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Stress responses have been excited by the painful stimuli, after induction of anesthesia and during the operation. In order to reduce these responses, it will be useful to select the type of anesthesia. Based on this fact, two groups of patients (Every group had 50 patients) were selected randomly. All patients are older than 18 years old and were chosen according to America Society of Anesthesiologist, class I, II, and were candidated for cataract surgery. Propofol were used for induction and maintenance of anesthesia In group 1 (TIVA group). In group 2 (Balance anesthesia), Sodium Thiopental induced anesthesia and the combination of N2O and Halothane were used for maintenance of anesthesia, respectively. Blood Glucose in two groups was measured before induction of anesthesia that all were in normal range (80-120 mg/d). Then after induction, incision and 30 minutes after start of surgery, blood Glucose was measured again and deviation from basal level were classified in three categories as: <10%, 10-20%, >20%. The results demonstrated meaningful difference between two groups, statistically (Chi-square, P<0.001). Increasing the blood Glucose in group 2, in three stages, was more than group 1. Blood Glucose level was increased about 20% from its basal level, in the majority of group 2 (32% after induction, 64% after incision, 62% 30 minutes after start of surgery). But, this amount of increasing in group 1 was detected as follow. 16% after induction, 16% after incision, 12% 30 minutes after start of surgery. It is possible that in TIVA group’s, control of blood Glucose and stress responses better than balance anesthesia group’s. The comparative measurements of catecholamine level in both groups would be the next investigations.

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For a patient under any treatment it is very important to maintain a stable cardiovascular system (CVS) under anesthesia. The CVS can be disturbed due to many factors, and one of the factor which can later the hemodynamic system of the patient is laryngoscopy and intubation. Hence the assessment of the variations in the blood pressure (BP) and heart rate (HR) of the patient during laryngoscopy and intubation is very important. Hypertension and Tachycardia as a great disorders causing great problems. Such as cerebral hemorrhagia and myocardial infection, which are occurred during general anesthesia. Laryngoscopy and endotracheal intubation is necessary for airway management prevention of the aspiration of gastric contents. The amount of blood pressure and heart rate is measured in 1, 3, 5 after laryngoscopy and intubation. 70 patients ASA1 with the age of 16-55, undergone elective surgery and a general anesthesia were selected. Some drug pre-medication and induction were the same in rate about all patients. 35 patients are intubated orally and the rest of them nasally. The subjects were chosen among patients who did not have difficult intubation and cardiovascular disorders. Before laryngoscopy and 1, 3, 5 minutes blood pressure and HR measured. According to outcoming results, blood pressure and HR increasing after laryngoscopy in both group (Oral intubation and nasal intubation). The increase of nasotracheal intubation was more than oral one remarkably. The difference would be meaningful according to statistic point (P<0.05). According to research finding the most amount of increase in the blood pressure and HR was related to the laryngoscopy and intubation. These changes can make problems for some cardiovascular patients. So it is suggested that all anesthetists should lessen the probable complication of patients under laryngoscopy a tracheal intubation by monitoring BP and HR.

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Background & Objective: Post-general anesthesia urinary retention is a common and bothering complication. In this study prediction value of IPSS for post-general anesthesia urinary retention was evaluated. Materials & Methods: This prospective study include 100 male patients over 50 years old who were candidated for nenurologic and non-nenurological elective surgery without any urology and neurologic past medial history. IPSS was calculated for each patient. The patients were followed in post operative period for urinary retention. Results: 1.8% of patients who had mild symptoms (IPSS=0-7) had urinary retention in 2nd 24 hours of post-operative period, 20% of patients who had IPSS=8-19 and 53.3% of patients with IPSS=20-53 had urinary retention at same period (P<0.05). Conclusion: IPSS can predict postoperative urinary retention in elderly male patients. If severe symptoms by IPSS was encountered the patients and health care personals must be cautioned about possibility of postoperative urinary retention and if required urologic consulation.

