Efficacy and Safety of Prophylactic Use of Ketamine for Prevention of Postanesthetic Shivering

A Systematic Review and Meta Analysis

Yang Zhou; Abdul Mannan; Yuan Han; He Liu; Hui-Lian Guan; Xing Gao; Ming-Sheng Dai; Jun-Li Cao


BMC Anesthesiol. 2019;19(245) 

In This Article


Postanesthetic shivering is a frequent complication of anesthesia, perhaps even aggravating pain. It is characterized by involuntary movement that may affect one or more muscle groups and is a very unpleasant and physiologically stressful experience. Postanesthetic shivering can interfere with electrocardiography (ECG) and oxygen saturation (SpO2) monitoring.[1] More importantly, it can increase oxygen consumption combined with minute ventilation and carbon dioxide production. Moreover, it is believed that postanesthetic shivering can increase mortality in the elderly and patients with coronary artery disease.[2]

The aetiology of shivering is not sufficiently understood. Thermoregulatory and non-thermoregulatory factors may contribute to postoperative shivering including exposure to cold weather, inadequate pain control, and opioid withdrawal.[3,4] The gold standard for treatment and prevention has not yet been defined. A variety of pharmacological treatments and methods to reduce postoperative shivering have been used including meperidine, alfentanil, tramadol, magnesium sulfate, ondansetron, dolasetron, and dexmedetomidine.[5–9] Ketamine has also been used as an anti-shivering drug. It is a non-competitive N-methy-D-aspartate (NMDA) receptor antagonist; it may prevent postanesthetic shivering by decreasing core-to-peripheral heat distribution. Although many published literatures have investigated the potential effects of ketamine for prevention of postanesthetic shivering, there is no consensus regarding the appropriateness of this drug. Thus, an evidence-based understanding of the benefits and risks of ketamine would identify its rational and optimal use. We conducted the meta-analysis to assess the efficacy and safety of ketamine for the prevention of shivering in patients undergoing various surgical procedures.