قدرت اخوان اکبری

Using medications that decrease postoperative pain and opioid consumption is a widely recommended approach. The aim of this study was to evaluate the efficacy of intravenous Ibuprofen and its complication in controlling pain after abdominal surgery.

This study was a randomized, double-blind, interventional clinical trial. Sixty patients aged 20 to 60 years were candidates for abdominal surgery (inguinal hernioplasty and appendectomy). Patients were divided into two equal size groups (n=30) using a random block design method. The First group received (400 mg IV) ibuprofen every 6 hours for 24 hours as well as (15 microgram/ml bolus) fentanyl pump with PCA. Second group only received (15 microgram/ml blous) fentanyl pump with PCA. 

Demographic characteristics and duration of surgery, ASA class, type of anesthesia and type of surgery were similar in the two groups. Pain severity in 24 postoperative hours was significantly lower in the ibuprofen group compared with the control group. Nausea and vomiting frequency in 24 postoperative hours was significantly lower in the ibuprofen group compared with the control group. Patients belonging to ibuprofen group were significantly more satisfied with their analgesic method.

Results showed that using 400 mg intravenous ibuprofen every 6 hours mitigates postoperative pain, reduces fentanyl consumption and is highly tolerated by patients.

Intraoperative nausea and vomiting causes anxiety for the patient , gynecologist and anesthesiologist, and can increase the risk of visceral injury during surgery due to unintentional abdominal movements. The purpose of this study was to compare the efficacy of low-dose Ketamine and dexamethasone in controlling nausea and vomiting in patients undergoing cesarean section with spinal anesthesia.

A total of 135 patients underwent cesarean section by spinal anesthesia in the operating room. All patients were 18-40 years old and ASAI-II. Patients were randomly divided into three groups using blocking method as Ketamine intake group (including 45 subjects diluted 20mg ketamine diluted in normal saline 5ml total volume), dexamethasone group (including 45 patients diluted 8mg dexamethasone normal saline 5ml total volume) and control group (including 45 patients who received 5 ml of saline) and the incidence of nausea and vomiting were recorded during anesthesia, nausea by an anesthesia technician under the supervision of an anesthetic resident who was unaware of the patient`s group. Finally, all data were analyzed by statistical analysis (spss21) program.

In this study, 135 patients were divided into three groups of 45 (dexamethasone, ketamine and placebo). In this study, low dose of dexamethasone and ketamine before cesarean section did not significantly reduce the incidence of nausea and vomiting (P=0.02) and shivering (P=0.550). However, the intensity of nausea and vomiting was significantly decreased in the low dose ketamine group compared to the dexamethasone group. There was no significant change in the blood pressure and heart rate of the patients, and blood pressure falctuations were consistent at different times. Also, there was no significant difference in the incidence of hypotension (P=0.885), Ephedrine intake for hypertension (P=0.623), and the incidence of bradycardia (P=0.146) in the study groups. On the other hand, it was observed that the incidence of bradycardia was significantly lower in the ketamine recipients than in the dexamethasone group.

This study showed significant reduction in nausea and vomiting in the Ketamine group compared to Dexamethasone and no significant difference between two groups regarding the hypotension and shivering. It also showed that there was no statistically significant difference between groups receiving Dexamethasone and low dose Ketamine compared to control group during the operation period regarding the decrease in rate of nausea and vomiting, hypotension and shivering.

Aims and Postoperative pain is a common side effect following surgery that can postpone patient’s discharge from hospital. Pain control in orthopedic patients can significantly reduce joint movement problems and patients can easily get back to normal life. In this study we aimed to study the efficacy of sublingual Buprenorphine in postoperative pain control following orthopedic surgery of the lower limbs.
This double blind clinical trial was conducted on 60 patients referred for orthopedic surgery of the lower limbs. They were in classes I and II of the American Society of Anesthesiologists (ASA( and they were under spinal anesthesia. Patients were divided into two groups of Buprenorphine (0.4mg, every 8h hours( and control group (Morphine 20mg in 100cc(. This trial was practiced after surgery and in the recovery room. Amount of meperidine usage, pain score and side effects including nausea and vomiting, level of sedation and pruritis were recorded at 1, 8, 16 and 24 hours after surgery.
Findings: 60 Patients in the control (Morphine) and Buprenorphine groups were studied. There was no significant difference between the two groups in terms of gender distribution (p=0.766(, average age (p=0.350(, weight (p=0.195(, ASA score (p=0.519( and operation time (p=0.510(. Average pain score in the Buprenorphine group was significantly lower than the control (Morphine) group at 8 (p=0.025), 16 (p This study showed that Sublingual Buprenorphine administration after orthopedic surgery of the lower limbs can lead to better postoperative pain control in comparison to control group (Morphine PCA pump(. Also it has minimal side effects and is compatible with Morphine in this field.

