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Background: Pain following propofol injection was reported between 28- 90 %. Ketamine have lesser cardiovascular depression effect and also local anesthetic effect. In this study effect of ketamin were analyzed when it given before propofol injection. Methods and Materials: In a randomized double blind clinical trial selected 120 ASA I, II Ptients with 15-65 years old. They were candidated for elective surgery, in half of the patients 100 µg/kg ketamine in 2 ml volume and in another half, 2 ml distilled water were given before propofol injection. Severity of injection pain was evaluated according to 4 scale criteria (none, mild, moderate, or severe) fifteen seconds after injection of 25% of the calculated dose of propofol. Heart rate (HR) and noninvasive blood pressure were recorded before and after propofol injection, immediately and 3 minutes after intubation. The data were analysed by Mann Whitney U, Pooled t-Test and the Chi-squared test. Results: Pain was not sensed in 51.56% and 75% of control and case groups respectively. In cases group showed little decrease in systolic and diastolic pressures after anesthetic induction (p=0.012 and p=0.005). There were upper diastolic pressures after intubation (p=0.00) and 3 minutes after intubation (p=0.000). During intervention heart rate changes had not significant difference between two groups. Conclusion: Ketamine pre-treatment was an effective method in reducing pain and providing hemodynamic stability after propofol induction.

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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: 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