الفهرس 
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Abstract
H
ypothermia may cause significant discomfort in awake patient. Recovery is prolonged not only because a sense of coldness alters mentation and delays awakening, but because drug metabolism is reduced. These considerations are compounded by the negative physiological influences addressed previously. As with most complications in anaesthesia, prevention is the best management.
Shivering is an involuntary, oscillatory muscular activity that augments metabolic heat production. Shivering is elicited when the preoptic region of the hypothalamus is cooled. Efferent shivering pathway arises and descends from the posterior hypothalamus.
Postoperative shivering is a common complication following regional anesthesia in pregnant females undergoing elective cesarean section. Even a small decrease of 0.5°C may induce shivering. Patients often identify feeling cold as one of the most unpleasant aspects of their treatment, sometimes worse than any pain associated with the procedure. Shivering is not only subjectively unpleasant but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. Moreover, shivering may aggravate pain and hinder wound closure by simply stretching surgical incisions.
Various methods have been used to prevent and treat Shivering in patients who receive spinal anesthesia, one of these, meperidine appears to be the most effective treatment agent for perioperative shivering, although meperidine is the best studied drug in the treatment of post anaesthetic shivering, other drugs like tramadol hydrochloride, ketamine and magnesium sulfate infusion were used.
Our study presents a placebo-controlled prospective randomized single blinded study. Included patients was randomly (using computer generated randomization table) allocated into four equal groups each group consists of 28 patients:
group 1, control group, received placebo of 3 ml of normal saline.
group 2 received 2 mg/kg IV hydrocortisone.
group 3 received 40 mcg/kg IV granisetron.
group 4 received 0.4 mg/kg IV meperidine.
All these drugs were given after delivery of the fetus in the operating room.
Automatic readings of heart rate, mean arterial blood pressure, respiratory rate, and saturation using pulse oximetry were obtained. Recording of obtained measures were done at baseline and every 15 minutes, starting half an hour before induction of regional anaesthesia extending to 3 hours postoperatively.
Our results indicate that pethidine, granisetron and hydrocortisone were effective in prevention of post spinal shivering in patients undergoing elective cesarean section and these results agreed with other results of studies done before.