Tehran University Medical Journal

Background: Nausea and vomiting is one of the most common complications after the strabismus surgery. In this study, we evaluated the efficacy of atropine versus ondansetron administration on the incidence of postoperative nausea and vomiting and duration of recovery stay in patients undergoing this procedure.
Methods: In this case-control study, 90 patients between 3 to 30 years old who were candidates for elective strabismus surgery in Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, from February to April 2019, were randomly divided into three groups (placebo, ondansetron and atropine group). Patients who had taken hypnotic drugs while entering the operating room were excluded. In all patients, after arriving into the operating room and installation of standard monitoring equipment and peripheral vein implantation, anesthesia was induced by receiving 0.05 mg/kg midazolam, fentanyl 1 μg/kg and propofol 2.5 mg/kg. After induction of anesthesia, placebo group was compared with ondansetron group and atropine group that received 0.1 mg/kg ondansetron and 30 µg/kg atropine, respectively. The rate of postoperative nausea and vomiting, duration of recovery stay and satisfaction of recovery nurses were recorded and compared between groups.
Results: There was no statistically significant difference between the three groups in terms of mean age, weight, and gender. It seems that group matching is appropriate and there are no confounding factors for demographic variables. Administration of atropine and ondansetron significantly reduces the incidence of nausea and vomiting postoperatively and in recovery. There was no significant difference in the incidence of nausea and vomiting between the atropine and ondansetron groups. Duration of recovery stay was decreased after ondansetron and atropine administration versus control group. Postoperative laryngospasm and bronchospasm were not observed in any of the three groups after surgery and at the time of recovery. The satisfaction of recovery nurses in both atropine and ondansetron groups were higher than control group.
Conclusion: It seems that the administration of atropine as much as ondansetron can be effective in reducing the incidence of postoperative nausea and vomiting and the length of recovery stay in patients who undergoing strabismus surgery.

Background: Cataract is one of the most common eye diseases especially in elderly patients and most of these patients require surgery. In the process of sedation, different drugs are used, each with its advantages and disadvantages. Dexmedetomidine is one of the drugs that has recently received special attention for sedation. In this study, we compared the drug combination of dexmedetomidine-fentanyl with midazolam-fentanyl in cataract surgery.
Methods: In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.
Results: Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).
Conclusion: Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.

Background: Cataract surgery is one of the most common surgeries in the world, especially in elderly patients, and often performed topically with sedative agents. Ketamine is one of the most commonly used agents and the effect of different doses on intraocular pressure is in dispute. The present study investigates the effect of a low dose of ketamine on intraocular pressure in patients undergoing cataract surgery.
Methods: This case-control study was performed in Farabi Hospital, Tehran University of Medical Sciences from January 2020 to February 2020. In this study 92 patients undergoing cataract surgery were randomly divided into two groups of 46 patients. Patients' intraocular pressure and blood pressure were measured at baseline, and then all patients received 1 mg midazolam and 1 μg/kg fentanyl before initiation of the study. In the case group, 0.15 mg/kg ketamine was injected intravenously. Intraocular pressure and blood pressure of all subjects were measured three minutes after injection of sedation. Also, postoperative pain, need for opioids and, postoperative nausea and vomiting were compared between the two groups.

Background: Sore throat after endotracheal intubation during general anesthesia is a common complaint of patients especially in children. Strabismus surgery in one of the common procedures in child patients. The present study investigates the use of intratracheal ketamine administration in reducing sore throat after strabismus surgery.
Methods: This study was performed on 60 patients undergoing elective strabismus surgery under general anesthesia from December 2019 to February 2020 in Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. These cases were referred to our center for strabismus operation from other centers of our country. Patients were randomly divided into two equal groups. After sufficient depth of anesthesia with sevoflurane and injection of fentanyl, endotracheal intubation was performed. In the control group, the endotracheal tube was inserted and 2 ml of ketamine solution at a concentration of 5 mg/ml were administered in endotracheal tube. The severity of sore throat, length of stay in recovery, incidence of delirium in recovery, satisfaction of recovery nurses and their parents and other complications were compared between the two groups.

Background: CSF fluid leakage due to damage to the dura mater layer is a rare complication of spine surgery. One of the methods to control symptoms in case of failure of supportive treatments is to inject the patient's blood into the epidural space at the levels adjacent to the leakage site
Case Presentation: The patient is a 56-year-old woman, who suffered a CSF leak after laminectomy of the fourth vertebra. Due to the presence of a surgical incision at the leak site, the lack of access to the epidural space from that location, and disturbing symptoms, caudal space was chosen. Method, In a prone position with vital signs monitoring, proper sedation, and local anesthetic injection, in completely sterile conditions, with the help of fluoroscopy, through the sacral hiatus  Tuohy 18G needle entered into the epidural space and contrast material was injected, the exact location of the needle in the AP-Lateral view ensured, the epidural catheter was measured from the skin to the approximate location of the L4 vertebra and about 20 cm of the catheter was shortened to facilitate blood injection then the catheter was inserted into the epidural space again, the contrast material was injected into the catheter and the diffusion of the contrast material was seen at the level of the fifth vertebra. Then, in the cubital vein, a 16G IV cannula was inserted under completely sterile conditions. Then 20 cc of blood was taken from the patient's peripheral vein and slowly injected into the catheter. After the injection of 17 cc, the patient felt heaviness and pain in the lower back, the blood injection was stopped and the catheter and needle were removed. The needle insertion site was bandaged and the patient with stable vital signs and full consciousness was transferred to the recovery room and then to the ward.

Conclusion: when it is not possible to access the epidural space via the interlaminar approach, the caudal space by inserting a catheter can be a good alternative.

Background: Postoperative pain remains a major concern following abdominal surgeries, including laparoscopic cholecystectomy. Inadequate pain control may lead to increased opioid consumption, delayed recovery, prolonged hospitalization, and reduced patient satisfaction. Therefore, the use of anesthetic adjuvants with effective analgesic properties and minimal side effects has gained increasing attention. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, and dexmedetomidine, a highly selective α2-adrenergic agonist, are commonly used agents with distinct mechanisms of action. The present study aimed to compare the effects of intraoperative ketamine and dexmedetomidine on postoperative pain following laparoscopic cholecystectomy.
Methods: This randomized, double-blind, controlled clinical trial was conducted on 252 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned into three equal groups: ketamine, dexmedetomidine, and control. The ketamine group received an intravenous infusion of ketamine at a dose of 0.5 mg/kg/h, the dexmedetomidine group received 0.6 µg/kg/min of dexmedetomidine, and the control group received normal saline. Pain intensity was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Hemodynamic parameters, including heart rate and mean arterial pressure, were continuously monitored throughout the perioperative period. Data were analyzed using appropriate statistical tests, including ANOVA and nonparametric analyses.
Results: The results demonstrated that postoperative pain scores were significantly lower in the ketamine group compared to both the dexmedetomidine and control groups at all evaluated time points within the first 24 hours after surgery (P < 0.001). Although dexmedetomidine also provided effective analgesia compared with the control group, ketamine showed superior pain reduction. No statistically significant differences were observed among the three groups regarding hemodynamic parameters, indicating comparable cardiovascular stability.
.Conclusion: Intraoperative administration of ketamine was more effective than dexmedetomidine in reducing postoperative pain following laparoscopic cholecystectomy, without compromising hemodynamic stability. Nevertheless, both agents proved to be safe and effective options for postoperative pain management. Ketamine may be considered a preferable.