کتامین

Delirium is a disruption of consciousness and cognitive function that frequently occurs in the postoperative period. The incidence of delirium following open-heart surgery has been reported to exceed 90%, potentially leading to delays in extubation among patients admitted to the intensive care unit (ICU). Ketamine, an anesthetic agent with distinct pharmacological properties, may influence the prevention or management of postoperative delirium. However, its precise role in this setting remains unclear and warrants further investigation.

This narrative review aimed to investigate delirium and extubation time in patients undergoing coronary artery bypass grafting (CABG) surgery. A systematic search was conducted across databases including Scopus, Web of Science, PubMed, Cochrane Library, and Google Scholar, using MeSH terms and relevant keywords covering the past decade. Inclusion criteria consisted of randomized clinical trials, cohort studies, and meta-analyses that addressed postoperative delirium and/or extubation time in CABG patients.

This review analyzed 11 key domains, including: the definition of delirium, its epidemiology, and pathophysiology; risk factors for delirium following cardiac surgery; the relationship between postoperative pain control and delirium; the association between sedation levels and delirium after cardiac surgery; complications arising from postoperative delirium; optimal dosing and timing of ketamine administration during cardiac surgery; the effect of ketamine on extubation time; the association between extubation time and postoperative complications; and factors influencing extubation timing.

Evidence suggests that ketamine may offer benefits in reducing postoperative delirium following cardiac surgery, particularly due to its anti-inflammatory properties. However, it does not appear to significantly influence extubation time. The heterogeneity among existing studies and the absence of standardized protocols limit the generalizability of these findings. Future research should focus on randomized, controlled trials with standardized methodologies to better evaluate ketamine's role in this context.

Shivering is one of the side effects of anesthesia that occurs both in general anesthesia and regional anesthesia. Ketamine, as an N-methyldiaspartate receptor antagonist, may prevent shivering after spinal anesthesia by reducing central heat distribution to the environment. Therefore, the purpose of this study is to investigate the effect of ketamine in preventing tremors after spinal anesthesia in lower limb orthopedic surgeries.

This randomized, single-blind clinical trial study was conducted on 60 patients who were candidates for orthopedic surgery of the lower limb referred to 5 Azar Hospital in Gorgan. Patients were randomly divided into two equal groups of ketamine (0.25 mg/kg) and control (placebo). The data collection tool includes a checklist containing information; Age, gender, mean arterial pressure, percentage of arterial oxygen saturation, heart rate, tremors and hallucinations. Data analysis was performed using descriptive statistics and inferential statistical tests at a significance level of P<0.05.

There was no statistically significant difference in gender between the control and intervention groups. The mean age of the study subjects in the control group was 36.13±12.53 and in the intervention group was 40.30±11.96. There was no statistically significant difference in age between the control and intervention groups. There is no statistically significant difference in mean arterial pressure (MAP) between the control and intervention groups. The incidence of shivering after spinal anesthesia was 13.33% in patients receiving prophylactic ketamine and 40% in patients receiving placebo. The incidence of hallucinations in the ketamine group was 26.67%. The rate of nausea and vomiting was similar in both groups. According to this study, between the two groups in terms of hemodynamic parameters, including mean arterial pressure, heart rate, percentage of arterial oxygen saturation; There was no significant difference.

The incidence of shivering in spinal anesthesia in the preventive use of ketamine has been more effective than placebo. Considering the effectiveness of ketamine in reducing the incidence of shivering, its use as a prevention is suggested to reduce the incidence of shivering.

Ketamine, a derivative of phencyclidine, is utilized as an anesthetic agent in surgical procedures. Like other medications, it can be associated with various adverse effects on different organs in the body. This study was conducted to determine the effect of injectable ketamine on the histopathological changes in the liver in neonates born to pregnant rats subjected to short-term and long-term anesthesia.

In this experimental study, 15 pregnant female Wistar rats were randomly divided into 3 groups of 5 each: A control group, a short-term anesthesia group (receiving an intraperitoneal injection of ketamine at a dosage of 25 mg/kg/bw), three times per week for 4 weeks), and a long-term anesthesia group (receiving an intraperitoneal injection of ketamine at a dosage of 75 mg/kg/bw, once per week for 4 weeks). Following parturition and during the lactation period, when the neonatal rats reached two weeks of age, they were initially anesthetized and sacrificed for tissue sampling via intraperitoneal injection of 7 units of ketamine and 3 units of xylazine. Tissue samples, with a thickness of 5 to 6 microns, were sectioned and examined using light microscope after fixation in formalin.

