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Propofol

در نشریات گروه پزشکی
  • Azin Tahvildari, Faranak Behnaz, Hamidreza Azizi Faresani, Sogol Asgari
    Background

    Skin metastases occur in 5% - 30% of breast cancer patients, highlighting the need for effective treatments. Electrochemotherapy, which combines electric pulses with chemotherapy, enhances drug uptake but requires sedation due to muscle spasms caused by the pulses. Dexmedetomidine, which minimizes respiratory depression, and propofol, which provides rapid sedation, are commonly used. However, research on their use specifically during electrochemotherapy is limited.

    Objectives

    The aim of this study was to compare the efficacy of dexmedetomidine and propofol in breast cancer skin lesion electrochemotherapy.

    Methods

    Sixty-four patients between the ages of 18 and 60 years, in ASA group II, I, III, with skin metastases of breast cancer were selected and referred for electrochemotherapy. The participants were randomly assigned to two equal groups, using sequentially numbered, opaque-sealed envelopes with computer-generated randomization. One group received dexmedetomidine, and the other received propofol. To minimize selection bias, an opaque covering was used to conceal the IV bag and tubing. Dexmedetomidine was administered to 32 patients with an initial bolus dose of 0.5 to 1 mcg/kg, followed by a continuous infusion of 0.1 to 1 mcg/kg per hour. Propofol was administered to the other 32 patients at a dose of 25 to 75 mcg/min/kg. Peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), Ramsay Sedation Scale (RSS) score, Neuropathic Pain Scale (NPS) score, and Aldrete score were recorded during the procedure. The sample size was calculated for 80% power at a type I error of 0.05. Repeated-measures analysis of variance and independent-samples t-test were used to compare continuous variables.

    Results

    The MAP decreased in the propofol group from time points 1 to 3 (P < 0.05) and in the dexmedetomidine group from time points 1 to 6 (P < 0.05), with significant differences between the groups at time points 1 to 3 (P < 0.05). Heart rate decreased in the dexmedetomidine group from time points 1 to 7 (P < 0.05), while the propofol group showed a decrease only at time point 2 (P < 0.05), with significant differences between the groups from time points 2 to 7 (P < 0.05). The SpO2 reduction was not significant in the dexmedetomidine group, while the propofol group exhibited a decrease from time points 1 to 3 (P < 0.05), with significant differences between the groups at time points 3 to 7 (P < 0.05). All patients in the dexmedetomidine group scored above 8 on the Aldrete scale, compared to 34.3% in the propofol group (P < 0.001). The mean RSS score during the procedure was significantly lower for the dexmedetomidine group than for the propofol group (P < 0.001). Overall patient satisfaction was similar between groups, but surgeon satisfaction was higher in the dexmedetomidine group (P < 0.001). No harm or unintended effects occurred in any of the patients. The generalizability of the findings may be limited due to variability in drug administration rates and timing across groups, as well as the exclusion of patients with cardiovascular disease and critically ill individuals.

    Conclusions

    Dexmedetomidine provides satisfactory sedation and analgesia outcomes, making it a viable alternative to propofol for patients undergoing electrochemotherapy.

    Keywords: Dexmedetomidine, Propofol, Electrochemotherapy, Clinical Trial
  • Ahmad Eghbali Zarch, Narjes Amiri Tehranizadeh, Ghassem Ansari, Masoud Fallahinejad Ghajari*
    Background and Aim

    Various medications are used for intravenous (IV) sedation in pediatric dentistry. This study evaluated the efficacy of IV midazolam/ketamine (MK) versus propofol/ketamine (PK) for dental sedation of uncooperative children.   

    Materials and Methods

    This double-blind, randomized controlled clinical trial was carried out on 22 healthy, uncooperative children aged 2-6 years requiring two similar dental treatment sessions. Children were randomly assigned to two groups. Group A received PK in their first, and MK in their second visit. Group B received the same combinations in a reverse order. Oxygen saturation rate (SPO2) and heart rate (HR) were recorded at baseline, at the time of IV administration, local anesthetic injection, 15 and 30 minutes later, and at the time of discharge. Two independent calibrated pedodontists scored the sedation level using the Houpt scale during treatment. Data were analyzed by t-test, Wilcoxon, Mann-Whitney, and one-sample Kolmogorov-Smirnov tests.   

    Results

    The mean age of the participants was 3.6 years with a mean weight of 15.68 kg. SPO2 was not significantly different between the two groups (P=0.609). However, the HR was significantly higher in the MK combination (P=0.001). No significant difference was detected between the two combinations for sleepiness (P=0.283), movement (P=0.180), crying (P=0.093), or overall behavior (P=0.364). The recovery time in the PK group was significantly shorter than that in the MK group (P=0.03).

    Conclusion

    Both sedation regimens are effective for dental treatment of uncooperative children. PK combination provided a more acceptable hemodynamic stability and shorter recovery.

    Keywords: Deep Sedation, Conscious Sedation, Pediatric Dentistry, Anesthetics, Dissociative, Midazolam, Ketamine, Propofol
  • Qi Ang, Jing Luan, Wenli Yu*
    Background

    To evaluate the safety of propofol and sevoflurane for general anesthesia in elderly.

