# A Scoping Review: Ketamine for the Prevention of Perioperative Shivering in Patients Undergoing Spinal Anesthesia

## TL;DR

This review examines how well ketamine prevents shivering during spinal anesthesia, finding it effective but with mixed comparisons to other drugs.

## Contribution

The study provides a comprehensive evaluation of ketamine's efficacy in preventing shivering compared to other drugs in spinal anesthesia.

## Key findings

- Ketamine was more effective than saline in preventing shivering in three out of five studies.
- Ketamine showed mixed results when compared to tramadol and dexmedetomidine.
- Meperidine was more effective than ketamine in reducing shivering intensity.

## Abstract

Shivering is a frequently encountered perioperative complication in patients undergoing spinal anesthesia. Numerous different pharmacological agents have been employed to mitigate this issue. This scoping review aims to evaluate the efficacy of ketamine in mitigating the incidence of shivering. This review process utilized PubMed, JAMA, and Cochrane as primary databases. Searches were performed using combinations of key terms: "Ketamine," "Shivering," "Spinal Anesthesia," and "Hypothermia." Reviews of reference lists for additional pertinent data were performed. When ketamine was compared against a saline control, three out of five studies found ketamine to be more effective (p < 0.05, p < 0.001, p < 0.001) in the prevention of shivering. When compared with tramadol, two studies found ketamine to be more effective (p < 0.001, p < 0.001), one found no difference (p = 0.261), and one found tramadol to be more effective (p < 0.001). Two studies found dexmedetomidine more effective (p < 0.022, p < 0.027) than ketamine and tramadol. When comparing ketamine, ondansetron, and meperidine, all three were effective (p < 0.001) versus saline, with no significant difference between the three. Meperidine demonstrated more efficacy (p < 0.05) in reducing the intensity of shivering than ketamine. Ketamine's effects on hemodynamics were shown to be equivocal or more favorable across several studies. While there is mixed evidence on whether it is better than other treatments, ketamine may have advantages from a hemodynamic standpoint. Dosages of 0.2-0.5 mg/kg with or without a subsequent infusion of 0.1 mg/kg per hour may aid in the prevention of perioperative shivering. Overall, ketamine is a safe and effective drug for the prevention of perioperative shivering. However, other drugs may be equally or more effective; therefore, patient population, hemodynamic status, patient preferences, and provider familiarity with different agents should be considered.