Two Different Concentrations of Ketofol for Procedural Sedation and Analgesia in Closed Reduction of Nasal Fracture.

OBJECTIVES: Ketofol is a mixture of propofol and ketamine in various concentrations. It is accepted as a suitable combination in procedural sedation and analgesia. The mixture of propofol and ketamine with different respiratory and hemodynamic effects may result in fewer dose-related side effects and a probable synergistic effect. This study was designed to compare the adverse effects and quality of analgesia of 2 different intravenous concentrations of ketofol in patients undergoing closed reduction of the nose. METHODS: This randomized double-blinded study was conducted on 100 patients who underwent closed reduction of nose. The patients were divided into 2 groups of 50, and received either a combination of propofol/ketamine (1:1) (Group I) or propofol/ketamine (3:1) (Group II). Hemodynamic changes, including systolic blood pressure, diastolic blood pressure, heart rate and O2sat, and side effects such as hallucination, vomiting, coughing and apnea, were recorded. RESULTS: Data analysis showed that the demographic characteristics (age, height, and weight) were similar in 2 groups, and there were no significant differences between the 2 groups. There was no significant hemodynamic change between both groups. However, there was a decrease in hallucination and vomiting in the group that received higher concentration of ketofol (ketamine/propofol of 1:3). CONCLUSION: There was no significant hemodynamic change between both groups that received concentrations of 1:1 and 3:1 propofol /ketamine. However, there was a reduction in hallucination, vomiting, and recovery duration in the group that received higher concentration of propofol. In conclusion, increasing the concentration of propofol can be useful with fewer side effects and lower duration of recovery.

The role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis.

BACKGROUND: There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). OBJECTIVE: To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals. MATERIALS AND METHODS: Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm H2O). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals. RESULTS: There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO2 was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO2 showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group. CONCLUSION: Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV.

Efficacy of prophylactic dexamethasone in prevention of postoperative nausea and vomiting.

OBJECTIVE: Many trials have been conducted with regard to the relative benefits of prophylactic anti-emetic interventions given alone or in combination, yet the results remain unknown. This study reviewed the efficacy of a single prophylactic dose of dexamethasone on postoperative nausea or vomiting (PONV) after abdominal hysterectomy. METHODS: In a prospective study of 100 women undergoing total abdominal hysterectomy (TAH) under general anesthesia, the dexamethasone group (n=50) received a single dose (8 mg) immediately after the operation, and the saline group (n=50) received a dose of saline as a placebo, in addition to conventional management. The incidence of nausea, vomiting, the need for an anti-emetic and patient satisfaction with the management of PONV were evaluated during the first 24 postoperative hours. RESULTS: The overall frequency of nausea during the initial postoperative 24 in the dexamethasone and saline groups were 12% and 18%, respectively, and vomiting was 10% and 16%, respectively (P=0.001). However, there was a lower need for a rescue anti-emetic drugs in the dexamethasone group (18% vs 24%), but it was not statistically significant (P=0.06). CONCLUSION: The results of this study indicate that a single prophylactic dose of dexamethasone after an operation can reduce postoperative nausea and vomiting.

The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients.

BACKGROUND: Acute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients. METHODS: After approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups. RESULTS: Mean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test). CONCLUSION: Blood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery.

Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery.

BACKGROUND: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15-20 minutes compared to 15-30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery. METHODS: 30 patients aged 30-70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P). RESULTS: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate. CONCLUSION: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.

Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial.

BACKGROUND: Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants. OBJECTIVES: Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone. PATIENTS AND METHODS: Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups. Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients. RESULTS: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients. CONCLUSIONS: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean section provides more effective and long lasting pain relief than control group.

Unwanted intra-operative penile erection during pediatric hypospadiasis repair. Comparison of propofol and halothane.

