Ashfaq Ahmed, Brig Mohammad Aslam.
Prevention of shivering during lower segment cesarean section; comparison of prophylactic use of ketamine, and ketamine plus midazolam during spinal anaesthesia.
Professional Med J Jan ;20(3):409-15.

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.

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