In the short-term anesthesia group, dilation of the centrilobular veins and fluid accumulation were observed, with an intensity score of 2. Additionally, some hepatocytes exhibited degenerative-necrotic changes, characterized by acidophilic and dark cytoplasm, with an intensity score of 1. In the long-term anesthesia group, the liver tissue showed hyperemic changes in the portal space with a score of 1, as well as increased dilation of sinusoidal spaces and centrilobular veins of varying sizes and irregularities, also with an intensity score of 1. Fluid and blood accumulation were also noted in some of these structures. In the control group, cellular structures were maintained with complete regularity, and the intensity score of changes was determined to be zero.

Ketamine administration to pregnant rats can induce histopathological changes in the liver tissue of their offspring. These detrimental changes were more pronounced in the long-term group compared to both the short-term and control group.

To perform colonoscopy as a diagnostic and therapeutic method, short-term, appropriate, and sufficient sedation is needed. Conscious sedation is a state that allows the patient to tolerate an invasive procedure while maintaining cardiac and respiratory function. This study aimed to compare the sedative effect of ketamine with propofol in patients undergoing colonoscopy.

The present study was conducted as a clinical trial on patients referred to the colonoscopy department of Imam Khomeini Hospital in Ahvaz, and the patients were divided into two groups. For one group, intravenous lidocaine 2% 1.5 mg/kg, fentanyl 1 µg/kg, and ketamine 0.5 mg/kg were prescribed, and for the other group, intravenous lidocaine 2% 1.5 mg/kg, fentanyl 1 µg/kg, and propofol 0.5 mg/kg were prescribed. Then, hemodynamic changes, degree of sedation, and pain score were checked for both groups.

There was no significant difference between age, gender, and weight in the two groups (P > 0.05). Mean arterial blood pressure, pain, and recovery time decreased in both groups, and sedation improved, but no significant difference was observed between these variables. In the ketamine group, the percentage of arterial blood oxygen saturation and pain after sedation decreased in all minutes compared to before, but no substantial difference was observed (P > 0.05). In the propofol group, there was a significant difference between the heart rate before and after sedation in all minutes (P < 0.05).

Both methods are associated with minimal hemodynamic changes, sedation, and adequate analgesia and can be used for effective sedation in patients.

Femoral nerve block can lead to painless surgery during the operation and pain reduction after the operation. Therefore, this study was conducted with the aim of comparing the effect of lidocaine and ketamine with lidocaine and dexamethasone in  femoral block  on reducing pain after femur fracture surgery.

This study was a clinical trial study, the statistical population of which was patients undergoing femur fracture surgery with class I and II anesthesia. Patients in three groups A: with lidocaine 1% (kg/mg 4) and ketamine (50 mg), group B: with lidocaine 1% (kg/mg 4) and dexamethasone (8 mg) and group C: with lidocaine 1% (kg/mg 4 ) it placed. He was subjected to femoral nerve block using an ultrasound device and a sterile needle (26 G). The patient's VAS was checked and at 0 (immediately after the removal of the spinal block), 15 and 30 minute after surgery, and 1, 2, 3, 6, 9, 12 and 24 hours after the operation. When the VAS was above 3, 0.2 mg/kg of pethidine was intravenous injected. at the end of 24 hours, the total doses received by the patient were calculated.

The results of the present study showed that comparing the effect of lidocaine and ketamine in femoral block with lidocaine and dexamethasone on pain reduction after femur fracture surgery based on pain intensity at 0, 15 and 30 minutes and 1,2,3,24 hours after surgery  was dominant in lidocaine and ketamine group.

The intensity of pain and the dose of narcotics used after the operation in the femoral blocker group with lidocaine and ketamine were lower than the other groups and there was a significant difference.

Ketamine, an NMDA glutamate receptor antagonist, has become a promising treatment for treatment-resistant depression. Its rapid antidepressant effects are observed within a few hours after consumption. S-ketamine nasal spray is approved for use with oral antidepressants. There are still challenges such as maintaining therapeutic response, potential side effects, and the possibility of abuse of this drug. This article examines single-dose intravenous ketamine and intranasal esketamine for the treatment of major depressive disorder and treatment-resistant depression. It also discusses their use for other psychiatric conditions, side effects, combination therapy, and treatment guidelines.