PURPOSE: To compare the erectile effect of propofol and halothane on unwanted intraoperative penile erection (UIOPE) during pediatric hypospadiasis repair. MATERIALS AND METHODS: One hundred and seventeen boys who were in the age range of 6 months to 6 years and referred for hypospadiasis repair to our referral teaching hospital were included in this randomized clinical trial. Patients were randomly assigned to one of the two study groups before anesthesia induction. Anesthesia was maintained with a continuous intravenous infusion of propofol and inhalational halothane in the propofol (P) and halothane (H) groups, respectively. Data regarding the patients' age, weight, pre- and intra-operative chordee, UIOPE, anesthesia time, surgery time, hematoma formation, and wound infection were collected. The Chi-Square and Fisher's exact tests were used for comparison. RESULTS: No statistically significant differences were noted regarding age, weight, and pre and intra-operative chordee between the two groups. The incidence of UIOPE (10.34% versus 57.63%; P = .000), anesthesia time (174.15 +/- 15.02 versus 181.26 +/- 15.19; P =.012), and surgery time (162.34 +/- 12.99 versus 167.69 +/- 13.90 +/- 13.90; P = .034) were significantly lower in group P compared with group H. CONCLUSION: The use of propofol during hypospadiasis surgical repair is more safe and effective than halothane in preventing UIOPE and reducing surgery and anesthesia time.

Comparison of postoperative analgesic effect of tramadol and bupivacaine subcutaneous infiltration in patients undergoing cesarean section.

Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n = 30) or 50 mg of tramadol in 10 mL of normal saline (n = 30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Data were analyzed by SPSS software version 15 and p < 0.05 was considered significant. The VAS score did not differ significantly between the two groups at 1 and 2 hours after cesarean section, but it was higher in bupivacaine group than tramadol group 6 hours after operation (p < 0.05; Fisher exact test). Postoperative consumption of analgesic was higher in bupivacaine group than tramadol group but the difference was not significant (p > 0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.

Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial / Remifentanilo en la inducción de la anestesia general para la cesárea: estudio clínico doble ciego, aleatorizado

Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p> 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

Introducción: El Remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de Remifentanilo durante la cirugía cesárea. Métodos: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología) y que fueron sometidas a anestesia general para ces´rea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. Resultados: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo Remifentanilo en comparación con el grupo control (p <0,05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0,05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0,05). No neonato requiere ventilación asistida o administración naloxan. Conclusión: El Remifentanilo puede ser un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior.

Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial.

INTRODUCTION: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. METHODS: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. RESULTS: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p <0.05). There were no significant differences regarding heart rate between groups at any time (p > 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. CONCLUSION: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

INTRODUCCIÓN: El Remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de Remifentanilo durante la cirugía cesárea. MÉTODOS: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología) y que fueron sometidas a anestesia general para ces´rea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. RESULTADOS: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo Remifentanilo en comparación con el grupo control (p <0.05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0.05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0.05). No neonato requiere ventilación asistida o administración naloxan. CONCLUSIÓN: El Remifentanilo puede ser un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior.

Effect of oral low dose clonidine premedication on postoperative pain in patients undergoing abdominal hysterectomy: a randomized placebo controlled clinical trial.

UNLABELLED: This study evaluated the effect of oral low dose clonidine premedication on postoperative pain and hemodynamic status of the patients during abdominal hysterectomy under general anesthesia. METHODS: This study is a randomized, placebo controlled double-blinded clinical trial. After approval of the study protocol by the Ethics Committee 60 patients were recruited and written informed consents were obtained. Two hours before surgery, patients in the treatment group (n=30) received a single oral dose of 100 microgram of clonidine and those in the placebo group received an oral dose of placebo (n=30). The severity of postoperative pain was assessed at 2nd, 6th, 12th and 24th hours after the operation using the visual analog scoring system (VAS score). Also the total dose of administered analgesics during 24 hours after the surgery and the interval between the surgery and the first request of analgesic were compared between the two groups. Systolic blood pressure and pulse rate were recorded during the surgery and at the post anesthesia care unit. Drug related adverse effects were also evaluated. RESULTS: Postoperative pain VAS during 24 hours after the surgery was significantly (P=0.001) lower in clonidine group (3.86 +/- 0.89) compared to the placebo group (4.86 +/- 0.93). Also, the interval between surgery and the first request of analgesic in clonidine group was 4.13 +/- 3.27 hours on of longer duration (P=0.02) compared to 2.88 +/- 3.74 hours in placebo group. The mean heart rate and systolic blood pressure were lower in the clonidine group. CONCLUSION: A single oral 100 microg dose of clonidine administered 2 hours before abdominal hysterectomy significantly reduces the severity of postoperative pain.