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Background & Objective: The deterious effects of pressor response (Tachycardia and hypertension) are not hidden from any personal of anesthesia group. The present study is performed in Chamran Hospital affiliated to the university of medical sciences, Shiraz, with the aim to introduce the most effective, cheapest as well as the easiest method to prevent or reduce the pressor response to direct laryngoscopy and intubation. Materials & Methods: This randomized clinical trial was conducted in Chamran Hospital in Shiraz. 90 patients scheduled for elective surgical fixation of femur or tibia were randomly divided in group A (30 patients), group B (30 patients) and group C (30 patients). In-group A patients were directly sprayed with Lidocaine 10%, hypopharyngealy, after induction of anesthesia and 3 minutes before tracheal intubation. Patients in group B were sprayed with Lidocaine 10% oropharyngealy before induction of anesthesia while the patients, were awake, patients in group C were not sprayed with Lidocaine (Control group). Premedication and drugs used for induction of anesthesia were same in 3 groups. The heart rate, systolic and diastolic blood pressure were recorded in all patients included in the study, before tracheal intubation (Base line) just after tracheal intubation and 3 and 5 minutes after intubation. Results: Spraying Lidocaine oropharyngealy before induction of anesthesia and hypopharyngealy after induction of anesthesia both were effective in controlling the pressor response to laryngoscopy and tracheal intubation, but spraying Lidocaine oropharyngealy before induction of anesthesia is more effective than spraying Lidocaine hypopharyngealy after induction of anesthesia (P<0.05). Conclusion: According to the results of present study, applying Lidocaine spray, oropharyngealy is a simple, very effective as well as cheap method for controlling pressor response to tracheal intubation.

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Background & Objective: The cuff of the endotracheal tube is securing for mechanical ventilation during anesthesia. Diffusion of N2O in the cuff results in an increase in cuff pressure. The different method was used for the control of cuff pressure, but may have difficulty and side effect. This study was to determine whether inflating the ETT cuff with air, Lidocaine 1% or N2O with O2, prevent the increase in cuff pressure during N2O anesthesia. Materials & Methods: In this randomized control trial study after obtating ethics committee 224 patients went understudy, these patients divided in 2 blocks (Sufe, Roach) and the one of the each block were randomized into 3 groups. Group, air Lidocaine 1% N2O with O2 difficult intubation and the film anesthesia with less than 30-min were excluded. All patients were similarly anesthetized and performed tracheal intubation. The pilot balloon of the endotracheal tube cuff was connected to a Japanes pressure manometer. The first pressure was measured immediately and further reading at 10-minute intervals for 70 minutes. The results were readings analyzed using T-test, paired T-test, ANOVA and the Chi-square test. A P-value of <0.05 was considered significant. Results: Cuff pressure increased gradually during anesthesia in-group air but remained stable in group’s Lidocaine and N2O with O2. The cuff pressure had significant differences between the Supa and Roach groups in all of the times during anesthesia (P<0.05). Conclusion: Inflating the ETT cuff with Lidocaine 1% or N2O/Oxygen mixtures are methods of keeping intracuff pressure stable during N2O anesthesia due to N2O diffusion the cuff tube causes increase the cuff pressure. We suggest that continuous monitoring of the UCP during anesthesia to be carried out.

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Background&Objective: Sellick’s maneuver is a routinely used technique for the prevention of pulmonary aspiration of gastric contents during anesthesia. The rationale for the application of cricoid pressure necessitates that it is applied at the loss of consciousness during rapid sequence induction. Cricoid pressure therefore, may be fully applied at a level of anesthesia where awareness, and possibly recall, of the maneuver occurs. Materials&Methods: This study was setup to determine the frequency of awareness and recall Sellick's maneuver following 100 patients (ASA I, II) who candidates for lower extremity surgery were randomly enrolled in this prospective study. After induction of anesthesia and application of cricoid pressure, symptoms of awareness and recall were recorded. Data were analyzed by SPSS software and Spearman correlation. Results: The frequency of awareness and recall were 45% and 16% respectively. The frequency distribution of awareness severity based on grade 1, 2 and 3 were 16%, 6% and 1% respectively. The frequency distribution of recall severity based on mild, moderate and sever were 15%, zero and 1% respectively. The correlation between awareness severity and recall severity was statistically significant (P<0.05). Conclusion: Due to high frequency of awareness and recall following Sellick's maneuver and its complications, it is advaiable to revise the procedure of this maneuver and inparticular the accurte time in its application.

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Background & Objective: Monitoring the depth of anesthesia is very important to prevent undesirable events during surgery, such as intra operative awareness and overdosing. It is shown that anesthetic agents have direct effects on synaptic activity of brain neurons. So there is a great interest on electroencephalogram analysis as a depth of anesthesia estimator. Due to difficulties in visual explanation of EEG, automatic and computer based signal processing methods have been used to assess the depth of anesthesia. Investigating the relationship between conscious level of patients and electrical activity of brain neurons was the main aim of this study. Materials & Methods: In this study, EEG signals of six patients undergoing aortic valve replacement surgery have been acquired and recorded in a computer. After applying signal processing methods to these data, 3 different measures included temporal, spectral and bispectral parameters have been extracted. Mean values of mentioned parameters in different anesthetic regimens and levels have been analyzed by ANOVA in SPSS software. Results: Extracted temporal parameter is correlated with depth of anesthesia in deep anesthetic levels and spectral one is correlated with depth of anesthesia in moderate and light levels (P<0.05). Bispectral parameter is correlated with the depth of anesthesia only in ICU (P<0.05). Conclusion: Findings of this study confirm the relationship between consciousness and electrical activity of brain neurons and recommend the use of EEG processing techniques to monitor, control and estimate the depth of anesthesia in operating room and ICU ward.

