PREVENTION OF SHIVERING DURING LOWER SEGMENT CESAREAN SECTION;

Comparison of prophylactic use of ketamine, and ketamine plus midazolam during spinal anaesthesia

Abstract

Objectives: To compare the efficacy of low-dose prophylactic use of ketamine with ketamine plus midazolam for the
prevention of shivering caused by spinal anesthesia, during lower segment cesarean section. Main Outcome Measures: Heamodynamic
monitoring, avoidance of lactic acidosis/ increased carbon dioxide production and patient satisfaction. Design: Prospective Randomized
Controlled trial. Place: Department of Anesthesia and ICU PNS Shifa Karachi. Duration of study: March 2010 to June 2010. Patients and
Methods: 100 ASA-I & II consecutive patients who reported for LSCS in PNS Shifa Hospital were studied. In this double-blind study,
patients were randomly allocated to receive ketamine alone (Group I, n= 50), and ketamine plus midazolam (Group II, n = 50). After
standardized Spinal anesthesia, a shivering was recorded at 5 min intervals for 15 minutes. Results: Shivering was observed in 9/50
(18%) patients of group I (Ketamine only) as compared to only 2/50 (4%) patients in Group II (ketamine + midazolam) (p=0.025) which
is statically significant. The two groups were comparable regarding distribution of age (p=0.37), BMI (p=0.27) and duration of surgery.
Results were analyzed by using chi square test. Conclusions: The efficacy of i.v. ketamine plus midazolam is better as compared to lowdose
i.v. ketamine alone in preventing shivering in lower segment Cesarean Section patients, during spinal anesthesia.