We tested the efficacy of pethidine and cutaneous warming to prevent shivering during percutaneous cooling in unanaesthetized patients. Ten patients scheduled for cranial neurosurgery received pethidine infusion and skin warming. The Setpoint™ internal heat-exchanging catheter was inserted and cooling to 33.5°C was started. Clonidine and chlorpromazine were given as “rescue medication” to treat shivering. General anaesthesia was planned to be induced after cooling was complete. Rewarming was initiated at dural closure. Three patients successfully completed the protocol, cooling to 33.8°C at a median rate of 3.6 (range: 3.4-3.8) °C/h. Two patients cooled to 33.8°C but required treatment for shivering (cooling rate: 2.9 [2.8-3.1] °C/h). Four patients failed to cool adequately because of refractory shivering (cooling rate: 2.0 [1.5-2.9] °C/h). One patient did not shiver and yet failed to cool adequately (cooling rate: 0.76 °C/h). Rewarming was at a rate of 2.6 (1.2-4.3) °C/h. There were no significant complications arising from catheter placement. The combination of skin warming and pethidine was not reliable enough to be recommended for use during endovascular cooling in unanaesthetized patients.
KriegerD., De GeorgiaM., Abou-CheblA.Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke2001; 32: 1847–1854.
2.
SchwabS., SchwarzS., SprangerM.Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke1998; 29: 2461–2466.
3.
HindmanB., ToddM., GelbA.Mild hypothermia as a protective therapy during intracranial aneurysm surgery: a randomized prospective pilot trial. Neurosurgery1999; 44: 23–32.
4.
BustoR., DietrichW.D., GlobusMY-T, ValdesI., ScheinbergP., GinsbergM.D.Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab1987; 7: 729–738.
5.
BustoR., GlobusM.Y., DietrichD., MarinezE., ValdesI., GinsbergM.Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke1989; 20: 904–910.
6.
ChoppM., ChenH., DereskiM., GarciaJ.Mild hypothermic intervention after graded ischemic stress in rats. Stroke1991; 22: 37–43.
7.
IllievichU.M., ZornowM.H., ChoiK.T., StrnatA.M.P., SchellerM.S.Effects of hypothermia or anesthetics on hippocampal glutamate and glycine concentrations after repeated transient global cerebral ischemia. Anesthesiology1994; 80: 177–186.
8.
CliftonG., MillerE., ChoiS.Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med2001; 344: 556–563.
9.
MarionD., PenrodL., KelseyS.Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med1997; 336: 540–546.
10.
BernardS., GrayT., BuistM.Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med2002; 346: 557–563.
11.
GroupTHACAS. Mild therapeutic hypothermia to improve neurologic outcome after cardiac arrest. N Engl J Med2002; 346: 549–556.
12.
SchmiedH., KurzA., SesslerD.I., KozekS., ReiterA.Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet1996; 347: 289–292.
13.
FrankS.M., FleisherL.A., BreslowM.J.Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. JAMA1997; 277: 1127–1134.
14.
KurzA., SesslerD.I., LenhardtR.Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med1996; 334: 1209–1215.
15.
FrankS., HigginsM., BreslowM.The catecholamine, cortisol and hemodynamic responses to mild perioperative hypothermia—a randomized clinical trial. Anesthesiology1995; 82: 83–93.
16.
ChengC., MatsukawaT., SesslerD.I.Increasing mean skin temperature linearly reduces the core-temperature thresholds for vasoconstriction and shivering in humans. Anesthesiology1995; 82: 1160–1168.
17.
JorisJ., BanacheM., BonnetF., SesslerD.I., LamyM.Clonidine and ketanserin both are effective treatment for postanesthetic shivering. Anesthesiology1993; 79: 532–539.
18.
HornE-P, StandlT., SesslerD., von KnobelsdorffG., BuchsC., Schulte am EschJ.Physostigmine prevents postanesthetic shivering as does meperidine or clonidine. Anesthesiology1998; 88: 108–113.
19.
BoschiG., LaunayN., RipsR.Neuroleptic-induced hypothermia in mice: lack of evidence for a central mechanism. Br J Pharmacol1987; 90: 745–751.
20.
KurzA., IkedaT., SesslerD.I.Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology1997; 86: 1046–1054.
21.
StoenR., SesslerD.I.The thermoregulatory threshold is inversely proportional to isoflurane concentration. Anesthesiology1990; 72: 822–827.
22.
IkedaT., SesslerD., TayefehF.Meperidine and alfentanil do not reduce the gain or maximum intensity of shivering. Anesthesiology1998; 88: 858–865.
23.
MokhtaraniM., MahgoubA., MoriokaN.Buspirone and meperidine synergistically reduce the shivering threshold. Anesth Analg2001; 93: 1233–1239.
24.
LambergT., KivistoK., NeuvonenP.Effects of verapmail and diltiazem on the pharmocokinetics and pharmacoydnamics of buspirone. Clin Pharmacol Ther1998; 63: 640–645.
25.
CrankshawD., EdwardsN., BlackmanG., BoydM., ChanH., MorganD.Evaluation of infusion regimens for thiopentone as a primary anaesthetic agent. Eur J Clin Pharmacol1985; 28: 543–552.
26.
ScottJ.C., PonganisK.V., StanskiD.R.EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology1985; 62: 234–241.
27.
DoufasA., AkcaO., BarryA.Initial experience with a novel heat-exchanging catheter in neurosurgical patients. Anesth Analg2002; 95: 1752–1756.
28.
RamanathanN.L.A new weighting system for mean surface temperature of the human body. J Appl Physiol1964; 19: 531–533.
29.
ChernikD., GillingsD., LaineH.Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol1990; 10: 244–251.
FrankS., RajaS., BulcaoC., GoldsteinD.Relative contribution of core and cutaneous temperatures to thermal comfort, autonomic, and metabolic responses in humans. J Appl Physiol1999; 86: 1588–1593.
32.
ZweiflerR., SesslerD., ZivinJ.Thermoregulatory vasoconstriction and shivering impede therapeutic hypothermia in acute ischemic stroke victims. J Stroke Cere Dis1996; 6: 100–104.
33.
BelaniK., SesslerD.I., SesslerA.M.Leg heat content continues to decrease during the core temperature plateau in humans anesthetized with isoflurane. Anesthesiology1993; 78: 856–863.
34.
KurzA., SesslerD.I., ChristensenR., DechertM.Heat balance and distribution during the core-temperature plateau in anesthetized humans. Anesthesiology1995; 83: 491–499.
35.
KurzM., BelaniK.G., SesslerD.I.Naloxone, meperidine and shivering. Anesthesiology1993; 79: 1193–1201.
36.
DelaunayL., BonnetF., LiuN., BeydonL., CatoireP., SesslerD.I.Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans. Anesthesiology1993; 79: 470–474.
37.
CalvaneseJ., SpohrM.Hyperthermia from a near hanging. Ann Emerg Med1982; 11: 152–155.
38.
NordengH., LindemannR., PerminovK., ReikvamA.Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr2001; 90: 288–291.
