5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis

Zhou, Chengmao; Zhu, Yu; Liu, Zhen; Lin, Run

doi:10.1177/0300060516668776

Cited by 12 publications

(16 citation statements)

References 24 publications

(29 reference statements)

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“…12 Third, Zhou et al had not performed subgroup analysis for different kinds of 5-HT 3 receptor antagonists. 13 In addition, new RCTs were published over the past few years. Therefore, an updated meta-analysis was required.…”

Section: Discussionmentioning

confidence: 99%

5-HT₃receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Shen

Li²,

Zhou

et al. 2020

BMJ Open

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ObjectivePerioperative shivering (POS) is a common complication in patients undergoing spinal anaesthesia. The present study investigated the efficacy of 5-HT3 receptor antagonists in preventing POS following spinal anaesthesia.DesignSystematic review and meta-analysis.Data sourcesPubmed, Embase, the Web of Science and Cochrane Library were searched from database establishment on 31 July 2019.Eligibility criteriaRandomised controlled trials that reported the effects of 5-HT3 receptor antagonists in the prevention of POS in patients after spinal anaesthesia.Data extraction and synthesisTwo reviewers independently extracted data. The primary outcome of the present study was the incidence of POS. The risk of bias for the included studies was assessed according to the Cochrane Handbook. The quality of primary outcome was evaluated by Grading of Recommendations Assessment, Development and Evaluation. Trial sequential analysis for the primary outcome was performed to reduce the type 1 error caused by repeated meta-analysis and the required information size was calculated.ResultsA total of 13 randomised controlled trials consisting of 1139 patients were included. The overall incidence of POS was significantly lower in the 5-HT3 receptor antagonists group (risk ratio 0.31; 95% CI 0.26 to 0.38; p<0.01; I2=0%). Subgroup analysis for different types of 5-HT3 receptor antagonists and timing of administration produced similar results. Also, patients had a lower incidence of postoperative nausea and vomiting after administrating 5-HT3 receptor antagonists. No statistically significant differences in drug-related adverse effects were observed. Grading of Recommendations Assessment, Development and Evaluation revealed a high level of evidence. The cumulative z-curve crossed the trial sequential monitoring boundary.ConclusionsThe present study revealed that prophylactic 5-HT3 receptor antagonists were an effective measure for reducing the incidence of POS in patients after spinal anaesthesia. However, further studies investigating the different types of surgeries are required.PROSPERO registration numberCRD42019148191.

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Section: Discussionmentioning

confidence: 99%

5-HT₃receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Shen

Li²,

Zhou

et al. 2020

BMJ Open

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“…5-HT 3 antagonists effectively prevent postoperative shivering after general anaesthesia and spinal anaesthesia [45].…”

Section: Antiserotonergic Agentsmentioning

confidence: 97%

“…More recently, 5-HT 3 receptor antagonists have emerged as means of preventing postoperative shivering. According to meta-analysis by Zhoy C, 5-HT 3 receptor antagonists appear to prevent postoperative shivering, with a broadly comparable efficacy to meperidine [45].…”

Section: Antiserotonergic Agentsmentioning

confidence: 99%

Postanaesthetic shivering – from pathophysiology to prevention

López

2018

Rom J Anaesth Int Care

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Postoperative shivering is a common complication of anaesthesia. Shivering is believed to increase oxygen consumption, increase the risk of hypoxemia, induce lactic acidosis, and catecholamine release. Therefore, it might increase the postoperative complications especially in high-risk patients. Moreover, shivering is one of the leading causes of discomfort for postsurgical patients. Shivering is usually triggered by hypothermia. However, it occurs even in normothermic patients during the perioperative period. The aetiology of shivering has been understood insufficiently. Another potential mechanism is pain and acute opioid withdrawal (especially with the use of short-acting narcotics). Besides that shivering is poorly understood, the gold standard for the treatment and prevention has not been defined yet. Perioperative hypothermia prevention is the first method to avoid shivering. Many therapeutic strategies for treating shivering exist and most are empiric. Unfortunately, the overall quality of the antishivering guidelines is low. Two main strategies are available: pharmacological and non-pharmacological antishivering methods. The combination of forced-air warming devices and intravenous meperidine is the most validated method. We also analysed different medications but final conclusion about the optimal antishivering medication is difficult to be drawn due to the lack of high-quality evidence. Nevertheless, control of PS is possible and clinically effective with simple pharmacological interventions combined with non pharmacological methods. However, to be consistent with the most up-to-date, evidence-based practice, future antishivering treatment protocols should optimize methodological rigor and transparency.

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“…Shivering an involuntary, oscillatory muscular activity, is a physiological thermoregulatory response to cold. Under spinal anaesthesia, shivering occurs as a response to lowering of core body temperature and decrease in blood supply to the upper body [11] . Factors lead to hypothermia and Shivering; age, duration of surgery, the operating room temperature, type of regional anesthesia (spinal or epidural), and infusion solution [12] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Prophylactic Intravenous Pethidine versus Intravenous Ondansetron in Prevention Post Spinal Shivering in Hysterectomy

Azzam

2019

The Medical Journal of Cairo University

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Background: Spinal anesthesia is known to significantly impair thermoregulation; shivering associated with spinal anesthesia is reported up to 55%. Pethidine probably acts directly on the thermoregulatory center or via opioid receptors. Mechanism of action of 5HT antagonist as anti-shivering is thought to be related to inhibition of serotonin reuptake on the preoptic anterior hypothalamic region. Aim of Study: This study was designed to compare the effectiveness of intravenous Pethidine versus intravenous Ondansetron for prevention of post-spinal shivering (primary outcome), hemodynamic changes, side effects of both groups were also evaluated (secondary outcome). Material and Methods: Patients were randomly assigned allocated into two groups (Group P n=30 patients) received pethidine 0.4mg/kg and (Group O n=30 patients) received Ondansetron 4mg as premedication (each drug was mixed into 10ml isotonic saline and given to the patient, slowly IV). Results: Non-significant differences between two groups as regards episodes of shivering, grading of shivering and tympanic temperature, but there is delayed onset of shivering episodes in pethdine group. There was statistically significant decrease in patients had nausea and vomiting in O group. While there was no statistically significant difference as regard sedation in both groups. Conclusion: The use of Prophylactic 4mg Ondansetron (5HT3 antagonist) is equally effective as 0.4mg/kg pethidine in the prevention of perioperative shivering following spinal anesthesia, maintains core temperature and Prophylactic Ondansetron also reduces the need of antiemetics.

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5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis

Cited by 12 publications

References 24 publications

5-HT₃receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

5-HT₃receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Postanaesthetic shivering – from pathophysiology to prevention

Comparison of Prophylactic Intravenous Pethidine versus Intravenous Ondansetron in Prevention Post Spinal Shivering in Hysterectomy

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5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis

Cited by 12 publications

References 24 publications

5-HT3receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

5-HT3receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Postanaesthetic shivering – from pathophysiology to prevention

Comparison of Prophylactic Intravenous Pethidine versus Intravenous Ondansetron in Prevention Post Spinal Shivering in Hysterectomy

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5-HT₃receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

5-HT₃receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials