fereshteh amiri

Simulation training is currently the most widely used training method for practical skills in the field of medicine and treatment. The present study aimed to determine the effectiveness of personalized video feedback in endotracheal intubation skills and the satisfaction of undergraduate anesthesia students using the video feedback method.

This quasi-experimental study was conducted on anesthesia students of Jundishapur University of Medical Sciences in Ahvaz in 2021. A total of 46 students were selected via convenience sampling method and were randomly assigned to two groups (intervention and control) by block method. For the intervention group, a personalized video feedback session was also implemented in addition to a one-session training on endotracheal intubation using a mannequin. To collect data, a questionnaire on students' demographic characteristics, a researcher-made checklist of tracheal intubation skills, and a researcher-made satisfaction questionnaire were used. Data were analyzed in SPSS software (version 25) using statistical tests. A p-value less than 0.05 was considered statistically significant.

Based on the obtained results, no statistically significant difference was observed between the two groups in terms of demographic characteristics. The mean scores of endotracheal intubation skill scores before the intervention were 54.45±7.34 and 52.38±6.06 in the intervention and control groups, respectively, demonstrating no statistically significant difference (P=0.32). After the intervention, the mean skill scores reached 65.36±5.66 and 51.90±3.9 in the intervention and control groups, respectively, illustrating a statistically significant difference (P<0.001). After the intervention, the mean scores of satisfaction with endotracheal intubation training were 117.72±11.68 and 60.57±35.28 in intervention and control groups, respectively, pointing to a statistically significant difference (P<0.001).

Considering the effectiveness of personalized video feedback intervention in the endotracheal intubation skill and satisfaction of undergraduate anesthesia students, it is suggested to implement this method in teaching the tracheal intubation skills among undergraduate anesthesia students.

One of the major challenges in intensive care unit (ICU) patients is sepsis. The incidence of sepsis in patients admitted to the ICU has been reported from 13.6-39.3%. Many factors affect patient mortality, including acute phase proteins such as albumin.

The present study was a retrospective study in which patients with a diagnosis of sepsis referred to Golestan Hospital in Ahvaz from March to August were collected. In the present study, patients with sepsis admitted to the ICU who did not show improvement for more than 7 days were evaluated for length of hospital stay, survival and the relationship with albumin levels. During the study, albumin was checked every 72 hours and its validation was done. Based on albumin levels less than 2.6, they were treated with albumin. The patients who did not have an increase in the level of albumin remained in the study.

124 patients including 64 women (51.6) and 60 men (48.4) with a mean age of 66.4±15.4 were included in the study. The mean duration of hospitalization was 31.4±18.9 days, in which 24 patients (19.4%) died and 100 patients (80.6%) were discharged. Age, albumin and protein levels were associated with disease prognosis (P<0.001). Also, the duration of hospitalization in the deceased patients was longer than the recovered patients (27.7±25 vs. 32±17.1) (P=0.04). After further investigations, it was found that there is no difference between the deceased people (66±15.7) and the recovered people (67.7±14.1) (P=0.7).

The results of the present study showed that albumin has a direct effect on the severity of sepsis and this issue affects older patients more. Therefore, it is recommended that albumin be considered as a risk factor and one of the influential factors in choosing the best treatment strategy, which is associated with a reduction in mortality, hospitalization and treatment costs.

The use of new educational methods for medical students is of great importance. Simulation method is one of these methods that can be used as personalized video feedback. The present study set to determine the effectiveness of personalized video feedback on the level of endotracheal intubation knowledge of anesthesiology students.

A quasi-experimental study was conducted with pre-test and post-test design and a control group which was performed on anesthesiology students of Ahvaz Jundishapur University of Medical Sciences in 2021. Forty-six students were selected by convenience sampling method and were randomly assigned to intervention and control groups by using the block method. A researchers-made questionnaire of demographic characteristics of students and endotracheal intubation was used for data collection. A session of personalized video feedback was performed for the intervention group in addition to a one 90-min session of endotracheal intubation trainings using a mannequin.

There was no statistically significant difference between the two groups in terms of demographic characteristics. The mean scores of endotracheal intubation knowledge of students before the intervention were 7.82)2.56(in the experimental group and 8.48)3.89(in the control group, which were not statistically significant (P=0.51). After the intervention in the experimental group, these scores changed to 11.64 )2.17(in the experimental group and 9.62)2.59) in the control group, which was a significant difference (P<0.001). Also, the mean scores of endotracheal intubation knowledge of students in the intervention group improved from the pre-test to post-test (P<0.001), while it was not so in the control group (P=0.19).

Considering the effectiveness of personalized video feedback intervention on endotracheal intubation knowledge of anesthesiology students, it is suggested to use this method in teaching endotracheal intubation skills in anesthesia students and consider it as a part of the medical clinical education curriculum.

 This study aimed to investigate the factors affecting the sustainability of Gomishan urban areas. Understanding the situation of urban areas plays an important role in achieving sustainable urban development. The neighborhood is one of the important elements of the urban body, and the balance of social life in cities depends on maintaining the neighborhood. Nearly three decades after the introduction of sustainable development, the focus on social sustainability in terms of economic and environmental dimensions has been very low; but in recent years, the literature related to this dimension of sustainable development has expanded. Studies show that they are the best scale for assessing and measuring the social sustainability of urban neighborhoods, but the important point is the multiplicity and diversity of indicators at different levels and scales with intertwined causal relationships. Thus, today, the creative development approach, which nurtures and nurtures local talents in innovative ways, has attracted much attention at various levels of decision-making.

 The statistical population of the study included people over 18 years old living in Gomishan in 1400, from which 210 people were selected by available sampling. The sample size was based on the Morgan sampling method, which was 20 questionnaires for each urban area. To access them, a sample has been assigned to them from the systematically classified method according to the neighborhoods and the population of the neighborhoods. To analyze the data obtained from field operations from a one-sample t-test to measure the state of stability, from analysis of variance to compare urban textures in the form of SPSS software, and from multi-criteria decision models (Electr, Topics, Copeland, and Vicor) have been used to rank urban areas.

 The results of the one-sample t-test showed that the stability of the neighborhood is undesirable. The one-way analysis of variance indicates there is a big difference between Gomishan urban areas in terms of the level of stability so that Gomishan urban areas in The two categories were unstable and relatively stable. Finally, multi-criteria decision-making models showed that the share of economic sustainability and physical sustainability (infrastructure development and facilities) as sustainable urban dimensions is higher than the other two indicators (social and environmental sustainability) as well as vitality components and Participation is in a bad situation and this situation is different among districts of Gomishan city.

 The results showed that most areas of Gomishan city are in an unstable situation in terms of economic dimensions. The results showed that most areas of Gomishan city are unsustainable in terms of the environment. It has suggested that green spaces for sports and leisure expanded and the sewage network of neighborhoods. It is one of the main threats, to be completed and maintained. Considering that the areas of Gomishan city are also in an unstable condition in terms of physical dimension, it is recommended: to avoid creating dry and lifeless environments, and rough and rugged buildings inside the neighborhood, and to create mixed uses to increase access and reduce travel costs. Urban neighborhoods' continuation of the current trend is the main challenge in achieving sustainable urban development. The results show that most variables and dimensions of research are in a state of stability, among the variables, dynamics and adaptability, access and services, identity, security and health, vitality, spatial affiliation, social capital, participation, employment, and contaminants are in moderate to high stability. Among the dimensions of research, the social aspects have a relatively good situation, and the institutional and environmental dimensions are in a state of instability, and in general, the stability of Gomishan neighborhoods and urban contexts is at a moderate level.

Deep vein thrombosis, especially in the lower extremities, is one of the complications of immobility. Major surgeries, especially orthopedic surgeries and inpatient care in the intensive care unit, predispose the patients to such complications. The aim of this study was to compare the prevalence rats of venous thromboembolism between the patients treated with enoxaparin and subcutaneous heparin in the intensive care unit.

This was a retrospective cross-sectional study. Sampling method was census. All the patients who had been admitted to the intensive care units of Imam Khomeini Hospital in Ahvaz from the beginning of September 2017 to the end of December 2017, were entered into this study. Data were extracted from the patients' medical records and recorded in a checklist for every patient. Using SPSS20 software, data were analyzed by descriptive and analytical statistics.

Out of 600 patients, 64 (10.66%) patients had venous thromboembolism, of which 35 patients (54.7%) were in the heparin group and 29 patients (45.3%) in the enoxaparin group (P >0.05). 18 patients had deep venous thrombosis (3%), among them 13 (72.22%) patients were in the heparin group and 5 (27.78%) patients in the enoxaparin group (P <0.05).

In this study, enoxaparin administration was more effective than heparin in the prevention of deep vein thrombosis but the effects of these two drugs were the same in the prevention of pulmonary thromboembolism. More concrete conclusions require further studies with control of underlying and confounding factors.

 Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined.

 This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU.

 Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium.

 Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05).

 There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.
 

Mechanical ventilation is the most basic supportive care in patients admitted to the intensive care units. Some factors such as increase in airway resistance due to bronchospasm, may affect ventilation, that measured by different methods. The aim of this study was to compare the diagnosis of bronchospasm based on the calculation of airway resistance using ventilator data and clinical examination in patients admitted to the intensive care unit.

This descriptive cross-sectional study was performed on 180 patients, who admitted in the intensive care units of Ahvaz teaching hospitals and undervent mechanical ventilation. Patients were included in the study according to the inclusion criteria and were evaluated daily in terms of increasing airway resistance in two ways: clinical examination (presence of wheezing or Ronchi) and ventilator data (calculation of airway resistance). Data was recorded in a researcher-made checklist.

Among 180 patients enrolled in the study, the mean age was 57.77±18.95 years. There was a significant relationship between diabetes, asthma, hypertension and hyperlipidemia with an increase in airway resistance (P<0.05). Airway resistance was higher in women than men (P=0.004). There was a statistically significant difference between airway resistance detection through clinical examination and airway resistance detection based on ventilator data (p <0.001).

The results showed that detecting increased airway resistance through ventilator data was more sensitive than physical examination, So the use of it, in patient management is recommended.

burn injury remains as a major medical problem throughout the world. This injury is accompanied with inflammatory and wound healing responses. Since Royal jelly (RJ) has anti-inflammatory and wound healing activity therefore, the aim of this study was to evaluate the repairing effects of RJ on skin burn- damage.

In an experimental study, 40 male wistar rats (8 weeks old) were engaged. The animals were divided into five equal groups. Group 1 was considered healthy control. Group 2 (positive control) was treated topically with Silver Sulfadiazine Cream, group3 received Eucerin as negative control, and group 4, 5 treated with RJ (10 and 30%).
Sampling was performed after observing the second-degree burns on the first, seventh and fourteenth days.  Then after 28 days, rats were sacrificed and their skin tissues were used for morphological and morphometric assessments.

The results of this study showed that the amount and arrangement of collagen type 1 protein was higher in the RJ treatment groups versus control group.
Reconstruction and thickening of the epithelium in RJ treated groups confirmed therapeutic effects of RJ. In addition, RJ increased angiogenesis compared to the control group. The woundchr(chr('39')39chr('39'))s surface area was reduced in the RJ treatment groups compared to the control group. In addition, Fibroblast cell proliferation was increased in the groups receiving RJ versus control.

It could be concluded that, RJ induce wound healing effects and might be considered as potential treatment option to improve the burn wound healing.

Sugar and Lipid disorders are the main risk factors for vascular abnormalities. Due to the gender and age, other variables can influence serum Fasting blood sugar and lipid levels, certifying the determination of population-specific reference interval. This study was designed to investigate the age-and gender-specific reference values for serum Fasting blood sugar (FBS), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein-cholesterol (HDL) in healthy Babolianadults.

FBS, TC, TG, and HDL were calculating applying the colorimetric method. The Friedewald equation (LDL=TC−HDL−TG/5) was used to calculate LDL concentrations in individuals. After using the exclusion parameters, 519 participants (199 men and 320 women) aged ≥23 years were included. The Clinical Chemistry guidelines of the International Federation applied for characterizing the reference values for samples.

Reference values for serum FBS, TG, TC, LDL, HDL were 77.01-107.69 mg/dL, 35.34-204.38 mg/dL, 117.97-242.81 mg/dL, 47.6-137.16 mg/dLand 33.29-67.13 mg/dLin men. In women, reference values for serum FBS, TG, TC, LDL, HDL were 75.03-107.99, 27.49-192.33 mg/dL, 125.84-244.32 mg/dL, 44.08-139.48 mg/dLand 36.66-81.1 mg/dL. FBS, TG, and LDL parameters were higher in men, and TC and HDL parameters were higher in women.