 A comprehensive search of PubMed, Scopus, and Google Scholar databases was performed for English studies using keywords selected based on the MeSH model, including “anesthesia, depression, ketamine, treatment.” The research focused on the antidepressant effects of ketamine in primary and secondary studies from 1995 to August 2024.

Ketamine, a drug originally developed as an anesthetic inducer, has recently emerged as a potential treatment for depression, revolutionizing the field of mental health. Studies have shown that unlike common antidepressants, which take weeks or even months to produce therapeutic results, ketamine can produce a rapid, longer-lasting antidepressant effect and significant improvement in symptoms. This development may be a new option for people struggling with treatment-resistant depression, offering hope for improved mental health and a better quality of life.

Research provides strong support for the rapid but temporary antidepressant and antisuicidal effects of an intravenous ketamine injection for treatment-resistant depression and bipolar depression. Further studies are needed to investigate the effectiveness of ketamine for other disorders, different dosage forms, and combination therapy. It is important to consider the risks and potential side effects associated with ketamine treatment, including withdrawal symptoms, hallucinations, and the potential for abuse. In addition, optimal dosage and administration methods should be carefully evaluated to minimize adverse effects. Despite these challenges, ketamine is a new and innovative approach to treating depression. Its unique mechanism of action and rapid kinetics of action have given hope to people who have not responded to traditional antidepressants. The paradigm-shifting nature of ketamine’s antidepressant response underscores its importance in treating a variety of depressions. It emphasizes the need for standardized treatment guidelines to potentially improve the lives of individuals suffering from this debilitating condition.

Ketamine is a general anesthetic drug that acts by inhibiting the NMDA receptoran important component of excitatory neurotransmission. Existing of NMDA receptors all over the central nervous system and the special type of anesthesia induced by ketamine, called dissociative anesthesia  has led to its use as an analgesic and also paved the way for abuse. Ketamine affects the cardiovascular system by increasing indices such as heart rate, blood pressure, and cardiac output.

For further evaluation of ketamine effects on heart tissue, we used 15 male and 15 female Wistar rats and divided them into 6 groups, including male and female control groups (MC and FC), male and female short-term exposure (MS and FS), and male and female long-term exposure (ML and FL) to ketamine. Each group included 5 Wistar rats. The ML and FL groups received 75mg of ketamine once a week for 4 weeks in the posterior muscle of the thigh and the MS and FS groups received 25mg of ketamine 3 times a week for 4 weeks at the same site.

After preparation of histopathological slides, it was observed that only in the group of female mice receiving long-term ketamine, empty spaces and intercellular distances increased, and in the group of male mice receiving long-term ketamine, in addition to the increase of intercellular spaces, tissue accumulations were also observed in the heart tissue.

This study showed that long-term ketamine injection in both sexes can cause some qualitative changes in heart tissue. Expanding the duration of long-term exposure to ketamine and more studies based on sexes can lead to more findings.

One of the common drugs used in modern anesthesia, especially during pregnancy, is ketamine, which is used to control chronic pain by inhibiting the N-methyl-D-aspartate receptor. Therefore, in this study, we investigate the effects of injected ketamine on the histological changes of the hearts of rats born to exposed mothers.

This study was conducted as a laboratory experiment on 15 female Wistar rats. These rat were divided into three groups of 5 including control, short-term and long-term groups, and after induction of fertility, 10 baby rats were randomly selected from each group and subjected to cardiac tissue dissection and sampling.

In the short-term dose group, cellular characteristics and heart tissue were normal, and no clear changes were observed compared to the control group, but in some areas, there were small intercellular spaces with a decrease in density. In the long-term dose group, a slight inflammatory process was seen in some areas, but there were no changes in the cells, cytoplasm, and nuclei.

Although the long-term exposure of mother rat to ketamine can cause mild inflammation and moderate hyperemia in the heart tissue of newborn rat, and the short-term exposure of mother rat to ketamine causes mild changes in heart muscle tissue like long-term exposure but these changes have not been noticeable.