    Materials and Methods

    All studies on sevoflurane, propofol, and hyperamylasemia from the establishment of Embase, Ovid, Cochrane Library, and Google Scholar from database establishment to December 2024 were searched. Literatures were screened, and data were extracted on the grounds of inclusion and exclusion criteria. Review Manager (RevMan) (Version 5.4. The Cochrane Collaboration.) was used for statistical analysis. Outcomes assessed included time to spontaneous eye opening, extubation time, incidence rate of postoperative cognitive dysfunction (POCD), postoperative delirium, agitation, nausea and vomiting.

    Results

    Fourteen trials were identified and included in this meta?analysis. The results showed no significant difference in time to spontaneous eye opening (P = 0.54), the incidence of POCD (P = 0.07), postoperative delirium (P = 0.37), and postoperative nausea and vomiting (P = 0.8) between the sevoflurane and propofol groups. Compared with propofol groups, extubation time (P < 0.0001) was significantly shortened by sevoflurane groups. Conversely, compared with sevoflurane, the incidence of postoperative agitation in the propofol group was significantly reduced (P = 0.04).

    Conclusion

    There was no difference in time to spontaneous eye?opening, the incidence of POCD, postoperative delirium, postoperative nausea, and vomiting between the sevoflurane and propofol groups. However, compared with propofol, sevoflurane can significantly shorten intubation time. The incidence of postoperative agitation (P = 0.04) was significantly lower in the propofol group compared with sevoflurane.

    Keywords: Aged, Meta?Analysis, Postoperative Cognitive Dysfunction, Postoperative Nausea, Vomiting, Propofol, Sevoflurane
  • Rabab Mohamed Mohamed, Ashraf Elsayed Elgahrib Abdalla, Mohsen M. Eissa, Reda Khalil Abdelrahman, Mohamed Galal Flefel, Asmaa Abdelbadie, Jehan Mohammadezzat Hamed Darwish *
    Background

    Propofol is commonly used for sedation during colonoscopy but often requires high doses.

    Objectives

    This study aimed to compare the outcomes of propofol alone versus propofol combined with clonidine for colonoscopy sedation.

    Methods

    In this randomized, double-blind controlled trial, 60 adult patients scheduled for elective colonoscopy were enrolled. Patients were divided into two groups: Group 1 (G1) received propofol alone, while group 2 (G2) received propofol plus 2 μg/kg clonidine intravenously over 10 minutes. Propofol infusion was initiated at 25 - 75 μg/kg/min IV for the first 10 - 15 minutes, then titrated to 25 - 50 μg/kg/min based on clinical response.

    Results

    Sedation onset was significantly faster in G2 than in G1 (P = 0.001). The total propofol requirement was 22% lower in G2 (P = 0.001). Heart rate (HR) and mean arterial pressure (MAP) were significantly lower in G2 at induction and at the end of the procedure (P < 0.05). Patient satisfaction scores were higher in G2 (P = 0.042). The observer's assessment of alertness/sedation (OAA/S) score after induction was lower in G2 (P = 0.015), indicating deeper sedation. However, Aldrete scores in the post-anesthesia care unit (PACU) were lower in G2 (P = 0.001), suggesting a slower recovery.

    Conclusions

    The addition of clonidine to propofol for colonoscopy sedation led to faster sedation onset, reduced propofol requirements, improved patient satisfaction, and deeper sedation, but with potentially prolonged recovery times.

    Keywords: Colonoscopy, Sedation, Propofol, Clonidine, Patient Satisfaction
  • رضا آخوندزاده، فاطمه مفتخر*، علیرضا اولی پور، سمیرا انصاری
    مقدمه

    جهت انجام کولونوسکوپی به عنوان یک روش تشخیصی و درمانی، به آرام بخشی کوتاه مدت، مناسب و کافی نیاز است. آرام بخشی هوشیارانه حالتی است که به بیمار اجازه می دهد تا یک روش تهاجمی را ضمن حفظ عملکرد قلبی و تنفسی تحمل نماید. این مطالعه با هدف مقایسه ی اثر آرام بخشی کتامین با پروپوفول در بیماران تحت کولونوسکوپی انجام شد.

    روش ها

    پژوهش حاضر از نوع کارآزمایی بالینی برروی بیماران مراجعه کننده به بخش کولونوسکوپی بیمارستان امام خمینی شهر اهواز انجام شد و بیماران به دو گروه تقسیم شدند. برای یک گروه لیدوکایین وریدی 2 درصد  mg/kg1/5، فنتانیل µg/kg1 و کتامین mg/kg 0/5 و برای گروه دیگر لیدوکایین وریدی 2 درصد mg/kg 1/5، فنتانیل µg/kg1 و پروپوفول به میزان mg/kg 0/5 تجویز شد. سپس برای هر دو گروه تغییرات همودینامیک، درجه ی آرام بخشی و نمره ی درد بررسی گردید.

    یافته ها

    بین سن، جنسیت و وزن در دو گروه تفاوت معنی دار وجود نداشت (0/05 < P). فشارخون متوسط شریانی، درد و مدت زمان ریکاوری در هر دو گروه کاهش داشته و آرام بخشی بهبود یافته اما بین این متغیرها تفاوت معنی دار مشاهده نشد. در گروه کتامین، درصد اشباع اکسیژن خون شریانی و درد بعد از آرام بخشی در تمام دقیقه ها نسبت به قبل از آرام بخشی کاهش داشته اما تفاوت معنی دار مشاهده نشد (0/05 < P). در گروه پروپوفول، بین ضربان قلب قبل و بعد از آرام بخشی در تمام دقیقه ها تفاوت معنی دار وجود داشت (0/05 > P).

