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PubMed1984

Metabolism of meperidine in several animal species.

Four new meperidine metabolites were identified by GC-MS in the urine of rats, guinea pigs, rabbits, cats, and dogs. In addition to known meperidine metabolites, 4-ethoxycarbonyl-4-phenyl-1,2,3,4-tetrapyridine (dehydronormeperidine; IV, the N-hydroxydehydro derivative of normeperidine (X), the dihydroxy derivative of meperidine (XII), and the dihydroxy derivative of normeperidine (XIII) were identified. The possible role of the N-hydroxy derivative of normeperidine (IX) in the pharmacological interaction of meperidine (I) with MAO inhibitors, seen selectively in the rabbit (and humans), is discussed. Following the administration of the p-hydroxy derivative of meperidine (VII), the major metabolite was conjugated VII. Trace amounts of the p-hydroxy derivative of normeperidine (VIII), the methoxy hydroxy derivative of meperidine (XI), XII, and XIII also were detected as metabolites of VII. The degree of N-demethylation of VII, both in vitro and in vivo, was small.

Animals↗
PubMed1978

Double-blind comparison of the neurobehaviour of neonates following the administration of different doses of meperidine to the mother.

The Early Neonatal Neurobehavioural Scale (E.N.N.S.) tests, first described by Scanlon, et al.1 were administered to 920 neonates on the first and second days of life. Meperidine was not given to 389 mothers, 50 mg was given to 358 mothers and 75 to 150 mg to 173 mothers within four hours of delivery. The delivery was conducted under chloroprocaine epidural anaesthesia in 280, ketamine-nitrous oxide general anaesthesia in 180, thiopentone-nitrous oxide general anaesthesia in 180 and lidocaine pudendal block in 280. All babies were over 2500 grams in weight with an Apgar score of at least 8 at one minute and 10 at five minutes. All were delivered from healthy women 18 to 35 years of age following a normal labour. The evaluator was unaware of the anaesthetic management, the method of delivery or the perinatal risk factors. There was no significant difference between the mothers and babies in the three meperidine dosage groups for maternal parity, maternal age, birth weight, number of forceps deliveries or duration of labour. Administration of meperidine was associated with a broad spectrum depression of most items on the E.N.N.S. on both the first and second days of life. The depression was greatest with the highest dose of meperidine. The depression produced by anaesthetic agents and meperidine were additive and the highest scores on this scale were obtained in those babies delivered under chloroprocaine epidural anaesthesia without meperidine.

Adolescent↗
PubMed1977

Comparison of analgesia by intravenous butorphanol and meperidine in patients with post-operative pain.

Intravenous doses of butorphanol tartrate (0.5 mg, 1.0 mg and 2.0 mg) and meperidine hydrochloride (20 mg and 40 mg) were compared under controlled conditions employing a double blind study design. Informed consent was obtained from all post-operative patients suffering from moderate to severe pain who participated in this study. Approximately 25 patients were included in each group. The data from 125 patients were subjected to statistical analysis. The results indicated that butorphanol is approximately 40 to 50 times more potent than meperidine. In addition, at most of the time intervals, there were no statistically significant differences between the responses to butorphanol 0.5 mg and 1 mg and meperidine 20 mg and 40 mg; but the response to butorphanol 2 mg was significantly (p less than 0.05) better than the low dose of each agent. The low doses of butorphanol (0.5 mg) and meperidine (20 mg) appear to have an effective duration of action of less than two hours. The larger doses (butorphanol 1.0 mg and 2.0 mg and meperidine 40 mg) appeared to produce a two- to four-hour duration of action. The largest butorphanol dose (2.0 mg) appeared to produce the longest duration of action. A comparison of the test groups with respect to the incidence and type of side effects showed that butorphanol 2.0 mg produced a greater incidence of drowsiness (39 per cent). The overall incidence of drowsiness for patients receiving either the 0.5 mg or 1.0 mg dose of butorphanol was 12 per cent, as compared with an 8 per cent overall incidence in the meperidine group. The incidence of other side effects was relatively low in all test groups. No significant differences were noted among the groups with regard to the onset (usually less than or equal to 30 minutes post-therapy) or the duration (usually less than or equal to 2 hours) of side effects. Butorphanol appears to be a safe and effective analgesic for the relief of moderate to severe post-operative pain.

Adult↗
PubMed1999

Adding low dose meperidine to spinal lidocaine prolongs postoperative analgesia.

