COMPARISON OF VECURONIUM AND MEPERIDINE ON THE CLINICAL AND METABOLICEFFECTS OF SHIVERING AFTER HYPOTHERMIC CARDIOPULMONARY BYPASS

The use of vecuronium and meperidine on the clinical and metabolic eff ects of shivering in mechanically ventilated patients after hypothermi c cardiopulmonary bypass (CPB) was compared. Twenty adult male patient s undergoing cardiac surgery were randomized to meperidine, 25 to 75 m g (n = 10), or vecuronium. 0.1 mu g/kg (n = 10), for the treatment of shivering during postoperative rewarming. Vecuronium was continued as an infusion at 1.0 mu g/kg/min for 4 hours. Meperidine abolished shive ring in 50% of patients with a 60% recurrence within 2 hours and did n ot correct acute respiratory acidosis when it occurred. Vecuronium uni formly abolished shivering, corrected acute respiratory acidosis, and improved mixed Venous oxygen saturation (20% v 4%), decreased oxygen c onsumption (-32% v -7%) and decreased end-tidal carbon dioxide (-21% v -5%) significantly more than meperidine (p < 0.005). Meperidine admin istration caused a significant decline in systolic blood pressure (121 .9 +/- 10.6 mmHg to 106.9 +/- 8.5 mmHg, p = < 0.02). The authors concl ude that, during rewarming after hypothermic CPB, muscle relaxation wi th vecuronium reverses both the clinical and metabolic effects of shiv ering more reliably and effectively than repeated boluses of meperidin e, and with greater hemodynamic stability. Control can be maintained b y continuous infusion of vecuronium with concomitant sedation for up t o 4 hours without prolonging intubation time. Copyright (C) 1995 by W. B. Saunders Company