Aims and Pain is one of the important factors in the acceptance of surgery in patients and may be the most important factor in the fear of surgery. The gold standard for controlling postoperative pain is the use of narcotic drugs, but its use is limited due to side effects. The present study was designed and performed with a comparative study betwwn the effect of infusion of ketorolac and acetaminophen on pain reduction and opioid use after surgery in patients undergoing orthopedic surgery of lower extremities.
This study is a randomized double blind clinical trial. In this study, 100 patients undergoing orthopedic surgeries in the lower limbs with general anesthesia were randomly assigned to two groups of 50. The first group received 1 gr of acetaminophen every 6 hours intravenously, and the second group received 90 mg of ketorolac in 1 liter of normal saline serum for 24 hours. VAS system was used at 0, 12 and 24 hours to evaluate pain after surgery. In case of pain in patients, Meperidine was injected, and the dose of Meperidine consumed was measured and recorded at the end. Finally, the data was analyzed.
Findings: In this study, intravenous administration of acetaminophen was initially less effective than ketorolac infusion, but after 12 hours it was observed that the effect of acetaminophen on pain relief was greater than that of ketorolac. Also, the level of Meperidine was initially lower in the ketorolac group than in the acetaminophen group, but after 12 hours, Meperidine levels increased in the ketorolac group. It was also observed that the rate of nausea and vomiting in the ketorolac infusion group was significantly lower than that of the intravenous acetaminophen recipient group. However, the patient’s satisfaction with acetaminophen was more than that of the ketorolac infusion.
The results of this study showed that the effect of acetaminophen and ketorolac is different at different times. The pain reduction in the first 12 hours in the ketorolac group and the second 12 hours in the acetaminophen group significantly changed.

Aims and Pain is an unpleasant experience due to tissue damage. Postoperative pain control is one of the essential issues in postoperative care, and plays an important role in quick healing of general status of surgery patients. Appropriate control of the postoperative pain is particularly important in preventing tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation and poor wound healing. Therefore, in this study the efficacy and adverse effects of morphine and diclofenac suppositories are compared to injectable pethedine in controlling postoperative pain in appendectomy and inguinal hernia.
Material and This study is a clinical trial. The patients were among the ones admitted to Doctor Fatemi Hospital of Ardabil city with appendicitis and inguinal hernia, aged between 18 to 70 years old during 1392. 75 individuals, chosen in 3 groups of 25 patients by Systematic random allocation were chosen.The first group received 10 mg of morphine suppository after surgery, the second group received 100 mg of Diclofenac suppository after surgery, and in the third group 50 mg of intra muscular pethedine was used to control pain.
Findings: The average scores of pain )VAS( in the Diclofenac receiving group at 2- 6-12- 24 hours after surgery were 4/56, 4/40, 3.68 and 3/36, respectively. The average scores in the morphine suppository group were 4/36, 3/84, 3/12, and 2/44, respectively; the scores were 6/52, 6/68, 6/28 and 5/84 in the control group )pethedine group(. According to ANOVAS test, there was significant difference among patients’ pain relief in the three studied groups.
Both morphine and diclofenac suppositories, cause significant pain relief in comparison to the group receiving IM pethedine to control pain after appendectomy and inguinal hernia surgery.

