What is the initial dose of Demerol (Meperidine) to administer intravenously to a patient experiencing post-anesthesia shivering?

From the Guidelines

The initial dose of Demerol (meperidine) to administer intravenously for post-anesthesia shivering is 25 mg, as indicated in the most recent and highest quality study available 1. This medication should be given as a slow IV push over 2-3 minutes to minimize side effects. For elderly patients or those with renal or hepatic impairment, consider reducing the initial dose to 12.5 mg. The onset of action is rapid, typically within 5-10 minutes, and the anti-shivering effect usually lasts 1-2 hours. If shivering persists after the initial dose, an additional 25 mg may be administered after 20-30 minutes, but the total dose should generally not exceed 100 mg in a 4-hour period. Meperidine is particularly effective for post-anesthesia shivering because it works through both opioid mechanisms and unique anti-shivering properties related to its effect on the thermoregulatory center in the hypothalamus. Monitor patients closely for respiratory depression, hypotension, and other opioid-related side effects during and after administration. Some key points to consider when administering meperidine for post-anesthesia shivering include:

• The dose and administration rate should be adjusted based on the patient's response and medical history.
• Meperidine can cause respiratory depression, hypotension, and other opioid-related side effects, so close monitoring is essential.
• The medication should be used with caution in patients with renal or hepatic impairment, as well as in elderly patients.
• Meperidine is not the only option for treating post-anesthesia shivering, and other medications such as fentanyl and propofol may also be effective 1. It's also important to note that the use of meperidine for post-anesthesia shivering is supported by the most recent and highest quality study available 1, which provides guidance on the management of sedation and shivering after cardiac arrest. Overall, meperidine can be an effective treatment for post-anesthesia shivering when used appropriately and with close monitoring.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION For Relief of Pain Dosage should be adjusted according to the severity of the pain and the response of the patient. The FDA drug label does not answer the question.

From the Research

Dose of Demerol for Post-Anesthesia Shivering

The initial dose of Demerol (Meperidine) to administer intravenously to a patient experiencing post-anesthesia shivering is:

• 25 mg, as indicated in studies 2, 3

Efficacy of Demerol in Treating Post-Anesthesia Shivering

Demerol has been shown to be effective in treating post-anesthesia shivering, with:

• A single dose of 25 mg meperidine stopping shivering in 18 of 20 patients in one study 2
• Meperidine being nearly 100% effective in treating postanesthetic shivering without negative side effects in another study 2
• The number-needed-to-treat (NNT) of meperidine 25 mg for no further shivering compared with placebo being 2.7 after 1 min and 1.3 after 5 min in a systematic review of randomized controlled trials 3

Comparison with Other Treatments

Demerol has been compared with other treatments for post-anesthesia shivering, including:

• Clonidine, which was found to be equally effective in some studies 2, 4
• Urapidil, which was found to be less effective than meperidine in one study 2
• Ketanserin, which was found to be effective in treating postanesthetic shivering in another study 4