Clinical Effect and Safety of Prophylactic Ondansetron for the Prevention of Postoperative Shivering: A Meta-analysis_West China Medical Journal

Authors：

 HUBai-long , DUYu ,  LUOJun

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LUOJun, Email: LLLjun@21cn.com

Keywords：

Postoperative shivering; Ondansetron; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.20140326

Video：

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Objective To evaluate the effectiveness and safety of prophylactic ondansetron for the prevention of postoperative shivering. Methods According to the Cochrane Handbook, we searched such databases as Cochrane Library, PubMed, OVID, EMbase, CNKI, CBM, and VIP (From January 1999 to September 2013) to collect the literature about ondansetron for the prevention of postoperative shivering. According to the predefined inclusion and exclusion criteria, we screened randomized controlled trials (RCTs). The included studies were evaluated and analyzed by meta-analysis with RevMan 5.0 software. Results Nine RCTs involving 655 patients were included. The results of meta-analysis showed that there was a significant difference in incidence of postoperative shivering between group ondansetron and the controls [RR=0.32, 95%CI (0.24, 0.42), P<0.05]. There was a significant difference in incidence of postoperative nausea and vomiting between the ondansetron group and the control group [RR=0.30, 95%CI (0.14, 0.63), P<0.05]. There was no significant difference in the 1 min and 5 min neonate born Apgar score between the ondansetron group and the control group [WMD=0.03, 95%CI (-0.02, 0.09), P=0.26; WMD=-0.02, 95%CI (-0.12, 0.08), P=0.68]. Conclusion Intravenous ondansetron before surgery can significantly reduce postoperative shivering without any increment of adverse effects.

Citation： HUBai-long, DUYu, LUOJun. Clinical Effect and Safety of Prophylactic Ondansetron for the Prevention of Postoperative Shivering: A Meta-analysis. West China Medical Journal, 2014, 29(6): 1063-1070. doi: 10.7507/1002-0179.20140326 Copy

1.	Alfonsi P. Postanaesthetic shivering epidemiology, pathophysiology and approaches to prevention and management[J]. Drugs, 2001, 61(15): 2193-2205.
2.	Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postoperative shivering[J]. Br J Anaesth, 2000, 84(5): 615-628.
3.	Dal D, Kose A, Honca M, et al. Efficacy of prophylactic ketamine in preventing postoperative shivering[J]. Br J Anaesth, 2005, 95(2): 189-192.
4.	Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients[J]. Anesth Analg, 2001, 93(5): 1288-1292.
5.	Sagir O, Gulhas N, Toprak H, et al. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron[J]. Acta Anaesthesiol Scand, 2007, 51(1): 44-49.
6.	Horn EP, Standl T, Sessler D, et al. Physostigmine prevents postanesthetic shivering as does meperidine or clonidine[J]. Anesthesiology, 1998, 88(1): 108-113.
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9.	Kelsaka E, Baris S, Karakaya D, et al. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia[J]. Reg Anesth Pain Med, 2006, 31(1): 40-45.
10.	Entezari Asl M, Isazadehfar Kh, Akhavanakbari G, et al. The effect of ondansetron in prevention of postoperative shivering after general anesthesia in gynecological surgery[J]. Iran Red Crescent Med J, 2012, 14(5): 316-317.
11.	Abdollahi MH, Forouzannia SK, Bagherinasab M, et al. The effect of ondansetron and meperedin on preventing shivering after off-pump coronary artery bypass graft[J]. Acta Med Iran, 2012, 50(6): 395-398.
12.	Robert MP, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia[J]. Anesth Analg, 2000, 90(6): 1423-1427.
13.	Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia[J]. J Anaesthesiol Clin Pharmacol, 2010, 26(4): 465-469.
14.	刘德昭, 黄品婕, 陈信芝, 等. 恩丹西酮预防剖宫产产妇寒战的临床观察[J]. 广东医学, 2004, 25(12): 1400-1401.
15.	曾振平. 昂丹司琼预防剖宫产产妇寒战的临床观察[J]. 实用临床医学, 2007, 8(4): 86-88.
16.	潘维敏, 臧凤松, 曲元. 恩丹西酮预防椎管内阻滞后寒战的效果[J]. 齐鲁医学杂志, 2001, 16(4): 273-275.
17.	邹延红, 李铁军, 孙继芬. 恩丹西酮预防经皮肾穿刺取石患者寒战效果观察[J]. 新乡医学院学报, 2007, 24(1): 60-62.
18.	Hsieh MT, Chueh FY, Lin MT. Magnolol decreases body temperature by reducing 5-hydroxytryptamine release in the rat hypothalamus[J]. Clin Exp Pharmacol Physiol, 1998, 25(10): 813-817.
19.	Dawson NJ, Malcolm JL. Initiation and inhibition of shivering in the rat: interaction between peripheral and central factors[J]. Clin Exp Pharmacol Physiol, 1982, 9(1): 89-93.