    نتیجه گیری

    هر دو روش با حداقل تغییرات همودینامیک، آرام بخشی و بی دردی مناسب همراه بوده و می تواند جهت آرام بخشی موثر در بیماران استفاده شود.

    کلید واژگان: آرام بخشی هوشیارانه، پروپوفول، کتامین، کولونوسکوپی
    Reza Akhondzadeh, Fatemeh Moftakhar *, Alireza Olapour, Samira Ansari
    Background

    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.

    Methods

    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.

    Findings

    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).

    Conclusion

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

    Keywords: Conscious Sedation, Colonoscopy, Ketamine, Propofol
  • Xi Chen, Wenxing Liu, Xiaohua Guo, Yinhui Zeng, Xingrong Song, Liu Wenlong

    Propofol, a quick‑acting systemic anesthetic agent widely used in general anesthesia, can alleviate airway T-helper 2 (TH2) inflammation. Group 2 innate lymphoid cells (ILC2s) are a newly discovered group of lymphoid cells and play key roles in allergic rhinitis (AR). We aimed to investigate the regulation of ILC2s treated with propofol and its possible mechanisms in a mouse model. An ovalbumin (OVA)-sensitized and challenged mouse model was established. Nasal lavage fluid (NLF) and tissue samples were collected for the detection of inflammatory cells, type II cytokines, and ILC2s using Giemsa staining, enzyme-linked immunosorbent assay, and flow cytometry. CD4+ T cells and ILC2s were cocultured and detected by flow cytometry to confirm the proportion of TH2 cells. Compared with OVA-sensitized and challenged mice, propofol-treated model mice presented decreased type II cytokine levels and total numbers of cells, eosinophils, neutrophils, and macrophages in NLF.  Mice treated with propofol presented decreased nasal ILC2 frequency. Moreover, the nasal expression of GATA binding protein 3 (GATA3) and retinoid-related orphan receptor α (RORα),  as well as the levels of IL-5 and IL-13, were significantly inhibited after propofol treatment. Compared with those cultured alone, cocultures of ILC2s and CD4+ T cells resulted in significantly more TH2 cells. When propofol was added, the percentage of TH2 cells significantly decreased. This effect was alleviated when anti-major histocompatibility complex class II (anti-MHC II) protein was added.  Our study provides preliminary evidence that propofol can play an inhibitive role in AR by regulating innate and adaptive immunity.

    Keywords: Allergic Rhinitis, Group 2 Innate Lymphoid Cells, Propofol
  • عظیم هنرمند، محمدرضا صفوی، سید مرتضی حیدری طبای زواره، حمیدرضا شتابی، مهدیه کاظمی*
    مقدمه

    این مطالعه با هدف تعیین تاثیر فنتانیل و سوفنتانیل در ترکیب با پروپوفول بر تغییرات ضربان قلب و فشارخون بعد از لارنگوسکوپی و لوله گذاری تراشه انجام گرفت.

    روش ها

    در این مطالعه ی کارآزمایی بالینی، 96 بیمار تحت لارنگوسکوپی در سه گروه 32 نفره توزیع شده، در سه گروه به ترتیب 3 میکروگرم بر کیلوگرم فنتانیل، 0/3 میکروگرم بر کیلوگرم سوفنتانیل و با حجم مشابه نرمال سالین به همراه سایر داروها در زمان القای بیهوشی تزریق گردید. پارامترهای همودینامیک در زمان پایه، درست قبل از لارنگوسکوپی و دقایق 1، 3، 5 و 10 بعد از لارنگوسکوپی در سه گروه تعیین و مقایسه گردید.

    یافته ها

    در طی مدت مطالعه از سه گروه فنتانیل، سوفنتانیل و نرمال سالین به ترتیب 15، 12، 2 و 28 نفر (37/5، 6/3 و 87/5 درصد) در دقیقه ی اول بعد از لارنگوسکوپی دچار تاکیکاردی (0/001 > P)، به ترتیب 8، 1 و 0 نفر (25، 3/1 و 0 درصد) در دقیقه ی اول بعد از لارنگوسکوپی دچار برادیکاردی (0/002 = P). و به ترتیب 14، 8 و 23 نفر (43/8، 25، 89 درصد) در دقیقه ی اول بعد از لارنگوسکوپی دچار افزایش فشارخون (0/001 = P) شده و اختلاف معنی دار بین سه گروه مشاهده شد. فراوانی هیپوتانسیون قبل از لارنگوسکوپی نیز در سه گروه فوق به ترتیب 2، 1 و صفر مورد بود (6/1، 3/1 و 0 درصد) ولی اختلاف سه گروه معنی دار نبود (0/77 = P).

    نتیجه گیری

    هر دو ترکیب دارویی پروپوفول- فنتانیل و پروپوفول- سوفنتانیل، نسبت به گروه شاهد که پروپوفول- نرمال سالین دریافت کردند، منجر به تعدیل فشارخون و ضربان قلب در بیماران تحت لوله گذاری داخل تراشه شدند ولی بروز اختلالات همودینامیک از جمله تاکیکاردی، برادیکاردی و هایپرتانسیون در گروه سوفنتانیل کمتر بود.