Shivering is one of the side effects of anesthesia that occurs both in general anesthesia and regional anesthesia. Ketamine, as an N-methyldiaspartate receptor antagonist, may prevent shivering after spinal anesthesia by reducing central heat distribution to the environment. Therefore, the purpose of this study is to investigate the effect of ketamine in preventing tremors after spinal anesthesia in lower limb orthopedic surgeries.

Methods & Materials:

 This randomized, single-blind clinical trial study was conducted on 60 patients who were candidates for orthopedic surgery of the lower limb referred to 5 Azar Hospital in Gorgan. Patients were randomly divided into two equal groups of ketamine (0.25 mg/kg) and control (placebo). The data collection tool includes a checklist containing information; Age, gender, mean arterial pressure, percentage of arterial oxygen saturation, heart rate, tremors and hallucinations. Data analysis was done using spss software version 21 and descriptive statistics and inferential statistical tests.

The incidence of shivering after spinal anesthesia was 13.33% in patients receiving prophylactic ketamine and 40% in patients receiving placebo. The incidence of hallucinations in the ketamine group was 26.67%. The rate of nausea and vomiting was similar in both groups. According to this study, between the two groups in terms of hemodynamic parameters, including mean arterial pressure, heart rate, percentage of arterial oxygen saturation; There was no significant difference.

The incidence of shivering in spinal anesthesia in the preventive use of ketamine has been more effective than placebo. Considering the effectiveness of ketamine in reducing the incidence of shivering, its use as a prevention is suggested to reduce the incidence of shivering.

Controlling postoperative pain by interfering with the pathophysiological changes that occur during surgery reduces the complications and shortens the recovery period after surgery and after discharge from the hospital. The present study was conducted with the aim of determining the effect of low dose intravenous ketamine on pain intensity after appendectomy in Bandar Abbas Shahid Mohammadi Hospital in 2016.

Methods & Materials: 

This study was conducted using a double-blind clinical trial method on 90 patients between 18-50 years of age with anesthesia class (ASA l, ll), candidates for appendectomy surgery, who visited Shahid Mohammadi Bandar Abbas Hospital in 2016. Patients were randomly assigned to two equal groups of ketamine (A) and placebo (B). At the end of the operation and after removing the endotracheal tube, one group received ketamine and one placebo group. The level of pain was evaluated based on the visual pain measurement tool (VAS) at the beginning of recovery, 10 minutes later, 30 minutes later, 2 hours later, 4 hours later and 6 hours later. Data analysis was done using SPSS version 21 software and using descriptive statistics (mean, standard deviation, percentage) and inferential statistical tests (independent t, Mann-Whitney and chi-square).

The results of the present study showed that only in the 60th minute, there was a significant difference in the amount of pain between the two groups, and in the ketamine group, the patients experienced less pain (P=.027). The pain intensity of the two groups was also significant at 10 and 30 minutes (P=.001 and P=.049). The results also showed; There was no statistically significant difference in the duration of anesthesia and recovery time in the two groups.

The results of this study showed that the use of ketamine in appendectomy surgery significantly reduces the incidence of pain in the first 60 minutes after the operation. Also, this study showed that low-dose ketamine had a statistically significant decrease in pain intensity in the first 30 minutes after surgery. It is suggested to conduct more studies in this field with a larger sample size.

Due to the desired effects of combination therapy to provide lesser drug complication and better sedation quality during operation and the lack of any studies investigating the effects of Sodium thiopental and Propofol, in Combination with Ketamine During Phacoemulsification Cataract Surgery, we decided to do the present study.

In this randomized, double-blinded clinical trial, 60 candidates for elective cataract surgery were divided into two groups, A and B. Group A received sodium thiopental-ketamine, and group B received Propofol-ketamine. Sedation score, hemodynamic parameters of patients before, during, and after surgery, Side effects, and patients’ and surgeons’ satisfaction were recorded and analyzed by the anesthesiologist and compared in the two studied groups.

According to the statistical results, the surgeon's satisfaction was significantly higher in the group receiving thiopental sodium-ketamine. However, there was no significant difference in hemodynamic parameters in both groups during surgery and the recovery period. Heart rate and blood pressure in both groups first decreased and then increased. Also, there was no significant difference between the study groups regarding the sedation score during and after surgery. On the other hand, headache was seen in the two patients in the group receiving Propofol-ketamine. The patient's satisfaction was not significantly different in both groups, and demographic characteristics didn’t affect the results.

