title: Physostigmine prevents postanesthetic shivering as does meperidine or clonidine.
abstract: BACKGROUND
  Postanesthetic shivering develops in as many as one half of patients recovering from isoflurane anesthesia. Cholinergic stimulation of the hypothalamic-pituitary-adrenal axis and adrenal medulla by physostigmine enhances secretion of arginine vasopressin, epinephrine, and norepinephrine. Because the hypothalamus is the dominant thermoregulatory controller in mammals, and these neurotransmitters may be involved in body temperature control, physostigmine administration may influence the incidence of shivering. Accordingly, the authors tested the hypothesis that physostigmine administration inhibits postanesthetic shivering. Its efficacy was compared with that of saline (negative control) and meperidine and clonidine (positive controls).
  
  
  METHODS
  Sixty patients having surgery of the ear or nose were tested. General anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 1.5 microg/kg fentanyl and maintained with isoflurane (1.5 +/- 0.4%) in 70% nitrous oxide. At the end of surgery, the patients were randomly assigned to receive an intravenous bolus of 0.04 mg/kg physostigmine, isotonic saline, 0.5 mg/kg meperidine, or 1.5 microg/kg clonidine. Heart rate, mean arterial blood pressure, oxygen saturation, visual analog pain score, temperature, and postanesthetic shivering were measured during recovery.
  
  
  RESULTS
  Postanesthetic shivering occurred in 6 of 15 (40%) patients given saline. In contrast, postanesthetic shivering was significantly reduced in physostigmine-treated patients (1 of 15, or 7%) and was absent in patients given clonidine or meperidine.
  
  
  CONCLUSIONS
  Physostigmine inhibited shivering as well as did two established treatments, meperidine and clonidine. These data suggest that cholinergic systems contribute to the genesis and control of postanesthetic shivering.
authors.affiliation: Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany. EPHORN@CompuServe.com
authors.forename: E P
authors.initials: EP
authors.lastname: Horn
authors.forename: T
authors.initials: T
authors.lastname: Standl
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.forename: G
authors.initials: G
authors.lastname: von Knobelsdorff
authors.forename: C
authors.initials: C
authors.lastname: Büchs
authors.forename: J
authors.initials: J
authors.lastname: Schulte am Esch
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008614:Meperidine / Q000494:pharmacology*; D008875:Middle Aged; D010830:Physostigmine / Q000494:pharmacology*; D012768:Shivering / Q000187:drug effects*
chemical_list: D008614:Meperidine; D010830:Physostigmine; D003000:Clonidine