Comparison of the Effects of Haloperidol, Metoclopramide, Dexmedetomidine and Ginger on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy.

Nausea is a mental sensation of unease and discomfort before vomiting. Vomiting refers to the return of the contents of the upper gastrointestinal tract to the mouth caused by contractions of chest and abdomen muscles. Postoperative nausea and vomiting is an unpleasant experience with high treatment costs. Therefore, this study aimed to compare the effects of haloperidol, metoclopramide, dexmedetomidine, and ginger on postoperative nausea and vomiting after laparoscopy. This double-blind clinical trial was performed on all laparoscopy candidates at Valiasr hospital, Arak, Iran. The patients were randomly divided into four groups (haloperidol, metoclopramide, dexmedetomidine and ginger), and all patients underwent general anesthesia using fentanyl, midazolam, atracurium, and propofol. After intubation, tube fixation, and stable hemodynamic conditions, the patients received four ginger capsules with a hint of lemon. A group of patients received 25 µg of dexmedetomidine. In the Plasil group, 10 mg of metoclopramide was given 30 minutes before the completion of surgery. In addition, 0.5 cc of haloperidol (5 mg) was administered to a group of patients. Heart rate, blood pressure, and oxygen saturation were recorded from the beginning of surgery, every 15 minutes until the end of the surgery. Furthermore, the occurrence of nausea and vomiting was recorded during recovery, 2 and 4 hours after surgery. Data were then analyzed using the SPSS software v.23. Eighty-eight patients were enrolled in the study. The youngest and the oldest were 30 years and 70 years old, respectively, and the mean age was 48.02 ± 9.31 years. Moreover, the number of women in the four groups was higher than that of men. Blood pressure in the dexmedetomidine group was lower than the other four groups (P <0.05). The lowest heart rate was observed in the haloperidol group, while the highest heart rate was seen in the plasil group (P <0.05). The occurrence of vomiting and nausea was not significantly different between the four groups (P <0.05). Our results showed no significant difference in postoperative nausea and vomiting between the four drugs. Due to the hemodynamic changes induced by each drug, it is best to use these drugs based on the patient's condition. Ginger is also a herbal remedy that has fewer side effects, and this drug can be a good option for patients when there is no contraindication.

Investigations of Silymarine Effects on Prognosis of Patients With Severe and Moderate Traumatic Brain Injury.

OBJECTIVE: The purpose of this study was to evaluate Silymarine effects on prognosis of patients with severe and moderate traumatic brain injury. STUDY DESIGN: This double blind, placebo-controlled clinical trial. SETTING: Valiasr hospital hospital in Arak, Iran. SUBJECTS AND METHODS: Research was performed among patients between 15 and 65 years of age with severe moderate (Glasgow Coma Scale score 9 to 12) and moderate (GCS 3 to 8) traumatic brain injury (TBI). Patients were divided into two groups (Each group: 40 patients). Patients assigned to the control groupwere receiving all standard treatments. Patients in case groups were administered 140 mg of silymarin every 8 hours for 7 days. We Checked the Glasgow Outcome Scale (GOS), GCS, age, gender, location, mechanism of trauma, site of accident and the incidence time of accident to arrival at emergency unite. Statistical analysis was conducted using SPSS (SPSS version 18; Chicago, IL). RESULTS: Our findings suggested that there was no a significant difference between intervention group and control in terms of parameters as GOS, GCS, age, gender, location, mechanism of trauma, and site of accident and the incidence time of accident to arrival at emergency unite (P > .05). Brain CT in two groups showed a significant difference (P = .002), where in the silymarin group there were more normal cases when comparing with control group. CONCLUSIONS: Silymarin did not reveal a significant effect for improving prognosis of patients with moderate and severe TBI.

The Efficacy Of Ginger And Doxedetomidine In Reducing Postoperative Nausea And Vomiting In Patients Undergoing Abdominal Hysterectomy.

