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Background: Preoperative anxiety is a common reaction in patients. Many techniques are used for alleviation of it, such as preoperative visit by the anesthetist, reassurance by a psychologist, and prescription of tranquilizer drugs. In this study we surveyed propofol compared to Midazolam on pre-operative anxiolysis. Methods and Materials: In randomized controlled double-blind clinical trial, 60 patient swith ASA class I candidates for elective abdominal operations were randomly allocated in 3 equal groups (propofol, midazolam and normal salin). Anxiety was measured with 2 different scales: visual analogue scale (VSA) and clinical global impression (CGI). Pulse rate (PR), blood pressure (BP), respiratory rate (RR), and saturation PO2 (SPO2) were measured before drug administration and 3 times after that in 2.5 min intervals. Results were analyzed with ANNOVA, repeated measures ANNOVA, TUKEY, and X2 tests. Results: There were no differences in demographic variables between groups. Both propofol and midazolam were more effective than placebo in anxiety reduction. Both drugs had equal effect (p>0.05). There was no significant difference in BP, PR, RR and SPO2 between two drugs. Conclusion: Both drugs were the same and more effective than placebo. Midazolam may be preferred for economical reasons.

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Background: Postoperative shivering is a common problem with multiple complications. This study was compared effect of low doses of Ketamine with Pethidine for controlling postoperative shivering. Methods and Materials: This clinical trial was done on 189 elective cesarean section with ASA class I or II who had postoperative shivering. Patients with grade 2 or higher were divided in three groups and were injected 0.3mg/kg Ketamine and 0.5mg/kg Pethidine intravenously. In 5th and 10th minutes after injection, they were investigated for shivering intensity. Results: After 5 minute of injection drugs rate and intensity of shivering in Pethedine group was less than ketamine group. Ketamine with 0.5 mg/kg was more effective than 0.3mg/kg dose of it and Ketamine(p=0.041). In group with 0.5mg/kg dose of Ketamine, rate and intensity of postoperative shivering was more reduce than group with 0.3mg/kg of it in recovery(p=0/007). In Pethedine group rate and intersity of shivering was more reduce then 0.5mg/kg dose of Ketamine(p<0/001). This demonstrated that Pethedine is more effective than Ketamine. Conclusion: Although 0.5mg/kg dose of Ketamine has considerable effect on control of shivering but Pethedine is still a better choice for this side effect.

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Background: Pain following tonsillectomy is common in children, and its elimination due to its subsequent complications is essential. Therefore, this study was conducted with the aim of obtaining the best method of administering ketamine for reducing pain following tonsillectomy with the greatest efficiency and the least side effects. Materials and Methods:This study was a double-blind clinical trial which was conducted on 92 children, aged 3-9, who had been admitted for tonsillectomy. The patients were randomly divided into oral ketamine and ketamine injection groups (each containing 46 patients). Thirty minutes before the operation, all the patients were given apple-juice ketamine injection group received normal apple juice without ketamine, whereas the oral ketamine group received 5mg/kg ketamine with the apple juice. Three minutes before tonsillectomy, 0.5 mg/kg ketamine was injected to the peritonsillar area in ketamine injection group while the same volume of saline was injected to the oral ketamine group. Data were registered, gathered, and, then, analyzed using Wilcoxon, Man Whitney, and t tests. Results: Demographic data and blood pressure before and after the operation did not have significant differences in the 2 groups. In terms of the duration of operation time, a significant difference was observed between the two groups the operation time in the ketamine injection group was shorter (p=0.006). Also, pain score in the ketamine injection group was less than the oral ketamine group. Conclusion: Ketamine is effective in reducing the pain after tonsillectomy operation. Peritonsillar injection of ketamine is more effective than its oral usage.

