Líquidos intravenosos aquecidos e calafrios maternos durante a cesariana sob anestesia neuroaxial: Uma revisão sistemática e metanálise

Objective: To evaluate the independent effect of warmed IV fluids, compared with room-temperature fluids, on the incidence of maternal shivering in women undergoing cesarean delivery under neuraxial anesthesia.Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Trials combining warmed IV fluids with other active warming interventions (e.g., forced-air warming) were excluded to isolate the effect of the fluids. The primary outcome was the incidence of maternal shivering. Data were pooled using a random-effects model to calculate risk ratios (RRs) and 95% confidence intervals (CIs). Risk of bias and certainty of evidence were evaluated using the Cochrane RoB 2 tool and the GRADE framework, respectively.Results: Four RCTs comprising 229 parturients were included. The incidence of maternal shivering was significantly lower in the warmed IV fluid group (20.5%, 26/127) compared to the room-temperature group (41.2%, 42/102). The pooled analysis demonstrated a 50% relative risk reduction favoring warmed fluids (RR 0.50, 95% CI 0.33–0.75; P = 0.001), with no observed statistical heterogeneity (I² = 0%). The overall certainty of evidence was graded as low due to serious imprecision driven by small sample sizes and methodological concerns.Conclusion: The administration of warmed IV fluids as a standalone intervention effectively halves the risk of maternal shivering during cesarean delivery under neuraxial anesthesia. While it represents a simple, low-cost, and pragmatic preventative strategy, the low certainty of current evidence necessitates larger, rigorously designed RCTs with standardized shivering assessments to confirm these findings.