Background According to the favorable effects of combination therapy to provide better sedation during phacoemulsification and lack of any studies investigating the sedative effect of etomidate, propofol, and midazolam in combination with fentanyl during the procedure. Objectives The current study aimed at comparing the sedative properties of the mentioned three combination therapies in this field. Methods The current double-blind, randomized, controlled clinical trial was conducted on patients referred for elective phacoemulsification surgery under sedation. They were randomly allocated to the three groups to receive fentanyl plus one of the following medications: Propofol, midazolam, and etomidate. Demographic characteristics, medical condition, and hemodynamic parameters before, during, and after surgery, sedation level, anesthetic complications, sedation-related adverse events, and patients’ and surgeons’ satisfaction were evaluated and recorded by the anesthesiologist and compared in the three studied groups. Results In the current study, out of 150 enrolled patients, 98 completed the study. Frequency of different levels of Ramsay scores was not significantly different between the groups (P = 0.41). Frequency of Ramsay scores 3 and 4 was 92%, 79.4%, and 88.2% in etomidate, midazolam and propofol groups, respectively (P = 0.32). The median recovery time was significantly higher in the midazolam group than the propofol group (P = 0.04); intergroup comparisons indicated that the patients’ mean score of satisfaction in the propofol group was significantly higher than that of the etomidate group (P = 0.006). Conclusions The current study findings indicated that though the quality of sedation during phacoemulsification cataract surgery was acceptable in the three agents and the results had no significantly differences among the groups, and considering other factors including recovery time, hemodynamic evaluation, sedation-related complications, and patients’ satisfication scores, it is suggested that propofol was superior to the other two agents.

Background: This study aimed to compare the effects of preoperative administration of midazolam and dexmedetomidine on cognitive dysfunction prevention after cataract surgery. Materials and Methods: This research was a double-blind controlled clinical trial. In this study, 150 candidates for cataract surgery under general anesthesia, over 65 years, and similar to American Society of Anesthesiologists I and II characteristics were selected as the sample and randomly assigned to three groups. Participants of these three groups were treated with 0.1 mg/kg of midazolam, 1 μg/kg of dexmedetomidine, and the same volume of normal saline (control), respectively. Hemodynamic parameters and cognitive dysfunction score of the participants were measured using the Mini-Mental State Examination (MMSE) before the surgery, 24 h and 1 week after the surgery. Results: An evaluation of hemodynamic parameters before anesthesia up to 24 h after the surgery showed no significant difference between the midazolam, dexmedetomidine, and control groups in terms of systolic and diastolic blood pressure, heart rate, and blood oxygen saturation ( P > 0.05). In addition, there was no statistically significant difference between the midazolam and dexmedetomidine groups in the MMSE score before the surgery and 24 h and 1 week after that ( P > 0.05). However, there was a significant difference between these two groups and control ( P < 0.05). Conclusion: There was no significant difference between midazolam and dexmedetomidine in reducing postoperative cognitive dysfunction (POCD). However, there is a significant difference between these two groups and control. Hence, either midazolam or dexmedetomidine can be prescribed to reduce POCD in cataract surgeries.

Background & Objective: Several studies have shown that topical and intravenous Dexmedetomidine and Lidocaine can decrease pain and reduce consumption of analgesic drugs. However, Lidocaine may be accompanied with several side effects such as respiratory suppression, seizure, and cardiac arrhythmias. On the other hand, Dexmedetomidine has favorable properties such as low risk of apnea, analgesia, sympatholysis, and sedation. Therefore, the aim of this study was to compare the effects of nebulized Dexmedetomidine and nebulized Lidocaine on hemodynamic characteristics of the patients undergoing bronchoscopy. Materials & Methods: In the present randomized, double-blind study; 75 children (1-6 years old) undergoing fiber-optic bronchoscopy were allocated to three groups. Group 1 received nebulized solution containing 2 µg/kg of Dexmedetomidine. Group 2 received nebulized solution containing 4 mg/kg of Lidocaine 1%. Group 3 received nebulized solution containing 0.9% of normal saline as the control group. Heart rate, mean arterial blood pressure and SpO2, Bispectral Index (BIS) were measured and compared. BIS, indicating the depth of anesthesia was considered as a confounding factor. Statistical analysis was performed using SPSS 20. Results: The mean of arterial blood pressure and heart rate was significantly lower in group 1 compared to groups 2 and 3 during bronchoscopy (P<0.05). Blood oxygen saturation and sedation scores were significantly higher in group 1 compared to the other groups during bronchoscopy (P<0.05). Furthermore, the hemodynamic parameters were more stable in group 1 compared to the other groups during recovery. Conclusion: Premedication with nebulized Dexmedetomidine was significantly associated with more stable hemodynamic parameters and lower risk of side effects compared to nebulized Lidocaine in children undergoing fiberoptic bronchoscopy.

