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Treatment of Postanesthetic Shivering A Quantitative Systematic Review



Treatment of Postanesthetic Shivering A Quantitative Systematic Review



Anesthesiology Abstracts of Scientific Papers Annual Meeting (2001): Abstract No A-25



Introduction: Postanesthetic shivering (PAS) is a frequent complication following anesthesia and it is worthwile to treat this symptom both from the patients and experts point of view (1, 2). Apart from being an unpleasant side effect of anesthesia PAS increases oxygen consumption (3) and is thus a threat for patients with a compromised cardiovascular system who are unable to adjust to the increased demand. The objective of this study was to compare, by means of a quantitative systematic review (metaanalysis), the relative efficacy of pharmacological interventions investigated in randomized controlled trials. Methods: Randomized controlled trials (RCT) investigating the treatment of PAS were systematically searched using MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and by manual screening the reference lists of retrieved publications and related review articles. Retrospective analyses, studies without adequate randomization, abstracts and unpublished data were not considered. The date of the last computer search was the 11th of August 2000. The main end point in each study was defined as the incidence of PAS 5 min after application of the investigated study drug. Pooled relative risk (RR) and the numbers-needed-to-treat (NNT) with their corresponding 95%-confidence intervals (given in parentheses) were calculated with the computer program Reference ManagerTM Collaboration (4). A RR < 1 means that the investigated interventions are associated with a lower risk of PAS compared to placebo. This difference was considered statistically significant when the 95%-confidence interval of the RR did not include the value of 1.00. Results: A total of 20 studies covering 42 comparisons were analyzed. Eligible for a quantitative analysis were the pooled data for the trials investigating pethidine, clonidine, ketanserin, doxapram and tramadol. In view of the relative small number of studies or number of patients the RCT investigating nefopam, nalbuphine, magnesium, methylphenidate, fentanyl, lidocaine, alfentanil, metamizol, morphine and pentazocine were only subjected to a qualitative analysis. Both pethidine with a RR of 0.22 (0.15-0.33), a NNT of 1.47 (1.30-1,69) and clonidine with a RR of 0.22 (0.13-0.37) and a NNT of 1.33 (1.19-1.52) were significantly superior to placebo in the treatment of PAS. With three comparisons each eligible for a quantitative analysis the RR and corresponding NNT were 0.39 (0.19-0.79) / 2.08 (1.59-2.94) for ketanserin, 0.39 (0.26-0.49) / 1.89 (1.52-2.44) for doxapram, and 0.09 (0.01-0.70) / 1.23 (1.02-1.56) for tramadol. Looking at the other investigated interventions there seems to be a potential benefit for nefopam, nalbuphine, magnesium and methylphenidate in the treatment of PAS but further studies are needed. Fentanyl, lidocaine, alfentanil, metamizol, morphine and pentazocine are poorly investigated but so far showed no promising beneficial effect. Conclusion: Clonidine (apprxeq75-150mug) and pethidine (apprxeq25-50mg) seem to effectively suppress PAS, with pethidine 25 mg intravenously currently being the best documented intervention for adults. These drugs will stop PAS within 5 min after application in about 70 out of 100 patients who otherwise would have shivered for a longer time.

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Accession: 035980583

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