to 35.9 -C T 0.4-C, and dexmedetomidine, which reduced the shivering threshold by 2.0-C to 34.7-C T 0.4-C (both p G .001).…”

Section: Risks Of Hypothermiamentioning

confidence: 99%

Therapeutic Hypothermia in Acute Stroke

Klassman¹

2011

Journal of Neuroscience Nursing

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Treatment of acute stroke is difficult due to the complexity of events triggered by ischemic insult. Current reperfusion strategies are time limited and, alone, may not be sufficient to achieve maximal neurologic outcomes. Therapeutic hypothermia (TH) appears to be a promising neuroprotective therapy, as it affects a wide range of destructive mechanisms occurring in ischemic brain tissue. Animal research has substantiated the use of TH in acute stroke. Human studies utilizing TH in acute stroke have shown trends toward positive effects; however, there have been a variety of measurements and methods making comparisons difficult. The ideal protocol for the use of TH in stroke has not yet been developed and requires determination of optimal depth, duration, and methods of temperature measurement and cooling for acute stroke. The purposes of this article were to (1) discuss the effects of ischemia and reperfusion in acute stroke, (2) discuss how TH can potentially limit neurological injury, and (3) review current literature on the use of hypothermia as a treatment for acute stroke.

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Suppression of Shivering during Hypothermia Using a Novel Drug Combination in Healthy Volunteers

Abstract: The combination of buspirone and dexmedetomidine additively reduced the shivering threshold. Thus, supplementing dexmedetomidine with buspirone blocks shivering and causes only minimal sedation.

Cited by 45 publications

References 43 publications

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Controversies in the temperature management of critically ill patients

Therapeutic Hypothermia in Acute Stroke

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