الفهرس 
Acknowledgment
MeperidineOnly 14 pages are availabe for public view
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Abstract
Shivering is a common complicationfollowing spinal anesthesia with an incidence up to 57% of patients (Jeon YT, 2005). Post anesthetic shivering may cause discomfort to the patient, aggravates wound pain by stretching incision, increase intra ocular pressure and increase intracranial pressure. Shivering may also increase tissue oxygen demand by as much as 500 % and accompanied by increase in minute ventilation and cardiac output to maintain aerobic metabolism. This may be deleterious in patient with impaired cardiovascular reserve or a limited respiratory capacity. Shivering may also interfere with the monitoring of patients by causing artifacts of Electrocardiography, blood pressure and pulse oximetry (Matsukawa T et al., 1995). Although meperdine is the best studied drug in the treatment of post anesthetic shivering, other drugs like tramadol Hydrochloride, Hydrocortisone and Magnesium Sulfate infusion were used (Muhammed Gozdemir et al.,2010) (Pawar MS et al.,2011) ( Haque MF et al.,2011). Meperidine combined mu and kappa receptor agonist is frequently recommended for the treatment of post anesthetic shivering ( Pauca AL et al.,1984) ( Wrench IJ et al.,1997) (De Witte JLet al.,1997) ( Alfonsi P et al.,1998). Much evidence has suggested that the anti-shivering effects of meperidine are mediated by kappa receptor activity (Pauca AL et al.,1984) (Kurz Met al.,1993)( Wang JJ et al.,1999)
Ketamine, which is a competitive receptor antagonist of N-methyl-D-aspartic acid (NMDA), has a role in thermoregulation at various levels. In rats, application of NMDA agonist increases the firing rate of neurones in the preoptic-anterior hypothalamus. Moreover, NMDA receptors act by modulating the noradrenergic and serotoninergic neurones in the locus ceroleus.