• Hiroshi Hoshijima, Risa Takeuchi, Norifumi Kuratani, Shuya Nishizawa, Yohei Denawa, Toshiya Shiga, and Hiroshi Nagasaka.
• Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan. Electronic address: hhoshi@saitama-med.ac.jp.
• J Clin Anesth. 2016 Aug 1; 32: 300-12.

Study ObjectiveTo determine whether the administration of remifentanil increases the incidence of postoperative shivering in comparison with the administration of alfentanil, fentanyl, or sufentanil.DesignMeta-analysis.SettingOperating room and postanesthesia care unit.MeasurementsWe 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).Main ResultsEighteen 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.ConclusionsOur 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.Copyright © 2015 Elsevier Inc. All rights reserved.

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