PURPOSE: To investigate the effects of the addition of low dose meperidine to spinal lidocaine on the sensory and motor blockade profile, and the quality and duration of postoperative analgesia. METHODS: In a randomized double blind prospective dose finding study 40 patients undergoing transurethral prostatectomy with spinal anesthetic were allocated to receive 75 mg lidocaine 5% intrathecally as the sole agent (group A), or co-administered with 0.15 mg x kg(-1) meperidine (group B) or 0.30 mg x kg(-1) meperidine (group C). Sensory and motor blockade profiles were documented. Postoperatively, the amount of analgesics required, time to first analgesic, visual analogue scores and adverse events were recorded. RESULTS: Sensory blocks at or above T10 was maintained for 128, 156 and 145 minutes in groups A, B and C respectively. There was no difference in the latency or duration of the motor block among the three groups. Patients in group C had lower visual analogue pain scores (VAPS) over time than did those in groups A and B (P < 0.05). Time to first analgesia was longer (429 +/- 197 minutes) in group C than in group A (254 +/- 157 minutes) (P < 0.05). Fewer patients in group C required parenteral opioid postoperatively than in group A (P < 0.05). The incidence of bradycardia was higher in the groups receiving meperidine. No symptoms of transient radicular irritation (TRI) were reported in the groups receiving meperidine. CONCLUSION: The addition of 0.3 mg x kg(-1) of meperidine to spinal lidocaine prolongs postoperative analgesia without delaying discharge from post anesthetic care unit (Table II) and reduces the requirement for parenteral analgesics (Table III).

Adjuvants, Anesthesia↗
PubMed2000

Epidural meperidine does not cause hemodynamic changes in the term parturient.

PURPOSE: Meperidine has local anesthetic properties and, therefore, when given epidurally it has the potential to cause hemodynamic changes. Our objective was to study the hemodynamic effects of an analgesic dose of epidural meperidine (50 mg) in 34 ASA 1-2 term parturients scheduled for elective Cesarean section under epidural anesthesia. METHODS: A lumbar epidural catheter was inserted and patients lay in the supine left wedge position. Intravenous fluid preload was withheld, and hemodynamic measurements comprising of mean arterial pressure, cardiac output and heart rate were made using automatic oscillotonometry (Dinamap 1486SX) and transthoracic electrical bioimpedance (Bomed NCCOM3). Following baseline measurements, the hemodynamic effects of sequential epidural injection of first, 10 ml saline, and 20 min thereafter, 50 mg meperidine diluted to 10 ml with saline, were recorded. Sensory blockade was assessed following each injection using loss of temperature discrimination to ice. Paired Student t tests were used to compare changes in hemodynamic variables. RESULTS: Epidural meperidine produced a small increase from the saline values in the mean (SD) cardiac output of 5.81 +/-1.44 to 6.04+/-1.54 L x min(-1) (P<0.05), and mean arterial pressure of 77.1+/-8.8 to 79.3+/-9.9 mm Hg (P<0.05). Sensory changes, the upper level of which ranged from L1 to T1, were detected in 94% of patients given epidural meperidine. Epidural saline injection had no such hemodynamic effects, but produced a detectable sensory level in two patients. CONCLUSION: Epidural meperidine, 50 mg, caused minimal hemodynamic changes in term parturients.

Analgesics, Opioid↗
PubMed1980

Meperidine's effect under shock titration and shock discrimination procedures.

Meperidine's effects were examined under a schedule of shock titration and under a shock intensity discrimination in which squirrel monkeys discriminated between the presence and absence of a low intensity shock. Meperidine did not increase the intensity at which monkeys maintained the shock in the shock titration procedure, nor did meperidine alter the percentage of correct responses under the shock intensity discrimination although meperidine did increase the time to respond in the presence and absence of shock. When meperidine was combined with a dose of SKF-525A, which did not alter responding when given alone, the intensity at which monkeys maintained the shock under the shock titration procedure was increased. Moreover, the percentage of correct responses in the presence of shock under the shock titration procedure was decreased by the combination of meperidine and SKF-525A.

Animals↗
PubMedDate not supplied

Meperidine: therapeutic use and toxicity.

