[Ephedrine reduces the pain from propofol injection]

Propofol is the most frequently used intravenous anesthetic today. One of its side effects is the pain on injection. Various methods such as adding lidocaine, cooling or warming and dilution of the propofol solution have been used for reducing the pain. However, each of these methods comes with a degree of failure. We designed this double-blinded randomized clinical trial to evaluate the effects of ephedrine of the injection pain caused by propofol. Fifty patients, between 20-60 years old and in the ASA physical status I and II, were enrolled in this experimental study and randomly divided into two equal groups. The basal vital signs for all patients were recorded, and 30 seconds prior to the induction of anesthesia, either 70 micro g/kg of ephedrine [study group] or an equal volume of normal saline [control group] was administered without premedication. Then, 20% of propofol was administered to each patient, and the pain intensity was measured and recorded by both the Verbal Rating Scale [VRS; grading 0-3] and Face Pain Scale [FPS; grading 1-6]. The remaining dose of propofol and atracurium were administered. Patients of two groups were similar with respect to age, sex, ASA status, and basal vital signs [P>0.05]. The mean degrees of pain severity, in the study and control group were 0.48 +/- 0.51 and 1.08 +/- 759 by VRS [P = 0.002], and 1.48 +/- 0.586 and 2.04 +/- 0.841 by FPS [P=0.009], respectively. Based on the results of the present study, also supported by other studies, it seems that administration of ephedrine prior to propofol is a suitable method for reduction of pain from propofol injection

[Evaluation of Intravenous ephedrine's effect on shortening the onset time of muscle relaxation of induced by atracurium]

Delayed onset time of neuromuscular blocking is one of the limitations of using nondepolarizing muscle relaxants for facilitation of endotracheal intubation. This double-blinded randomized clinical trial was designed with the presumption that ephedrine can increase cardiac index and muscle blood flow and therefore it may shorten the onset time of muscle relaxation by atracurium. Sixty patients, aged 18-60 yr, with ASA physical status I, II were randomly assigned into two equal groups. Baseline vital signs were recorded and then all patients received intravenous midazolam and fentanyl, as premedication. One minute before induction of anesthesia with propofol and atracurium, the experimental group received intravenous ephedrine 70 micro g/kg and control group received an equal volume of normal saline. Muscle relaxation was assessed by means of peripheral nerve stimulator, based on TOF pattern of stimulation on ulnar nerve. The time interval between atracurium injection and the absence of TOF response [TOF=0] was recorded in all patients. Using SPSS software, data were analyzed by means of student's t-test and Chi-square test. Demographic data and baseline vital signs were similar in both groups [p>0.05]. The mean time taken for onset of relaxation, needed for endotracheal intubation [from atracurium administration to the time of TOF =0], was less in study group compared to control group [185.1 +/- 21.59 vs. 258.43 +/- 20.63 seconds] which was statistically significant [p<0.001]. intravenous injection of ephedrine shortens the onset time of atracurium induced muscle relaxation which is similar to other nondepolarizing muscle relaxants, such as vecuronium and rocuronium

[Evaluation of the effect of ketamine as oral premedication on quality of pediatric anesthesia]

Strange and unfamiliar setting of the operation room and also fear of operation cause numerous problems for the patient, parents of the patient and anesthesiologist. Prescription of intravenous sedatives or opiates in addition to their side effects leads to more fear and anxiety because of venipuncture. To prevent these problems, we prescribed oral sedatives. In this controlled double blind clinical trial, sixty children, aged 1-7 year were divided randomly into two groups; group 1 received oral Ketamine but placebo was prescribed for group 2. Behavioral changes together with heart rate and respiratory rate alternations were evaluated before and 30 minutes after prescription of the medication. The results of this study showed that the children who received oral ketamin were calmer and separated from their parents easier in comparison to those who received placebo, which showed a significant statistical difference [p<0.001]. Also heart and respiratory rates decreased in the patients of ketamine group which revealed a significant difference [p < 0.01]. It seems that prescription of oral ketamine as a premedication thirty minutes before anesthesia can produce appropriate sedation and a relative decrease in heart and respiratory rates in children, which in turn can lead to less panic, easier separation of children from their parents and facilitation of induction of anesthesia

Intratracheal administration of lidocaine for sedation of patients under mechanical ventilation: a double-blind randomized clinical trial

Some patients with respiratory failure who are in need of mechanical ventilation require sedation to tolerate the inserted endotracheal tube [ETT] and other unpleasant stimuli. While a light sedation is satisfactory, deep sedation can interfere with the weaning process of patient from mechanical ventilator. Nevertheless, so far, the ideal regimen for sedatives and analgesics has not been found. We evaluate the effect of intratracheal administration of lidocaine for sedation of patients under mechanical ventilation. In a double-blind randomized clinical trial, 50 patients aged 33-65 years who had no obvious brain injury, in need of mechanical ventilation were enrolled into this study. They were randomized into two groups; the treatment group received 2.5 mL of 2% lidocaine, and the control group received 2.5 mL of normal saline via ETT each two hours for 12 h under sterile conditions. The baseline sedation was maintained with morphine, midazolam, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout the entire study. During 12 h of the study, the mean +/- SD total morphine and midazolam requirements were 7.13 +/- 0.96 and 4.65 +/- 1.15 mg, respectively, in the treatment group, and 11.08 +/- 0.77 and 6.37 +/- 1.17 mg, respectively, in the control group. There was a significant [P<0.05] reduction in the requirements for both drugs during the study in the treatment group as compared to the control group. Intratracheal administration of lidocaine significantly reduces sedative requirements in intubated patients during 12 h. In the short-term, no side effects or complications were observed