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Introduction: Many patients because of ischemic heart diseases, cerbral or pulmonary diseases are not appropriate candidates for general anesthesia in upper limb surgeries. Intravenous regional anesthesia (IVRA) is one of the anesthetic procedures for these patients. The aim of this study was to compare the effects of adding Pancronium and Fentanly to Lidocaine during IVRA.
Materials and Methods: In a single-blind clinical trial investigation, 46 patients-who were candidated for hand surgeries-were studied. The subjects were randomly classified into two groups. The first group who used 38 cc Lidocaine 0.5% and 2 cc sterile water (control group) and the second group who used 38 cc Lidocaine 0.5% besides 50  mgr Fentanyl and 0.5 mgr Pancronium (trial group) for sensory and motor blacking. Data analysis was performed by t-test through SPPS 10 software.
Results: The average time for storing of sensory and motor block in trial group was significantly faster than control group. Additionaly, the average time for starting of sensory and motor block in control group was significantly lower than trial group.
Conclusion: This study revealed that adding of Fentanyl and Pancronium causes better motor and sensory block and provide better relaxation for muscles during surgery.

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Introduction: Spinal anesthesia is a conventional way of anesthesia for cesarean section (CS), which nausea and vomiting is a common complication of it. Metoclopramide is the standard medication used for preventing intraoperative nausea and vomiting (IONV). Because of extrapyromidal side effects of Metoclopramide and known antiemetic effects of low-dose Propofol and Dexamethasone, this study was performed to compare the effectiveness of these drugs for preventing IONV. Materials and Methods: This study, is a randomized clinical trial which is done on 144 parturients who were admitted for emergency CS. Patients were divided randomly into four groups and received: Metoclopramide 0.1 mg/kg IV, Dexamethasone 150 g/kg IV, Propofol 0.1mg/kg every 5 minutes from clamping umbilical cord till the end of operation and the fourth group received 2 ml distilled water. During the operation parturients were monitored for IONV. Data was analyzed using Kruskal-Wallis and one way ANOVA. Results: The Number of patients having nausea was lowest in Propofol and highest in Dexamethasone group. There was no statistical significant difference between Dexamethasone and placebo groups. The lowest rate of vomiting was in Metoclopramide and Propofol groups and there was no significant difference between them. Also the lowest level of retching was in the Prepofol group. Conclusion: According to results, the antiemetic effects of Propofol and Metoclopramide are similar. Amount of retching in Propofol was slightly lower than Metoclopramide and administration of Propofol was simple, cheap and without serious complications, so we recommend it for emergency CS.

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Introduction: Chest wall in children is more compliant, slow twitch muscle fibers are less than adults and the alveolus are smaller in size and lesser in number. Airways are more expandable and smaller in diameter. In the other hand the inhalational anesthetics can cause respiratory depression and rapid shallow ventilation. These changes can cause microatelectasia, low respiratory system compliance and increase in work of breathing. Controlled ventilation probably will prevent these events. This study is going to compare behaviors of respiratory system under inhalational anesthesia. Materials and Methods: In a clinical trial, 60 pediatric patients between 6 months to 6 years of age, ASA I & II, who were candidates of elective surgery on extremities and lower abdomen, entered to study. Patients were randomly allocated in two groups of spontaneous and controlled ventilation. In the first group inhalational and in the second group intravenous inductions was performed. Both groups were given halothane (0.8-1%) in a 50% mixture of N2O and O2 for maintenance of anesthesia. HR, RR, BP, SPO2 and T before induction and all of these plus EVT and peak and plateau APs, 5 minutes after induction and every 15 minutes thereafter were measured and dynamic and static compliance were calculated by using measured data. Data was analyzed by ANOVA, T student and Chi square tests. Results: Patients in spontaneous ventilation group had significantly more RR and EtCO2 and less awakening time (p<0.05).Total mean of HR, SBP, DBP, SPO2, T, PIP, PltIP, dynamic and static compliance after induction of anesthesia had no statistical differences between the two groups. Conclusion: There are no constant significant differences between the two groups in respiratory system compliance, airway pressures and T and this study can not prove the development of significant changes in respiratory system indices between the two groups. Thus microatelectasis (if developed) is not clinically important during less than one hour surgeries.

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Introduction: Type of anesthesia is important in the maternal and fetal well being. There are different informations about effect of general and spinal anesthesia on Apgar score, so in this study a comparision was made on Apgar scores of neonates following these two methods. Materials and Methods: This study is a clinical trial and 168 term pregnant women were selected from elective cesarean candidates and divided in to general and spinal anesthesia groups by randomized allocation method. Then Apgar scores in first, fifth and twentieth minutes were mesured in infants. Also maternal age, cause of cesarean, sex and duration of cesarean section time were all documented. Data was analyzed using T and Chi square tests. Results: Mean Apgar scores were 8.66±0.68, 9.8±0.42 and 9.970.15 at first, fifth and twentieth minutes in general anesthesia group, and 90.38, 9.880.32 and 10 at first and fifth and twentieth minutes in spinal group. The group differed significantly for first minute Apgar score (p<0.001) but there were no significant differences in fifth and twentieth minutes Apgar scores. Conclusion: First minute Apgar score of newborns of mothers under spinal anesthesia was more than those of mothers under general anesthesia but there was no difference between their five minute Apgar score.

