Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials

• Published in: Canadian journal of anesthesia 2015-07, Vol.62 (7), p.816-829
• Main Authors: Liu, Zhen-Xiu, Xu, Feng-Ying, Liang, Xiao, Zhou, Miao, Wu, Liang, Wu, Jing-Ru, Xia, Jian-Hua, Zou, Zui
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-2 Receptor Agonists - administration & dosage; Adrenergic alpha-2 Receptor Agonists - adverse effects; Adrenergic alpha-2 Receptor Agonists - therapeutic use; Anesthesia; Anesthesiology; Cardiology; Clinical trials; Critical Care Medicine; Dexmedetomidine - administration & dosage; Dexmedetomidine - adverse effects; Dexmedetomidine - therapeutic use; Fentanyl; Humans; Intensive; Medicine; Medicine & Public Health; Meta-analysis; Pain Medicine; Pallets; Pediatrics; Pneumology/Respiratory System; Postoperative Complications - drug therapy; Review Article/Brief Review; Shivering - drug effects
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-015-0368-1

Purpose Shivering is a frequent complication in the postoperative period. The aim of the current meta-analysis was to assess the efficacy of dexmedetomidine on postoperative shivering. Methods Two researchers independently searched PubMed, EMBASE™ and the Cochrane Central Register of Controlled Trials for controlled clinical trials. The meta-analysis was performed by Review Manager. Results Thirty-nine trials with 2,478 patients were included in this meta-analysis. Dexmedetomidine reduced postoperative shivering compared with placebo (risk ratio [RR] = 0.26; 95% confidence interval [CI]: 0.20 to 0.34), with a minimum effective dose of 0.5 µg·kg −1 (RR = 0.36; 95% CI: 0.21 to 0.60). The anti-shivering effect can be achieved both intravenously and epidurally when administered within two hours prior to the end of surgery. The efficacy of dexmedetomidine was similar to widely used anti-shivering agents, such as fentanyl, meperidine, tramadol, clonidine and so on; however, dexmedetomidine may increase the incidence of sedation, hypotension, bradycardia and dry mouth. Conclusions The present meta-analysis indicates that dexmedetomidine shows superiority over placebo, but not over other anti-shivering agents. Therefore, considering its high price and potential adverse events, dexmedetomidine may not be appropriate solely for the purpose of the prevention of postoperative shivering.