title: Incidence of postoperative shivering comparing remifentanil with other opioids: a meta-analysis.
abstract: OBJECTIVE
  To determine whether the administration of remifentanil increases the incidence of postoperative shivering in comparison with the administration of alfentanil, fentanyl, or sufentanil.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Operating room and postanesthesia care unit.
  
  
  METHODS
  We performed a computerized search of articles on PubMed, MEDLINE, and Scopus. Meta-analysis was performed using Review Manager and the DerSimonian and Laird random-effects model. The pooled effect estimates for binary variables were calculated as relative risk (RR) values with 95% confidence intervals (CIs).
  
  
  RESULTS
  Eighteen randomized controlled trials met our inclusion criteria. Remifentanil was associated with a significantly increased incidence of postoperative shivering compared with other opioids (RR=2.17; CI, 1.76-2.68; P<.00001; I(2)=0.00%). A subgroup analysis of remifentanil compared with alfentanil, fentanyl, or sufentanil showed that only sufentanil had a similar rate of postoperative shivering incidence (RR=2.13; CI, 0.67-6.74; P=.20; I(2)=0.00%). Remifentanil administration was associated with a significant increase in the incidence of postoperative shivering compared with the administration of other opioids when both propofol (RR=2.44; CI, 1.52-3.92; P=.0002; I(2)=0.00%) and inhalation anesthesia drugs (RR=2.45; CI, 1.46-4.11; P=.0007; I(2)=0.00%) were used for anesthesia maintenance. In addition, the administration of remifentanil at both low (RR=2.06; CI, 1.63-2.60; P<.00001; I(2)=0.00%) and high dosages (RR=2.77; CI, 1.67-4.57; P<.0001; I(2)=0.00%) was associated with a significant increase in the incidence of postoperative shivering compared with the administration of other opioids.
  
  
  CONCLUSIONS
  Our meta-analysis showed that remifentanil was associated with an increased incidence of postoperative shivering compared with alfentanil or fentanyl, but no significant difference was seen when compared with sufentanil.
authors.affiliation: Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan. Electronic address: hhoshi@saitama-med.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshijima
authors.affiliation: Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan.
authors.forename: Risa
authors.initials: R
authors.lastname: Takeuchi
authors.affiliation: Department of Anesthesiology, Saitama Children's Medical Center, Saitama, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kuratani
authors.affiliation: Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Nishizawa
authors.affiliation: Department of Internal Medicine, Drexel University College of Medicine, PA, USA.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Denawa
authors.affiliation: Department of Anesthesia, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Chiba, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shiga
authors.affiliation: Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagasaka
mesh_terms: D015760:Alfentanil / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D010880:Piperidines / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D000077208:Remifentanil; D012768:Shivering / Q000187:drug effects*; D017409:Sufentanil / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D015760:Alfentanil; D017409:Sufentanil; D000077208:Remifentanil; D005283:Fentanyl
keywords: Postoperative shivering; Remifentanil