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Background: The main advantage of regional anesthesia is the elimination of post-operative pain without the need for narcotics, which leads to a more rapid outpatient recovery and faster return to consciousness in pediatric patients. The aim of this study was to compare caudal anesthesia with midazolam and neostigmin co-administered with bupivacain in reduction of post-operative pain in lower abdominal surgery in pediatrics (2- 8 years old). Materials and Methods: In a double-blind clinical trial, 45 pediatric patients were randomly allocated to midazolam, neostigmine, and placebo groups. Induction of anesthesia was done with inhalation of halothane and O2. Bupivacaine 0.25% in 0.5 ml/kg with midazolam in 50μ/kg was administered in caudal form to the first group, and bupivacaine 0.25% in 0.5 ml/kg with neostigmine in 2 μg/kg dose was administered to the second group. The third group received the placebo plus bupivacaine 0.25% in 0.5 ml/kg. Results: Mean durations of analgesia in neostigmin, midazolam, and placebo groups were 16.5± 0.25, 12.3±0.22, and 6±0.11 hours, respectively (P<0.001). Also, in the neostigmin group, mean score of pain in outpatient recovery 6 , 12 , 24 hours post operatively was less than that in the other two groups (P<0.001). Conclusion: Duration of analgesia period in neostigmin group was more than that in midazolam and placebo groups

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Background: Postoperative pain brings about undesirable effects such as medical complications, increased healthcare costs, and the need for opioids administration. The aim of this study was to determine the effect of low dose (0.15 mg/kg) ketamine in comparison with the placebo on postoperative pain and analgesics consumption after cesarean section. Materials and Methods: In a randomized clinical trial, 120 women undergoing elective cesarean section were randomly divided into case and control groups. Ketamine (0.15 mgkg-1) or an equal volume of normal saline were administered intravenously immediately after initiating spinal anesthesia to the case and control groups, respectively. The anesthesia and surgery techniques were the same for both groups. Data were analyzed using SPSS version 11. Results: Means of age in the case and control groups were 28.85±4.81 and 28.87 ±5.62 years, respectively. Analgesics consumption, pain scores, homodynamic signs, drowsiness of the mothers, and the neonates’ Apgar scores after cesarean section were similar in both groups and no significant differences were found between them (P>0.05). The mean of postoperative arterial pressure in the early hours in the ketamine group showed a significant decrease compared to the placebo group (P>0.03). The means of the first time of request for analgesics after surgery in the ketamine and placebo groups were 99.75±68.88 and 96.1±52.59 minutes, respectively (P>0.05). Conclusion: It seems that the administration of 0.15 mg/kg dose of ketamine (0.15mg/kg) does not have a significant impact on decreasing the postoperative pain in cesarean section. Therefore, in order to obtain the desirable analgesic effects of this drug, further studies should be conducted with greater doses of this drug and its use in combination with other opioids.

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Background:Hypotension is one of the common complications of spinal anesthesia. Ephedrine with sympathomimetic effects is the selective vasopressor in obstetric. The aim of this study was to compare the effect of different doses of ephedrine on hypotension due to spinal anesthesia. Materials and Methods: This randomized double-blind clinical trial included 120 parturient patients with ASA Ι and П scheduled for cesarean section under spinal anesthesia at Fatemy Hospital of Hamedan in 2008.The patients were divided into three groups. Immediately after spinal anesthesia, the patients randomly received 10 mg ephedrine, 20 mg ephedrine, or placebo intravenously. Then vital signs were recorded every minute for 5 minutes and after delivery every 10 minutes till the end of the surgery. Results: Incidence of hypotension in 10 mg ephedrine, 20mg ephedrine, and placebo groups was 37.5,12.5, 85%, respectively (P<0.001 ). The difference in the prevalanceof hypotension was significant between the three groups (P<0.05).Based on Chi2 test, the prevalence of hypotension in 20 mg ephedrine group was less than 10 mg ephedrine group, and in the 10mg ephedrine group it was less than the placebo group (P<0.05). Conclusion: Intravenous injection of 10mg and 20mg ephedrine to parturient patients undergoing cesarean section reduces the incidence of hypotension, though thisdecrease is more significant with 20 mg ephedrine.