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Background and Objective: A common complication after general anesthesia is nausea and vomiting followed by different problems such as spasm, hypoxia and pulmonary aspiration. This complication is more common in patients with full stomach, Eye injury, head trauma, cesarean and laparoscopy. Propofol and metoclopramide are two common drugs to prevent nausea and vomiting after operation. On the other hand adding dexamethasone to the above drug, has an important effect on decreasing nausea and vomiting. In this study, the effect propofol and metoclopramide associated with dexamethasone on nausea and vomiting after operation was investigated.

Materials and Methods: In this clinical trial study, 100 patients with ASA I, II classes, aged 16-60 years with selective orthopedic surgery randomly have divided into two groups. In group one, 48 patients received metoclopramide (10mg) with dexamethasone (8mg) and in group two, 52 patients received propofol (20mg) with dexamethasone (8mg), five minutes before the end of operation. Prevalence of nausea and vomiting in both groups was considered after 4 hours and results were analyzed by Chi-Square, t-student and Fisher exact tests.

Results: The rate of nausea in group 1 and 2 was 35.4% and 11.5% respectivly (P<0.05). The rate of vomiting was 27.7% and 7.7% in group 1 and 2 respectivly (P<0.05).

Conclusion: This study showed that the antiemetic effect of propofol with dexamethasone is more effective to prevent nausea and vomiting than metoclopromide with dexamethasone.

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Background and Objective: Post dural puncture headache (PDPH) is a relatively common complication in spinal anesthesia. Several regimens had explained for treatment of this problem. The aim of this study was to determine the effect of intravenous single dose of Aminophylline (1.5mg/kg/body weight) on the incidence of PDPH in cesarean section under spinal anesthesia. Materials and Methods: In a double blind randomized trial study, 120 patients undergone spinal anesthesia for the elective cesarean section in Motahhari hospital of Marvdasht in Fars province in south of Iran during 2008. After umbilical cord clamping 1.5mg/kg/body weight of Aminophylline injected slowly and intravenously in 60 patients. In placebo group (n=60) normal saline injected intravenously. At the 1st, 4th, 24th and 48th hour after surgery, PDPH in patients were evaluated. Results: The incidence of PDPH was significantly lower in cases compared with controls during the first 24 hours post operation (5% vs. 31.7%, P<0.001). Incidence of PDPH in case and control groups after 48 hours was 5% and 23.3% respectively (P<0.004). Conclusion: This study revealed that the intravenous single dose of Aminophylline (1.5mg/kg/body weight) significantly reduced PDPH after spinal anesthesia in cesarean section.

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Background and Objective: Hemodynamic alteration and hypotension due to spinal anesthesia can reduce tissue perfusion and increase ischemic risk, myocardial infraction, renal failures spinal damages and even deep veins thrombosis. This study was designed to compare pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alteration of women during spinal anesthesia in cesarean section. Materials and Methods: This randomized clinical and double blind study was done on 90 singleton pregnant women with ASA I and II class .the subjects gone elective cesarean section and allocated into three groups. subjects were received 500 ml ringer lactate before spinal anesthesia. Subjects in group I, II and III first received 0.1 mg/kg atropine (IV) 0.01mg/kg ephedrine and 100µgr phenilephrin (mucosal) prior spinal anesthesia, respectively. Hemodaynamic indexes including blood pressure, heart Rate, oxygen saturation and drug side effects were determined every 5 minutes interval through the surgery. Data was analyzed by using SPSS-11.5, Chi-Square and ANOVA tests. Results: Hemodaynamic indexes were changed during study, but three medicine showed similar effect on heart Rate, blood pressure and changes of oxygen saturation (P<0.05). There was a significant differences among three groups for dosage of extra ephedrine to control of blood pressure (P<0.05). This increase dosage of extra ephedrine was 56.7%,20% and in ephedrine, phenilephrin and atropine groups,respectively. Nosia rate was 6.7%, 50% and 46.7% in phenilephrin, atropine and ephedrine groups, respectively (P<0.05). Conclusion: This study showed that to prevent of blood pressure drop following spinal anestasia atropine, phenilephrin and ephedrine can be prescribed, but ephedrine is recommended for lowering the rate of nosia.