Meperidine is a synthetic opioid analgesic frequently prescribed in the emergency department. Meperidine is most often administered intramuscularly or intravenously, due to its poor oral bioavailability, and is metabolized extensively by the liver. Analgesic effects usually last 3-4 hours with parenteral administration, and some adverse effects such as nausea may be reduced when meperidine is combined with antiemetic or antihistaminic medications. Although meperidine is often a preferred analgesic by both patients and physicians in the treatment of disorders such as migraine headaches, its analgesic efficacy has rarely proven superior to alternative parenteral pain medications in controlled trials. In addition, meperidine can precipitate monoamine oxidase inhibitor reactions, and during metabolism it is demethylated to normeperidine, a compound with significant central nervous system (CNS) toxicity. Meperidine should be considered a second line agent in the treatment of pain when opioid analgesics are required.

Analgesics, Opioid↗
PubMedDate not supplied

Intravenous clonidine fails to reduce postoperative meperidine requirements.

STUDY OBJECTIVE: To investigate the effect of an additional postoperative intravenous (IV) clonidine infusion on meperidine requirements in the early postoperative period. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Postoperative recovery room at a university medical center. PATIENTS: Sixty female patients who had undergone a cholecystectomy. INTERVENTIONS: On first complaining of postoperative pain, 30 patients (clonidine group) received clonidine 150 micrograms IV over 30 minutes and an additional 150 micrograms of clonidine during the following 90 minutes. The other 30 patients (control group) were given identical volumes of 0.9% sodium chloride IV at identical time intervals. All patients received a patient-controlled analgesia device (initial dose, meperidine 16 mg; subsequent doses, meperidine 8 mg on demand; lockout time, 5 minutes; background infusion, meperidine 2.5 mg/hr). MEASUREMENTS AND MAIN RESULTS: Pain intensity was evaluated with a 101-point numerical rating scale. Blood pressure, heart rate (HR), respiratory rate, arterial hemoglobin oxygen saturation, and any side effects were recorded. There were no significant differences between the clonidine and control groups with respect to postoperative pain. The patients in the clonidine group required a total meperidine dose of 62.7 +/- 4.9 mg, compared with 70.4 +/- 3.9 mg in the control group (mean +/- SEM; not a significant difference). Systolic blood pressure and HR were significantly lower from 20 to 120 minutes and from 30 to 120 minutes, respectively after the start of the clonidine infusion compared with the placebo. No patient had to be treated for hypotension or bradycardia. Serious side effects were not observed. CONCLUSIONS: During the first 2 postoperative hours following cholecystectomy, postoperative meperidine intake could not be reduced by IV administration of clonidine 300 micrograms.

Analgesia, Patient-Controlled↗
PubMed1996

Effect of ketorolac on bleeding time and postoperative pain in children: a double-blind, placebo-controlled comparison with meperidine.

STUDY OBJECTIVE: To determine whether ketorolac 0.75 mg/kg would provide a comparable degree of analgesia to that of meperidine 1 mg/kg in terms of postoperative opioid requirements and pain scores in children undergoing surgeries associated with mild to moderate postsurgical discomfort. DESIGN: Randomized, prospective, placebo-controlled, double-blinded study of the initial 6 postsurgical hours. SETTING: University affiliated teaching hospital. PATIENTS: 90 healthy ASA status I and II children scheduled for elective general, orthopedic, or genitourinary procedures associated with mild to moderate postsurgical pain. Extensive surgical procedures associated with a significant risk of bleeding were excluded. INTERVENTIONS: Ketorolac 0.75 mg/kg, meperidine 1 mg/kg, or placebo (normal saline) was administered intramuscularly (IM) at the beginning of surgery. MEASUREMENTS AND MAIN RESULTS: Bleeding times were measured prior to and 180 minutes after study drug administration. Time to first rescue medication, total opioid requirement, pain scores, incidence of vomiting and length of stay were evaluated. Placebo-treated patients were rescued earlier (p < 0.0001) and required twice the rescue dosage (p = 0.013) when compared with either the ketorolac or meperidine groups. The ketorolac and meperidine groups did not differ with regard to time until first rescue, cumulative proportion requiring rescue, or the number of rescue doses required. A single dose of IM ketorolac prolonged bleeding time by 53 +/- 75 seconds (p = 0.006). CONCLUSIONS: Ketorolac provided analgesia comparable to that of meperidine and significantly reduced opioid requirements. Since ketorolac was not associated with a reduction in postoperative vomiting or length of stay, and in view of the uncertain risk of bleeding, it offers no advantage over meperidine in the management of mild to moderate acute postsurgical pain.

Analgesics, Non-Narcotic↗
PubMedDate not supplied

Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia.