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Background: Systemic and hemodynamic complications associated with stereotactic and Mayfield pin insertion pain and is one of the major problems in neuro-anesthesiology. The aim of this study was to decrease patients' hypertensive response to pain and stressful condition of the disease which may bring about problems during operation. Materials and Methods: In a randomized, double-blind clinical trial, thirty 16-65 year old ASA I and II patients at Al-Zahra Hospital of Isfahan were analyzed between September 2008 and November 2009. The level of pain according to VAS of pain was obtained from the patients in three stages: After pin insertion (stage 1), while returning from MRI (stage 2), and at the end of the procedure (stage 3) and recorded in the questionnaire. Data were analyzed through SPSS software. Results: The mean VAS of pin insertion pain for lidocaine in the three stages was 5.46, 5.00, and 2.46 and for bupivacaine was 5.76, 3.76 and 1.40, respectively (P<0.005). This indicated a significant difference between lidocaine and bupivacaine. Conclusion: As stereotactic operations take 3 to 3.5 hours on average, the use of bupivacaine instead of lidocaine is highly recommend during pin insertion.

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Background: Laryngoscopes are one of the potential mediators of infection transmission due to their blades contact with oral mucous membranes. Using single-use plastic blades is a method of preventing infection transmission. The aim of this study is to compare the efficiency of single-use plastic and reusable metal laryngoscope blades in orotracheal intubation during the rapid- sequence induction of anesthesia Materials and Methods: In this clinical-trial, 310 patients, more than 10 years of age, who were candidates for elective surgery, were selected. After anesthesia induction, orotracheal intubation was done by either single-use plastic or reusable metal blades for patients. Duration of intubation and arterial oxygen saturation were recorded before and after intubation. Data analysis was done using SPSS software. Results: Orotracheal intubation was done successfully in all patients. Mean differences of intubation time from the standard upper limit were 1.42±8.19 and 13.1±4.22 seconds in the plastic and metal blades groups, respectively. Also, the mean of difference in oxygen saturation of the low 90% after intubation were 6.07±2.71 and 7.16±1.21 in plastic and metal blades groups, respectively. Both parameters indicated statistically significant differences. Conclusion: In rapid-sequence induction of anesthesia, by using single-use blades, both intubation time and arterial oxygen saturation drop will increase in comparison with metal blades. This will cause complications such as aspiration in the patients.

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Background: One of the most important complications of tonsillectomy is laryngospasm which leads to airway obstruction, arterial hypoxemia, and hypercarbia. Thus the present study was carried out to compare the effect of propofol with sodium thiopental, as an induction agent of anesthesia, on the incidence and intensity of laryngospasm after extubation in tonsillectomy. Materials and Methods: This double-blind clinical trial was done on 60 3-12-year-old patients who were chosen for elective tonsillectomy at Qods Hospital in Qazvin. The patients were randomly divided into two equal groups. Method of anesthesia was the same in these two groups except for the induction of anesthesia one group received sodium thiopental and the other group received propofol. At the end of the operation, patients were extubated after the restoration of spontaneous respiration with adequate tidal volume and respiratory rate. Then the incidence and intensity of laryngospasm was evaluated. Data were analyzed by t-test, Chi-square, and Fisher's exact test using SPSS software. Results: Overall, 83% of the patients in the sodium thiopental group and 93% of the patients in the propofol group did not develop laryngospasm and there were no statistical differences between the two groups in terms of the incidence and intensity of laryngospasm after extubation in tonsillectomy (P=0.535). Conclusion: As an induction agent in general anesthesia, propofol has the same effect as sodium thiopental on the incidence and intensity of laryngospasm after tonsillectomy.

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Background: Metastasis or compress effect of adjacent tumors and thyroid neoplasms are the most common causes for airway obstruction which may lead to emergent intubation or tracheostomy due to respiratory distress. Case: A 61 year-old, female patient with history of papillary cell carcinoma with metastasis to lung, trachea and vocal cords was referred to our hospital with complaint of dyspnea. In the early hours of hospital admission the patient suffered from attacks of apnea and gasping, and initial efforts to control the airway were performed immediately which were not successful. Then it was decided to perform broncoscopy and tracheostomy to provide a safe airway. Conclusion: In the absence of adequate equipment and emergency respiratory situation, it is better to provide a secure airway immediately. For this purpose, we can use low depth of anesthesia without use of muscle relaxants.

