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| 1 | Effect of oral premedication of midazolam, ketamine, and dexmedetomidine on pediatric sedation and ease of parental separation in anesthesia induction for elective surgery: A randomized clinical trial显示文摘Objective:To compare effect of midazolam,dexmedetomidine,and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction.Methods:This multicenter,prospective,randomized,double-blind,clinical trial focused on a pediatric population aged 2-7 years(n=153)with the American Society of AnesthesiologistsⅠ-Ⅱwho required elective surgery.The patients were stratified into three intervention groups:midazolam,ketamine,and dexmedetomidine.Hemodynamic parameters(blood pressure,heart rate,and oxygen saturation)every 5 min until induction of anesthesia along with non-hemodynamic factors,comprised of sedation score before the administration and at the time of being separated from the parents,as well as parental separation anxiety scale,acceptance of anesthesia induction,and side effects were recorded and compared.Results:No statistically significant difference in oxygen saturation,heart rate,blood pressure,duration of surgery,time to achieve an Aldrete score of 9-10,or sedation score was noted in the study groups.More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group(P=0.001).Moreover,fewer patients accept anesthesia induction(P=0.001)and more had side effects in the ketamine group(P=0.047).Conclusions:Our findings indicate that compared to the ketamine group,dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects.Dexmedetomidine and midazolam may be considered better choices.However,the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference.Clinical registarion:This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1. | Aref Zarei Hesameddin Modir Behnam Mahmoodiyeh Alireza Kamali Farzad Zamani-Barsari | 2022 | Journal of Acute Disease2022，11，4： | 0 |
| 2 | Comparison of impact of adjuvant treatment of midazolam, fentanyl, and magnesium sulfate with intrathecal bupivacaine on block characteristics and postoperative analgesia in knee arthroplasty: A randomized clinical trial显示文摘Objective:To compare the efficacy of midazolam,fentanyl,and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty.Methods:This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists classⅠorⅡ,who needed knee arthroplasty.Patients were stratified into three intervention groups,including the midazolam group,the fentanyl group,and the magnesium sulfate group,and the patients were administered with midazolam,fentanyl,and magnesium sulfate,respectively.Hemodynamic parameters,sensory and motor block,and pain score(Visual Analogue Scale)were measured and compared among the three groups.Results:A total of 105 patients were included in this study with 35 patients in each group.There was no statistically significant difference in terms of oxygen saturation,mean blood pressure,duration of surgery,and postoperative complications,including nausea,vomiting,bradycardia,dizziness,and hypotension,as well as the time of opioid administration among the three groups(P>0.05).Statistically significant differences were found in terms of heart rate at 15,30,45,60,75,and 105 min after beginning of operation among the three groups,which was lower in the midazolam group(P<0.05).The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia,sensory block to T8 or higher and sensory block to T12 and L1(P<0.05).Besides,the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3(P=0.001).No significant difference was noted in pain scores among the three groups(P>0.05).Conclusion:Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher,the onset of motor block and sensory block after spinal anesthesia,and time to achieve sensory block to T12 and L1,and the pain scores were not significantly different among the groups.Thus,midazolam can be highly underlined,if a shorter onset of sensory and motor blocks is targeted.[Funded by the research deputy of Arak University of Medical Sciences(No.99258);fa.irct.ir number,IRCT20141209020258N164]. | Hesameddin Modir Esmail Moshiri Mehran Azami Tayebe Sadat Sayafi-Sharifi | 2022 | Journal of Acute Disease2022，11，3： | 0 |
| 3 | Comparative efficacy of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia in treating opium-addicted patients undergoing tibia fracture surgery:A randomized clinical trial显示文摘Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146. | Hesameddin Modir Esmail Moshiri Mehran Azami Maryam Joshaghani Zad Amir Almasi Hashiani | 2022 | Journal of Acute Disease2022，11，5： | 0 |
| 4 | Comparative effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on preventing post-spinal anesthesia shivering and adverse events in hip fracture repair patients:A randomized clinical trial显示文摘Objective:To compare effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on the prevention of post-spinal anesthesia shivering and adverse events in hip fracture repair patients.Methods:In a randomized,double-blind trial,132 patients with American Society of Anesthesiology(ASA)ⅠandⅡspinal anesthesia who needed hip fracture surgery were enrolled.Patients were stratified into 4 intervention groups based on a randomized block pattern:meperidine,tramadol,magnesium sulfate,and dexmedetomidine.Hemodynamic parameters including blood pressure,heart rate,and oxygen saturation,as well as the severity of shivering,core body temperature,Ramsay sedation score,adverse events,meperidine consumption were recorded and compared.Results:There was no statistically significant difference in the normal hemodynamic parameters,temperature,duration of surgery,meperidine consumption,and adverse events such as dizziness,hypotension,nausea,and bradycardia among groups(P>0.05).Compared to other groups,severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery.The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery(P=0.020).Conclusion:Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering.Overall,these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia,based on anesthesiologists’discretion and patients’general conditions.Clinical registration:The study was approved by the Research and Ethics Committee at the Valiasr Hospital(Arak,Iran)with the clinical trial code of IRCT20141209020258N153. | Mansoreh Kokhaei Hesameddin Modir Esmail Moshiri Mehran Azami | 2022 | Journal of Acute Disease2022，11，6： | 0 |
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