Intravenous dexmedetomidine versus intravenous clonidine for post spinal anesthesia shivering: a meta-analysis of randomized controlled trials

Abstract

Background Dexmedetomidine and clonidine are the most extensively studied drugs for shivering treatment, because α2-adrenergic agonists can reduce the shivering threshold. The objective of this meta-analysis was to compare the efficacy and complications of dexmedetomidine with those of clonidine, when used for control of post spinal anesthesia shivering. Methods Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of dexmedetomidine versus clonidine for control of post spinal anesthesia shivering. The endpoints were effective rate of shivering treatment, time to cease shivering, recurrent rate of shivering and complications. Results Six studies comprising 340 adult patients were included in this meta-analysis. Dexmedetomidine had higher effective rate of shivering treatment (odds ratio [OR]: 4.11, 95% confidence interval (CI): [1.53, 11.07], P = 0.005), shorter time to cease shivering (Mean differences (MD)=–1.91; 95% CI [–3.66, –0.15], P = 0.03), lower recurrent rate of shivering (OR = 0.30; 95% CI [0.12, 0.75], P = 0.01), compared to clonidine. Dexmedetomidine had a lower rate of hypotension and higher incidence of sedation than clonidine. Conclusions Dexmedetomidine is superior to clonidine when used for shivering treatment after spinal anesthesia, because of higher incidence of effective rate and sedation, faster control of shivering, lower incidence of recurrent rate and hypotention.

Alpha-2-adrenergic receptor agonists for the prevention of delirium and cognitive decline after open heart surgery (ALPHA2PREVENT): protocol for a multicentre randomised controlled trial

“… 74 To our knowledge, a widely agreed evidence-based intravenous dosage regimen has not been developed for intravenous clonidine. A study by Grest et al in critically ill patients after cardiac surgery 74 and a recent meta-analysis favour equipotency mg per mg. 75 Thus, our choice is fairly pragmatic, but the doses are similar to that currently used in many ICUs as part of routine practice.…”

Comparison of dexmedetomidine and meperidine for the prevention of shivering following coronary artery bypass graft: study protocol of a randomised controlled trial

“…Dexmedetomidine is a highly selective α 2 -adrenoceptor agonist with an eightfold higher affinity for the α 2 -adrenoceptor than clonidine, which can cause sedation, analgesia, anxiolysis and attenuation of the neuroendocrine and haemodynamic responses to anaesthesia and surgery. 13 14 It may also provide a deeper level of sedation, decrease the incidence of postoperative nausea and vomiting (PONV), and increase haemodynamic stability during a sudden increase in stress. 15 Previous studies have shown that dexmedetomidine can reduce the incidence of shivering after both spinal and general anaesthesia.…”