    کلید واژگان: لارنگوسکوپی، همودینامیک، فنتانیل، سوفنتانیل، پرپوفول
    Azim Honarmand, Mohammadreza Safavi, Seyed Morteza Heidaritabaeizavareh, Hamidreza Shetabi, Mahdieh Kazemi *
    Background

    This study aims to determine the impact of fentanyl and sufentanil in combination with propofol on heart rate and blood pressure changes following laryngoscopy and tracheal intubatio.

    Methods

    In this clinical trial, 96 patients undergoing laryngoscopy were allocated to three groups of 32 individuals each. The three groups received three µg /kg fentanyl, 0.3 µg /kg sufentanil, and a similar volume of normal saline along with other drugs during induction of anesthesia. Hemodynamic parameters were assessed and compared at baseline, just before laryngoscopy, and at minutes 1, 3, 5, and 10 after laryngoscopy across the three groups.

    Findings

    During the study period, among the fentanyl, sufentanil, and normal saline groups, 15 (46.9%), 2 (6.3%), and 28 (87.5%) patients experienced tachycardia, respectively (P < 0.01). Bradyarrhythmia occurred in 8 (25%), 3 (9.4%), and 1 (3.1%) patients in the respective groups (P = 0.036). Additionally, 16 (50%), 9 (28.1%), and 24 (75%) patients in the same order experienced increased blood pressure (P = 0.001), and the differences between the three groups were significant. Hypotension frequency was 2 (6.3%), 2 (6.3%), and 0 (0%) in the three groups, with no significant difference between them (P = 0.54).

    Conclusion

    Both propofol-fentanyl and propofol-sufentanil drug combinations, compared to the control group receiving propofol-normal saline, led to the modulation of blood pressure and heart rate in patients undergoing tracheal intubation. However, fewer hemodynamic disturbances, including tachycardia, bradyarrhythmia, and hypertension, were observed in sufentanil groups.

    Keywords: Sufentanil, Fentanyl, Propofol, Laryngoscopy, Hemodynamics
  • Hamidreza Shetabi*, Samira Rostami
    Background

    Sedation is recommended during flexible fiberoptic bronchoscopy (FFB) to aid in airway evaluation, minimize patient mobility, and enhance patient safety. This study was conducted to compare the impact of different sub-dissociative ketamine (SDK) doses on the quality of sedation within FFB.

    Methods

    This research utilized randomized clinical trial design involving three cohorts, each consisting of 30 participants. The cohorts were administered varying doses of ketamine: 0.2 mg/kg (SDK1), 0.4 mg/kg (SDK2), and 0.5 mg/kg (SDK3). After receiving ketamine, all participants received propofol in bolus dose 0.4 mg/kg followed by infusion 50-100 µg/kg.
    FFB started when sedation level 4 was reached, according to Ramsey's sedation score.

    Results

    Regarding demographic variables revealed no statistically notable discrepancy among the cohorts (P>0.05). The SDK3 cohort exhibited a higher average sedation score and longer duration of sedation compared to the SDK2, with both metrics also surpassing those of the SDK1 cohort. (P>0.001). Furthermore, the satisfaction levels reported by the bronchoscopist (P=0.78) and the participants (P=0.019) were notably greater in the SDK3 cohort than in the other groups. Additionally, the amount of propofol administered to the SDK3 cohort was less than that given to the SDK2, and both cohort received lower doses than the SDK1 cohort (P>0.001).

    Conclusion

    Elevating the SDK from 0.2 mg/kg to 0.5 mg/kg when administered alongside propofol correlates with a rise in the score of sedation, increasing patient and bronchoscopist satisfaction, and decreasing propofol consumption in FFB in adults. A dosage of 0.5 mg/kg might be more advantageous compared to alternative dosages for FFB in adult patients.

    Keywords: Fiberoptic Bronchoscopy (Flexible), Ketamine, Propofol, Sedation
  • Ahmed Mohamed Ibrahim, Mohammed Said Elsharkawy, Reda Khalil Abdelrahman, Abdallah Elabd Hassan, Mohammedgaber Ibrahim Saad, Ismail Ahmed Elzoughari, Abdelkarem Hussini Ismail Alsayed, Asmaa Abdelbadie, Rehab Abd El Fattah Helal
    Background

    Patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) experience significant distress, which triggers a stress response.

    Objectives

    This study aimed to assess the effectiveness of dexmedetomidine and propofol in reducing stress levels, using salivary alpha-amylase (SAA) as a specific indicator of stress.

    Methods

    A randomized, open-label trial was conducted involving 40 patients newly placed on MV. In a parallel study design, participants were randomly assigned into two equal groups (n = 20) through the sealed envelope method using computer-generated randomization. Group D received dexmedetomidine at a dosage of 0.2 to 1.4 μg/kg/h, while group P received propofol at a dosage of 0.3 to 4 mg/kg/h for sedation. Salivary alpha-amylase levels were measured according to the kit manufacturer's protocol.