BACKGROUND AND OBJECTIVES: Perioperative hypothermia is a common problem in anesthesia practice. Regional anesthesia, like general anesthesia, influences the thermoregulatory process. The aim of our study was to compare the efficacy of ondansetron and meperidine in the prevention of shivering during and after spinal anesthesia. METHODS: In this double-blind study, 75 patients were randomized into 3 groups. Group O and Group M were given ondansetron 8 mg and meperidine 0.4 mg/kg intravenously immediately before spinal anesthesia, respectively. Group C received saline at identical times. The core temperatures and the incidence of shivering were recorded. Association between maximum block height and mean rectal temperatures of the patients were also evaluated. RESULTS: The core temperature was preserved in both ondansetron and meperidine groups with respect to the control group. Shivering was observed in 8% of patients in groups O and M and 36% in group C. The correlation between maximum block height and mean rectal temperatures was lost in the ondansetron and meperidine groups. CONCLUSION: Ondansetron and meperidine have similar anti-shivering effects. In addition, both ondansetron and meperidine altered the correlation between the core temperature and block level during spinal anesthesia.

Adult↗
PubMed2001

The comparison of midazolam and topical lidocaine spray versus the combination of midazolam, meperidine, and topical lidocaine spray to sedate patients for upper endoscopy.

BACKGROUND: Whether an opiate-benzodiazepine combination is superior to benzodiazepine alone for sedation in upper endoscopy is controversial. The purpose of this study was to compare the effectiveness of intravenous midazolam alone versus the combination of intravenous midazolam and intravenous meperidine for the sedation of patients undergoing upper endoscopy. METHODS: One hundred seven patients scheduled for outpatient diagnostic esophagogastroduodenoscopy were randomly assigned to receive 50 mg intravenous meperidine (53 of 107) or placebo (54 of 107). All patients received topical lidocaine spray and as much midazolam as the endoscopist thought the patient needed. Patients and endoscopists were blinded as to assignment. Data collected included intubation time (seconds), procedure time (minutes), pulse, blood pressure, complications, and the need for reversal agents. The endoscopist evaluated the quality of sedation immediately after the procedure (1 = excellent, 2 = good, 3 = fair, and 4 = poor). The patient evaluated the procedure the next day by phone (1 = no discomfort or did not remember, 2 = slightly uncomfortable, 3 = extremely uncomfortable, and 4 = unacceptable). Patients were also asked whether they would agree to another esophagogastroduodenoscopy if their doctor thought it was medically necessary. RESULTS: The intubation time, procedure time and blood pressure were not significantly different between the 2 groups. In comparing the meperidine group versus placebo group, the highest pulse (82.3 vs. 93.7, p = 0.0010), lowest pulse (67.2 vs. 72.3, p = 0.0194) and amount of midazolam used (4.0 vs. 4.8 mg, p = 0.0185 or 0.53 vs. 0.67 mg/kg, p = 0.0083) were significantly different by using a t test analysis. Patient evaluations comparing meperidine versus placebo showed responses of 1 (52 vs. 49), 2 (1 vs. 3), 3 (0 vs. 2) and 4 (0 vs. 0), which were not significantly different. The endoscopists'evaluation comparing meperidine versus placebo gave responses of excellent (44 vs. 27), good (6 vs. 22), fair (3 vs. 5) and poor (0 vs. 0), which were highly significantly different (p < 0.001) by using chi-square statistical techniques. CONCLUSION: The addition of meperidine to midazolam in sedating patients undergoing upper endoscopy adds no benefit from the patient viewpoint, whereas endoscopists favored the use of both medications.

Administration, Topical↗
PubMed1996

Intravenous ketorolac tromethamine versus meperidine for adjunctive sedation in upper gastrointestinal endoscopy: a pilot study.

BACKGROUND: Meperidine is commonly used with a benzodiazepine to achieve conscious sedation but may potentiate respiratory depression. Ketorolac tromethamine has few sedative effects and no respiratory depression. The purpose of this study was to compare ketorolac to meperidine as adjuncts in conscious sedation for upper gastrointestinal endoscopy (EDG). METHODS: Patients undergoing diagnostic EGD (n = 47) were randomly assigned to receive normal saline solution or 50 mg meperidine or 30 mg ketorolac intravenously. Midazolam was subsequently administered (as needed, to achieve adequate conscious sedation) by endoscopists who were blinded to the test substance given before the procedure. RESULTS: For all treatment groups, there was no significant difference in extent or adequacy of sedation, incidence of oxygen desaturation, patient amnesia, time of procedure, or vital signs (except for a relative procedural tachycardia in the ketorolac and placebo groups as compared to baseline). The ketorolac group experienced more pain and anxiety. The meperidine group experienced less gagging, a shorter sedation time, less midazolam usage, and more discomfort at the intravenous site. Meperidine seemed to offer a "protective" effect against procedural tachycardia. CONCLUSION: There is no benefit to ketorolac as an adjunct in conscious sedation for EGD. Meperidine had several benefits; however, discomfort at the intravenous site was common.