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Background: Pain is a complex problem, which can affect patients' physical and psychological condition. Inadequate postoperative pain control has adverse effects on the patients' physiological, metabolic and mental condition. Adding new supplement will increase the duration of analgesia. This study aimed to comparison of intratechal neostigmine and midazolam in increasing the time of postoperative analgesia. Materials and Methods: In this randomized double blind clinical trial, 60 patients with ASA class Ι, II who were candidate for elective colporrhaphy surgery under spinal anesthesia were randomly divided into 3 groups of 20 patients. All patients received hyperbaric lidocaine 5% and groups I received 1 mg midazolam, groups II received 50 μg Neostigmine and groups III received 0.5 cc normal saline additionally. Then according VAS pain score, postoperative painless duration and pain score were compared between groups by running SPSS software. Results: Mean of painless duration in the Midazolam, Neostigmine and control groups were 98.4±18.2, 74.5±32.6 and 64.5±9.9 minutes respectively which was significantly longer than in Midazolam group (p<0.001). The mean dose of requested analgesia in first 24 hours after surgery was significantly lower in Midazolam group (p<0.001). Conclusion: Inthrathecal midazolam and Neostigmine as a complementary medication to lidocaine 5% can increase painless duration in colporrhaphy surgery and midazolam is more effective than Neostigmine. Key Words : midazolam & Neostygmine , Spinal anesthesia, painless time , colporrhaphy

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Background: The use of propofol alone for insertion of supraglottic devices can lead to undesirable events such as cough, gagging, and laryngeal spasm. Narcotic drugs are used to improve the insertion of these devices. In this study, the effect of two narcotics, remifentanyl and sufentanyl, on ease of insertion of two types of supraglottic airway devices were evaluated. Materials and Methods: In this clinical trial, 200 patients undergoing general anesthesia were divided into four groups through blocked randomization. Induction of anesthesia was performed using propofol 2.5 mg/kg. Then the first group received remifentanyl and laryngeal mask, the second group remifentanyl and SLIPA, the third group sufentanyl and laryngeal mask, and the fourth group sufentanyl and SLIPA. The amount of jaw opening, ease of insertion of supraglottic devices, cough, laryngospasm, gag reflex, heart rate, and arterial blood pressure were recorded one, three, and five minutes after insertion of supraglottic devices. Results: No significant differences were observed in the amount of jaw opening, ease of insertion of supraglottic devices, cough, laryngospasm, gag reflex, and hemodynamic parameters between the four groups. Conclusion: The results of our study indicated that for controlling airways using supraglottic devices, use of laryngeal mask or SLIPA in the presence of remifentanyl or sufentanyl have no priority over each other and do not lead to hemodynamicimpairement

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Background: Post-anesthetic shivering is the most common cause of patient discomfort during recovery with a prevalence of 5 to 65%. Post-anesthetic shivering can increase pain, oxygen consumption, and cardiac output. The aim of this study was to compare the efficacy of various classes of drugs for preventing post-anesthetic shivering.

Materials and Methods: In this double-blind clinical trial, patients undergoing elective laparotomy were randomly divided into six groups, 40 each. The patients, respectively, received hydrocortisone, ketamine, tramadol, magnesium sulfate, pethidine, and normal saline. All patients were observed for body temperature and shivering for 20 minutes after arrival to recovery room.

Results: Seventy patients in the pethidine group did not have shivering upon arrival to recovery room which was significantly higher than other groups (&chi2=0.00002). Also, the patients in the pethidine group did not shiver 10 and 20 minutes after arrival to recovery room that was significantly lower than other groups.

Conclusion: According to the results, it can be concluded that pethidine is more effective than other drugs in prevention of post-anesthetic shivering.

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Background: Familiarity with different methods and medications in anesthesia and producing sufficient depth of anesthesia are very important in anesthesia practice. Due to the central analgesic and sedative effect of lidocaine in the presence of the sufficient blood level, it can be used for general anesthesia. This study was carried out to compare the effect of halothane with lidocaine infusion on BIS during maintenance of anesthesia.