    Results

    Salivary alpha-amylase levels were significantly lower in group D than in group P at 12, 24, 36, and 48 hours after the initiation of MV (P < 0.05). Heart rate and mean arterial pressure were also significantly lower in group D at 12, 18, and 24 hours (P < 0.05). The duration of MV was significantly shorter in group D compared to group P (4.4 ± 1.85 vs 6.1 ± 2.45 days, P = 0.018). There were no significant differences in ICU length of stay, mortality, or adverse events between the groups.

    Conclusions

    Dexmedetomidine demonstrated superior stress-reducing effects compared to propofol in MV patients, as evidenced by lower SAA levels and improved hemodynamic stability. The shorter duration of MV in the dexmedetomidine group further suggests potential clinical benefits of its use in managing stress in MV patients.

    Keywords: Dexmedetomidine, Propofol, Mechanical Ventilation, Stress, Salivary Alpha-Amylase
  • Seyed Morteza Heidari, Mohammadreza Habibzadeh, Azim Honarmand, Behzad Nazemroaya, Sayed Abolfazl Mousavi
    Background

    Sedation plays a crucial role in the care of intensive care unit (ICU) patients, addressing the challenges presented by factors such as agitation, anxiety, and delirium, particularly during mechanical ventilation (MV). Dexmedetomidine and propofol are commonly used sedatives, each with its unique characteristics and side effects. Combining these agents has been proposed to optimize effectiveness and minimize adverse effects. This study aims to compare the efficacy of the dexmedetomidine-propofol combination with dexmedetomidine alone and propofol alone for sedation during mechanical ventilation in ICU patients.

    Methods

    A triple-blinded clinical trial was conducted in Isfahan, Iran, involving patients eligible for spinal fusion surgery and mechanical ventilation. Patients were randomized into three groups: dexmedetomidine alone (DO), propofol alone (PO), and a combination of both drugs (DP) dexmedetomidine-propofol (ProDex). Various dosages and infusion protocols were carefully administered, and patients were assessed for demographic and clinical variables. Hemodynamic parameters and sedation levels were monitored, and statistical analysis was performed.

    Results

    The study involved 87 patients, with the ProDex group demonstrating the shortest mechanical ventilation duration. Hemodynamic stability was observed in the ProDex group, with significantly lower systolic blood pressure and heart rate compared to other groups. Sedation scores did not differ significantly among groups, suggesting similar sedative effects. The ProDex group exhibited favorable outcomes despite differences in hemodynamic variables.

    Conclusion

    The dexmedetomidine-propofol combination appears effective in minimizing side effects associated with monotherapy sedation, leading to favorable clinical outcomes. This study contributes valuable insights into optimizing sedation strategies for mechanically ventilated ICU patients.

    Keywords: Dexmedetomidine, Propofol, Mechanical Ventilation, Ramsey Score
  • Tahere Abbasi-Asl, Farid Zayeri, Masoud Fallahinejad Ghajari, Narjes Amiritehranizadeh, Maryam Heydarpour Meymeh, Erfan Ghasemi, Alireza Akbarzadeh Baghban *
    Background
    Vital parameters must be monitored during sedation. This study aimed to evaluate the effects of ketamine-midazolam (KM) and ketamine-propofol (KP) combinations on the heart rate (HR) and oxygen saturation (SPO2) of non-cooperative children. The model parameters were estimated using the Bayesian approach.
    Methods
    The data were collected in a double-masked crossover study with repeated measurements (CSWRM). Twenty-two non-cooperative children 3–6 years old were included, and the linear mixed model was adopted for data analysis. The Bayesian estimation of the parameters and their 95% credible interval were calculated in SAS 9.4.
    Results
    The mean heart rate of KM recipients compared to KP recipients was significantly different by 4.47 beats per minute (bpm). The mean HR in KP was lower than KM's, but oxygen saturation (SPO2) was not significantly different.
    Conclusion
    Although the two drug combinations did not differ in SPO2, they differed in HR. As such, the KP combination is recommended.
    Keywords: Ketamine, Midazolam, Propofol, Non-Cooperative Children, Crossover Trial, Bayesian Approach
  • Ahmed Mohamed Soliman, Yehya Mohamed Hamad, Abeer Abdelmonem Almaghraby, Ahmed Abdalla Mohamed, Shady Rady Abdallah
    Background

    Endoscopic retrograde cholangiopancreatography (ERCP) is a primary diagnostic and therapeutic option for pancreaticobiliary pathologies.

    Objectives

    This study aimed to investigate the efficacy and safety of dexmedetomidine versus propofol during ERCP in cancer patients.

    Methods

    This randomized controlled single-blinded trial was conducted with 202 cancer patients aged 21 to 60 years, of both sexes, with a body mass index of 18.5 to 30 kg/m 2 , and classified as American Society of Anesthesiologists (ASA) class II - III, who were undergoing ERCP. The patients were randomly assigned to two equal groups. The Propofol Group (n = 101) received a loading dose of propofol (1 - 2 mg/kg over 30 seconds) followed by an infusion (0.05 - 0.1 mg/kg/hour). The Dexmedetomidine Group (n = 101) received a loading dose of dexmedetomidine (1 μg/kg over 10 minutes) followed by an infusion (0.2 - 0.7 μg/kg/hour). The maintenance dose was adjusted during the procedure based on vital signs, Bispectral Index (BIS), and oxygen saturation.

