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Medical Interventions for Preventing Postanesthesia Shivering in Children: A Network Meta-analysis
Chuan-Qi Yang1, Yu-Hao Liang1, A-Xue Cheng1
1Department of Anesthesiology, Luoyang Central Hospital Affiliated to Xinxiang Medical University, Luoyang, Henan, China.
Insights
Ketamine and alpha2-adrenoceptor agonists are effective in preventing postanesthetic shivering (PAS) in children. Ketamine showed the strongest effect, but its efficacy may be influenced by study size.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Evidence-Based Medicine
Background:
- Postanesthetic shivering (PAS) affects 6.3% to 14% of children after surgery.
- While adult treatments exist, pediatric meta-analyses for PAS are lacking.
Purpose of the Study:
- To evaluate various medical interventions for preventing PAS in children.
- To conduct a network meta-analysis (NMA) comparing treatment efficacies.
Main Methods:
- Systematic review and NMA of randomized controlled trials.
- Searched multiple databases including PubMed, Embase, and ClinicalTrials.gov.
- Synthesized results using a frequentist Mantel-Haenszel approach and common effect model, reporting pooled odds ratios (ORs).
Main Results:
- Ketamine demonstrated superiority over magnesium sulfate, midazolam, and placebo (ORs ranging from 0.01 to 0.04).
- Alpha2-adrenoceptor agonists were also superior to magnesium sulfate, midazolam, and placebo (ORs ranging from 0.02 to 0.16).
- 5-Hydroxytryptamine type 3 receptor antagonists showed efficacy against magnesium sulfate and placebo (ORs 0.03 and 0.18).
Conclusions:
- Ketamine, alpha2-adrenoceptor agonists, and 5-HT3 receptor antagonists are effective in preventing pediatric PAS.
- Ketamine exhibited the largest effect size but may be susceptible to small-study effects.
- Further research may be needed to fully understand the robustness of ketamine's efficacy.
Purpose:
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.
Design:
Systematic review and NMA.
Methods:
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.
Findings:
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.
Conclusions:
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.
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