الفهرس 
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Abstract
Regional anesthesia is a safe and popular anesthetic technique for various surgeries.
Around 40-60% of patients under regional anesthesia develop shivering.
Shivering can be very unpleasant and physiologically stressful for the patient. It increases the metabolic rate and O2 consumption up to 100-600%.It can induce arterial hypoxemia and acidosis. It increases intraocular pressure and intra cranial tension. It causes stretch on suture lines. It interferes with monitoring like ECG, pulse oximetry and non-invasive blood pressure measurement. It can be detrimental to patients with low cardio-respiratory reserve.(Ozaki et al ., 2005).
After enjoying the benefits of modern anesthesia, patients experience shivering as unpleasant occurrence.
Many physical and pharmacological interventions are used to decrease the incidence and to reduce the severity of post-spinal shivering. .(Bhattacharya et al., 2003).
Among pharmacological interventions, Pethidine which belongs to opioids is effective in prevention of post-spinal shivering. Also ,Ketamine which is NMDA receptor antagonist tried to prevent shivering. Also, Ondansetrone which is serotonergic antagonist recently tried to decrease post-spinal shivering.(Chan A M H et al., 1999).
Aim of the study: the study was done to compare the effect of meperidine which is time-tested anti-shivering drug with ketamine and ondansetron which are recently tried to prevent post-spinal shivering.
Patients and methods: This Prospective, single blind randomized clinical study, in which 120 Patients were randomized into three equal groups, group P (40 patients received 0.5 mg/kg Mepridine). group K (40 patients received 0.25 mg/kg Ketamine). group O(40 patients received 4mg Ondansetron).
Patients with psychological disorders, body temperature above 38 or below 36.5, history of convulsions, coagulopathy, neuromuscular disorders and Patients with known allergies to the study drugs were excluded from the study.
Pre operative assessment in form of clinical examination and routine investigations in the form of twelve leads electrocardiography (ECG), complete blood count (CBC), coagulation profile (bleeding time, prothrombine time, international normalized ratio and partial thromboplastine time), liver functions, kidney functions as well as arterial blood gases (ABG) were fulfilled .
All patients were premedicated with oral diazepam 0.2mg/kg at night and one hour before coming to the operation room.
Just after the Intrathecal injection, one of the study drugs was given as IV bolus according to the patient group.
The main outcome measures : Shivering grades, Tympanic temperature.
The secondary measurements include: Pulse rate, B.P, SPO2 were noted every 5 minutes for 60 minutes. Side effects such as hypotension, nausea and vomiting, sedation and hallucinations were recorded and managed.
As regard significant shivering, was lower in group P&K than group O. Also , there was more decrease in core temperature in group O than in group P&K. Side effects were less in group O than in group P&K.