Background:Breast lumpectomy is an integral part of the treatment of mammary masses in women. This study was conducted to evaluate and compare two-drug combinations of propofol–ketamine (PK) (ketofol) and propofol–fentanyl (PF) (fenofol) on quality of sedation and analgesia in lumpectomy.Materials and Methods:This was a randomized, double-blind, clinical trial performed on 64 patients aged 15–70 years with breast cancer lumpectomy referred to Isfahan's Seyed Al-Shohada Hospital. Consequently, patients were divided into two groups of 32 patients, each group receiving PF combination or PK combination during anesthesia.Results:The patients in two groups, PF and PK, were compared in their sedation levels, severity of pain, and other variables. The mean arterial blood pressure, systolic blood pressure, and heart rate (HR) did not show any significant difference at the beginning of the study in the two groups, but the fenofol (PF) group had a significantly lower oxygen saturation than the ketofol (PK) group. The sedation level was significantly lower in the fenofol group than the ketofol group (P < 0.001). The mean pain intensity was significantly lower in the PF group than the PK group (P < 0.001).Conclusion:The two combinations of ketofol and fenofol cause rapid, favorable, safe anesthetic with minimal side effects and hemodynamic effects but it may be a superior alternative to fenofol combination, in terms of respiratory depression.

Background: Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children. Materials and Methods: Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 μg/kg per hour and group 2 received a dose of 0.3 μg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney. Results: According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups. Conclusion: A dose of 0.6 μg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.

Background: Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy. Methods: This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes. Results: Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients. Conclusions: The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

Background:Failure to ventilate patients by mask leads to serious complications especially if associated with difficult intubation. Previous studies have used subjective and indirect measures to evaluate difficulty in mask ventilation, which are associated with high inter-observer discrepancies. In this study, we have defined and used efficiency of mask ventilation (EMV) as an objective and direct surrogate for ease of mask ventilation in patients undergoing GA and mask ventilation using neuromuscular relaxation.Materials and Methods:1050 adult patients prospectively were evaluated with respect to different patients demographic and physical factors and EMV. EMV was defined as the ratio of minute ventilation via anesthesia mask to that via tracheal tube expressed as percentage. Edentolous patients were ventilated using lip-over-mask techniques. Separate analyses were done for edentolous and non-edentolous patients.Results:EMV in edentolous patients (n=269) using the lip-over-mask method was relatively high (90.9 ± 14.3%, 60.14–128.57 range). The result of multiple regression analysis in patients with normal denture determined receded chin, presence of beard, male gender, high Mallampati classes, high neck circumference, low inter-incisors gap, and old age as independent factors for estimating EMV. A regression formula for predicting EMV was developed which had an acceptable R-square value with a good model fit.Conclusions:Using EMV is an easy and reliable tool for measuring efficiency of mask ventilation. Based on the result of this study, EMV can be estimated from patient's demographic and physical factors. In edentolous patients, using the lip-over-mask method results in adequate ventilation of lungs.

Background and Aim: The purpose of this study was to compare the effect of thiopental sodium-midazolam combination on the stress response and hemodynamic changes between tracheal intubation and laryngeal mask airway insertion during airway management. Materials and Methods: In this clinical trial study, 70 patients ASA 1, 2 candidates for elective surgery were randomly divided into two groups of tracheal intubation and laryngeal airway mask insertion. Hemodynamic variables including mean arterial pressure, heart rate, and arterial oxygen saturation were measured and compared between the two groups before and after intubation. Results: There was no significant difference between the two groups in regard to demographic data (age, sex, height, and weight), heart rate, mean arterial pressure and arterial oxygen saturation at 1 and 3 minutes after induction of anesthesia and 1, 3, 5 and 10 minutes after intubation. (P> 0.05). But there were significant differences between the two groups in relation to heart rate at 1 and 3 minutes after intubation, so that heart rate at these times was significantly higher in the intubation group than in the laryngeal airway mask group (P <0.05). Conclusion:Based on the findings of this study, use of thiopental sodium midazolam combination was effective and safe and attenuated the stress response to airway management with resultant minimal changes in the heart rate and blood pressure.