Medical Interventions for Preventing Postanesthesia Shivering in Children: A Network Meta-analysis

About 6.3% to 14% of children undergoing surgery develop postanesthetic shivering (PAS). Many drugs were used to relieve PAS in adults. However, no relevant meta-analyses have been conducted in children. The network meta-analysis (NMA) was performed to evaluate different medical interventions in children.

Systematic review and NMA.

Randomized controlled trials were retrieved through PubMed, CINAHL, Web of Science, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The outcome was the incidence of PAS. For the NMA, a frequentist Mantel-Haenszel approach was adopted. The common effect model was employed. Results were synthesized into pooled odds ratios (ORs). P scores were generated to rank the treatments.

Overall, 13 trials were included in the study. In NMA, ketamine was superior to magnesium sulfate, midazolam, and placebo: OR 0.01 (95% confidence interval [CI] 0.00 to 0.09), OR 0.06 (95% CI 0.01 to 0.46), and OR 0.04 (95% CI 0.01 to 0.16). α₂-Adrenoceptor agonists were superior to magnesium sulfate, midazolam, and placebo: OR 0.02 (95% CI 0.00 to 0.21), OR 0.16 (95% CI 0.07 to 0.35), and OR 0.10 (95% CI 0.03 to 0.30). 5-Hydroxytryptamine type 3 receptor antagonists were superior to magnesium sulfate and placebo: OR 0.03 (95% CI 0.00 to 0.38) and OR 0.18 (95% CI 0.06 to 0.51). Ketamine was ranked higher than other interventions.

While ketamine, α₂ adrenoceptor agonists, and 5-hydroxytryptamine type 3 receptor antagonists all demonstrate significant efficacy in preventing PAS, the extreme effect size observed for ketamine is particularly vulnerable to small-study effects.