Uncontrolled postoperative pain can cause many adverse effects such as tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation and poor wound healing. In this study we evaluated the preoperative administration of pregabalin in relieving postoperative pain after lower limb orthopedic surgery and reducing the need for opioids and their possible side effects. This study is a randomized, double-blind clinical trial. It was performed on 60 patients under lower limb surgery in Fatemi Hospital. Patients were randomly allocated to two groups, one group has received a 150 mg pregabalin capsule 2 hours before surgery and the other group has received placebo as a control. In both groups at 2, 6, 12 and 24 hours after surgery, the patients were evaluated and the pain score by a visual analogue scale (VAS), the score of sedation by Ramsay sedation scale and the incidence of nausea and vomiting were recorded in the checklists. Then, the data were analyzed by SPSS v16. P <0.05 was considered significant. In this study 51.7% of patients were male and 48.3% were female. The age averages of these patients in both group were similar (p =0.578). Visual analog pain scores at 2 h after surgery reduced in pregabalin group (p <0.0001). Similar reduction was observed in other studied hours (p <0.0001) too. In the pregabalin group nausea and vomiting scores at all hours, sedation levels at 2 h and 6 h postoperation, and pethidine consumption in all hours have significantly been reduced (p <0.05). Preoperative administration of pregabalin is an effective method for reducing postoperative pain for patients, and with reduction in pethidine consumption, it can decrease problems of opioid usage.

A routine method to control post-operative pain is patient-controlled intravenous analgesia (PCIA) using opioids. Regarding complications of opioids, it seems necessary to reduce their dosage and to improve the quality of analgesia using adjuvants. We aimed to assess the effect of adding ketamine to morphine in PCIA pumps for post-operative pain control in orthopedic patients. Sixty patients, being 20-60 years old (ASA class I-II) and undergoing orthopedic surgery in lower extremity, were enrolled They had no history of opioid addiction or epilepsy. Our patients were randomly allocated to three groups 20 mg morphine sulfate, 100 mg ketamine plus 20 mg morphine and 200 mg ketamine plus 10 mg morphine in their PCIA pump. The pain score was evaluated using VAS (0-10) and VRS (0-5); besides the sedation score and the degree of nausea-vomiting were assessed with Ramsay scale (0-5) and N&V score (1-4), respectively. All these measurements were performed 2, 4, 12, 24, and 48 hours postoperatively. The incidence of adverse drug reactions was not different among the three groups (p>0.05), but pain control was significantly better in the second and third group (ketamine plus morphine) in comparison with the first one (p<0.05). There was no difference in the quality of pain control between the second and the third groups. Also, the need for additional opioid was significantly reduced in the two latter groups compared with the first one (p<0.05). Adding ketamine to morphine in PCIA pumps would result in better pain control and less need for additional break-through analgesic.

Cesarean section is one of the common surgeries among women with a current rate of 14-15% in western societies. However, the rates are much higher in Iran. Acute postoperative pain is one of the recognized complications after cesarean section. Uncontrolled postoperative pain may interfere with breast-feeding. It might also affect the emotional relation between newborn and mother. This study was designed to compare the effects of indomethacin, diclofenac sodium, and acetaminophen suppositories on opioid usage after cesarean section in Alavi Hospital, Ardabil, Iran. In this triple-blind clinical trial, 120 ASA I-II candidates of cesarean with spinal anesthesia were randomly divided into 4 groups of 30. Acetaminophen, indomethacin, and diclofenac were used after the operation in the first, second, and third groups, respectively. The dosage was repeated every 6 hours and opioid usage was compared during the first 24 hours after the surgery. The fourth group was considered as the control group and received placebo suppository. Opioid was also used when required (PRN). The severity of pain was recorded based on a visual analogue scale (VAS). In case of severe pain (VAS > 5), 0.5 mg/kg intramuscular pethidine was prescribed. The data was analyzed in SPSS using analytical statistics such as analysis of variance (ANOVA), chi-square test and Tukey's post hoc test. There were no statistically significant differences between the groups in baseline data. There were statistically significant differences between the control group and other groups in pain scores 1, 12, and 24 hours after the operation. Groups receiving acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), i.e. indomethacin and diclofenac, were significantly different in pain scores 12 and 24 hours after the operation. The three intervention groups received the first dose of pethidine much later than the control group and the distance for both NSAIDs (diclofenac and indomethacin) was significantly longer (P < 0.001). Indomethacin, diclofenac, and acetaminophen significantly reduced the amount of pethidine usage during the first 24 hours after the surgery compared to the control group. This reduction was more in indomethacin and diclofenac groups compared to acetaminophen group (P = 0.001). Considering the significant reduction in pain scores and opioid usage especially in indomethacin and diclofenac groups in comparison with the control group, it is suggested to prescribe indomethacin and diclofenac for post cesarean section analgesia.