BACKGROUND: Nausea and vomiting are the most common complaints of patients after any general anesthesia, which are often accompanied by postoperative pain. Previous studies showed that ginger and dexmedmoidine can reduce postoperative nausea and vomiting. Therefore, the effectiveness of ginger was compared with dexmedmoidine for prevention of postoperative nausea and vomiting. METHODS: This randomized clinical trial study was performed on 92 patients who had abdominal hysterectomy in a double-blind evaluation. In this study, 92 patients were randomly divided into two equal groups of dexmedmotidine and ginger. In the ginger group, 1 gr of ginger was given orally before and after the anesthesia and in the second group, 25 mg of dexmedmotidine was slowly injected before surgery. Finally, after the operation, the questionnaire was completed for patients and the data obtained from the questionnaires were analyzed by SPSS19 software. RESULTS: There was a significant difference between the two groups of dexmodetomidine and ginger in terms of scorpion vomiting in recovery and 2 hours after operation. Vomiting scores were significantly lower in the ginger group than dexmodetomidine group (P = .02 and P = .03). However, no significant difference was defined between the two groups 4 hours after operation, and the scoring was reported to be zero in both groups. Moreover, a decreased level of nausea was observed in the ginger group as compared to the of dexmedetomidine group. CONCLUSION: Both dexmedmotidine and ginger are effective in reducing postoperative nausea and vomiting. But the effect of ginger is greater than that of dexmodetomidine.

An investigation into the effect of evening primrose in dilatation of cervix and pain during and after hysterosalpingography.

Hysterosalpingography is one of the essential diagnostic methods for examining women who have difficulty becoming pregnant. This procedure is somehow invasive and is associated with numerous complications such as allergic sensitivity, pain, abdominal cramps and shock. Therefore, this study aimed to investigate the effect of evening primrose on cervical length and pain during and after hysterosalpingography. In this double-blind clinical trial, 66 candidates for hysterosalpingography were randomly divided into two groups. A group received 1000 mg of evening primrose orally for two days prior to hysterosalpingography, while the control group received a placebo drug similar in size to evening primrose three days prior to hysterosalpingography. The pain level was recorded based on the Visual Analogue Scale (VAS), during tenaculum placement but also immediately and four hours after hysterosalpingography. Finally, the data were analyzed using SPSS (version 20). There was a significant difference between the two groups in terms of pain during insertion of speculum and injection of the contrast medium (p <0.05). Less pain was reported in the evening primrose group compared to placebo. There was no significant difference between the two groups in terms of the length and diameter of the cervix (p <0.05). Given the fact that it is a medicinal plant with no complications and can reduce pain during speculum insertion and during contrast medium injection, evening primrose seems to be a good drug for managing pain during hysterosalpingography.

Effects of Selenium Supplementation on Metabolic Status in Patients Undergoing for Coronary Artery Bypass Grafting (CABG) Surgery: a Randomized, Double-Blind, Placebo-Controlled Trial.

This study was carried out to evaluate the effects of selenium supplementation on glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress in patients undergoing for coronary artery bypass grafting (CABG) surgery. This randomized, double-blind, placebo-controlled trial was performed among 33 patients undergoing for CABG surgery, aged 40-85 years old. Subjects were randomly allocated into two groups to intake either 200 µg/day selenium supplements as selenium yeast (n = 17) or placebo (n = 16) for 4 weeks. Glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress were assessed at baseline and at the end of trial. After the 4-week intervention, selenium supplementation significantly decreased fasting plasma glucose (FPG) (ß, 6.76 mg/dL; 95% CI, - 13.13, - 0.40; P = 0.03), insulin (ß, - 1.14 µIU/mL; 95% CI, - 2.01, - 0.28; P = 0.01); homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (ß - 0.35; 95% CI, - 0.62, - 0.08; P = 0.01); and total-/HDL-cholesterol ratio (ß - 0.31; 95% CI, - 0.51, - 0.09; P = 0.008); and significantly increased HDL-cholesterol levels (ß, 2.72 mg/dL; 95% CI, 0.89, 4.55; P = 0.005) compared with the placebo. Moreover, selenium supplementation led to a significant reduction in high-sensitivity C-reactive protein (hs-CRP) (ß, - 0.68 mg/L; 95% CI, - 1.18, - 0.17; P = 0.01) and malondialdehyde (MDA) (ß, - 0.27 µmol/L; 95% CI, - 0.47, - 0.07; P = 0.009), and a significant elevation in total glutathione (GSH) levels (ß, 77.33 µmol/L; 95% CI, 56.11, 98.55; P < 0.001) compared with the placebo. Selenium supplementation did not affect other metabolic profiles. Overall, our study demonstrated that selenium supplementation for 4 weeks to patients undergoing for CABG surgery had beneficial effects on FPG, insulin, HOMA-IR, total-/HDL-cholesterol ratio, HDL-cholesterol, hs-CRP, GSH, and MDA levels, but did not affect other metabolic profiles. Clinical trial registration number: http://www.irct.ir : IRCT2017090533941N22.