    Results

    The Dexmedetomidine group showed a significantly lower incidence of intra-procedural hypoxemic events (14.9% vs. 26.7%, P = 0.037) and a comparable incidence of hypotension (17.8% vs. 13.9%, P = 0.441). Dexmedetomidine also demonstrated significantly lower intraoperative pain scores according to the Facial Pain Score (P < 0.05), significantly lower postoperative Visual Analog Scale (VAS) scores (P < 0.05), and a lower frequency of postoperative nausea and vomiting (PONV) compared to the Propofol group. Additionally, there was a significantly higher frequency of endoscopist satisfaction in the Dexmedetomidine group compared to the Propofol group (P < 0.05).

    Conclusions

    Dexmedetomidine can be used as a safe and effective alternative to propofol for deep sedation of cancer patients undergoing ERCP. It is associated with a lower incidence of hypoxemic events, effective intraoperative sedation, quicker recovery, and superior analgesic effects both intraoperatively and postoperatively compared to propofol.

    Keywords: Propofol, Dexmedetomidine, Sedation, Cancer, Endoscopic Retrograde Cholangiopancreatography
  • Rasoul Azarfarin, Mohsen Ziaei Fard, Maryam Ghadimi*, Yasmin Chaibakhsh, Marziyeh Yousefi
    Introduction

    Sleep quality is the main concern of patients after cardiac surgery. We compared the effect of two routinely used sedatives on the sleep quality of patients admitted to the intensive care unit (ICU) after cardiovascular surgery.

    Methods

    It is a prospective, controlled, randomized clinical trial. A total of 120 patients, after cardiac surgery were enrolled. During extubating, patients were randomized into two groups: 60 patients received an infusion of dexmedetomidine (precede; 0.5 μg/kg/h), and 60 patients received 50 μg/kg/min propofol for 6 hours. Baseline characteristics were compared between the groups. The patients completed the St. Mary’s Hospital Sleep Questionnaire, and the scores were compared between the groups.

    Results

    The groups were not different in terms of demographics, underlying diseases, smoking/drug abuse/alcohol, number of vessels involved, history of non-cardiac surgery, and mean levels of serum parameters (P>0.05). Most of the medications used were similar between the groups (P>0.05), except calcium channel blockers (more frequently used in the propofol group [P=0.027). The details of surgery were not statistically significant different (P>0.05); but, the mean volume of platelet received after the surgery was higher in propofol group (P=0.03). The propofol group had less problems with last night’s sleep (0 vs 0.1±0.66), felt more clear-headed (4.9±0.6 vs 4.68±0.58, were more satisfied with their last night’s sleep (52.1% vs 47.9%), but spent more time getting into sleep (0.38±1.67 vs 0 ) (P<0.5).

    Conclusion

    The sleep quality of patients under the influence of propofol seemed to be better than dexmedetomidine after cardiac surgery.

    Keywords: Dexmedetomidine, Propofol, Sleep Quality, Cardiac Surgery
  • Hassan Reza Mohammadi, Ali Erfani, Aminollah Vasigh, Hosein Karimiyarandi, Sohrab Sadeghi *
    Objectives
    Laminectomy is one of the most prevalent back surgeries. Considering the importance of controlling and minimizing surgical complications, this study was conducted to determine the effect of Sevoflurane and Propofol on the state of renal complications in patients undergoing laminectomy surgery.
    Methods
    This clinical trial was conducted in Ilam (Iran). The study used a double-blind random sampling procedure, and the patients were divided into three groups receiving Sevoflurane (n=25), Propofol (n=25), and the combination of Sevoflurane and Propofol (n=25). The research tool included a checklist of demographic characteristics as well as a clinical examination. Kidney complications were diagnosed based on history, clinical examinations, and laboratory test results. The obtained data were analyzed using SPSS software.
    Results
    In this study, the patient’s mean age in the Propofol group was 52.4±5.6, the Sevoflurane group was 50.8±2.5, and Sevoflurane plus Propofol group was 53.5±3.4. The Sevoflurane plus Propofol group had the highest rate of urinary retention (n=7, 28%). In addition, there was no difference between laboratory results of creatinine and urinary retention in the studied groups (P>0.05). Besides, the comparison of the mean of renal laboratory indicators in the research patients indicated that the level of serum creatinine, and cystatin C of the patients had no significant change.
    Conclusion
    There was no significant difference between the complications in the three groups. Therefore, all three drugs can be administered to patients.
    Keywords: Sevoflurane, Propofol, Laminectomy Surgery
  • ‎Zahra Eslamifar*, ‎Morteza Habibi Moghadam ‎, Leila Jafaripour
    Background

    Silymarin is utilized in the treatment of liver conditions primarily because of its antioxidant properties and its ability to lower blood lipid levels. Propofol, an anesthetic and antioxidant, is harmful to patients with hyperlipidemia. The aim of this study was to investigate the beneficial effects of silymarin and propofol on liver enzymes and blood indices. We also studied the impacts of propofol and silymarin on propofol-induced hyperlipidemia in male Wistar rats.

    Methods

    The rats were divided into four groups: 1) controls; 2) silymarin; 3) propofol; and, 4) combined propofol and silymarin. On the 22nd day after the treatments, all rats were anesthetized, and their blood samples were collected to estimate the levels of AST, ALT, ALP, LDH, TG, TC, LDL-C, and HDL-C. After being sacrificed, the liver was removed from each rat to determine the levels of MDA, GPx, GSH, and CAT. Moreover, histopathological examinations were performed on all liver samples.

