Effectiveness of active warming to prevent shivering during elective cesarean delivery under spinal anesthesia: A systematic review and meta-analysis.

BACKGROUND

Active warming (AW) is commonly used to prevent hypothermia during cesarean delivery (CD).

OBJECTIVE

To evaluate the effects of AW on shivering during CD under spinal anesthesia (SA).

SEARCH STRATEGY: PubMed, Embase, CENTRAL, Web of Science, and Wanfang were searched without language or date restrictions.

SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating forced-air warming (FAW), intravenous fluid (IVF) warming, and warmed mattresses alone or in combination for shivering during CD under SA.

DATA COLLECTION AND ANALYSIS: A random effects model was used to compare AW with no AW and combined AW with single AW on shivering and hypothermia.

MAIN

RESULTS

Twenty-four RCTs were included. AW reduced the incidence of shivering (risk ratio [RR] 0.38, 95% confidence interval [CI] 0.28-0.50) and hypothermia (RR 0.50, 95% CI 0.37-0.68) compared with no AW, but combined AW provided no additional benefit over single AW for shivering (RR 0.72, 95% CI 0.50-1.05) or hypothermia (RR 0.59, 95% CI 0.27-1.29). Different AW methods, different durations of FAW, and the use of intrathecal opioids did not affect the effects of AW on shivering.

CONCLUSIONS

AW techniques, either alone or in combination, are equivalent in preventing shivering during elective CD under SA.

PROSPERO REGISTRATION: No. CRD42024555800.