title: Meta-analysis of randomized controlled trials on the efficacy and safety of ondansetron in preventing postanesthesia shivering.
abstract: OBJECTIVE
  Considerable controversy exists regarding the efficacy of ondansetron in preventing postanesthesia shivering (PAS). We performed a meta-analysis of randomized controlled trials to examine the controversy.
  
  
  METHODS
  Randomized controlled trials assessing the effect of ondansetron on the prevention of PAS were identified from electronic databases (PubMed and EMBASE). The meta-analysis was performed with the fixed-effect model or random-effect model according to heterogeneity.
  
  
  RESULTS
  Twelve trials randomized clinical trials met the inclusion criteria including 1205 subjects. Compared with placebo (saline), ondansetron was associated with a significant reduction of PAS (relative risk 0.33; 95% confidence interval, 0.21-0.51), Substantial heterogeneity was observed between trials (P = 0.0002; I2= 71%). Trial sequential analysis showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit establishing sufficient and conclusive evidence. Meta-analysis with all five studies using a fixed-effects model suggested that ondansetron and meperidine have similar effects on the prevention of PAS (relative risk, 0.86; 95% confidence interval, 0.66-1.11), the heterogeneity was not significant (P = 0.34; I2= 11%). No significant association of ondansetron with bradycardia was found both comparison with placebo and meperidine.
  
  
  CONCLUSIONS
  Treat with ondansetron is safe, and may reduce PAS. This finding encourages the use of ondansetron to prevent PAS, but, more high quality randomized clinical trials are still warranted to confirm the effects of different doses of ondansetron on PAS.
authors.affiliation: Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Anaesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
authors.forename: Xiaolan
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
authors.forename: Baoping
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China. Electronic address: zytang07016@sina.com.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Tang
mesh_terms: D000758:Anesthesia / Q000009:adverse effects*; D006801:Humans; D017294:Ondansetron / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012702:Serotonin Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D012768:Shivering / Q000187:drug effects*
chemical_list: D012702:Serotonin Antagonists; D017294:Ondansetron
keywords: Meta-analysis; Ondansetron; Shivering