Adjuvants, Anesthesia↗
PubMed1992

A randomized, double-blind, comparative study of the efficacy of ketorolac tromethamine versus meperidine in the treatment of severe migraine.

STUDY OBJECTIVE: To evaluate the relative efficacy of ketorolac tromethamine and meperidine hydrochloride in the emergency department treatment of severe migraine. DESIGN: Prospective, randomized, double-blind trial. SETTING: University hospital ED. PARTICIPANTS: Patients presenting to the ED with an isolated diagnosis of common or classic migraine. INTERVENTIONS: Subjects were randomized to receive a single intramuscular injection of either 30 mg ketorolac or 75 mg meperidine. MEASUREMENTS AND MAIN RESULTS: Of the 31 patients completing the trial, 15 received ketorolac and 16 received meperidine. The demographic characteristics of both groups were comparable. At one hour, ketorolac was significantly less effective than meperidine in reducing headache pain (P = .02) and in improving clinical disability (P = .01). Ketorolac also was less effective at reducing nausea, photophobia, and the need for rescue medication (P less than .05). Sustained headache relief was experienced by 44% of the patients treated with meperidine at 12- to 24-hour follow-up, compared with 13% of the patients treated with ketorolac (P = NS). No significant side effects were observed for either group. CONCLUSION: IM ketorolac tromethamine is less effective than meperidine in the ED treatment of severe migraine.

Acute Disease↗
PubMed1989

Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache.

Approximately 20% of the population suffers from migraine headache, and a significant number develop "fixed" migraines, refractory to oral medications. Of this group, many become habitual narcotic users. A previously published case series using IV chlorpromazine suggested efficacy, so a randomized, double-blind, controlled trial was conducted. The study compared IV chlorpromazine against IV meperidine with dimenhydrinate. Entry criteria were emergency department patients from 18 to 60 years of age with a clinical diagnosis of common or classic migraine headache. After informed consent was obtained, an IV line with normal saline was established, and a bolus of 5 mL/kg was administered. Patients were randomized into two groups: chlorpromazine and meperidine with dimenhydrinate. The chlorpromazine group received a bolus injection of 5 mL normal saline placebo followed by 0.4 mL/kg chlorpromazine solution (0.1 mg/kg). The chlorpromazine was repeated every 15 minutes as needed up to a total of three doses. The meperidine with dimenhydrinate group received 5 mL dimenhydrinate solution (25 mg) followed by 0.04 mL/kg meperidine (0.4 mg/kg). Again, the meperidine solution was repeated in the same dosage every 15 minutes as needed up to a total of three doses. If response was inadequate 15 minutes after the third dose, the sequence was broken, and the other medication given. Blood pressure and response were assessed at 15-minute intervals for one hour. Pain was assessed by both visual and verbal analogue scales every 15 minutes. In all, 46 patients were entered in the study (24 chlorpromazine and 22 meperidine with dimenhydrinate).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Antagonism of the response rate-decreasing effects of meperidine and morphine by beta-funaltrexamine and naltrexone in squirrel monkeys.

Level pressing by squirrel monkeys was maintained under a fixed-ratio 30 schedule of food presentation. The response rate-decreasing effects of meperidine and morphine were examined alone and in combination with several doses of the irreversible, mu-selective opioid antagonist beta-funaltrexamine and the reversible, opioid antagonist naltrexone. beta-Funaltrexamine alone decreased response rates to greater than 50% of control at all doses in two of the four monkeys and at the highest dose in one monkey. In the monkeys in which beta-funaltrexamine decreased rates, beta-funaltrexamine either did not shift the meperidine or the morphine dose-effect curve or it shifted these curves to the left. In the monkeys in which beta-funaltrexamine alone did not decrease rates, it shifted the meperidine and the morphine dose-effect curves to the right. Naltrexone also shifted both the meperidine and morphine dose-effect curves rightward, although not in a dose-dependent manner. These data suggest that the rate-decreasing effects of meperidine and morphine in squirrel monkeys are altered by beta-funaltrexamine and naltrexone in a similar manner, providing additional evidence that the rate-decreasing effects of both meperidine and morphine are mediated by mu-opioid receptors.

