Journal of Anesthesiology and Pain

Introduction: According to the importance of hemodynamic stability during anesthesia, usage of drugs and technics which change the hemodynamic in a minimum rate has become one of the most important purposes.Widely spread usage of propofol for sedation in cataract surgery made us to evaluate the effect of ketamine,which in itself has sympathetic effects, in usage accompaning with propofol.
Materials and Methods: In a double blinded clinical trial 110 patients whom were candidate for cataract surgery were divided in two groups accidentally. After dripping topical analgesic drop and intravenous fentanyl injection 1mcg/kg : In one of the groups 0.25 mg/kg ketamine and in the other one 2cc normal saline were injected. Propofol infusion was started up to reaching to Ramsy score 3. Blood pressure, pulse rate and arterial O2 saturation were measured before and after injection of drug or placebo and also every 2 minutes for 10 minutes and the every 5 minutes up to end of surgery and transportation to recovery. Recovery time and propofol prescribed dosage were also measured. The results were analyzed with SPSS software.
Results: The average of systolic blood pressure and diastolic blood pressure was higher in 2 and 6 minutes and diastolic blood pressure was higher in minute 4 in ketamine group after injection. After injection and 2 minute later the average of pulse rate was higher in ketamine group. Also the usage of propofol in ketamine group was less and the recovery time was longer.
Conclusion: Although the recovery time in ketamine - propofol usage is longer but it provides a better stability in patients hemodynamic and also reduces the propofol dosage.

Background : The main purpose of sedation in patients under ocular surgery  is patients' preparing to stay calm during surgery .Inadequate or deep sedation  may lead to patient's  sudden movement  and subsequently serious complications .

Objectives : The main purpose of  this study is  compare the effects of Melatonin and Gabapentin on pain and anxiety  during cataract surgery under topical anesthesia.

Methods : This study was  a single  blinded  clinical trial conducted on 81 patients undergoing cataract surgery with topical anesthesia  in Amir-al-Momenin  Academic Hospital in 2014. Patients were randomly assigned into 3 groups:27 patients receiving 6 mg of melatonin tablet,27 patients receiving 600 mg of Gabapentin capsule, and 27 patients receiving placebo(control) 90 minutes pre -operative .In operation room, placebo group received 1 mg Midazolam intravenous, all  patients received 0.5 mic/kg Fentanyl .  The pain and anxiety were evaluated on premedication time(T1), in the operating room (T2), and post operative (T5).The sedation was evaluated at T1, T2, at the time topical anesthesia(T3), 15 minutes after the start of surgery (T4) and T5.

Results: In our study, there was not statistically significant difference in demographic variables )age, sex and coexisting disease ), the intensity of anxiety and pain in 90 minutes before surgery among the three groups of patients undergoing cataract surgery in the time intervals. It was found that in entering operating room and discharge from recovery, there was a statistically significant difference between mean pain intensity  among three groups (p=0.001 and p=0.0001).. In each of the time periods, studying the difference between the intensity of anxiety among the three groups of patients showed a significant difference at the time of entering the operating room between mean anxiety in the three groups (p=0.034). However, there was no significant difference among the mean anxiety of the three groups in recovery discharge time ( p=0.316).

Conclusion: The results show that pretreatment with Melatonin and Gabapentin  Midazolam decreased anxiety scores to the same extent of Midazolam. In addition, a single dose of Gabapentin or melatonin administered as pre- medication reduce pain intensity in the patients.