    Results

    Silymarin and propofol, used either separately or in combination, had a favorable effect on the indicators of oxidative stress and the liver’s antioxidant markers. The propofol treatment alone significantly increased the blood lipid parameters. The administration of Silymarin had a modulating effect on propofol-induced hyperlipidemia in rats.

    Conclusion

    Propofol and silymarin had favorable effects on the liver; however, propofol increased the blood lipids due to its lipid structure, which is a warning for patients with hyperlipidemia. In this regard, silymarin may be considered a protective option, making it a potential treatment for patients experiencing hyperlipidemia induced by propofol.

    Keywords: Hyperlipidemia, Liver Antioxidant Factors, Liver Enzymes, Male Wistar Rats, Propofol, Silymarin
  • Parsa Afghaniyan, Maryam Farhadian, Masoud Tarbiat, Mohammadhossein Bakhshaei, Seyed Ahmadraza Salim Bahrami
    Background

    Hemodynamic disorders during anesthesia lead to complications. To reduce hemodynamic complications, this study was conducted to compare midazolam, etomidate, and propofol following anesthesia induction in patients undergoing coronary artery bypass grafting surgery (CABG).

    Methods

    A double-blind, randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to 1 of 3 groups receiving propofol, etomidate, or midazolam. Hemodynamic variables, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and 1 and 5 minutes after intubation.

    Results

    Ninety patients with coronary artery disease (mean age: 60.83 y) were included in the study. Women and men comprised 74.4% and 25.6% of the study population. HR, SBP, DBP, and MABP exhibited significant decreases in all 3 groups after intubation. The etomidate group demonstrated the least change in SBP (P<0.001) and MABP (P<0.001), followed by the midazolam group. Concerning HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). After intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared with the levels during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure during intubation, a significant difference across all 3 groups (P<0.001).

    Conclusion

    This study, conducted on candidates for CABG, demonstrated that anesthesia induction with etomidate and midazolam resulted in less variation in hemodynamic variables compared with propofol.

    Keywords: Coronary Artery Bypass, Etomidate, Midazolam, Propofol
  • Faranak Behnaz, Atiyeh Tizghadam, Gholamreza Mohseni, Leila Nazari
    Background

    One of the most important treatments used in women with infertility is IVF, and improving its results can affect the success of assisted reproductive techniques. It was previously shown that anesthetics can enter the follicular fluid (FF), so there is concern about the accumulation of anesthetics in the FF and their negative effects on fertilization and fetal growth under general anesthesia. The use of drugs that have both analgesic and sedative effects but do not have hemodynamic side effects is of particular importance and dexmedetomidine is one of the drugs introduced in this field. On the other hand, the use of sedatives such as midazolam and propofol may cause hemodynamic disturbances and severe hypotension in these patients, which limits the use of such drugs. Accordingly, and considering the importance of the issue, in this study, we decided to evaluate and compare the effect of propofol and dexmedetomidine on fertility in IVF candidates.

    Methods

    In this clinical trial study, 78 infertile patients who underwent IVF were randomly examined. After dividing the patients into two groups receiving dexmedetomidine and propofol or standard recording doses, the fertility rate of the patients in the two groups was evaluated using chi-square and Fisher tests at a significance level of 0.05.

    Results

    The use of dexmedetomidine for (P = 0.0348) Pressure_After_Dia, HR_Before (P = 0.0204), Injection_Time (P =0.000) and Recovery Time (P =0.000) indices caused a significant increase compared to the propofol group.

    Conclusion

    The results of the present study did not show a significant difference in the use of these two drugs on fertility.

    Keywords: Propofol, Dexmedetomidine, Fertility Rate, IVF
  • Saeed Abbasi, Majid Ghodsipoor, Davood Farsi, Mahdi Rezai, Peyman Hafezimoghadam, Mani Mofidi, Mobina Yarahmadi, Nazanin Alaei Faradonbeh
    Background

    Orthopedic procedures are one of the most common medical procedures in the emergency department (ED) and are also among the most painful procedures performed on the conscious patient. This study aimed to compare different doses of ketofol in procedural sedation and analgesia (PSA) in patients referred to the EDs.

    Methods

    In this double-blinded clinical trial, 296 patients aged 18 years or over who presented with the need for orthopedic procedures in the three academic EDs in 2020 were studied. After completing the written consent, the patients were randomly assigned to four treatment groups. Demographic information, underlying diseases, patients' physical condition, type of orthopedic injuries requiring intervention, and patients' vital signs were recorded in a checklist for each patient.

    Results

    In this study, the mean age, gender, level of education, addiction, patients' physical condition, type of procedures performed, apnea, hypoventilation, bradycardia, hypotension, and agitation in all four treatment groups were not statistically different, but hallucination and hypoxia in group C (propofol 1 mg/kg plus ketamine 0.33 mg/kg) were much less than other groups; thus, oxygen administration was more common in other groups.

    Conclusion

    By testing different doses of ketamine, we concluded that doses of 1 mg and 0.5 mg were associated with more side effects. A dose of 0.33 mg of ketamine has fewer side effects while causing analgesia and sedation as in the above doses. A dose of 0.25 mg of ketamine increases thelikelihood of requiring subsequent doses. Therefore, it seems that 0.33 mg of ketamine is the best dose of choice.

