Cooling methods based on medications
Dantrolene sodium is a skeletal muscle relaxant that reduces
muscular heat produced during abnormally sustained contraction
such as observed in malignant hyperthermia and neuroleptic
malignant syndrome [28,29,41]. It acts directly on the
skeletal muscle and is thought to inhibit calcium release from
the sarcoplasmic reticulum to the cytosol during sustained
contraction and thereby reverses muscle rigidity and
decreases production of heat [41,42]. Table 5 presents a
summary of data on pharmacologic cooling in the treatment of
classic heatstroke. Two randomized controlled studies
assessed the cooling enhanced pharmacologically by using
dantrolene sodium [28,29].
In a randomized study of 20 patients, 2 to 4 mg/kg dantrolene
sodium plus evaporative cooling was found to reduce significantly
the cooling time compared with evaporative cooling
alone [28]. However, flaws in the study design (namely, a small
number of patients and an undefined randomization procedure
with the use of different cooling techniques and doses of
dantrolene sodium, which were non-blinded to clinicians) raise
doubts about the scientific validity of the results.
Cooling methods based on medicationsDantrolene sodium is a skeletal muscle relaxant that reducesmuscular heat produced during abnormally sustained contractionsuch as observed in malignant hyperthermia and neurolepticmalignant syndrome [28,29,41]. It acts directly on theskeletal muscle and is thought to inhibit calcium release fromthe sarcoplasmic reticulum to the cytosol during sustainedcontraction and thereby reverses muscle rigidity anddecreases production of heat [41,42]. Table 5 presents asummary of data on pharmacologic cooling in the treatment ofclassic heatstroke. Two randomized controlled studiesassessed the cooling enhanced pharmacologically by usingdantrolene sodium [28,29].In a randomized study of 20 patients, 2 to 4 mg/kg dantrolenesodium plus evaporative cooling was found to reduce significantlythe cooling time compared with evaporative coolingalone [28]. However, flaws in the study design (namely, a smallnumber of patients and an undefined randomization procedurewith the use of different cooling techniques and doses ofdantrolene sodium, which were non-blinded to clinicians) raisedoubts about the scientific validity of the results.
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