Based on current results, the thiopental sodium-ketamine combination is preferred to use during Phacoemulsification Cataract Surgery under topical anesthesia and intravenous sedation.

The high use of ketamine in different treatment regimens, as well as its abuse for non-medical purposes, especially in recent years, has led to concern about its side effects. In the following study, an attempt has been made to investigate the effect of ketamine on the cerebral cortex tissue of fetuses obtained from exposed maternal rats.

The study was conducted on 15 female rats (3 groups of 5 including the control group, the long-term anesthetized group with ketamine, the short-term and repeated anesthetized group with ketamine). Then, the histopathological changes of the cerebral cortex of newborns resulting from the fertility of mice receiving ketamine were evaluated. In the implementation of this plan, the ethics of working with laboratory animals have been observed.

The findings of our study showed that no changes were observed in the brain tissue and different layers in the samples of the control group, and the brain tissue was reported completely clear and normal. In the short-term and long-term dose groups of ketamine, there was no change compared to the control group, and only the number of microglia cells was lower compared to the control group.

Exposure to ketamine during embryogenesis can prevent cell proliferation in the neuronal area of ​​the cerebral cortex of rat embryos. In the present study, a decrease in microglia cells was observed in both groups injected with ketamine, but significant tissue and structural changes were observed in the two recipient groups. Ketamine was not seen compared to the control group.

Due to the high prevalence of complications during and after laryngoscopy, especially hemodynamic disturbances, and the absence of a suitable solution for preventing these complications, this study was conducted to compare the effect of“Ketamine-Midazolam-Sufentanil” with “Etomidate-Sufentanil” combinations on changes in heart rate and blood pressure after laryngoscopy and endotracheal intubation.

In this controlled, triple-blind randomized clinical trial, 96 laryngoscopy candidate patients were divided into three groups of 32 members and were given “Ketamine-Midazolam-Sufentanil” (KMS), “Etomidate-Sufentanil” (ES) and” Etomidate-Normal Saline” (NS) respectively before laryngoscopy.Hemodynamic parameter changes at baseline and 1,3,5and 10 minutes after laryngoscopy, were measured and compared between the 3 groups.

During the study, the 3 groups KMS, ES, and NS had 0%, 15.6% and, 3.1% bradycardia respectively (p value = 0.024). Changes in systolic blood pressure were significantly different in the 3 groups (p value = 0.043). However, the incidence of tachycardia, hypertension, and hypotension were not significantly different among the 3 groups.

Results of this study showed that using the “Ketamine-Midazolam-Sufentanil” combination before laryngoscopy can reduce hemodynamic disturbances during and after laryngoscopy. Patients who receive this drug combination seem to have more desirable hemodynamic stability during and after laryngoscopy

Ketamine is one of the most common drugs that weaken the central nervous system and alertness, and it is essential to know its side effects.

The purpose of this study is to investigate the effects of short-term and long-term anesthesia of ketamine on the histopathological changes of the cerebral cortex in rat infants.

This study was conducted on 15 female rats (3 groups of 5 including the control group, the long-term anesthesia group with ketamine, and the short-term and repeated anesthesia group (with ketamine). Then the histopathological changes of the cerebral cortex were analyzed by IHC immunohistochemistry method. SPSS software was used to compare the data.

The findings of our study showed that no changes were observed in the brain tissue and different layers in the samples of the control group, and the order and coherence of the brain tissue was reported to be completely clear and normal. There is no significant change in the short-term and long-term dose groups of ketamine, compared to the control group, and only the number of microglia cells was lower than the control group.

Ketamine reduces the number of microglia cells both in the short term and in the long term, and investigating the cause requires biochemical studies, free radicals and other effective factors that play a role in cell apoptosis. Although memory and learning were not examined in our study, the findings of our study did not show drastic changes in the tissue. However, a more detailed examination of the changes in the biochemical and behavioral changes of the mice needs a more detailed examination in subsequent studies to address all aspects of the effect of ketamine on the brain.

