الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
This study was conducted in EL-Minia university hospital in the period from February 2011 to December 2011.
After obtaining approval from our hospital ethics committee and obtaining written consent from the patient in each case, 60 female patients aged 18-45 years old, ASA physical state I and II undergoing elective Cesarean section, were selected for this prospective randomized double blinded study .
When post-spinal shivering grade 3 or 4 occurred, patients were randomly assigned to one of three treatment groups using computer based software technique(random allocation software version 1.0.0) according to the drug used for treatment of shivering: patients were bdivided into three groups , each group is 20 patients .
Group N: received I.V. nalbuphine 0.08 mg/kg.
Group O: received I.V. ondansetron 8mg.
Group MK: received I.V. ketamine 0.25 mg/kg plus midazolm 37.5 ug/kg.
The aim of this study was to compare the effectiveness of ondansetron, nalbuphine and midazolam plus ketamine in treatment of post spinal shivering in cesarean section.
Our results showed that there was no significant difference between all groups as regard demographic variables(mean age, weight, height, duration of surgery and shivering grade).
There was a state of hemodynamic stability in the three groups throughout the study period with no significant difference requiring medical intervention.
There was a decrease in HR in all groups after spinal anaesthesia, however, there was no significant difference between groups all over the study.
There was a decrease in mean BP in all groups after spinal anaesthesia , however, there was no significant difference between groups
There was no significant difference between all groups as regard mean arterial oxygen saturation during the study period.
There was a decrease in core temperature in all groups after spinal anaesthesia as would be expected, however, the decrease in core temperature was less in the MK treated group.
There was a significant difference between group I and group III and a significant difference between group II and group III started at 5 min after treatment to the end of the study.
There is a significant difference in success rate between group O 60% and group N 85% and a significant dfiference rate between group O and group MK about 90%.
There is no significant difference in success rate between group N and group MK.
Recurrence occurred in 16.6%, 17.6% and 27.7% in ondansetron group, nalbuphine group and MK group, respectively
There were some complications noticed; In ondansetron group dizziness occurred in 5% of patients and headache in 30% of patients.
In nalbuphine group nausea and vomiting occurred in 10% of patients, dizziness occurred in 5% of patients and sedation occurred in 35% of patients.
In MK group nausea and vomiting occurred in 25% of patients, hallucination occurred in 25% of patients and sedation occurred in 100% of patients.