1. Alfonsi P. Postanaesthetic shivering epidemiology, pathophysiology and approaches to prevention and management[J]. Drugs, 2001, 61(15): 2193-2205.
2. Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postoperative shivering[J]. Br J Anaesth, 2000, 84(5): 615-628.
3. Dal D, Kose A, Honca M, et al. Efficacy of prophylactic ketamine in preventing postoperative shivering[J]. Br J Anaesth, 2005, 95(2): 189-192.
4. Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients[J]. Anesth Analg, 2001, 93(5): 1288-1292.
5. Sagir O, Gulhas N, Toprak H, et al. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron[J]. Acta Anaesthesiol Scand, 2007, 51(1): 44-49.
6. Horn EP, Standl T, Sessler D, et al. Physostigmine prevents postanesthetic shivering as does meperidine or clonidine[J]. Anesthesiology, 1998, 88(1): 108-113.
7. 杨冬, 薛富善. 麻醉后寒战及防治[J]. 国外医学·麻醉与复苏分册, 2003, 24(1): 21-23.
8. Higgins JPT, Green S. Assessing risk of bias in included studies[M/OL]//Cochrane handbook for systematic reviews of interventions 5.1.0.[updated March 2011]. The Cochrane Collaboration, http://www.cochrane-handbook.org.
9. Kelsaka E, Baris S, Karakaya D, et al. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia[J]. Reg Anesth Pain Med, 2006, 31(1): 40-45.
10. Entezari Asl M, Isazadehfar Kh, Akhavanakbari G, et al. The effect of ondansetron in prevention of postoperative shivering after general anesthesia in gynecological surgery[J]. Iran Red Crescent Med J, 2012, 14(5): 316-317.
11. Abdollahi MH, Forouzannia SK, Bagherinasab M, et al. The effect of ondansetron and meperedin on preventing shivering after off-pump coronary artery bypass graft[J]. Acta Med Iran, 2012, 50(6): 395-398.
12. Robert MP, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia[J]. Anesth Analg, 2000, 90(6): 1423-1427.
13. Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia[J]. J Anaesthesiol Clin Pharmacol, 2010, 26(4): 465-469.
14. 刘德昭, 黄品婕, 陈信芝, 等. 恩丹西酮预防剖宫产产妇寒战的临床观察[J]. 广东医学, 2004, 25(12): 1400-1401.
15. 曾振平. 昂丹司琼预防剖宫产产妇寒战的临床观察[J]. 实用临床医学, 2007, 8(4): 86-88.
16. 潘维敏, 臧凤松, 曲元. 恩丹西酮预防椎管内阻滞后寒战的效果[J]. 齐鲁医学杂志, 2001, 16(4): 273-275.
17. 邹延红, 李铁军, 孙继芬. 恩丹西酮预防经皮肾穿刺取石患者寒战效果观察[J]. 新乡医学院学报, 2007, 24(1): 60-62.
18. Hsieh MT, Chueh FY, Lin MT. Magnolol decreases body temperature by reducing 5-hydroxytryptamine release in the rat hypothalamus[J]. Clin Exp Pharmacol Physiol, 1998, 25(10): 813-817.
19. Dawson NJ, Malcolm JL. Initiation and inhibition of shivering in the rat: interaction between peripheral and central factors[J]. Clin Exp Pharmacol Physiol, 1982, 9(1): 89-93.

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Clinical Effect and Safety of Prophylactic Ondansetron for the Prevention of Postoperative Shivering: A Meta-analysis

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