The treatment of postanaesthetic shivering: a double blind comparison between alfentanil and pethidine.
It has been postulated that pethidine may mediate its effects on postanaesthetic shivering (PAS) via kappa-opioid receptors. However, clinical evidence indicates that alfentanil, a pure mu-agonist, may also have beneficial effects on PAS. In order to assess whether opioid effects on PAS are effected via kappa receptors, fifty-one patients were randomised to receive alfentanil 250 micrograms (n = 18), pethidine 25 mg (n = 18) or placebo (n = 15) on a double-blind basis for the treatment of established postanaesthesia shivering (PAS). Both drugs proved significantly better in treating PAS than placebo (P < 0.005). Following treatment, blood pressure fell and oxygen saturation increased in patients in the two treatment groups when compared with the control group (P < 0.05). There was a highly significant incidence of reshivering in the alfentanil treated group (P < 0.005). In conclusion, the high incidence of reshivering indicates that alfentanil is unlikely to supercede pethidine in the treatment of PAS, but its initial success rate implies that pethidine's anti-shivering effect is unlikely to be mediated via kappa-opioid receptors.
Lyons
B
B
Department of Anaesthesia, St. Vincents Hospital, Elm Park, Dublin, Ireland.
Carroll
M
M
McDonald
N J
NJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000627:therapeutic use*; D000758:Anesthesia / Q000009:adverse effects*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007530:Isoflurane; D008297:Male; D008614:Meperidine / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D015742:Propofol; D017473:Receptors, Opioid, kappa / Q000187:drug effects; D017450:Receptors, Opioid, mu / Q000819:agonists; D012008:Recurrence; D012768:Shivering / Q000187:drug effects*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D009294:Narcotics; D017473:Receptors, Opioid, kappa; D017450:Receptors, Opioid, mu; D015760:Alfentanil; D008614:Meperidine; D007530:Isoflurane; D015742:Propofol