Assessment of ketamine effect as adjuvant to morphine in post- operative pain reduction in donor kidney transplanted

Morphine is a strong analgesic agent being used in acute pain but adverse effects may lead to its discontinuation before sufficient pain relief is obtained. Ketamine is an anti-nociceptive drug which blocks N-Methyl-D-Aspartate receptors and can modulate acute pain. In this study, ketamine effect as an adjuvant with morphine for post-operative pain management is evaluated. In a double blind randomized clinical trial, 50 kidney donors undergoing nephrectomy and receiving morphine as analgesics were enrolled. Patients were divided into two groups receiving ketamine [ketamine group] and saline serum [placebo group]. Post-operative pain was assessed by measuring cumulative morphine consumption and visual analog scale pain scores were assessed in 48 hours duration after surgery. Pain intensity and cumulative morphine consumption were lower and sedation score was higher in the ketamine group. Both groups were similar regarding the side effects. Regarding post-operative analgesia management, ketamine administration improved pain intensity and when its administration was continued for 48 hours post-operatively, there was a significant decrease in morphine consumption

Acid-base disturbances and related factors in patients under general anesthesia

In patients undergoing surgery, acid-base imbalance during general anesthesia causes disruption in the function of cardiovascular, respiratory, musculoskeletal and the central nervous system. Since the potential complications of acid-base disturbances are serious, we decided to explore these changes and related causes so that prevention and compensation would be feasible. In this study, acid-base disruption and its causes during general anesthesia were studied in 60 patients. The patients were divided into three groups based on the location of surgery: abdominal [I], extremities [II], and head and neck [III]. Body central temperature, type, and volume of injected fluids and bicarbonate [as needed] were recorded. In the second, third, and fourth hours of surgery, arterial blood gases and pH were measured. The incidence and degree of metabolic acidosis in all patients were significantly related to the duration of the surgery. The number of patients with acidosis and the number of patients requiring treatment were also greater in groups I and II than in group III. Although all patients became hypothermic during the surgery, there was no significant relationship with development of acidosis. No relationship was found between the type and volume of the solution administered and development of acidosis. In our opinion, monitoring of acid-base status in prolonged surgeries especially in abdominal and extremity operations seems necessary