Comparison of effects of ephedrine, lidocaine and ketamine with placebo on injection pain, hypotension and bradycardia due to propofol injection: a randomized placebo controlled clinical trial.

Propofol is a widely used anesthetic drug because of its minor complication and also its fast effect. One of most popular complication in using this drug is pain during injection that is more sever in new generation of its components (lipid-free microemulsion). Other complications of propofol are bradycardia and hypotension. This study compares 3 drugs with placebo in control of these complications of propofol. In this double blinded randomized placebo controlled trial 140 patient who were candidates for elective surgery were divided in 4 groups (35 patients in each groups) and drugs (ephedrine, lidocaine, ketamine and NaCl solution (as placebo) were tried on each group by a blinded technician and responses to drugs were evaluated under supervision of a blinded anesthesiologist. Pain after injection, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured 5 times during anesthesia process of each patient. All gathered data were analyzed using t-test and Chi-square under SPSS software. Our data shows that in pain management all tested drugs can decrease pain significantly comparing with placebo (P=0.017). In control of hemodynamic parameters ephedrine could efficiently control SBP, DBP, MAP at the time 1 min after intubation. Based on our study ephedrine can be an appropriate suggestion for control of both pain and hemodynamic changes induced by propofol, although because of inconsistent result in other studies it is recommended to design a systematic review to draw a broader view on this issue.

Hemodynamic effects of intraocular epinephrine during cataract surgery: a double blinded placebo controlled randomized clinical trial.

OBJECTIVE: To evaluate hemodynamic effects of intraocular epinephrine irrigation in patients undergoing cataract surgery. MATERIALS AND METHODS: This study was conducted as a prospective double blinded clinical trial at the Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Eighty-eight patients of age 38-90 years undergoing were randomly allocated into two groups: Group E received intraocular irrigation fluid (balanced salt solution) with epinephrine 1:1000, 000, and group C received intraocular irrigation fluid (balanced salt solution) without epinephrine. Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were measured before and at 5, 10, 15 minutes after starting intraocular infusion of epinephrine1:1000, 000 in both groups. RESULTS: HR and SBP were similar in the two groups at different time intervals. DBP was decreased at 5 minutes after epinephrine administration in the epinephrine group and increased at 10 and 15 minutes but there was no significant differences between the two groups. CONCLUSION: Intraocular infusion of epinephrine 1:1,000,000 can be used during cataract surgery without hemodynamic side effects and so is a safe and effective method for this purpose.

Comparison of two doses of tranexamic acid on bleeding and surgery site quality during sinus endoscopy surgery.

