[ effect of low-dose ketamine infusion on hemodynamic change in coronary artery bypass graft surgery]

Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery. In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion [Ketamine group, n=25] or normal saline infusion [Control group, n=25] during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction [T1], 4 h, 24h, and48h after the surgery [T2,T3 and T4]. The data were evaluated with using of variance analyzing test and repeated measurement. There were significant interaction effect between time [pre operation, 4, 24 and 48 hours after operation] and group of study [ketamine and placebo] in assessment of systolic blood pressure [p=0.0001], diastolic blood pressure[p=0.0001], heart rate [p=0.004], central venous pressure [p=0.0001] and lactate [p=0.035]. These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters [p>0.05]. low dose ketamine during and 48 hours after operation not only didn't show hemodynamic stability effect but also decreased tissue perfusion slightly

[Frequency of oral mucosal disease in referral patients to dental faculty of Tabriz in 2007]

Oral disease is a significant burden to all countries of the world. Since there is little know about this in Iran we decided to identify of oral mucosal disease in patients referred to Oral Medicine Center affiliated to Tabriz Dental School. A consecutive sample of admitted patients to OMC between April to June 2007 were included in this study. We employed a standard questionnaire in order to. Eight hundred two patients were completed the requested questionnaire. Seventy percent was female. The mean age of the study sample was 32.68 [SD=12.25] years. Approximately 70% of subjects had oral lesion,%19.2 had normal mucosa and%21.60 of patients had oral mucosal lesions that need to follow and control. The most common lesions were ankiloglossia [%29.7] then fissural tongue [%25.7] and coated tongue [%23.7]. Many patients attending the center were unaware of oral lesions in their soft oral tissue which needed to follow up. This emphasizes that examination of soft oral tissue should be considered by health policy makers in oral health agenda at national level

Impact of bispectral index monitoring versus clinical judgment as a guide for conduction of anesthesia on serum cortisol level in coronary artery bypass graft surgery

Inadequate depth of anesthesia leads to release of stress hormones. Electroencephalographic monitoring by bispectral index is a guide to asses the depth of anesthesia. The aim of the present study was to measure the serum cortisol levels as an index of stress response in patients who are candidates for coronary artery bypass graft surgery in two groups of patients. Seventy-six patients who were scheduled for primary elective cardiopulmonary bypass were enrolled in a double- blind randomized study. The patients were divided into two groups. The infusion of anesthetic drugs was guided by bispectral index in group I [n=38], and by clinical judgment in group II [n=38]. For all the patients the blood cortisol level was measured four times during operation. Serum cortisol levels decreased during operation in both groups, reaching 67.8% of the baseline in group I and 63.2% of the baseline in group II. There were no significant differences in mean serum cortisol levels between the two groups [p<0.09]. Preoperatively, the mean blood cortisol level was 19.94 micro g/dl in group I and 16.89 micro g/dl in group II which reached to 10.48 micro g/dl in group I and 6.42 micro g/dl in group II postoperatively. There was no significant difference between two groups regarding bispectral index values. It seems that monitoring of the patients by clinical judgment or bispectral index has equal influences on serum cortisol levels during coronary artery bypass graft surgery