Document Detail


The effects of nefopam on the gain and maximum intensity of shivering in healthy volunteers.
MedLine Citation:
PMID:  20529984     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mild hypothermia has been shown to improve neurologic outcome after cardiac arrest. Nefopam, a centrally acting, nonsedative analgesic, decreases the threshold of shivering, but not vasoconstriction, and thus might be a suitable drug for induction of therapeutic hypothermia. However, not only the threshold but also the gain and maximum intensity of shivering define the thermoregulatory properties of a drug and thus are clinically important. Therefore, we evaluated the gain and maximum intensity of shivering at 2 different doses of nefopam and placebo. METHODS: Seven healthy volunteers were randomly assigned to 3 study days: (1) control (saline), (2) small-dose nefopam (50 ng/mL), and (3) large-dose nefopam (100 ng/mL). On all study days volunteers were cooled using central venous infusion of cold IV fluid while mean skin temperature was maintained at 31 degrees C. Core temperature was recorded at the tympanic membrane. Threshold, gain, and maximum intensity of shivering were evaluated using oxygen consumption. RESULTS: Both 50 and 100 ng/mL nefopam significantly reduced the shivering threshold as well as the gain of shivering: shivering threshold: 35.6 degrees C + or - 0.2 degrees C (control); 35.2 degrees C + or - 0.3 degrees C (small dose); 34.9 degrees C + or - 0.5 degrees C (large dose), P = 0.004; gain of shivering: 597 + or - 235 mL x min(-1) x degrees C(-1) (control); 438 + or - 178 mL x min(-1) x degrees C(-1) (small dose); 301 + or - 134 mL x min(-1) x degrees C(-1) (large dose), P = 0.028. Maximum intensity of shivering did not differ among the 3 treatments. CONCLUSIONS: Nefopam significantly reduced the gain of shivering. This reduction, in combination with a reduced shivering threshold, will allow clinicians to cool patients even further when therapeutic hypothermia is indicated.
Authors:
Yoshie Taniguchi; Syed Z Ali; Oliver Kimberger; Sandra Zmoos; Rolf Lauber; Monica Markstaller; Andrea Kurz
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2010-06-07
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  409-14     Citation Subset:  AIM; IM    
Affiliation:
Department of Outcomes Research, Anesthesia Institute, Cleveland Clinic, Cleveland, OH 43195, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesics, Non-Narcotic / administration & dosage*,  blood
Blood Pressure / drug effects
Female
Heart Rate / drug effects
Humans
Hypothermia, Induced / methods*
Male
Nefopam / administration & dosage*,  blood
Oxygen Consumption / drug effects
Sensory Thresholds / drug effects*
Shivering / drug effects*
Skin Temperature / drug effects
Young Adult
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 13669-70-0/Nefopam

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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