Efficacy of Dexamethasone on Prevention of Post-Operative Spinal Shivering in Comparison with Intravenous Ketamine Plus Midazolam during Elective Cesarean Section

Abstract
Background: Post-anesthetic shivering is a common complication of modem anesthesia, affecting 5-65% of patients after general anesthesia and (33%) of patients during epidural anesthesia. Shivering can cause more server complicationin patinets with history of cardio-respiratory diseases.
Aim of Study: In this study we compared the anti-shivering effect of dexamethasone with that of ketamine plus midazolam in comparison with placebo after spinal anesthesia, in addition to evaluating any side effect of such medications.
Patients and Methods: This study was performed for 90 women ASA I, II at the age of 20-35 years with uncomplicated singleton pregnancies of more than 36 weeks gestation, who was scheduled for elective cesarean delivery under spinal anesthesia. Full medical history and examination was done to each parturient.
The patients were allocated randomly to one of three equal groups:
•Group D: Received 0. 1mg/kg dexamethasone (n=30).
•Group K.M: Received 0.25mg ketamine plus 40mg kg–1 midazolam (n=30).
•Group S: Received same volume of saline 0.9% as placebo (n=3 0).
Results: Our study results showed a significant decrease in the incidence of shivering among the: Ketamine plus midazolam (10%). Group K.M.
Grade I (6.7%), Grade II (3.3%), Grade III (0%), Grade IV (0%) in comparison with the Dexamethasone (33.3%). Group D. Grade I (23.3%), Grade II (6.7%), Grade III (3.3%), Grade IV (0%) and Placebo (40%). Group S. Grade I (26.7%), Grade II (10%), Grade III (3.3%), Grade IV (0%).
The incidence of sedation was higher in females who received: Ketamine plus midazolam (26.6%) Group K, M.
Grade I (16.6%), Grade II (10%) and Grade III (0%) than Dexamethasone group (0%) Group D and Placebo group (0%). Group S.
Conclusion: We conclude that intravenous (0.25mg keta-mine plus 40mg kg–1 midazolam) five min before spinal anesthesia had better anti shivering results than using intra-venous (0.1mg/kg dexamethasone) with minor side effects of such medications in women undergoing elective cesarean section.