Evidence map›Paper›PMID 41716312›Full record

SynthesisFrontiers in pharmacology2026

Estimated preventive dose of racemic ketamine for shivering and pruritus prophylaxis in cesarean delivery: a Monte Carlo simulation guided network meta-analysis.

Wei-Long Wang, Jin Zhou, Yi Cai, Min-Zhu Zheng, Kai-Yu Chen, Ying Hu, Xin Men, Jian-Liang Sun, Xu Qiu, Zhen-Feng Zhou

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Wei-Long Wang *The Fourth Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China.
Jin Zhou *The Fourth Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China.
Yi Cai *The Fourth Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China.
Min-Zhu ZhengDepartment of Delivery Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Healthcare Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China.
Kai-Yu ChenDepartment of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Healthcare Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China.
Ying HuDepartment of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Healthcare Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China.
Xin MenDepartment of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Healthcare Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China.
Jian-Liang SunDepartment of Anesthesiology, Hangzhou First People's Hospital, Hangzhou, China.
Xu QiuThe Fourth Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China.
Zhen-Feng ZhouThe Fourth Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: The use of ketamine and esketamine in cesarean delivery is limited by their dose-dependent adverse effects. This study aimed to precisely quantify the dose-response relationships for the prevention of shivering and pruritus and to determine the associated risk of neuropsychiatric side effects, thereby defining its therapeutic window. Methods: A systematic review and network meta-analysis were conducted. We searched databases for randomized controlled trials (RCTs) evaluating a single intravenous bolus of ketamine or esketamine during cesarean delivery under neuraxial anesthesia. Study quality was assessed using the Cochrane RoB 2 tool. We integrated traditional and network meta-analysis with logistic regression, Monte Carlo simulation, and polynomial regression to establish continuous dose-response models and calculate key dose parameters (ED Results: 25 studies(3,842 participants) were included. The ED Conclusion: The benefits of low-dose ketamine (≈0.12 mg/kg) for pruritus prophylaxis clearly outweigh its risks. In contrast, the dose required for shivering prevention (≈0.33 mg/kg) falls within the range where side effects become common, resulting in a narrow therapeutic window. This study provides critical dose-finding evidence for individualized, goal-directed use of ketamine in cesarean delivery. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251073122, identifier CRD420251073122.

Indexed as

adverse effectsdose-responsesketamineMonte Carlo simulationnetwork meta analysispruritusshivering

Identifiers

PMID41716312
PMCPMC12913502

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.