 Nowadays, the importance of ketamine as a widely used drug in medicine, especially anesthesia, cannot be ignored. On the other hand, due to the increase in the number of different surgeries during pregnancy and the urgent need for a safe anesthetic agent, we decided to conduct this study to investigate the histological changes of the kidney, which is a vital organ in maintaining homeostasis and normal body function, in infants of maternal rats receiving injectable ketamine.

 It was a laboratory field study that used fifteen female rats, which were randomly divided into three groups. The control groups, the group receiving short-term doses of ketamine through repeated injections and the group receiving long-term doses of ketamine. Then the histopathological changes of newborns resulting from the fertility of these rats was evaluated qualitatively with the help of an optical microscope.

 In the short-term dose group, most of the glomeruli were normal in terms of morphology, only some of the glomeruli were disorganized and in a small number of them, shrinkage was observed. In the long-term dose group, some glomeruli had irregular size and shape, and the urinary space showed a small decrease. Also, the structure and shape of proximal and distal tubule cells were normal in both short-term and long-term groups.

 The qualitative changes of histopathology in both groups receiving short-term and long-term doses of ketamine were not significant compared to the control group.

A smooth endotracheal intubation minimizes hemodynamic changes. We assessed the effect of ketamine and lidocaine on Diastolic blood pressure (DBP) Systolic blood pressure (SBP), heart rate (HR), Mean arterial pressure (MAP) and, oxygen saturation (SpO2) changes after endotracheal intubation compared to a control group.

In this randomized, triple-blind clinical trial (IRCT20200825048515N56) approved by the Medical Ethics Committee of the Isfahan University of Medical Sciences (IR.MUI.MED.REC.1400.721) 90 patients aged 18-65 years as candidates for surgery under general anesthesia at Alzahra Hospital in Isfahan were included between December 2022 and February 2023. They were randomly allocated to the ketamine hydrochloride (ketamine) (0.5 mg/kg), lidocaine hydrochloride 2% (Lignodic)          (0.5 mg/kg), and control groups. The subjects, age, height, weight, gender, Body mass index (BMI) and clinical information, such as mean blood pressure, HR, SBP, DBP, MAP, and, oxygen saturation 1, 3, 5 and 10 minutes following endotracheal intubation, recovery stay and, extubation time were noted and analyzed by repeated measure analysis using SPSS version 28. The significance level in all analyses was considered less than 0.05.

Ninety candidates for electroconvulsive therapy (ECT) were randomly assigned to three groups of 30: one group receiving lidocaine hydrochloride, one receiving ketamine hydrochloride, and the other a control group. Overall, 60 cases (66.7%) were male and 30 cases (33.3%) were female.
Both lidocaine and ketamine effectively reduce hemodynamic changes during endotracheal intubation, but lidocaine potentially has greater benefits in terms of improving oxygenation and reducing heart rate variability, as well as reducing recovery time during anesthesia. No significant difference was detected between the two studied groups regarding diastolic blood pressure, systolic blood pressure, heart rate, mean arterial pressure changes, recovery stay, extubation time, and laryngoscopy grade.

Based on the findings in this study, lidocaine offered more desirable hemodynamic stability than ketamine and resulted in fewer hemodynamic disturbances. Also, in the case of persistent hypertension or tachycardia. This was not observed in any of the groups.

Sore throat after surgery is the second most common cause of complications in recovery. It causes decreased patient satisfaction, and it affects patients’ well-being after surgery. The aim of this study was to compare the effects of ketamine and magnesium sulfate gargle on sore throat after laminectomy.

In this randomized clinical trial, 69 candidates for laminectomy patients in Shohade-Tajrish hospital from June 2021 to December 2022 were randomly assigned to three groups of ketamine (n=25), magnesium (n=23) and control (n=21). The Magnesium group received magnesium sulfate gargle (30 mg/kg in a total of 30 ml 5% Dextrose water), Ketamine gargle (0.5 mg/kg in a total of 30 ml 5% Dextrose water), and the control group received 30 ml 5% Dextrose water gargle. Standard similar anesthesia protocols were applied for all patients. In PACU (0) and 2, 4, 24 hours afterward sore throat was assessed using a visual analog scale (VAS) scoring.