Reference values for serum FBS, TC, TG, LDL, HDL in healthy Babolianadults were specified, and these data could supply a clear pathway for better decision making in both clinical settings and prevention

The incidence of metabolic syndrome has been rising in the Iran population. In parallel, vitamin D deficiency has also been increasing in Iran. This study aims to explore the association of vitamin D serum concentrations with metabolic syndrome and its components in the Iranian population.

Materialsand Methods:

A case-control study was managed. We enrolled 110 metabolic syndrome patients, according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria as a case group and 130 healthy individuals as a control group. The serum level of 25-hydroxy vitamin D (25 (OH)D), lipid profile, and fasting blood glucose(FBS) status were determined using a commercially available ELISA method. Enzymatic methods determined total cholesterol (Chol), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL), and triglyceride (TG) levels.

In case group, the prevalence rate of 25 (OH)Ddeficiency (<10 ng/mL) was 10%, 25 (OH)D insufficiency (10–29 ng/mL) was 71.0%, and 25 (OH)D sufficiency (>30 ng/mL) was 19.0%. A non-significant association between Chol level and age was noted (p=0.46, p=0.124). The levels of FBS and TG were significantly higher, and the levels of 25 (OH)D, LDL, and HDL were significantly lower in the case of the group compared to the control group.

We found that the serum level of 25 (OH)D in patients with metabolic syndrome is lower than in the healthy group, and a low level of 25 (OH)D is related to increased risk of metabolic syndrome and its components

Infectious diseases are one of the most common diseases in the world, including Pseudomonas aeruginosa. In burn wounds, Pseudomonas aeruginosa is used to treat burns, but a number of resistances have been created, which has led to the use of plants to treat diseases. The aim of this study was to compare the effects of antimicrobial and healing marigold extract, eucalyptus, walnut, jujube, turpentine oil with silver sulfadiazine to create an effective agent in the treatment of burns is due to Pseudomonas aeruginosa.

Alcoholic and ethanolic extracts of walnut and jujube leaves were prepared in the laboratory and Eucalyptus oil, turpentine oil and marigold extracts were prepared for ready and we also used silver sulfadiazine ointment. In the next step, the MIC and MBC extracts were determined. In the animal model, the burn was initially burned and then infected by the bacterium Pseudomonas aeruginosa. Then the silver sulfadiazine ointment was used alone and in combination with each of the extracts separately and one gram and for three consecutive days, was injected into the wound of mice and The number of bacterial colonies was counted after the culture on the Muller Hinton Agar and culture Nutriant Agar.

MIC and MBC of Extracts of Marigold 5.25 and 10.50 mg/ml, Eucalyptus 1.75 and 3.50 mg/ml, Alcoholic Extract of Walnut 59.0875 and 118.175 mg/ml, Estonian Extract of Walnut 8.375 and 16.75 mg/ml, Alcoholic extracts of jujube 39.875 and 79.75 mg/ml, Estonia extracts of jujube 8.625 and 17.25 mg/ml and Turpentine 8.375 and 16.75 mg/ml. The study of mouse model confirmed the effect of extracts with silver sulfadiazine against Pseudomonas aeruginosa. The acetone extract of walnut leaf, the acetone and alcoholic extract of jujube, as well as the eucalyptus extract, reduced the number of Pseudomonas aeruginosa bacteria and had better antimicrobial activity against Pseudomonas aeruginosa than other groups.

Alcoholic juices and Estonian jujube have a better effect than other groups.