BACKGROUND: One of the main concerns in sinus surgery is blood loss due to the high vasculature of the mucosa. Tranexamic acid (TA) is an antifibrinolytic agent which reduces bleeding following certain surgical procedures. MATERIAL AND METHODS: This randomized double-blinded clinical trial was performed on 70 patients with class I and II ASA (American Society of Anesthesiologists) who were scheduled for endoscopic sinus surgery under general anesthesia. The average ages of the patients were 18 to 50 years old. Thirty-five patients (group A) received 5 mg/Kg of TA, and another 35 patients (group B) received 15 mg/Kg of TA. The mean arterial pressure (MAP), diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) were documented. Also, the amount of blood loss and satisfaction scores were obtained from the surgeon in 30th, 60th, 90th, 120th and 180th minutes. All the data was analyzed by SPSS-15 software with T-test. RESULTS: A total of 52 males and 18 females participated in the study. There were no significant differences between the mean age, MAP, DBP, SBP and HR during surgery between groups. Blood loss was 272.74 ± 25.77 mL 242.89 ± 51.77 mL in the group A and B respectively (P < 0.003). The surgeon was more satisfied with the surgical field of the group B than the group A (mean scores 4 (3-5) vs. 3 (1-5) respectively, P < 0.005). Surgery period and need for supplement drug to control bleeding in group B was significantly less than in group A (P < 0.05). But there was no significant difference between the two groups in terms of side effects. CONCLUSIONS: Administration of 15 mg/Kg TA intravenously is more effective than 5 mg TA to achieve hemostasis and improving the quality of surgical field, surgeon satisfaction, less surgery period and bleeding volume during endoscopic sinus surgery without any significant side effects.

Preoperative analgesia with local lidocaine for cesarean delivery pain relief.

OBJECTIVE: The purpose of this study was to determine whether local analgesia at the incision site could reduce pain in women undergoing cesarean delivery or not. METHODS: One hundred and four women undergoing cesarean deliveries were randomized in two groups according to 10 ml of 2% lidocaine (n = 52) or 0.9% saline (n = 52) was injected at the abdominal incision prior to the performance of the cesarean section (CS). Postoperative pain treatment consisted of oral analgesia with mefenamic acid 500 mg. Morphine 5 mg was used for rescue analgesia. Pain intensity was self-evaluated with visual analog scale. Data were analyzed by SPSS software version 11.5 and p value <0.05 was considered significant. RESULTS: Women in lidocaine group perceived a significant reduction in postoperative pain in the first hours after surgery. There was also significantly less opioid analgesic requirement in the lidocaine than control group 4 h after CS (19 vs 44 women, p = 0.001). No side effects were reported in either group. CONCLUSION: Preemptive analgesia with lidocaine infiltration at the incision is a simple and efficient mode with few side-effects that may reduce pain and opioid requirements in women undergoing CS.

Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial.

BACKGROUND: Postanesthetic shivering is one of the most common complications of anesthesia. We compared the efficacy of meperidine and two low doses of ketamine with placebo to prevent postanesthetic shivering after general anesthesia. METHODS: This was a prospective, randomized double-blind placebo controlled clinical trial involving 120 ASA I-II patients aging 20-50 years, undergoing endoscopic sinus surgery with general anesthesia. Patients were randomly allocated to receive meperidine 0.4 mg/kg (Group M, n = 30), ketamine 0.3 mg/kg (Group K(1), n = 30), ketamine 0.5 mg/kg (Group K(2), n = 30), or normal saline (Group N, n = 30) 20 minutes before completion of the surgery. Tympanic temperature, blood pressure, and heart rate were measured before and immediately after induction of anesthesia, 30 minutes after induction, and before administration of the study drugs. The drugs were prepared and diluted to a volume of 2 ml and presented as coded syringes. An investigator, blinded to the groups, graded postanesthetic shivering using a four-point scale. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Windows version 16. A p-value < 0.05 was considered statistically significant. RESULTS: Patient characteristics of the four groups were similar. The number of patients with observed shivering in groups was 0, 3, 1, and 9 in Groups M, K(1), K(2) and N, respectively. The difference between groups M, K(1), and K(2) with Group N was statistically significant. However, differences between groups M and K(1), M and K(2), and K(1) and K(2) were not significant. The number of patients with a shivering score of 2 or 3 was higher in Group N compared with other groups. CONCLUSIONS: Prophylactic use of low doses of intravenous ketamine (0.3 or 0.5 mg/kg) was found to be effective to prevent postanesthetic shivering. However, administration of 0.3 mg/kg ketamine lowered the rate of hallucination as compared with 0.5 mg/kg.