Although pregabalin shows efficacy against neuropathic pain, very limited evidence support postoperative analgesic efficacy. Our study objective to investigate analgesic efficacy of oral pregabalin in orthopedic surgery postoperative pain and opioid consumption. A randomized, double-blind, placebo-controlled was performed in. Patients received in first groupand in second group(30 patients) PCA morphine (10 mg/100ml) + oral pregabalin 300 mg daily for 48h after surgery. Pain score (VAS) and opioid consumption assessed in 48 hr after surgery. There was not significant difference between groups for demographic data. Pain score and opioid consumption in pregabaline group was significantly lower than morphine group without any significant complications. preoperative oral dose of 300 mg pregabalindailyfor 48h after surgery reduces post operative acute pain in orthopedic surgery.

Maintaining low back pain after spinal surgeries is one of the pretty challenging problems in treating patients. Various modalities have been introduced for treatment and one of the most effective ways between them، is steroid and other drugs injection into epidural space. In a double blind RCT study، 25 patient from pain clinic with low backpain due to failed back surgery syndrome were candidate for epidural transforaminal block and divided into case and control groups randomly. The selected drug regimens were as follow: in case group bupivacaine %0. 5، triamcinolone 40mg، hypertonic saline5%، hyaluronidase 1500IU، and in control group stilled water instead of hyaluronidase was used per each nerve root. Pain score، analgesic consumption، neurological examinations and satisfaction were evaluated in recovery and 1، 2، and 4 weeks later. There was no difference in demographic data between 2 groups. Pain score and total analgesic consumption in case group was meaningfully higher 2 and 4 weeks after blockade (p<0. 01). Patient satisfaction was higher in case group. Adding hyaluronidase to transforaminal injectate should be an effective for managingchronic low back pain in failed back surgery syndrome.

Anesthesia for ophthalmic surgery requires management of intraocular pressure (IOP) during preoperative period. Any degree of IOP increasing could reduce visual acuity. Administration of narcotics concomitant with anesthetics has the ability to reduce this increase of IOP. This clinical trial aims to compare the efficacy of Remifentanil and Alfentanil in preventing an increase in IOP after administration of succinylcholine, intubation and during anesthesia. This double blind clinical trial was intended to 50 patients undergoing elective general surgery for cataracts. Patients were randomly divided to two groups; Alfentanil (20µg/Kg in 30 second) for group 1 and Remifentanil (1µg/kg in 30 second) for group 2 were injected before induction of anesthesia and 0.5µg/kg/min Alfentanil for group 1 and 0.1µg/kg/min Remifentanil for group 2 were infused during the anesthesia. Systolic and diastolic blood pressure, heart rate and IOP from normal eye were measured before the induction, after administration of thiopental and succinylcholine, after tracheal intubation and 2 minutes later and were repeated in 2-minute intervals until the end of operation. IOP decreased after injection of anesthetics and remitted lower all through the operation in both groups, but IOP decreased after injection of succinylcholine in Remifentanil group while it increased in Alfentanil group (P<0.05). Results of this study indicate benefits of both Remifentanil and Alfentanil for managing IOP after induction and during anesthesia. It seems that Remifentanil is better than Alfentanil in controlling the IOP after injection of succinylcholine.