The study showed that the incidence of sore throat in the magnesium group was lower than ketamine. Comparison of the three groups at the time of recovery (0), 2, 4, and 24 hours after surgery showed that the differences between the three groups were significant in terms of sore throat. Also, the difference in the incidence of sore throat within each group in the four times in all three groups was statistically significant (P=0.001). There was no statistically significant difference between age, gender, body mass index, heart rate, blood pressure, duration of intubation, duration of surgery and anesthesia, size of laryngoscopy insertion and Cormack and Lehane score in the three studied groups. A drop in systolic blood pressure was observed in the both groups half an hour after the operation, which was statistically significant. Changes in diastolic blood pressure were significant only in the magnesium group.

The preventive effect of "magnesium sulfate gargle" on sore throat after laminectomy is much better than "ketamine" or "placebo" gargle.

Resistant Status Epilepticus (RSE) is one of the most common neurological emergencies in children. So far, there is no definitive treatment for resistant Status epilepticus refractory to benzodiazepines or other anticonvulsants. Different protocols have been introduced as the second line of treatment after benzodiazepines, which include phenytoin, sodium valproate, levotiracetam, barbiturates, and propofol. In case of failure of the first-line (benzodiazepines) or second-line (other anticonvulsants) ketamine with a bolus dose of 1 mg/kg and then an infusion of 2 mg/kg/h up to a maximum of 7 mg/kg/h along with other drugs is recommended. Ketamine is a non-competitive N-Methyl- D-Aspartate (NMDA) receptor antagonist, which controls seizures with neuron-protective effects and anti-inflammatory and anti-epileptic properties in the second and third lines. We reviewed the literature to demonstrate the potential role of ketamin as an advanced second and thirdline agent in the treatment of RSE and we concluded that the best way to treat resistant status epilepticus is to start treatment on time, use multiple drugs instead of one drug, and choose drugs with neuron protective effects with the least side effects. Therefore, using ketamine with other drugs seems to be effective for seizure control.

Ketamine is a popular drug for use in various populations, including pregnant women. Of note, the high prevalence of ketamine use may cause disorders, especially in the nervous system. This study aimed to investigate the effect of repeated short-term and long-term anesthesia with ketamine on balance behavior and cerebellar tissue changes in neonatal rats.

In total, 15 female and 3 male rats were prepared and then randomly divided into 3 groups of 5 including control, long-term, as well as short-term and repeated anesthesia with ketamine. Pregnant female rats in the group of long-term anesthesia with ketamine were anesthetized once a week (at a dose of 75 mg/kg), and those in the groups of short-term and repeated anesthesia with ketamine were anesthetized 3 times a week (at a dose of 25 mg/kg). Ketamine injections were given weekly and regularly until the end of pregnancy. In order to evaluate the balance behavior of rats, a balance behavior test was conducted after lactation of all neonates of different groups. Moreover, tissue sampling was performed at the end of the whole period.

Most tissue changes were related to the Purkinje layer in the long-term group. In terms of balance, there were significant differences among different groups in terms of traveling distances and the number of slips.

Increasing the dose of ketamine has mild effects on cerebellar tissue alongside significant effects on balance behavior.

Gastrointestinal endoscopy is a suitable diagnostic and therapeutic method for gastrointestinal diseases and choosing a suitable sedation method for this procedure is important. Sedation with propofol-ketamine is one of the most commonly used methods. This study was designed to evaluate intravenous lidocaine in endoscopy under sedation.

The designed study is a double-blind clinical trial that was conducted on 138 patients candidates for outpatient endoscopy after approving the proposed plan and obtaining approval from the Medical Ethics Committee of Ahvaz Jundishapur University of Medical Sciences. Patients were divided into two groups. In the first group, 0.5 mg/kg of propofol and 0.5 mg/kg of ketamine were, and in the second group, the same drugs and 1.5 mg/kg of lidocaine were injected. The level of sedation, nausea, vomiting and hemodynamic changes in the patients were recorded and compared.

The two groups were matched for age, gender, and weight. There was no significant difference in the duration of the endoscopy. . There was no significant relationship between the heart rate and mean arterial pressure in the two groups(p>0.05). There was no significant difference in recovery time between the two groups. The amount of additional propofol was significantly lower in the group receiving lidocaine The level of sedation did not differ between the two groups, and nausea and vomiting were significantly lower in the group receiving lidocaine.

Adding intravenous lidocaine to a propofol-ketamine combination improves clinical outcomes and reduces side effects.