Rabies virus (RV) is one of the most dangerous zoonotic disease and major public health problems in most of the world, especially underdeveloped countries. Rabies is preventable by proper vaccination, even shortly after exposure. Today, it seems a fast, sensitive, and reliable rabies diagnostic method is required, which might reduce the financial burden of inappropriate diagnosis. The aim of this study was to develop and validate two molecular techniques, including heminested RT-PCR and qRT-PCR assays, for comprehensive detection of rabies virus in the suspected rabid brain and saliva samples. In this study, we developed qRT-PCR as a fast, sensitive, and specific method for rapid detection of rabies virus in brain and saliva samples. Also, the sensitivity and specificity of the method were compared with heminested RT-PCR test and direct fluorescent antibody (dFA) as a serologic gold standard method of World Health Organization (WHO) and MIT (mouse inoculation test) as a confirmatory test. A combination of compatible primers based on RNA-dependent RNA polymerase (L) gene of the Pasteur virus fixed strain (PV) (accession number. M13215) was used for developing the qRT-PCR assay. Primer and probes were designed according to other Iran circulating viruses genomes that were available in public databases (GenBank). The clinical sensitivities of qRT-PCR and heminested RT-PCR methods were determined 97.14% and 94.3%, respectively. In addition, the clinical specificities of qRT-PCR and heminested RT-PCR methods were determined 93.75% and 88.24%, respectively. Also, the analytical sensitivities of qRT-PCR and heminested RT-PCR methods were about 5 × 102 and 5 × 103 FFU/mL, respectively. In this study, qRT-PCR assay as a diagnostic molecular method with high sensitivity and specificity was developed for the detection of the rabies virus genome in both brain and saliva samples. Therefore, this rapid, accurate, and cost-effective detection and quantification method may be used as an investigative tool, which can be valid for detection of target viral genome in the research and diagnosis field.

Postoperative nausea and vomiting (PONV), as one of the complications after laparoscopic cholecystectomy, occurs in over 40% - 77% of cases. Considering the numerous complications of synthetic drugs, there is a growing tendency towards the use of herbal medicines due to their unique features. Ginger root is one of the herbal compounds effective on nausea and vomiting. The aim of this study was to evaluate the effect of preoperative Zintoma capsules on PONV after laparoscopic cholecystectomy. In this quasi-experimental study, 130 eligible patients were randomly assigned to intervention (n = 65) and control (n = 65) groups using the four-block method. The intervention group received two capsules of 500 mg and one of 250 mg Zintoma. The control group received three placebo capsules. The severity of patients’ PONV was recorded at 0, 2, 6, 12, and 24 hours after surgery using a checklist and a standard VAS instrument. Data were analyzed using t-test, Chi-square test, and LSD Post Hoc test (ANOVA) in SPSS 19. The severity of PONV and vomiting was significantly different between the two groups (P = 0.001) at the above time points. The mean severity of nausea (by VAS) changed in the intervention group from 7.92 ± 1.28 to 0.33 ± 0.67 and in the control group from 8.00 ± 1.20 to 2.11 ± 1.55. The postoperative vomiting was less frequent in the group receiving the Zintoma capsules. The postoperative use of chemical anti-vomiting and nausea drugs was significantly lower in the intervention group than in the placebo group (P = 0.001). Zintoma capsules can be used as a supportive treatment in the prevention of nausea and vomiting by reducing the incidence rate of PONV

Cardiac transplantation has become the standard therapy for dilated cardiomyopathy and end stage is clinical heart disease & heart failure. With the introduction of newer lmmunosuppressants, together with better patient selection, improved period er at Ive monitoring and care, the overall survival of recipients has improved. An increasing number of patients who received a transplant present for either elective or emergency non_cardiac surgery. We hereby discuss the period era give management of such a patient who came for emergency surgery for upper limb amputation.

Surgical stress response to an involuntary response to tissue damage and changes in the form of autonomic, hormonal and metabolic appears And fluctuations in blood sugar leads. The purpose of this study was to evaluate the effects of spinal anesthesia and sedation in patients undergoing surgical abortion is blood sugar fluctuations.
In this cross-sectional study, 50 patients admitted for elective abortion, including the method selected and assigned to two groups of 25 sedation and spinal anesthesia were divided. In both groups, blood sugar 10 minutes before making the animals unconscious minutes, 20 and 60 min after induction were evaluated. Data Analysis with SPSS software, version 19 with t-test and chi-square tests.
The levels of blood sugar, 10 minutes before the start of anesthesia in sedation groups 89.96 ±13.32 and in the spinal anesthesia group 88.60±16.98, which was not significantly different(p=0.706). The levels of blood sugar, 20 min after induction in sedation group 80.88±13.13 and spinal anesthesia group 85.88± 15.05, which was not significantly different(p=0.268). 60 min after induction, the blood sugar in sedation group 83.24±15.78 and in the spinal anesthesia group 90.04±16.26, which did not show a significant difference(p=0.140).
The change of glucose in response to the stress of surgery under spinal anesthesia and Sedation in both groups had the same type of anesthesia had no significant effect on blood glucose.