Cesarean is one of the most common surgery. Sodium thiopental and propofol are two populary used anesthetic induction agents that have different pharmacological and pharmachocinetic effects. Hemodynamic variables of patients such as heart rate and blood pressure are criterias for evaluation of drug effects on the patient's hemodynamic condition.The aim of this study is comparing the effects of propofo l and thiopental-Na as induction agents on the maternal homodynamic status. In this double blind clinical trial study 60 pregnant women with ASA class I & II were studied. In a random way 30 patients received 2mg/kg propofol and the rest of them were given 4mg/kg of thiopental – Na. Pre and post-induction hemodynamic status of the patients were monitored noninvasively after tracheal intubations and during 12 minutes after that.Data were analyzed in SPSS software using descriptive and analytical statistics such as T-test, chi-square and ANOVA. The average mean of arterial pressure in group induced with propofol was 92/40 ± 7/5 and in group induced with thiopental 95/12 ± 8/12. The mean of basal heart rate in group induced with propofol was 91/83 ± 8/13 and in group induced with thiopental 98/33 ± 11/19. Statistical tests showed no significant difference between the maximum variations of heart rate and blood pressure in two groups of patients. Thiopental and propofol have no significant differences on maternal hemodynamic conditions at the time of intubation during cesarean section and depending on conditions and experience of anesthesiologist both drugs can be used for induction of anesthesia in cesarean section.

Regional anesthesia (spinal and epidural) is the method of choice for cesarean surgery, and frequency used during elective cesarean section. In emergent situation, general anesthesia is preferred. The aim of this study was to compare between general anesthesia and spinal anesthesia on neonate's Apgar score delivered by cesarean surgery. In a prospective study, 75 patients who were candidate for cesarean section with term fetus were randomly divided into three groups each 25 patients. The first group underwent spinal anesthesia with 5% Lidocaine, second group received general anesthesia with propofol (2mg/Kg) and third one anesthetized generally with thiopental sodium (5mg/kg). Apgar score of neonates were evaluated and recorded in each group at 1,5,10 and 15 minutes after delivery. Data were analyzed with SPSS.13 software by ANOVA test. Average neonatal Apgar's in first minute of delivery in different groups was as the followings: propofol 9.04±1.31, sodium thiopental 8.80±1.41 and spinal anesthesia 9.12±0.93 (P=0.636).The result of apgar score measurements in each group at fifth minutes after delivery was as the following: sodium thiopental 9.72±0.67, propofol 9.44±0.77 and spinal anesthesia 9.68±0.56 (P=0.289). The results of the same measurements at 10th and 15th minutes are as the following succedingly: sodium thiopental: 9.80±0.65, propofol: 10 spinal anesthesia 9.96±0.20 (P=0.166) and sodium thiopental 9.92±0.28, propofol 10, spinal anesthesia 10(P=0.132). General anesthesia with sodium thiopental or propofol and spinal anesthesia didnt have any significant effect on neonatal Apgar.

ECT is one of the most common methods in treatment of different types of psychological disorder. The effectiveness of this therapy has direct relation to the duration of convulsion. Knowing the rate of efficacy of anesthetic drugs over convulsion by ECT and preventing of hemodynamic complications are important. This study was conducted to compare effect of Propofol with Sodium Thiopental in the induction of anesthesia during ECT. The subjects of this randomized, controlled and trial study were 16 patents with psychotic disorders. These patients received Sodium Thiopental and Succinylcholine or Propofol and Succinylcholine during 72 sessions of ECT. Duration of subjective and objective convulsion and hemodynamic changes (HR and MAP) as well as side effects of anesthesia and ECT was recorded. The collected data were analyzed by SPSS. Duration of subjective and objective convulsion was lower in Propofol taken group than Sodium Thiopental taken patients, but this difference was not statistically significant (p=0.32). The variation of hemodynamic parameter was lower among Propofol taken patients. We observed significant difference between two groups regarding to increase of arterial BP’ mean after taking drugs and immediately after ECT (p=0.04). There was not significant difference from view points of prevalence of respiratory, Hemodynamic complications, nausea, vomiting and restlessness between two groups. Duration of convulsion in induction of anesthesia in ECT with Propofol and Sodium Thiopental was not different.

