[Comparison of hepatic enzymes level between operating room's staff and other wards' personnel]

Long exposure to inhalant anesthetic gases especially halothane, among the known hepatotoxic agents, is a serious health risk for the staff of operating room. Current study was performed to compare the level of hepatic enzymes between Operating's room staff and other therapeutic wards' personnel out of the operating room. A total of 100 personnel from educational hospitals were included and their demographic and occupational information were recorded. Hepatic function tests and bilirubin were analyzed. In cases with values more than normal, in order to rule out hepatitis B and C, Hbs-Ag, Hbs-Ab and HCV-Ab were tested. Demographic information and employment span were comparable in two groups. The average of ALT, AST were significantly higher among operating room's staff in comparison with the other group [P<0.05] and there was no significant difference between the average of GGT and ALP between two groups [P>0.05]. ALT, AST and GGT indicated significantly increase with the age of personnel [more than 40 years] and increase in employment period [more than 15 years]. The operating room's staff in educational hospitals of Ardabil may be exposed to hepatotoxic agents that caused significant rise in hepatic enzymes

[ effects of adding ketamine to morphine in patient-controlled intravenous analgesia after orthopedic surgeries]

A routine method to control post-operative pain is patient-controlled intravenous analgesia [PCIA] using opioids. Regarding complications of opioids, it seems necessary to reduce their dosage and to improve the quality of analgesia using adjuvants. We aimed to assess the effect of adding ketamine to morphine in PCIA pumps for post-operative pain control in orthopedic patients. Sixty patients, being 20-60 years old [ASA class I-II] and undergoing orthopedic surgery in lower extremity, were enrolled They had no history of opioid addiction or epilepsy. Our patients were randomly allocated to three groups 20 mg morphine sulfate, 100 mg ketamine plus 20 mg morphine and 200 mg ketamine plus 10 mg morphine in their PCIA pump. The pain score was evaluated using VAS [0-10] and VRS [0-5]; besides the sedation score and the degree of nausea-vomiting were assessed with Ramsay scale [0-5] and N and V score [1-4], respectively. All these measurements were performed 2, 4, 12, 24, and 48 hours postoperatively. The incidence of adverse drug reactions was not different among the three groups [p>0.05], but pain control was significantly better in the second and third group [ketamine plus morphine] in comparison with the first one [p<0.05]. There was no difference in the quality of pain control between the second and the third groups. Also, the need for additional opioid was significantly reduced in the two latter groups compared with the first one [p<0.05]. Adding ketamine to morphine in PCIA pumps would result in better pain control and less need for additional break-through analgesic