[Prophylactic nefopam administration for post-anesthetic shivering].
OBJECTIVE
Shivering is a frequent postanaesthetic complication. Its definite reason is unknown. Patients with cardiovascular or pulmonary diseases are endangered by postanaesthetic shivering. The aim of this study was to assess the efficacy of nefopam in prophylaxis of shivering. Additionally we investigated the influence of nefopam on haemodynamic parameters and on the time until extubation.


METHODS
30 patients (ASA I-II) were randomly allocated in a double-blind fashion to one of two groups to receive directly after the end of isoflurane application either nefopam (0.15 mg/kg) or placebo (0.9% saline). The period of anaesthesia had to be longer than 60 minutes. All patients received a premedication with lorazepam (0.02 mg/kg) 30-45 minutes prior to surgery. Induction of anaesthesia was standardised: fentanyl (3 micrograms/kg), thiopentone (5 mg/kg), atracurium (0.4 mg/kg). Intraoperatively a mixture of isoflurane, nitrous oxide (60%) and oxygen was used to maintain anaesthesia. The following parameters were evaluated: Age, sex, duration of operation and anaesthesia and the time between the end of application of volatiles and extubation. Heart rate (HR), mean arterial blood pressure (MAP), rectal temperature and O2-saturation were measured at predefined data points. Postoperatively the consumption of analgesic was documented. The severity of shivering was classified in five grades.


RESULTS
In the control-group nine patients shivered (60%), whereas in the nefopam group only one patient (6.6%) shivered (p < 0.05). In comparison to the placebo group we observed in the nefopam group a significantly decreased HR 30 and 60 minutes postoperatively (p < or = 0.007 and p < or = 0.002). We did not observe prolonged awakening in the nefopam-treated patients. MAP and O2-saturation showed similar reactions in both groups.


CONCLUSIONS
The data indicate that prophylactic administration of nefopam can suppress postanaesthetic shivering. Prolonged awakening was not observed.
Piper
S N
SN
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen.
Schmidt
C C
CC
Suttner
S W
SW
Kumle
B
B
Triem
J G
JG
Maleck
W H
WH
Boldt
J
J
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009340:Nefopam / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D012768:Shivering / Q000187:drug effects*
D018712:Analgesics, Non-Narcotic; D018685:Anesthetics, Inhalation; D009340:Nefopam; D007530:Isoflurane