With consideration the daily increased development of outpatient surgeries and high rate of these operations in elderly patients, rapid and safe recovery of patients for coming back to daily life is necessary. In this clinical trial study recovery time and nausea and vomiting after the use of two rapid-onset narcotic, alfentanil and remifentanil in elderly patients has been compared. In this double-blind clinical trial 40 elderly patients (age above 65) candidated to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group alfentanil was injected 10 g/kg and for second group remifentanil 0.5 g/kg during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia first group took infusion of alfentanil 1 g/kg/min and second group remifentanil 0.1 g/kg/min. At the end of surgery the time intervals between end of anesthesia drug adminstration and autonomic respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs especially nausea and vomiting were recorded. The data were analyzed in SPSS software using descriptive and analytical statistics as T-test, chi square and ANOVA. The time of autonomic respiration in alfentanil group was 2 minutes and in remifentanil group 3.3 minutes,this time in alfentanil groupe1.3 minutes shorter but the difference was not significant. The time of eyes opening with stimulation, verbal response and discharge of recovery room were not significantly different. During recovery incidence of nausea and vomiting in remifentanil group (30% of patients) was significantly more than alfentanil group (5% of patients) (P<0.05). The time of recovery between alfentanil and remifentanil group was not significantly different, but incidence of nausea and vomiting in remifentanil group was higher than alfentanil group significantly.

Postoperative nausea and vomiting are among the main complication after anesthesia and various methods are used for the prevention of this complication. In this study, the effect of the pre induction use of 10mg Metoclopramide’ 8 mg Dexamethasone and the combination of the both, on decreasing in the rate of nausea and vomiting after cataract surgery in intravenous anesthesia is compared with placebo. In this double blind clinical trial, one hundred patients of cataract surgery who are appropriate for this study were, randomly divided in to four groups. In the group of placebo (P), 2cc normal saline, in group (M), 10mg metoclopramide, in group (D), 8mg Dexamethasone, and in group (M+D), 10mg metoclopramide and 8 mg Dexamethasone, one minute before the induction of anesthesia was injected. Patients were received the anesthetic drugs in the sameway and after the tracheal intubation infusion of propofol was started. After the end of surgical operation, the appearance of nausea and vomiting in the recovery room and also 6 and 24 hours after the surgery are recorded in the patient's information forms. Finally the data were analysed by statistical software of SPSS and the statistical tests. After the use of these drugs, the rate of nausea in the recovery room decreased from 44% in placebo to 20% in metoclopromide group, 16% in Dexamethasone group, and 8% in combination of metoclopromide and Dexamethasone; and the rate of vomiting decreased from 20% in placebo group to 4% in metoclopromide group, 4% in Dexamethasone group, and 0% in combination of these two drugs, both the nausea and vomiting the effect of combination of metoclopromide and Dexamethasone in decreasing of postoperative mausea and vomiting was significant (P<0.05). The 24 hour following of nausea and vomiting, also had the same results. With regrard to the results of this study, implication of the combination of 10mg metoclopromide and 8mg Dexamethasone before the induction of anesthesia remarkably decreased the rate of postoperative nausea and vomiting and is useful for the high risk groups for this complication especially in out patient surgery.

Laryngoscopy and tracheal intubation could lead to hemodynamic responses in the from of hypertension and tachycardia as well as arrhythmia and myocardial ischemia. This alterations can be life-threatening particularly in elderly people. This clinical trial compared the effects of two rapid-onset narcotics, Alfentanil and Remifentanil, on the hemodynamic responses to the induction and tracheal intubation in elderly patients. This double-blind clinical trial was conducted on 40 subjects aged 65 and above. They were candidate of cataract surgery under general anesthesia. The patients were randomly allocated to two groups of 20. The first group, was gaiven Alfentanil 10 m g/kg and for second group Remifentanil 0.5 m g/kg was injected prior to the induction of anesthesia. Both groups were similiar in the method of anesthesia except in narcotics. The first group was infused with Alfentanil 1 m g/kg/min and Remifentanil 0.1 m g/kg/min was used for the second group. Hemodynamic variations including heart rate, systolic, diastolic and mean arterial blood pressure were measured and recorded eight times (before induction, aften injection, after intubation and five times during anesthesia). Data were analyzed with SPSS software using descriptive and analytical statistics such as T-test, chi squre and ANOVA. Immediately after injection of narcotic drugs, all hemodynamic variants decreased. Howerver diastolic blood pressure in Remifentantil group significantly more than Alfentanil group (P<0.05). After laryngoscopy and tracheal intubation all hemodynamic variants increased and slowly decreased in less than 10 minutes. Systolic, diastolic and mean arterial blood pressure decreased significantly in remifentanil group than alfentanil group (P<0.05). Although heart rate decreased during few minutes after intubation, there was not significant difference between two groups regarding this decrease (P>0.05). Ephedrin was used to treat severe hypotention in those under Remifentanil (11 patients) more than those under Alfentanil (4 patients) (P<0.05). According to the resukts of this study Remifentanil could prevent hemodynamic variation induced by laryngoscopy and treacheal intubation more than Alfentanil. However in some cases Remifentanil leads to hypotension during anesthesia. There is no important difference between two drugs in increasing heat rate after laryngoscopy and intubation.