Animals↗
PubMed1999

Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic.

To compare the efficacy of intramuscular ketorolac and meperidine in the emergency department (ED) treatment of renal colic, a prospective, controlled, randomized, double-blind trial was conducted in an academic ED with 76,000 annual visits. Participants were volunteer ED patients with a diagnosis of ureterolithiasis confirmed by intravenous pyelogram. Subjects were randomized 1:1 to receive a single intramuscular injection of either 60 mg ketorolac or 100 to 150 mg meperidine, based on weight. Of the 70 patients completing the trial, 33 received ketorolac and 37 received meperidine. Demographic characteristics and baseline pain scores of both groups were comparable (P = NS, Mann Whitney U). Ketorolac was significantly (P < .05) more effective than meperidine in reducing renal colic at 40, 60, and 90 minutes as measured on a 10-cm visual analogue scale. Similar proportions of patients in each group were given rescue analgesia and admitted. Of patients who were discharged home without rescue, those treated with ketorolac left the ED significantly earlier than those treated with meperidine (3.46 v 4.33 h, P < .05). These results show that intramuscular ketorolac as a single agent for renal colic is more effective than meperidine and promotes earlier discharge of renal colic patients from the ED.

Acute Disease↗
PubMed2001

A prospective study comparing i.m. ketorolac with i.m. meperidine in the treatment of acute biliary colic.

Ketorolac is a nonsteroidal anti-inflammatory medication that is used widely for pain management. Its effects are mediated through the inhibition of prostaglandins, which makes it uniquely different from opioids in relieving pain. We conducted a randomized, prospective, double blind study of patients presenting to our Emergency Department (ED) with a diagnosis of acute biliary colic. Study patients were randomized into one of two treatment groups, meperidine 1.5 mg/kg with a maximum dose of 100 mg or ketorolac 60 mg given intramuscularly (i.m.). The patients rated their pain before and 30 min after medication on a scale of 1 to 10 using a Visual Analog Pain Scale. Overall pain relief was compared between the two groups using a two-sample t test. Thirty patients were enrolled in the study, 16 in the ketorolac group and 14 in the meperidine group. Patients ranged in age from 18 to 71 years and 6 (20%) were male. The average pain score at time 0 was 7.6 for the ketorolac group and 7.3 for the meperidine group. Pain relief at time 30 min was 3.8 in the ketorolac group and 3.9 in the meperidine group, which was not statistically different. The mean global pain score and need for an emergency cholecystectomy were similar in the two groups. Rescue medication for additional analgesia at 30 min was needed in 4 patients in the meperidine group and in 2 patients in the ketorolac group (28.6% versus 12.5%, respectively; NS). In this study of patients with acute biliary colic there was no significant difference in the pain relief achieved by using either ketorolac or meperidine.

Adolescent↗
PubMed1995

Comparison of vecuronium and meperidine on the clinical and metabolic effects of shivering after hypothermic cardiopulmonary bypass.

The use of vecuronium and meperidine on the clinical and metabolic effects of shivering in mechanically ventilated patients after hypothermic cardiopulmonary bypass (CPB) was compared. Twenty adult male patients undergoing cardiac surgery were randomized to meperidine, 25 to 75 mg (n = 10), or vecuronium, 0.1 microgram/kg (n = 10), for the treatment of shivering during postoperative rewarming. Vecuronium was continued as an infusion at 1.0 microgram/kg/min for 4 hours. Meperidine abolished shivering in 50% of patients with a 60% recurrence within 2 hours and did not correct acute respiratory acidosis when it occurred. Vecuronium uniformly abolished shivering, corrected acute respiratory acidosis, and improved mixed venous oxygen saturation (20% v 4%), decreased oxygen consumption (-32% v -7%) and decreased end-tidal carbon dioxide (-21% v -5%) significantly more than meperidine (p < 0.005). Meperidine administration caused a significant decline in systolic blood pressure (121.9 +/- 10.6 mmHg to 106.9 +/- 8.5 mmHg, p = < 0.02). The authors conclude that, during rewarming after hypothermic CPB, muscle relaxation with vecuronium reverses both the clinical and metabolic effects of shivering more reliably and effectively than repeated boluses of meperidine, and with greater hemodynamic stability. Control can be maintained by continuous infusion of vecuronium with concomitant sedation for up to 4 hours without prolonging intubation time.

Acidosis, Respiratory↗