Efficacy of preoperative hydrocortisone versus tramadol for attenuation of postoperative shivering after percutaneous nephrolithotripsy: A randomized controlled trial

The Effect of Prophylactic Steroids on Shivering in Adults Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Shivering is common following anesthesia and surgery. Corticosteroids (steroids) have been tried to reduce the risk of shivering, but the evidence in favor of their use is uncertain. The primary objective of this review was to evaluate the effect of steroids on the risk of perioperative (intra- and postoperative) shivering versus controls (placebo and active controls). Additional objectives were to assess the risk of severity of shivering, patient satisfaction with shivering prophylaxis, quality of recovery (QoR), and the risk of steroid-related adverse effects.

METHODS

PubMed, Embase, Cochrane Central Registry of Trials, Google Scholar, and preprint servers were searched from inception until November 30, 2022. Randomized controlled trials (RCTs) published in the English language were retrieved, provided they reported on shivering either as a primary or secondary outcome following steroid prophylaxis in adult patients undergoing surgery under spinal or general anesthesia.

RESULTS

A total of 3148 patients from 25 RCTs were included in the final analysis. The steroids used in the studies were either dexamethasone or hydrocortisone. Dexamethasone was administered intravenously or intrathecally, while hydrocortisone was administered intravenously. Prophylactic administration of steroids reduced the risk of overall shivering (risk ratio [RR], 0.65 [95% confidence interval {CI}, 0.52-0.82]; P = .0002; I2 = 77%) as well as the risk of moderate to severe shivering (RR, 0.49 [95% CI, 0.34-0.71]; P = .0002; I2 = 61%) in comparison to controls. Administration of intravenous dexamethasone (RR, 0.67 [95% CI, 0.52-0.87]; P = .002; I2 = 78%) and hydrocortisone (RR, 0.51 [95% CI, 0.32-0.80]; P = .003; I2 = 58%) were effective in shivering prophylaxis. For intrathecal dexamethasone (RR, 0.84 [95% CI, 0.34-2.08]; P = .7; I2 = 56%), the null hypothesis of no subgroup difference was not rejected ( P = .47), preventing definitive conclusions about the efficacy of this route of administration. The prediction intervals for both overall shivering risk (0.24-1.70) and risk of severity of shivering (0.23-1.0) precluded generalization of results in future studies. Meta-regression analysis was used to further explore heterogeneity. Factors like the dose and timing of administration of steroids or the type of anesthesia were not found to be significant. Patient satisfaction and QoR were higher in the dexamethasone groups versus placebo. No increased risk of adverse events of steroids was noted versus placebo or controls.

CONCLUSIONS

Prophylactic steroid administration may be beneficial in reducing the risk of perioperative shivering. However, the quality of evidence in favor of steroids is very low. Further well-designed studies are needed for establishing generalization.

Magnitude and associated factors of intra-operative hypothermia among pediatric patients undergoing elective surgery: A multi-center cross-sectional study

BACKGROUND

Hypothermia is a core body temperature of less than 36 c0 that could increase perioperative morbidity & mortality of pediatric patients operated under general anesthesia. This study aimed to assess the magnitude and associated factors of intra-operative hypothermia among pediatric patients undergoing elective surgery.

METHOD

Institutional based cross-sectional study was conducted on 339 pediatric patients undergoing elective surgery in referral hospitals of Addis Ababa, Ethiopia. Data were collected using a structured questionnaire. Descriptive statics were expressed in percentage and presented with tables. Both Bivariable and multivariable logistic analysis was done to identify factors associated with intra-operative hypothermia among pediatric patients undergoing elective surgery. P < 0.05 with 95% CI was set as statistical significance.

RESULT

The magnitude of intra-operative hypothermia in this study was 39.8 [95% CI= (34.5-45.1)]. Multivariable logistic analyses showed that ambient temperature less than 26c0 [AOR = 6; 95%CI=(2.859-13.23)], volume of fluid administered greater than half a liter [AOR = 3.6; 95%CI=(1.83-7.23)], Patients who were received un-warm fluid [AOR = 2.2; 95%CI=(1.28-4.04)] and duration of surgery and anesthesia greater than 120 min [AOR = 3.4; 95%CI=(1.29-8.79)] and [AOR = 3.8; 95%CI=(1.25-11.53)] respectively were factors significantly associated with intra-operative hypothermia.

CONCLUSION

The magnitude of intra-operative hypothermia in this study was high. So, adherence must be done in the prevention of intraoperative hypothermia by health professionals such as increasing operation room temperature, warming administered fluid, optimal fluid administration, and reduction of the duration of surgery and anesthesia.