Succinylcholine is a depolarising muscle relaxant that is used for rapid tracheal intubation in general anesthesia. It is a short-acting drug which is hydrolyzed by plasma cholinesterase. Some factors can decrease the activity of this enzyme in body. Some patients may have abnormal form of this enzyme that leads to prolonged duration of action and apnea. The subjects of this research were a male (55) and a female (57) who had prolonged apnea after administration of succinylcholine (4-8h), and they improved completely after mechanical ventilation.

Laryngoscopy and tracheal intubation may lead to tachycardia, hypertension and dysrhythmia or myocardial ischemia. In this double blind study, the effects of midazolam and lidocaine on hemodynamic response to endotracheal intubation have been examined. 52 ASA class one patients, aged 20-50, who were candidate for elective inguinal hernia surgery with general anesthesia, were randomly assigned to two groups. All patients received normal saline or Ringer's lactate solution (5ml/kg) about 5-10 minutes before induction of anesthesia and were preoxygenated for 3 minutes. Group 1 received midazolam (0.05 mg/kg) and group 2 received lidocaine (1.5 mg/kg) during 3 minutes prior to intubation. Anesthesia was induced with fentanyl (100 µ g) and thiopental (5 mg/kg) and trachea was intubated by the aid of succinyl choline (1.5 mg/kg). Anesthesia was maintained with halothane (0.5-0.75%) and equal proportions of nitrous oxide and oxygen. Systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate were recorded before premedication and intubation, as well as immediately two and five minutes after intubation. The data were analyzed by SPSS software using paired t-test. After intubation Systolic and diastolic blood pressure, MAP and heart rate increased in both groups compared to the baseline values. The difference in increasing diastolic blood pressure and MAP between the two groups was significant (p<0.05), but the difference in increasing systolic blood pressure and heart rate between two groups was not statistically significant. The increase in diastolic blood pressure and MAP in group 1 was significantly more than group 2 (p<0.05). Clinically, midazolam was as much effective as lidocaine in controlling response to intubations. Consequently it can be used as an alternative lidocaine in intubations. It has also other priorities such as amnesia, anti-anxiety and anti-agitation.

Regional anesthesia is a method of choice in cesarean section. But in emergency cesarean sections general anesthesia is usually preferred. On the other hand, intravenous sedative drugs used in general anesthesia induction rapidly crosses the placenta and result in fetal depression. Because of higher prevalence of general anesthesia in Iran it is reasonable to conduct more researches in this field. This study set out to compare the effects of Propofol and Thiopental-Na as induction agents on the neonatal Apgar score and maternal hemodynamic status. In this double blind clinical trial 60 pregnant women with ASA class I & II were studied. In a random way 30 patients received 2mg/kg Propofol and the rest of them were given 4mg/kg of Thiopental-Na. All these subjects had full term and normal fetus. Pre and post-induction status of the patients was monitored noninvasively after tracheal intubations and during 12 minutes after that. Also time intervals between induction and birth (cord clipping) and between uterus incision and birth were measured. Apgar score of neonates was evaluated through clinical examination in 1st, 5th, 10th and 15th minutes after birth. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test, chi-square and ANOVA. Apgar score in different times (1.5,10&15 minute) had no significant difference between two groups. (In the 1st minute Propofol was 7.1 ± 2.2 and Thiopental was 74 ± 1.8, in the 5th minute Propofol was 9.2 ± 0.7 and Thiopental was 9.1 ± 0.9) Maximum variation of heart rate and blood pressure in two groups were not significantly different. The time intervals between induction and birth (less than 8 minutes) on the one hand and uterus incision and birth(less than 130 seconds) on the other were similar in two groups. Thiopental-Na and Propofol can be used with similar results for induction of general anesthesia in cesarean section.