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Introduction: As tonsillectomy operations are done in vicinity of airways, two important purposes in anesthesia are decreasing bleeding and recovery time. Because of common use of Halothane and its reported side effects, we managed a study for comparing these two factors in two methods of anesthesia with or without Halothane. Materials and Methods: In a single blinded clinical trial, 140 (4-12 years old) children undergoing tonsillectomy, were randomly allocated in two equal groups. In the control group maintenance was done with Halothane-N2O 50% but in the case group without Halothane plus hyperventilation (Liverpool technique). Bleeding volume was estimated according to preoperative and 6 hour's postoperative hematocrit. Recovery time was recorded in minutes. Data was ahalyzed using Mann-Whitney U, T, Leven and K-S tests. Results: There was not any significant difference in sex, age, and weight and operation duration in the two groups. Mean recovery time in the case group was 7.87 minutes and in the control group 15.59 minutes, which showed a significant difference (p=0.00001). Mean bleeding volume in the case group was 44.22 ml and in the control group 58.52 ml, which also showed a significant difference (p = 0.005). Conclusion: According to our study it seems that anesthesia with Halothane causes more bleeding and prolonged recovery time in comparison to Liverpool technique.

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Introduction: Despite different methods implemented, surgical wound infection is still an important cause of mortality and morbidity of patients which impose a considerable cost on health care system. According to recent data, administration of supplemental oxygen during operation can reduce the risk of wound infection due to increased tissue oxygenation and therefore better elimination of bacteria by oxidative killing. This study is done to investigate the effect of administered oxygen ratio on the incidence of wound infection in clean-contaminated surgery. Materials and Methods: This is a double blind clinical trial. 584 patients from both sexes between 18 to 60 years old, who were condidated for clean-contaminated surgery were divided into two equal groups randomly. One recived 80% and the other 40% FIO2 during anesthesia. The frequency of wound infection between the two groups was assessed during a two weeks period. Results: Of patients receiving 80% FIO2, 11 (3.9%) patients, and the group recieving 40% FIO2, 25(8.1%) patients had wound infection (p<0.05). Conclusion: This study similar to previous studies showed the positive effect of supplemental oxygen in decreasing risk of surgical wound infection. Therefore according to the low risk and low cost and effectivness of this method in patients undergone surgery, it is recommended in clean-contaminated surgery.

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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: 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: 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: 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: 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: Due to high prevalence of vitrectomy surgery, and the importance of anesthetic technique in conducting an uncomplicated surgery, we decided to do this study.

Materials and Methods: This prospective randomized study was conducted on 80 patients 40-80 years old candidating deep vitrectomy sugery under general anesthesia that were categorized into II and III Class by American Society of Anesthesiologist (ASA). Patients were randomly allocated to two groups of 40 members. Anesthesia was induced in both groups in the same manner. For maintaining anesthesia, patients from I group receiVed 1.2% isofluran with 50% O2 in air at 4L/min and infusion of remifentanil (0.1 mg.kg-1.min-1). But in the P group, we used propofol up to 10mg/kg /hr with infusion of remifentanyl. Propofol and isoflurane in fusion was discontinued with the last surgical stitches, but remifentanil infusion continued in both groups until the eye was covered with shield. Hemodynamic variables were recorded just before the induction of anesthesia and in different time intervals till discharging of the patients from the recovery room.  Then, data were compared.

Results: Results showed that there is a significant changes in propofol group compared to isofluran in deep vitrectomy surgery operations.

Conclusion: Hemodynamic changes are more significant in maintaining propofol anesthesia when compared with isoflurane.

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Introduction: Pain of anesthesia injection in children is necessary and one of the most painful local anesthetics is palatal infiltration anesthesia. So, the purpose of this study was to compare the effect of needle gauge on pain and anxiety during palatal infiltration anesthesia injection in children 4-8 years.
Methods: This triple-blind cross-over clinical trial study was performed on 60 children 4-8 years candidates for pulpotomy and SSC treatment of both maxillary first molar teeth. Based on the sequence of using 27- and 30-gauge needles, children were treated during 2 sessions. The anxiety level of children during palatal infiltration local anesthesia was measured using pulse rate (PR) and the pain level of patients was measured using SEM and FPR (objective and subjective criteria).
Results: Anxiety during palatal anesthesia injection with gauge 27 was higher than gauge 30 (treatment effect < 0.001). In subjective and objective criteria, the injection pain in the palatal mucosa with a 27-gauge needle was higher than 30-gauge needle (treatment effect < 0.001). There was no significant difference between earlier and later injection of palatal infiltration with different gauges during treatment sessions (P < 0.05) and according to 0.021 for the period effect, it can be said that the period of receiving two needle gauges had an effect on the average heart rate difference.
Conclusions: The pain of injection in the palatal mucosa with a 27-gauge needle is higher than with a 30-gauge needle, and the use of a 30-gauge needle in the palatal injection of children 4-8 years causes less discomfort than a 27-gauge needle.