The use of opioids has grown dramatically for reducing surgical and trauma pain in recent decades. Sedation، respiratory depression، nausea and vomiting are the worrisome opioid adverse effects. The purpose of this study was to evaluate the side effects of morphine suppositories are used after Laparoscopic Cholecystectomy.

Eighty-eight patients، aged 20-50 years،that scheduled for elective laparascopic cholecystectomy were enrolled to this double-blind randomized controlled-trial study. Patients were divided in to two groups of each 44. Group (M) recieved 10 mg suppository morphine and group (D) recieved 100mg suppository diclofenac، at the end of surgery. Nausea، vomiting، respiratory depression، pruritus and level of sedation were evaluated for initial 6 hours post surgery.

Incidence of nausea and vomiting in group M were significantly upper than group D (p<0. 05). Incidence of pruritus، respiratory depression and level of sedation was not significantly different in two groups (p>0. 05).

The morphine suppository for postoperative analgesia is safe and without serious adverse effects.

Pheochromocytoma has Complicated and challenging anesthetic management. Modern anethstetic techniques، new drugs and advanced monitoring have Improved intra oprative stability. In this report a 40- years- old man was presented that admitted due to tachyarythmia and hypertension with diagnosis of Pheochromocytoma. Patient had excessive blood pressure fluctuations during surgery despite adequate preoperative medical treatment. Patient''s blood pressure gradually became stable within six hours after surgery.

When talking about the beneficial effects of ketamine as a nociceptive N-methyl Daspartate (NMDA) antagonist for analgesia during surgery, psychological and systemic side effects should be considered. The purpose of this study was to evaluate the side effects of incisional subcutaneous administration of low dose ketamine after cesarean section.

Sixty patients, aged 18-25 years, scheduled for elective cesarean section were enrolled to this double-blind randomized controlledtrial study. Patients were divided into two groups of each 30 and group1(C) received 10 CC saline and group 2(k) received 0.5 mg/kg ketamine after skin closure subcutaneously at the site of surgery. Mean arterial pressure, heart rate, nausea, vomiting, nystagmus, hallucination, pruritus, level of sedation and respiratory depression were evaluated for 4 hours after injection.

Maximum mean arterial pressure and heart rate and also incidence of nausea were lower in group K but not significant (p>0.05). Incidence of vomiting, nystagmus, hallucination, pruritus, level of sedation and respiratory depression were not significantly different in two groups (p>0.05). Conclution: The subcutaneous prescription of low doses of ketamine for analgesia after surgery is safe and without serious adverse effects.

Diminished surgical trauma has made laparascopic cholecystectomy a standard technique for removal of gallbladder. Multimodal approach to post cholecystectomy pain management may enhance analgesia. The purpose of this study was to evaluate the clinical efficacy of suppository administration of morphine in reducing pain after laparascopic cholecystectomy.

88 patients, aged 20-50 years, scheduled for elective laparascopic cholecystectomy were enrolled to this double-blind randomized controlled-trial study. Patients were divided into two groups of each 44 and group1(M) received 10 mg of suppository morphine and, group 2 (D) 100mg suppository diclofenac at the end of surgry time. The intensity of pain 8 hours after surgery upon entering the recovery room and the total amount of analgesic consumed during the first 8 hours were recorded.

Amount of analgesic amount in the first 8 hour were significantly lower in group M compared with group D (p<0.05). Pain intensity was significantly lower at 3,4,5 hours in group M compared with group D (p<0.05), but was not significantly different at 0, 1, 2, 6, 8 hours in two groups (p>0.05).

Patients who were given suppository morphine after laparascopic cholecystectomy had better visual analog scale and less analgesic consumption than patients who were given suppository diclofenac.

Laparoscopic surgery is the most common abdominal surgical procedures throughout the world. In addition to its numerous benefits, there are also significant complications. Subcutaneous emphysema as a complication of insufflation of carbon dioxide can be created blowing accidentally extraperitoneal during laparoscopic surgery. In this report, 34_year_old man with a history of hepatitis, who came to the operating room for a diagnostic laparoscopy surgery, developed subcutaneous at the end of surgery. The patient was immediately ventilated and with intubation transferred to the intensive care unit. The subcutaneous emphysema subsided during 24 hours and the patient was discharged without any complications after 24 hours.