    Keywords: Orthopedic Procedures, Ketamine, Propofol, Analgesia, Pain Intensity
  • ahmad eghbali, khalil soloki, tahereh chavoshi
    Introduction

    Gastrointestinal endoscopy is a prevalent diagnostic and therapeutic procedure employed for both children and adults. Since Etomidate is a short acting intravenous drug with hemodynamic stability and also it is the choice for sedation and anesthesia among patients afflicted with cardiovascular conditions, we decided to compare the benefits and drawbacks of the mentioned drugs in children undergoing endoscopy.

    Materials and Methods

    For conducting the research, 90 pediatric participants, aged from 1 to 15 years, with ASA I and II class requiring upper gastrointestinal endoscopy (admitted to Mofid Children Hospital) were randomly selected. For 45 patients, intravenous anesthetic drug Propofol (Group P) was administered for sedation required during endoscopy, while in the remaining 45 patients, Etomidate (Group E) was used, and hemodynamic fluctuations, apnea occurrence frequency, sedation recovery length, and nausea and vomiting after sedation were monitored and compared between the two groups. Finally, the data were analyzed using SPSS v.18 software, and t-test and chi-square statistical tests.

    Results

    The average age of the patients was 7.8 ± 7.9 years. The recovery following anesthesia in Group P was 8.3 ± 4.3 minutes, while in Group E, it was 7 ± 3.2 minutes (p=0.373). The reduction in SPO2 levels in Group P was 7.1 ± 3.9%, and in Group E, it was 1.4 ± 0.6% (p=0.01). The variations in heart rate (HR) were 3.9 ± 7.1 in Group P and 0.6 ± 1.4 in Group E (p=0.01). Changes in blood pressure (BP) were 10.1 ± 7.9 mmHg in Group P and 2.7 ± 1.3 mmHg in Group E (p = 0.235). The incidence of apnea was 26.7% (12 individuals) in Group P and 46.7% (21 individuals) in Group E (p=0.02). The occurrence of nausea and vomiting was 4.4% (2 individuals) in Group P and 20% (9 individuals) in Group E (p=0.01).

    Conclusion

    The result of the findings suggests that the patients receiving Etomidate experienced lower saturation drop, and quicker awakening compared to the group of patients receiving Propofol, while the occurrence of apnea, nausea, and vomiting were higher.

    Keywords: Pediatric Endoscopy, Propofol, Etomidate, Intravenous Sedation
  • داریوش مرادی فارسانی*، سید مرتضی حیدری زواره ای، سید علی اکبر مرتضوی، فاطمه سادات آل ابطحی
    مقدمه

    با توجه به اثرات مطلوب درمان ترکیبی برای ایجاد عوارض کمتر دارویی و افزایش کیفیت آرام بخشی در حین عمل و عدم انجام مطالعاتی در مورد بررسی اثرات سدیم تیوپنتال و پروپوفول، در ترکیب با کتامین در حین جراحی آب مروارید فیکوامولسیفیکاسیون، بر آن شدیم تا مطالعه ی حاضر را انجام دهیم.

    روش ها

    در این کارآزمایی بالینی تصادفی دوسوکور، 60 کاندید جراحی کاتاراکت انتخابی به دو گروه A و B تقسیم شدند. گروه A تیوپنتال-کتامین سدیم و گروه B پروپوفول-کتامین دریافت کردند. نمره ی آرام بخشی، پارامترهای همودینامیک بیماران قبل، حین و بعد از عمل، عوارض جانبی و رضایت بیماران و جراحان توسط متخصص بیهوشی ثبت و در دو گروه مورد بررسی قرار گرفت.

    یافته ها

    بر اساس نتایج آماری، رضایت جراح در گروه دریافت کننده ی تیوپنتال سدیم کتامین به طور معنی داری بیشتر بود، اما تفاوت معنی داری در پارامترهای همودینامیک در هر دو گروه در طول جراحی و ریکاوری وجود نداشت. ضربان قلب و فشارخون در هر دو گروه ابتدا کاهش و سپس افزایش یافت. همچنین تفاوت معنی داری بین گروه های مورد مطالعه از نظر نمره ی آرام بخشی حین و بعد از عمل وجود نداشت. اما سردرد در دو بیمار گروه دریافت کننده ی پروپوفول-کتامین مشاهده شد. رضایت بیمار در هر دو گروه تفاوت معنی داری نداشت. همچنین مشخصات دموگرافیک بر نتایج تاثیری نگذاشت.

    نتیجه گیری

    بر اساس نتایج مطالعه ی حاضر، استفاده از ترکیب تیوپنتال سدیم-کتامین در حین جراحی کاتاراکت فیکوامولسیفیکاسیون تحت بی حسی موضعی و آرام بخشی داخل وریدی پیشنهاد می شود.

    کلید واژگان: پروپوفول، کتامین، تیوپنتال سدیم، کاتاراکت، آرام بخشی
    Darioush Moradi Farsani *, Sayed Morteza Morteza Heydari Zavarei, Seyed Aliakbar Mortazavi, Fatemeh Sadat Aleabtahi
    Background

    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.

    Methods

    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.

    Findings

    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.

    Conclusion

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

    Keywords: Propofol, Ketamine, Thiopental Sodium, Cataract
نکته
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