Comparison of meperidine and pancuronium for the treatment of shivering after cardiac surgery.
Shivering after cardiac surgery can produce adverse haemodynamic and metabolic sequelae. In this study, the metabolic effects of shivering and the efficacy of treatment with meperidine or pancuronium were studied, using a metabolic cart, in 61 patients who had undergone cardiac surgery. The patients received premedication with morphine, perphenazine and diazepam or lorazepam, and were anaesthetised with fentanyl or sufentanil and diazepam. Muscle relaxation was achieved with pancuronium. Patients were monitored with a radial arterial line, pulmonary artery catheter and oesophageal and urinary bladder temperature probes. Rewarming to an oesophageal temperature of 38 degrees C was achieved before the termination of CPB and was maintained for a minimum of 15 min reperfusion time. Every 15 min after surgery, the patients' temperature at three sites (pulmonary artery, oesophagus, bladder) and shivering scores were monitored. Hourly measurements were made of haemodynamic variables (MAP, PAOP, CVP, SVR, PVR, CI), carbon dioxide production, oxygen consumption and respiratory quotient. If the patient shivered, the measurements were recorded prior to drug treatment and repeated 30 min later following randomization to either: meperidine 0.25 mg.kg-1 (Group 1), meperidine 0.5 mg.kg-1 (Group 2) or pancuronium 0.06 mg.kg-1 intravenously (Group 3). Thirty-two patients shivered and mean VO2 and VCO2 values were greater in the shivering group than in the nonshivering patients (VO2 334.8 +/- 17.6 vs. 240.5 +/- 8.8 ml.min-1; VCO2 238.8 +/- 17.2 vs 199.2 +/- 8.4 ml.min-1, P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Cruise
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Department of Anaesthesia, Toronto Hospital, Ontario, Canada.
MacKinnon
J
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Tough
J
J
Houston
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P
D000704:Analysis of Variance; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001831:Body Temperature / Q000187:drug effects / Q000502:physiology; D002245:Carbon Dioxide / Q000378:metabolism; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D010197:Pancuronium / Q000008:administration & dosage / Q000627:therapeutic use*; D011229:Preanesthetic Medication; D012768:Shivering / Q000187:drug effects* / Q000502:physiology; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
D002245:Carbon Dioxide; D008614:Meperidine; D010197:Pancuronium