title: Implications of palonosetron in elderly patients undergoing laparoscopic cholecystectomy with respect to its anti-shivering effect.
abstract: BACKGROUND
  The elderly are vulnerable to hypothermia and have a higher risk of cardiovascular events induced by marked increases in oxygen consumption due to shivering. Five-hydroxytryptamine-3 (5-HT3) receptor antagonists have been previously reported to reduce post-anesthesia shivering.
  
  
  OBJECTIVE
  In the present study, the authors investigated the effects of palonosetron, a new-generation 5-HT3 antagonist, on core hypothermia and the incidence of shivering after laparoscopic cholecystectomy in elderly patients.
  
  
  METHODS
  Forty-eight patients (65-80 years) were randomly assigned to one of two groups and administered palonosetron 0.075 mg (palonosetron group, n = 24) or the same volume of normal saline (control group, n = 24) before anesthesia induction. Core body temperatures and hemodynamic variables were monitored during and after operation. Post-anesthetic shivering (PAS) and pain scores were obtained in a post-anesthetic care unit.
  
  
  RESULTS
  Intraoperative esophageal temperature changed significantly over time (P = 0.010), but significant intergroup difference in change was not observed (P = 0.706). Furthermore, shivering frequencies were similar in the two groups (P = 0.610). However, postoperative pain scores at 30 min after entering the post-anesthesia care unit were significantly lower in the palonosetron group (P = 0.002).
  
  
  CONCLUSIONS
  Regardless of the previously reported anti-shivering effect of 5-HT3 receptor antagonists, pre-operative palonosetron 0.075 mg did not influence perioperative hypothermia or PAS in this study. This discrepancy might be due to the dose responsiveness of palonosetron to PAS and relatively low incidence of PAS in the elderly.
  
  
  CONCLUSIONS
  Pre-operative administration of palonosetron 0.075 mg did not influence perioperative hypothermia or post-anesthesia shivering in elderly patients undergoing laparoscopic cholecystectomy. However, palonosetron might be beneficial for reducing early postoperative pain in elderly patients with opioid-based patient-controlled analgesia.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Youn Yi
authors.initials: YY
authors.lastname: Jo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Dongchul
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, South Korea. hyun615@gilhospital.com.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Kwak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000517:prevention & control; D007546:Isoquinolines / Q000008:administration & dosage*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D000077924:Palonosetron; D011300:Preoperative Care / Q000379:methods; D011812:Quinuclidines / Q000008:administration & dosage*; D012702:Serotonin Antagonists / Q000008:administration & dosage; D012768:Shivering / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D007546:Isoquinolines; D011812:Quinuclidines; D012702:Serotonin Antagonists; D000077924:Palonosetron
keywords: Elderly; Palonosetron; Post-anesthetic shivering