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Background and Objective: Post-operative nausea vomiting (PONV) and laryngospasm are the most common of complication following surgery. This study was conducted to compare the incidence of laryngospasm and PONV after pediatric infra umbilical surgery using two anesthetic methods: control ventilation and spontaneous respiration. Materials and Methods: This double-blind clinical trial study was conducted on 192 children with 2-7 year-old undergoing infra-umbilical surgery of ASA-I class with the estimated operation period of an hour in Tehran pediatric hospital, Tehran-Iran during 2009-10. The patients were randomly divided into two groups: controlled ventilation and spontaneous respiration. After anesthetization, Atracurium was injected to the control ventilation (CV) group and anesthesia continued with mechanical ventilation. For the patients of the second group (spontaneous respiration/SR), after the gradual increase of the dose of halothane and certainty of the optimal depth of anesthesia, patients were intubated to allow spontaneous respiration. After intubation, all patients were anesthetized with Halothane 1-2% and the N2O/O2. The rate of nausea, vomiting, laryngospasm, excessive post-operative discharge was recorded. Data were analyzed using SPSS-13, student’s t-test, chi-square and Fisher’s exact tests. Results: Post-operative nausea was non significantly higher in CV group (8%) than SR (6.52%). The rate of vomiting was higher in CV (16%) as compared to SR group (2.17%). (P<0.001, RR=8.57, CI: 1.91-38.41). The rate of laryngospasm at the end of the surgery was higher in CV group (15.21%) as compared to SR group (26%) (P<0.02, RR= 0.94, CI: 0.05-1.77). The rate of excessive discharge at the end of the surgery was significantly higher in CV group (52%) in comparison with SR group (11.95%) (P<0.001, RR=0.94, CI: 0.05-1.77). Conclusion: This study showed that in infra-umbilical surgeries in a period of less than an hour the incidence of post-operative vomiting and laryngospasm is higher in control ventilation group than spontaneous respiration group, which might be due to the injection of neostigmine to counter-act the effects of muscle relaxants.

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Background and Objective: Propofol is one of the most commonly used drugs in anesthesia with the pain during an injection is a side effect of this drug. This study was conducted to compare the effect of Lidocaine, Magnesium Sulfate, and Ketamine on reducing pain caused by intravenous injection of Propofol in patients Undergoing surgery.
Methods: In this double-blind randomized clinical trial study, 80 patients aged 18 to 65 years were randomly blocked and assigned into four groups including Lidocaine, Ketamine, Magnesium Sulfate and Normal Saline. The pain was measured with the Ambesh Score. Hemodynamic changes of patients were evaluated in 1, 3, and 5 minutes.
Results: The patients in Lidocaine, Ketamine, and Magnesium Sulfate groups with 75%, 70%, and 55%, respectively, did not feel pain after Propofol injection compared to Normal Saline group (25%) (P<0.05). The mean time trend of Systolic and diastolic blood pressure and mean arterial blood pressure between the studied groups were significant (P<0.05).
Conclusion: The use of Lidocaine or Ketamine during Propofol injection can be effective in reducing pain during injection in patients undergo surgery.

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Background and Objective: Ketamine, a derivative of phencyclidine, is utilized as an anesthetic agent in surgical procedures. Like other medications, it can be associated with various adverse effects on different organs in the body. This study was conducted to determine the effect of injectable ketamine on the histopathological changes in the liver in neonates born to pregnant rats subjected to short-term and long-term anesthesia.
Methods: In this experimental study, 15 pregnant female Wistar rats were randomly divided into 3 groups of 5 each: A control group, a short-term anesthesia group (receiving an intraperitoneal injection of ketamine at a dosage of 25 mg/kg/bw), three times per week for 4 weeks), and a long-term anesthesia group (receiving an intraperitoneal injection of ketamine at a dosage of 75 mg/kg/bw, once per week for 4 weeks). Following parturition and during the lactation period, when the neonatal rats reached two weeks of age, they were initially anesthetized and sacrificed for tissue sampling via intraperitoneal injection of 7 units of ketamine and 3 units of xylazine. Tissue samples, with a thickness of 5 to 6 microns, were sectioned and examined using light microscope after fixation in formalin.
Results: In the short-term anesthesia group, dilation of the centrilobular veins and fluid accumulation were observed, with an intensity score of 2. Additionally, some hepatocytes exhibited degenerative-necrotic changes, characterized by acidophilic and dark cytoplasm, with an intensity score of 1. In the long-term anesthesia group, the liver tissue showed hyperemic changes in the portal space with a score of 1, as well as increased dilation of sinusoidal spaces and centrilobular veins of varying sizes and irregularities, also with an intensity score of 1. Fluid and blood accumulation were also noted in some of these structures. In the control group, cellular structures were maintained with complete regularity, and the intensity score of changes was determined to be zero.
Conclusion: Ketamine administration to pregnant rats can induce histopathological changes in the liver tissue of their offspring. These detrimental changes were more pronounced in the long-term group compared to both the short-term and control group.