Shivering prevention

At present, no diugs exist that can selectively activate a2-receptor subtypes. Clonidine stimulates all three a2-subtypes with similar potency. Clonidine lowers blood pressure in patients with hypertension and it decreases sympathetic overactivity during opioid withdrawal. In intensive and postoperative care, clonidine is a potent sedative and analgesic and can prevent postoperative shivering. Clonidine and its derivative brimonidine lower... 

Chlorpromazine has direct effects on the CTZ and may also depress temperature control and prevent shivering. The effects are due to inhibition of dopamine centrally. It may potentiate the effects of hypnotics, sedatives and anaesthetic agents. It is rarely used in anaesthetic practice today. Promethazine was first developed for its antihistamine effects but is more commonly used for its sedative/anticholinergic, anti-emetic actions, and prevention of motion-related sickness. The sedative actions are quite marked and last longer than the anti-emetic effects. 

Hypothermia in stroke and head-injured patients is started as soon as possible after injury, and continues for the duration selected by the investigator. Each patient undergoing treatment with mild hypothermia should be paralyzed and sedated to prevent discomfort and reduce shivering. Unfortunately, this can compromise accurate evaluation of the neurological status in patients with acute head injury or stroke. Therefore, continuous monitoring of ICP is important in these intensive care unit patients. Because these patients are paralyzed and sedated, continuous mechanical ventilation is also necessary. Neuromuscular blocking... 

To prevent shivering use neuromuscular blockers via an infusion pump (Atracrium 200 mg in 50 mL). 

Horn EP, Standi T, Sessler DI, von Knobelsdorff G, Buchs C, Schulte am Esch J. Physostigmine prevents postanesthetic shivering as does meperidine or clonidme. Anesthesiology 1998 88(1) 108-13. 

One example of Na channel plasticity in central pathways subsequent to a non-ion channel gene deletion is revealed by analysis of the mutant mouse shiverer, which bears a major disruption of the myelin basic protein gene, leading to absence of the glial-specific intracellular membrane protein myelin basic protein (MBP) (Roach et al 1985). Lack of MBP prevents developmental formation of the major dense line essential for the compaction of glial wrappings that form the mature myelin sheath. As a result, large calibre axons in the shiverer brain are... 

Noebe/s I think the latter is correct, because myelin basic protein is actually present in oligodendrocytes centrally and Schwann cells peripherally. But in the shiverer mouse, Schwann cell myelination of peripheral nerves is relatively unaffected by the same genetic lesion that prevents formation of the central white matter. The protein must either play a different role in those two cell types, or they signal to axons in different ways. Whether it is there or not, if you irritate a ghal ceh, the oligodendrocyte will say one thing to a central axon and the Schwann cells may say something different to a peripheral axon. 

It was twenty-three minutes since the physicist s escape, and a form of delayed shock had begun to infiltrate Monica s body as her subconscious acknowledged just how lucky she d been to avoid vanishing down the Udat s wormhole. Her neural nanonics were helpless to prevent the cold shivers which spiralled their way around her limbs and belly muscles. 

Honarmand A, Safavi MR. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia a randomized double-blind placebo controlled trial. Br J Anaesth 2008 101(4) 557-62. 

Kose EA, Honca M, Dal D, Akinci SB, Aypar U. Prophylactic ketamine to prevent shivering in parturients undergoing Cesarean delivery... 

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