Materials and Methods: In this randomized double-blind controlled clinical trial, 66 patients scheduled for elective inguinal herniorrahaphy were randomized into two equal groups. For maintenance, one group received halothane (1%) with O2-N2O and another group received lidocaine infusion (100 &mug/kg/min). BIS was checked every 5 minutes for half an hour. Statistical analysis of data was done by Chi-square and T-test through SPSS software. P-values less than 0.05 were considered meaningful.

Results: Mean of BIS was 65.72 in the lidocaine group and 56.7 in the halothane group during the first 30 minutes. There was a significant statistical difference between the two groups (p<0.05).

Conclusion: Mean of BIS in lidocaine group was higher than that in the halothane group. If this indicates the presence of a light level of anesthesia, increasing the dose of hypnotics and opioids leads to an increase in the depth of anesthesia. However, since there is not any device for monitoring the effect of opioids on the central nervous system and the level of anesthesia, simultaneous monitoring of BIS and hemodynamic parameters seems to be a more reasonable idea.

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Background: Caesarean section is one of the most common gynecologic surgeries. Nausea and vomiting after pain is the most common side effect of surgeries, today, we most widely use of serotonin receptor antagonists, that are most effective antiemetic and have less side effect rather than other drug. Ondansetron is typical serotonin antagonists.

Materials and Methods: This is a randomized, double-blind clinical trial on 162 women undergoing cesarean section. 4mg intravenous ondansetron was given to first group and 8mg oral ondansetron was given to second group and thired group recived placebo. Blood pressure and heart rate were measured before and immediately after performing spinal and every 5 minute until 20 minute. Post operative nausea and vomiting and APGAR score were recorded after operation in recovery and 2, 4, and 6 houres after surgery.

Results: There was no significant difference among 3 groups according to age, gravidity, mean atrial pressure and heart rate before and during surgery. Nausea and vomiting in oral and intravenous groups at recovery, 2 and 4 hours after surgery were significantly less nausea and vomiting than placebo group (p<0.05). Whereas there was no significant difference between oral and intravenous groups.

Conclusion: It was concluded that using oral ondansetron with the same antiemetic effect is more convience to women undergoing cesarean section with spinal anesthesia.

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Background: Pain is a complex medical problem creating which inadequate control pain results adverse effects on the patients physiological, metabolic and mental conditions.The aim of this study was comparison effect of Ketamin-propofol with Alfentanil-propofol on creating analgesia and sedation during cystoscopy and comparing the side effects of two drugs and patient and physician satissfaction.

Materials and Methods: In this double- blind clinical trial 140 person who were candidate for cystoscopy were randomly divided into two groups The first group received 1mcg/kg alfentanil with 1mg/kg propofol and the second group received 0.5 mg/kg ketamin with 1mg/kg propofol. Sedation score ,pain score, time of cystoscopy and hemodynamic changes determined and data were analyzed by SPSS.

Results: The mean of sedation in alfetanil group was significantly more than ketamin group(p=0.001) . The mean of pain score in alfetanil group was significantly less than ketamin group( p=0.001) .The time of cystoscopy in cystoscopy in alfetanil group was significantly less than ketamin group (p=0.001).

Conclusion: Results showed that alfentanil-propofol compare to ketamin-propofol reduced pain score and increased time of sedation with less side effects during cystoscopy .So this study supports the preference alfentanil compare to ketamin.

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Background: Intrathecal morphine side effect is Nausea & Vomiting after surgery. The aim of the study was to evaluate the effect of intrathecal atropine on PONV in patients receiving intrathecal morphine in lower limb surgeries.

Materials and Methods: In this clinical trial , 120 patients undergoing lower limb surgery were randomly divided into 2 groups . Experimental group received 0.1 mg (1cc) Intrathecal atropine and control group received 1cc saline 0.9% . PONV during the first 24 hours and hemodynamic changes in minute 3, 5, 10 and 15 after surgery in both groups were measured. Data were analyzed using SPSS software (verision14). independent t-test, repeated measures manova,and chi-square were used to compare comparison of variables.

Results: Hemodynamic cheanges before injection and 3, 5, 10 and 15 after injection in two groups was not significant (P>0.05). None of the patients in the intervention group were PONV, but 17 patients in the control group had PONV that this difference was statistically significant (p =0.000 ). Pain in the control group was great than intervention group while 26 patients in the control group and 14 patients in the intervention group had vas greater than 3 that this difference was statistically significant( P = 0.04).

