Background:Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of postdelivery intra- and post-operative nausea and vomiting during CS under spinal anesthesia.Materials and Methods:A randomized, prospective, double-blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. The patients received 4 mg ondansetron in Group O, 8 mg dexamethasone in Group D, and 4 mg ondansetron +8 mg dexamethasone in Group OD intravenously within 1–2 min after the umbilical cord was clamped. Frequency of postdelivery intra- and post-operative nausea and vomiting episodes was recorded.Results:A total of 90 eligible patients were included in the study. There were 30 patients in Group O, 30 patients in Group D, and 30 patients in Group OD. Intraoperative nausea in Group D was more than the other two groups. Postoperative nausea in group OD was lesser than the other two groups. Intraoperative vomiting in Group OD was lesser than the other two groups. There was no statistically significant difference among the groups in postoperative vomiting (P > 0.05).Conclusion:Combined use of dexamethasone and ondansetron for the same indication seems to increase the antiemetic efficacy.
Background: Electroconvulsive therapy (ECT) is nowadays used commonly as one the most effective treatment methods in psychiatric disorders. In patients undergoing ECT, succinylcholine is usually used. In addition, cisatracurium is occasionally used on a case report basis globally. In this study, we compared the hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in ECT. Materials and Methods: The current crossover clinical trial was performed on 45 patients who were candidates for ECT between 2017 and 2018. The patients were given succinylcholine or cisatracurium randomly on two separate occasions of ECT. The independent t -test and Chi square Test were used to compare the data. Results: Comparison of mean systolic blood pressure ( P = 0.14), diastolic blood pressure ( P = 0.33), and mean arterial pressure ( P = 0.23) did not show any significant difference between the two groups. The induced seizure duration ( P = 0.002), return of spontaneous respiratory from seizure ending ( P = 0.001), and apnea duration ( P = 0.01) were significantly higher in the cisatracurium group compared to the succinylcholine group. However, the frequency of tachycardia in cisatracurium group was lower than the succinylcholine group ( P < 0.001). In addition, the serum potassium level had a significant difference ( P < 0.001) between the two groups. Conclusion: Using cisatracurium can be an alternative to succinylcholine during ECT since it causes less elevation in serum potassium and creates a longer duration of induced seizure, more rapid re emergence of spontaneous breathing at the end of seizure ( P = 0.001), and a lower prevalence of tachycardia compared to succinylcholine ( P < 0.001).
Background:The aim of this study was to examine the effects of preoperatively administered i.v. hypertonic saline on hypotension following induction of general anesthesia.Materials and Methods:Fifty-four patients who scheduled for elective surgery were randomly allocated to two groups of 27 patients who received hypertonic saline 5% (2.3 ml/kg) or received normal saline (13 ml/kg). Infusion of hypertonic saline was done half an hour before induction of anesthesia during 30 minutes. Anesthesia was conducted in a standard protocol for all patients. Age, sex, body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), heart rate (HR) and mean arterial pressure (MAP) were assessed in all patients.Results:The mean age of patients was 36.68 ± 10.8 years. Forty percent of patients were male. The mean SBP at min 2 and min 5, mean of DBP at min 2, 5, and 15, mean of HR at all time points and mean of MAP at min 2 and 15 between groups were no significantly different (P > 0.05), but mean of SBP at min 10 and 15, mean of DBP at min 10, and mean of MAP at min 5 and 10 in hypertonic saline group was significantly more than the normal group (P < 0.05). Trend of SBP, DBP, HR and MAP between groups were not significantly different (P > 0.05).Conclusions:Infusion of hypertonic saline 5% (2.3 mg/kg) before the general anesthesia led to a useful reduction in MAP and reduced heart rate, with no episodes of severe hypotension.
Background:Postoperative pain is one of the most common complaints after elective laparoscopic cholecystectomy. The present study was aimed to evaluate the effect of paravertebral block using bupivacaine with/without fentanyl on postoperative pain and complications after laparoscopic cholecystectomy.Materials and Methods:This study was done on 90 patients scheduled to undergo elective laparoscopic cholecystectomy. Patients were assessed in two groups: The case group received bupivacaine and fentanyl, and the control group received bupivacaine and normal saline. Primary outcomes were severity of postoperative pain at rest and during coughing. Secondary outcomes were postoperative cumulative morphine consumption and the incidence of side-effects.Results:Pain score at rest before surgery, after recovery, hour-1 and hour-6 was not significantly different between the groups. But in hour-24 cases, the pain score during coughing was significantly higher than controls. Severity of pain at rest in time points was not different between groups. The frequencies (%) of moderate pain at mentioned times in case and control groups were 64, 31, 16, 9, 0 versus 67, 16, 7, 4, and 0, respectively. Pain score during coughing was lower in controls at hour-24 in comparison with cases, but in other time points was not significant. The control group significantly received more total dose of morphine in comparison with cases group. Nausea, vomiting and hypotension were similar in groups, but pruritus was significantly different between the groups.Conclusion:Adding fentanyl to bupivacaine in paravertebral block did not significantly improve the postoperative pain and complications after laparoscopic cholecystectomy. However, further studies are needed to be done.
Background: Considering the importance of maintaining hemodynamic stability in the patient undergoing brain tumor surgery, this study aimed to compare the effects of fentanyl and dexmedetomidine on hemodynamic changes in patients undergoing brain tumor surgery. Methods: In a clinical trial study, 70 patients undergoing brain surgery were distributed in two groups of 35. The first group received 5 mg / kg fentanyl, and the second group received 1 mg / kg dexmedetomidine immediately after induction of anesthesia. During the operation, the patients were evaluated for hemodynamic parameters, blood gas levels and coagulation profile during operation and recovery and compared between the two groups. Findings: The mean changes of hemodynamic parameters was not differ between the two groups. Among blood gases HCO3had a higher level of in the dexmedotomidine group before, during and after surgery, and its changes during the study period were significant between the two groups (P <0.001). Also, PT level was higher in the dexmedmotidine group before surgery (P = 0.007), but its change was not significantly different during the study period (P = 0.14). Discussion: Our findings showed that the use of dexmeditomidine with more favorable hemodynamic stability, shorter hemodynamic presentation, and shorter duration of stay of patients undergoing cerebral surgery. Considering the serious side effects of doxedetomidine administration, it seems that the use of Dexmedetomidine is preferred in patients undergoing brain surgery than fentanyl. Keywords: Brain tumor, Dexmedmotidine, Fentanyl, Hemodynamic
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