[Evaluation of capsicum ointment application on Korean hand acupressure points KD2, K-K9 in reducing postoperative nausea and vomiting after cataract surgery with general anesthesia]

Post operative nausea and vomiting [PONV] is a very common and distressing complication after surgeries which may result in more serious problems such as incisional hernia wound dehiscence and aspiration. Cataract surgery following increase in intraocular pressure is sensitive to POVN. This study was designed to evaluate the effect of capsicum ointment on Korean acupressure points in reducing PONV and the amount of anti-emetic medications was used. This study is a double-blinded clinical trial which was done on 200 patients who were referred to Amir Kabir hospital for cataract surgery. The patient were randomized at the pressure points [K-K9 and K-KD2]. After applying the ointments and during the first 12 hours after the operation the patients were assessed for the incidence and intensity of PONV. The incidence of nausea and vomiting during the first 6 and 12 hours was higher in the placebo group in compare to the capsicum group [p=0.001]. Nausea scores were also higher in the 6 and 12 hours in the placebo group [p=0.0005]. Uses of metoclopramide was significant higher in the placebo group in compare to the capsicum group [p=0.001]. There was no significant difference between the two groups for vomiting during first 12 hours after operation. Stimulating of both K-D2 and K-K9 Korean acupressure points simultaneously is a simple, noninvasive, cheap and effective method for reducing PONV

Effect of ketamine on injection pain and hemodynamic effects of propofol

Pain following propofol injection was reported between 28- 90%. Ketamine have lesser cardiovascular depression effect and also local anesthetic effect. In this study effect of ketamin were analyzed when it given before propofol injection. In a randomized double blind clinical trial selected 120 ASA I, II Ptients with 15-65 years old. They were candidated for elective surgery, in half of the patients 100 /xg/kg ketamine in 2 ml volume and in another half, 2 ml distilled water were given before propofol injection. Severity of injection pain was evaluated according to 4 scale criteria [none, mild, moderate, or severe] fifteen seconds after injection of 25% of the calculated dose of propofol. Heart rate [HR] and noninvasive blood pressure were recorded before and after propofol injection, immediately and 3 minutes after intubation. The data were analysed by Mann Whitney U, Pooled t-Test and the Chi-squared test. Pain was not sensed in 51.56% and 75% of control and case groups respectively. In cases group showed little decrease in systolic and diastolic pressures after anesthetic induction [p = 0.012 and p = 0.005]. There were upper diastolic pressures after intubation [p = 0.00] and 3 minutes after intubation [p = 0.000]. During intervention heart rate changes had not significant difference between two groups. Ketamine pre-treatment was an effective method in reducing pain and providing hemodynamic stability after propofol induction

[Effect of Clonidine premedication on blood and urine electrolytes and urinary output]

Clonidine, as a premedicant in anesthesia, has a special role in decreasing anesthetic agents' dose and improving sedation. Because of its effects on body hemodynamics and electrolytes and the importance of these effects duuring anesthesia, we decided to investigate these side effects in this study. This is a double blind randomized clinical trial. Samples were 104 ASA Class I and II, 20-40 years old patients, undergoing elective surgery and were divided equally into two groups [case and control]. 90 minutes before induction of anesthesia, 5 micro g/kg Clonidine wa given to the case and placebo to the control group orally. Blood samples were taken before and 4 hours after induction of anesthesia. Also 24 hours urine was collected and measured for volume and sodium and potassium concentrations. Data analysis was done using independent T test. There wasn't any significant difference between two groups in the mean concentration of blood sodium and potassium before and after taking the drug. But the mean sodium and potassium concentration in urine was significantly more in the case group [P=0.022] and P=0.003 respectively]. The volume of 24 hourse urine was also more in the case group [P=0.008]. Although Clonidine induces diuresis and increases sodium and potassium excretion, blood concentration of these electrolytes dosen't change significantly

[Effects of laryngeal mask airway comparing to tracheal tube on the recovery time]

Patients' staying in recovery unit is associated with risk and complications and is expensive. Decreasing the duration of staying can both increase patients' safety and decrease hospital costs. Laryngeal mask airway [LMA] as a new instrument has been widely used for airway management and in this study, its effect on recovery time is investigated. In a double blind randomized controlled clinical trial, 62 ASAI and II patients were divided into two equal groups. In one group laryngeal mask and in the other, tracheal tube was used. The anesthetic drugs were similar in both groups. Patients with upper airway infections, as well as patients undergoing thoracic and upper abdominal surgeries were excluded. Those with more than one hour duration of anesthesia and more than 30 seconds need for intubations were also excluded. Duration of anesthesia was measured in minutes. Duration of recovery staying [in minutes] and complications were also recorded. Data was analyzed using Chi Square and Mann Whitney U tests. There were no significant differences in age, sex and mean time of anesthesia between the two groups. But mean recovery time in LMA group with 10.65 minutes and tracheal tube group with 16.71 minutes was significantly different [P=0.007]. Two patients [6.45%] in LMA and 11 patients [35.48%] in tracheal tube group developed complications during recovery period which was a statisyically significant difference [P=0.004]. Laryngeal ,mask airway, decreased recovery time and the number and severity of respiratory complications. Complications such as cough, laryngospasm, bronchosam, and arterial hypoxemia were significantly less in patients with laryngeal mask airway compared to patients with tracheal tube, so the use of LMA is recommended

Nutritional assessment of GI cancer patients at admission and seven days after major intraabdominal surgery

Pre-existing malnutrition has been reported to affect a high percentage of cancer patients. Various methods are being used to assess nutritional status in hospitalized patients. The aim of this study was to apply two different nutritional assessment techniques to determine the prevalence of malnutrition in GI cancer patients and to assess their nutritional status, at admission and seven days after surgery. For this purpose, the nutritional status of fifty one patients who underwent major intraabdominal surgery was assessed. The Subjective Global Assessment [SGA], Nutritional Risk Index [NRI], anthropometric measurements, serum albumin, prealbumin, lymphocyte count and hematocrit were used to assess nutritional status of the patients. At the time of admission, based on the SGA and NRI, 70.6% and 74.5% of the patients were malnourished respectively. Both anthropometric and laboratory data, including weight, body mass index, mid arm circumference, triceps skin fold, mid arm muscle circumference, albumin, prealbumin, hematocrit and lymphocyte decreased significantly seven days after surgery [p<0.01]. The malnutrition rates increased significantly to 98% with both the SGA and NRI, seven days after surgery [p<0.01]. From the findings of this study it is concluded that there was a high prevalence of malnutrition in GI cancer patients and in almost all patients, nutritional status deteriorated seven days after surgery. Both methods proved useful for detection of the prevalence and development of malnutrition. Based on these results it is suggested that nutritional care after surgery should be improved by providing enough calories via enteral and/or parenteral route