RESUMO
BACKGROUND: Ketamine, a non-competitive NMDA (N-Methyl-D-Aspartate) receptor antagonist, is recognized as an intraoperative anesthetic agent. Increasing interest in the use of low-dose ketamine for postoperative analgesia has developed in part because of its NMDA-antagonistic properties, which may be important in attenuating central sensitization and opioid tolerance. Despite of many trial evaluations which have been done on the effect of low-dose ketamine in postoperative pain, the role of ketamine, as a component of perioperative analgesia, remains unclear. We evaluated the analgesic effect of low-dose ketamine during anesthesia induction in painful ophthalmic surgery. MATERIALS AND METHODS: After institutional approval and written informed consent, 88 patients undergoing retinal detachment, strabismus, and keratoplasty surgery aged 18-80 years old were randomly divided intoequal case and control groups. Anesthesia was induced with sodium thiopental, fentanyl, atracurium, and liducaine, and maintained with N2O, O2, and propofol. Ketamine 0.5 mg/kg was administered intravenously to patients in the case group during anesthetic induction. Mean blood pressure and pulse rate were listed in questionnaire every 5 minutes. The consumption of anesthetic, perioperative additional analgesic, extubation time, postoperative pain and nausea scores (based on Visual Analog Scale), vomiting frequency, and the recovery time were recorded. RESULTS: There were no differences in the recovery time (17.3 ± 3.4 in the case group vs. 16.3 ± 3 in the control group, P < 0.05), postoperative pain scores (5 ± 1 in the case group vs. 5.6 ± 2 in the control group, P < 0.05), the consumption of anesthetic (9376.9 ± 1245.8 in the case group vs. 9012.9 ± 1620 in the control group, P < 0.05), the analgesic requirements (1000 in the case group vs. 940.9 ± 135.6 in the control group, P < 0.05), and perioperative additional analgesic (63.4 ± 26.5 in the case group vs. 69.4 ± 25.6 in the control group, P < 0.05) between two groups. The extubation time in the case group (13.59 ± 4.83) was significantly shorter than in the control group (15.9 ± 3.6) (P = 0.01). CONCLUSION: This study demonstrates that a low dose administration of ketamine during anesthesia induction in retinal detachment, strabismus, and keratoplasty surgery improves the extubation time but have no effect on postoperative pain, nausea and vomiting, and perioperative additional analgesic requirements.
RESUMO
BACKGROUND: Hospital-prepared tube feedings from three intensive care units of two hospitals in Isfahan, Iran were analyzed for microbial contamination. METHODS: A total number of 152 samples (76 samples each at the time of preparation and 18 hours following preparation) were collected. Standard plate count, coliform count and Staphylococcus aureus count for all samples were conducted. Samples were analyzed also for the presence of Salmonella spp. and Listeria spp. RESULTS: At the time of food preparation, out of 76 samples, 53 samples (70%) had coliform contamination and 87% of these contaminated samples had counts greater than 10(1) cfu/g. Also, 68 samples (90%) had S. aureus contamination greater than 10(1) cfu/g. In standard plate count, 74 samples (97%) had counts greater than 10(3) cfu/g, while 54 samples (71%) had counts greater than 10(4) cfu/g. In second sampling occasion, out of 76 samples, 68 samples (90%) had coliform contamination and 84% of these contaminated samples had counts greater than 10(1) cfu/g. Also, 72 samples (95%) had S. aureus contamination, 98.6% of these contaminated samples had counts greater than 10(2) cfu/g. In standard plate count, 74 samples (97%) had counts greater than 10(4) cfu/g. No Salmonella or Listeria was detected from samples. CONCLUSIONS: The results indicated that a majority of the blenderized enteral tube feedings in those hospitals are not safe. In comparison to the standard limits, these enteral tube feedings are highly contaminated and posed substantial risk for developing a foodborne disease or nosocomial infection.