The Effects of Apotel and Remifentanil on Postoperative Pain.

CONTEXT: One of the most common complications of a Caesarean section (C-section) is postoperative inflammation as well as operative and postoperative pain associated with the surgery. The control and mitigation of pain after surgery is the main goal of anesthesiologists. OBJECTIVES: This study aimed to compare the effects of intravenous apotel and remifentanil on postoperative pain control in women undergoing an elective C-section. DESIGN: The research team designed a single-blinded, randomized clinical trial. SETTING: The study was performed at the Taleghani Hospital (Arak, Iran). PARTICIPANTS: Potential participants were 70 patients undergoing an elective C-section. INTERVENTION: Participants were divided randomly into 2 groups, the apotel (A) and remifentanil (R) groups, with 35 participants in each group. The participants in the A group received an infusion of 1 g of apotel to 200 cc of normal saline for 20 min, after anesthesia, the removal of their fetuses, and the clamping of their umbilical cords. The same procedure was followed for the R group (ie, the participants received an infusion of 0.5 µg of remifentanil per kg of body weight per minute after anesthesia), removal of their fetuses, and clamping of their umbilical cords. OUTCOME MEASURES: Pain scores were measured 3 times using a visual analogue scale during the recovery period (from anesthesia and pain scores) and at 4 and 12 h after surgery after surgery. Participants' use of narcotics during the 24 h after surgery was recorded. Data analysis was done using SPSS (version 16) statistical software. RESULTS: The pain scores of the R group were lower than those of the A group during the recovery period and a statistically significant difference existed between the pain scores of the 2 groups during that period (P = .01). No statistically significant difference existed between the groups in participants' mean use of narcotic drugs during the 24 h of surgery. Moreover, no statistically significant differences were found between the groups in participants' blood pressures or heart rates during the recovery period or at 4 and 12 h after surgery (P ≥ .05). CONCLUSION: Remifentanil can provide better postoperative pain control than apotel immediately after surgery.

Investigation of the outcome of patients with hip fractures using vitamin D3.

Hip fracture is one of the important health problems of human societies. The aim of this study was to investigate the outcome of patients with this fracture using vitamin D3. This double-blind clinical trial was performed on 100 patients with hip fractures who referred to Valiasr Hospital. All specimens were evaluated for vitamin D3. Group A have had vitamin D3 in the normal range and received a dose of 50,000 vitamin D3 as blouse. Group B included individuals with hip fractures that did not have normal vitamin D3 levels. In this group, individuals received a dose of 50,000 units vitamin D3 in the form of muscular blouse, and then 50,000 units of vitamin D3 were given orally each week up to 12 weeks after surgery. After surgery, both groups were examined clinically and radiologically for ulcer and fracture healing. Moreover, mortality was checked 2 weeks after surgery and each month until healing. There was no significant difference in radiographic examination in the two groups in the term of adhesion and fracture union (P <0.05). The formation of the union in the clinical examination 4 and 8 weeks after treatment in two groups showed significant difference. The formation of union in clinical presentation 4 weeks and 8 weeks after treatment in two groups showed significant difference (P = 0.005; P = 0.036). The results showed that a group with low vitamin D, but with supplementation, had more fracture union after 4 and 8 weeks after starting treatment. Vitamin D supplementation could improve patients' condition 4 and 8 weeks after treatment.