الفهرس 
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Abstract
ypothermia may cause significant discomfort in the 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 anesthesia, prevention is the best management.
Shivering is an involuntary, oscillatory muscular activity that augments metabolic heat production up to 600% above basal level. 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 hernia surgeries. 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.
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Summary
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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 anesthetic shivering, other drugs like Tramadol Hydrochloride, ketamine, ondansetron and Magnesium sulfate infusion were used.
This study presents prospective randomized single blinded study. Included patients was randomly allocated (by using computer generated numbers (CGN) with sealed envelopes handed to third party blinded to treatment assignment) into two equal groups each group consists of 15 patients:
group (K) received 0.25 mg/kg IV ketamine.
group (O) received 4 mg IV ondansetron.
Just after the intrathecal injection, one of the study drugs (Ondansetron 4 mg/ Ketamine 0.25 mg/kg) was given as IV bolus in the operating room.
Automatic readings of heart rate, mean arterial blood pressure, respiratory rate, and saturation using pulse oximetry will be obtained. Recording of obtained measures will be done at baseline and every 15 minutes, starting half an hour before induction of regional anesthesia extending to one hour postoperatively.
Summary
64
Our results indicate that low dose ketamine and ondansetron were effective, with more extent to ketamine, in prevention of post spinal shivering in patients undergoing hernia surgeries and these results agreed with other results of studies done before