title: Neither nalbuphine nor atropine possess special antishivering activity.
abstract: The special antishivering action of meperidine may be mediated by its kappa or anticholinergic actions. We therefore tested the hypotheses that nalbuphine or atropine decreases the shivering threshold more than the vasoconstriction threshold. Eight volunteers were each evaluated on four separate study days: 1) control (no drug), 2) small-dose nalbuphine (0.2 microg/mL), 3) large-dose nalbuphine (0.4 microg/mL), and 4) atropine (1-mg bolus and 0.5 mg/h). Body temperature was increased until the patient sweated and then decreased until the patient shivered. Nalbuphine produced concentration-dependent decreases (mean +/- SD) in the sweating (-2.5 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.75 +/- 0.25), vasoconstriction (-2.6 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.75 +/- 0.25), and shivering (-2.8 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.79 +/- 0.23) thresholds. Atropine significantly increased the thresholds for sweating (1.0 degrees C +/- 0.4 degrees C), vasoconstriction (0.9 degrees C +/- 0.3 degrees C), and shivering (0.7 degrees C +/- 0.3 degrees C). Nalbuphine reduced the vasoconstriction and shivering thresholds comparably. This differs markedly from meperidine, which impairs shivering twice as much as vasoconstriction. Atropine increased all thresholds and would thus be expected to facilitate shivering. Our results thus fail to support the theory that activation of kappa-opioid or central anticholinergic receptors contribute to meperidine's special antishivering action.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California, USA.
authors.forename: R
authors.initials: R
authors.lastname: Greif
authors.forename: S
authors.initials: S
authors.lastname: Laciny
authors.forename: A M
authors.initials: AM
authors.lastname: Rajek
authors.forename: M D
authors.initials: MD
authors.lastname: Larson
authors.forename: A R
authors.initials: AR
authors.lastname: Bjorksten
authors.forename: A G
authors.initials: AG
authors.lastname: Doufas
authors.forename: M
authors.initials: M
authors.lastname: Bakhshandeh
authors.forename: M
authors.initials: M
authors.lastname: Mokhtarani
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D001285:Atropine / Q000008:administration & dosage / Q000494:pharmacology*; D001831:Body Temperature / Q000502:physiology; D003080:Cold Temperature / Q000009:adverse effects; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D009266:Nalbuphine / Q000008:administration & dosage / Q000494:pharmacology*; D010101:Oxygen Consumption / Q000187:drug effects; D010108:Oxyhemoglobins / Q000378:metabolism; D011680:Pupil / Q000187:drug effects; D015656:Respiratory Mechanics / Q000187:drug effects; D012768:Shivering / Q000187:drug effects*; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000701:Analgesics, Opioid; D018727:Muscarinic Antagonists; D010108:Oxyhemoglobins; D001285:Atropine; D009266:Nalbuphine