Effect of pethidine, fentanyl and morphine on post-operative shivering in man.

One hundred consecutive patients who shivered following general or regional anesthesia and a surgical procedure were randomly treated with 25 mg pethidine, 2.5 mg morphine, 25 micrograms fentanyl or sodium chloride 0.9%, given in equal intravenous volumes over a 15-min period. The effects were evaluated every 5 min after the first injection. There was a spontaneous, time-related disappearance of shivering in the sodium chloride-treated patients. In the pethidine-treated group, shivering disappeared more than twice as fast as in the control group. The difference was highly significant at 15 and 20 min (P less than 0.001) and was unrelated to weight, body temperature or duration of anesthesia. Women responded sooner than men, reaching significance at 10 min (P less than 0.05), while men did so only at 20 min. Morphine or fentanyl had no effect. Nausea and vomiting were minimal and of equal incidence in narcotic- and placebo-treated patients.

Results of a comprehensive rehabilitation program. Physiologic and functional effects on patients with chronic obstructive pulmonary disease.

Forty-two patients with chronic obstructive pulmonary disease participated in a comprehensive inpatient rehabilitation program. Criteria for a safe, maximum treadmill exercise regimen were established; all patients pursued this regimen for six weeks, without complications, even though 31 of 39 patients showed a decline in PaO2 with exercise. Postprogram O2 consumption, minute ventilation, heart rate, and respiratory rate were significantly reduced during exercise when compared with preprogram values. Sixteen of 29 patients improved in terms of dyspnea class; an additional 11 of these 29 improved with regard to activities of daily living. Most patients who improved physiologically also improved functionally. Patients able to tolerate higher levels of treadmill exercise initially had the greatest improvement in postcourse exercise performance. The data suggest that precourse functional and exercise classification is useful in selecting candidates who will receive the greatest functional benefits from participation in rehabilitative programs.