Tehran University Medical Journal

Background: Phacoemulsification surgery is one of the most common surgeries in the world. Various drugs have been used alone or in combination with each other to provide effective and safe sedation in patients, but so far, a drug method agreed upon by anesthesiologists has not been proposed. The purpose of this research was to evaluate the sedative quality of midazolam or propofol with a low dose of ketamine in phacoemulsification surgery.
Methods: This study was a double-blind randomized clinical trial conducted from November 2017 to August 2019 at Faiz Hospital, Isfahan. In this study, 68 patients were assigned in the groups of midazolam (M) and propofol (P) using randomization software entered the study. The midazolam (M) group received 0.04 mg/kg and the propofol (P) group received 0.5 mg/kg, then in both groups, ketamine 0.3 mg/kg was injected intravenously. The quality of sedation, cardiovascular response and patient and surgeon satisfaction were assessed and recorded. Data were entered into SPSS 23 software and analyzed by using ANOVA and Independent samples t‐test.

Background: A variety of sedatives like ketamine, propofol, opioids, and benzodiazepines are used during Fibroptic bronchoscopy. The effectiveness of ketamine-dexmedetomidine and ketamine-midazolam on pain level and sedation after Fibroptic bronchoscopy was examined.
Methods: A double-blind, randomized clinical trial was carried out from October 2020 to April 2021 at educational hospitals affiliated with Isfahan University of Medical Sciences. The participants were 60 candidates for fibroptic bronchoscopy who were allocated randomly into two groups of 30 people. Group one (Ketodex) received 1mg/kg ketamine and 1 µg/kg dexmedetomidine for 10 min followed by an infusion of 0.5 µg/kg of dexmedetomidine and 0.5mg/min ketamine. Group two (Ketomed) received 2.5mg of midazolam and 1mg/kg of ketamine for 10min along with infusion of 1 µg/kg/min midazolam and 0.5mg/min of ketamine. The variables under the study were systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), percentage of arterial oxygen saturation (SpO2), heart rate (HR), and level of pain. Furthermore, the sedation score of patients were recorded on the basis
of sedation score is a 5-point scale from 1 to 5. The obtained data were analyzed in SPSS (v.26). To compare the data collected at different occasions and different groups, repeated measure tests and independent t-test were used (P<0.05).

Results: Compared to the Ketomed group, the sedation term in patients in the Ketodex group was longer significantly (P<0.001) with a significantly shorter recovery term (P<0.001). In addition, the differences between the groups were insignificant in terms of diastolic blood pressure, systolic blood pressure, mean arterial pressure, heart rate, and percentage of arterial oxygen saturation (P>0.05). The pain levels were notably lower in patients who received Ketomed compared to Ketomed during 20 min (P=0.04) and 30 min (P=0.001) following the procedure. Conclusion: The use of Ketodex was associated with a longer sedation duration and significantly shorter stay in the recovery room and lower pain intensity compared to Ketomed, therefore it may be more preferable in bronchoscopy.

Background: Rhinoplasty is a challenging and complex surgery because it is designed to meet the unique needs of the patient. In rhinoplasty surgery, many factors contribute to achieving the desired result. These factors include the surgeon's care and observation, analysis of the existing anatomy, choice of surgical technique, degree of soft tissue and cartilage trauma, amount of bleeding, quality of surgical instruments and anesthesia, and anything that helps reduce bleeding.
Methods: This double-blind study was conducted on 50 patients aged 18 to 45 years undergoing septorhinoplasty surgery referred to Motahari Hospital in Jahrom city in 2022. Patients were randomly divided into dexmedetomidine and control groups. The degree of sedation, bleeding and surgeon satisfaction were evaluated and recorded. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, standard deviation, percentage, number, frequency) and inferential statistical tests (Mann-Whitney U test, Kruskal-Wallis, t-test, chi-square test). The significance level in all tests was considered P<0.05.

Results: The majority of patients in the study groups were female and the mean age of patients in the dexmedetomidine group was 34.36±7.33 years and in the control group was 36.60±9.59 years. The study groups were similar in terms of age and body mass index (P<0.05). The frequency of patient sedation in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05). The results showed that at the beginning of the operation and 90 minutes later, the satisfaction level of the patient surgeon in the dexmedetomidine group was significantly better than the control group (P<0.001). In the dexmedetomidine group, the field of view of the surgeon was relatively clear and completely clear. The amount of bleeding in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05). Conclusion: Dexmedetomidine increased the surgeon's satisfaction by reducing bleeding and improving the surgeon's visual field. Therefore, this drug can be used as an anesthetic aid in surgery.