Conclusion: Intrathecal atropine without interfering Hemodynamic and pain relief prevent nausea and vomiting caused by Intrathecal morphine in patients undergoing surgery to the lower limbs..

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Background: Spinal anesthesia is an efficient method of providing intra operative analgesia and a safe alternative to general analgesia in many cesarean patients. Despite its advantages, SA is not free from adverse effects, which include unwanted cardiovascular events, in most cases: hypotension and bradycardia. Ondansetron is a 5HT3 receptor antagonist, with known efficacy on preventing nausea and vomiting. Maybe ondansetron given intravenously attenuates the fall of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on BJR.(Bezold jarish Reflex).

Materials and Methods: In this clinical trial 102 healthy pregnant women that were candidate for elective cesarean in hamedan fatemieh hospital during 3 months in 1390, studied. They were randomized into 2 groups: the ondansetron group, n= (51) received (4miligram) ondansetron intravenously before performing spinal anesthesia, and placebo group n= (51): received 2cc sterile water before spinal anesthesia. Spinal anesthesia was performed with hyperbaric bupivacaine (0.5%) 10 mg and sufentanil (5 µg) BP and HR were measured and recorded before and after anesthesia immediately. If hypotension happened, ephedrine 5- 10mg injected. Itching and nausea recorded every 10 min during operation by observation and question.

Results: There were no significant differences in SBP, DBP, MAP, HR and itching in both groups. Nausea and vomiting ,and mean consumed ephedrine was siginificantly different in both groups.(p=0.001, p=0.009).

Conclusion: Ondansetron given intravenously with antiemetic dose (4miligram), decreases mean consumed ephedrine and nausea and vomiting after spinal anesthesia, but doesn't have an influence on BP, HP and pruritus

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Background: Unpleasant side effect of awareness within general anesthesia is potentially an important concern in patients. The patient may sleep during anesthesia and feels the pain due to loss of pain suppression of sensory perception of pain during surgery. The aim of this study is to determine the effect of BIS monitoring on level of awareness during anesthesia in women undergoing elective caesarean section.

Materials and Methods: In this double-blind, randomized clinical trial, 214 ASAI–II patients, over 15 years of age, candidate for elective cesarean section were included in the study. Patients randomly divided to two groups of anesthesia with and without BIS monitoring. Patients were assessed for awareness within anesthesia immediately, 24 hours, and 3-6 days after operation.

Results: From 107 patients without BIS monitoring, 8 patients (7.4%) suffered from awareness during anesthesia and their awareness score was two and greater than two. While none of the patients in the BIS group experienced awareness during anesthesia. Level of awareness during anesthesia in the control group was significantly more than the BIS group (p<0.0000).

Conclusion: The incidence of awareness during anesthesia is significantly lower in BIS monitored group than the control group.

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Background: Reducing the duration of the effect of sedatives and increasing their quality is one of the tasks of ICU staff. The aim of this study is to compare the sedative effects of these medications on neurosurgery patients under mechanical ventilation.

Materials and Methods: In this double-blind clinical trial, 70 patients requiring mechanical ventilation in neurosurgery ICU were enrolled. Patients were randomly assigned to one of remifentanil or fentanyl groups. The first group received 0.05 µg/kg/min remifentanil and the second group received 1 µg/kg/hr fentanyl infusion for sedation and analgesia in the first 24 hours. Sedation score, Minogue scale and hemodynamic parameters were evaluated throughout the study and at regular intervals. 

Results: There was no significant statistical difference in demographic variables such as age, sex, and body weight between two groups. The results of this study showed a significant difference in sedation score (p=0.0001) and Minogue scale (p=0.0001) and both variables were lower in remifentanil group. Also, heart rate (p=0.011) and mean arterial blood pressure (p=0.007) were significantly higher in fentanyl group.

Conclusion: Generally, sedative effect of remifentanil has several relative advantages over older medication of fentanyl and causes more effective sedation and better control of hemodynamic parameters in patients under mechanical ventilation.