The treatment of postanaesthetic shivering: a double blind comparison between alfentanil and pethidine

@article{Lyons1995TheTO,
  title={The treatment of postanaesthetic shivering: a double blind comparison between alfentanil and pethidine},
  author={Barry Lyons and Matthew B Carroll and N. J. McDonald},
  journal={Acta Anaesthesiologica Scandinavica},
  year={1995},
  volume={39}
}
It has been postulated that pethidine may mediate its effects on postanaesthetic shivering (PAS) via kappa‐opioid receptors. However, clinical evidence indicates that alfentanil, a pure ma‐agonist, may also have beneficial effects on PAS. In order to assess whether opioid effects on PAS are effected via kappa receptors, fifty‐one patients were randomised to receive alfentanil 250 μg (n=18), pethidine 25 mg (n=18) or placebo (n=15) on a double‐blind basis for the treatment of established… 
The effects of meperidine and sufentanil on the shivering threshold in postoperative patients. pascal.alfonsi@apr.ap-hop-paris.fr.
TLDR
Data from a method to accurately determine postoperative shivering thresholds are consistent with clinical observations suggesting that meperidine indeed possesses special antishivering activity and sufentanil inhibited shivering better than would be expected based on the equianalgesic potency ratio.
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TLDR
An updated quantitative review of randomized controlled trials studying efficacy of pharmacological treatment of post-anesthetic shivering found meperidine 25 to 50 mg, tramadol 0.5 to 1mg/kg, clonidine 30 to 150 μg, ketanserin 10 mg, doxapram 25 to 100 mg, and nalbuphine 0.05 to 0.1 mg/kg were significantly more effective than placebo within 15 minutes after treatment.
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TLDR
Antishivering efficacy depended on the active regimen and the length of follow-up, and there were not enough data for alfentanil, fentanyl, morphine, nalbuphine, lidocaine, magnesium, metamizol, methylphenidate, nefopam, pentazocine, and tramadol to draw meaningful conclusions.
Comparative Study of Tramadol with That of Butorphanol for the Control of Shivering in Patients Undergoing Neuraxial Blockade
TLDR
Tramadol is most rapid acting & effective in control of shivering with neauraxial block without any significant side effects and least reappearance of shivered as compared to Butorphanol.
COMPARATIVE STUDY OF TRAMADOL WITH THAT OF BUTORPHANOL FOR THE CONTROL OF SHIVERING IN PATIENTS UNDERGOING NEURAXIAL BLOCKADE
TLDR
Tramadol is most rapid acting & effective in control of shivering with neauraxial block without any significant side effects and least reappearance of shivered as compared to Butorphanol.
Comparative Effectiveness of Tramadol, Clonidine & Butorphanol for the Control of Shivering in Patients Undergoing Neuraxial Blockade
TLDR
Tramadol is most rapid acting & effective in control of shivering with neauraxial block without any significant side effects and least reappearance of shivered as compared to Butorphanol.
Postanaesthetic Shivering
TLDR
No link has been demonstrated between the occurence of shivering and an increase in cardiac morbidity, but it is preferable to avoid postanaesthetic shivering because it is oxygen draining, mainly by preventing peroperative hypothermia by actively rewarming the patient.
Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis
TLDR
Ketamine can prevent postanesthetic shivering without severe side effects, however, ketamine shows no advantage over other anti-shivering drugs.
Postoperative Shivering in Children
TLDR
The treatment of established shivering is efficacious, simple, inexpensive, and relatively safe, and since prevention is only efficacious if the baseline risk is very high, the ‘wait and see’ strategy is recommended.
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