Postpartum depression is a common disabling psychosocial disorder that could have adverse effects on the life of the mother, infant, and family. The present study was conducted to evaluate the effect of ketamine on preventing postpartum depression in women undergoing caesarian sections considering the relatively known positive effect of ketamine on major depression. The present double-blind, randomized clinical trial was conducted on 134 women undergoing scheduled caesarian sections. Participants were randomly allocated into two groups of control and intervention. To induce anesthesia, 1–2 mg/kg of body weight of Nesdonal and 0.5 mg/kg of body weight of ketamine were used in the intervention group, while only 3–5 mg/kg of body weight Nesdonal was administered in the control group. Data were gathered using the Edinburgh Postnatal Depression Scale (EPDS) in three stages: before the caesarian section and two and four weeks after the caesarian section. Data were analyzed using variance analysis with repeated measures and the Chi-square test. Results of the present study showed that the mean (± standard deviation) of the depression score in the intervention and control groups were 13.78±3.87 and 13.79±4.78(p = 0.98) before the caesarian section, 11.82±3.41 and 14.34±4.29 (p < 0.001) two weeks after and 10.84±3.48 and 13.09±3.79 (p = 0.001) four weeks after the caesarian section, respectively. Using ketamine in the induction of general anesthesia could be effective in preventing postpartum depression. However, further studies are required to strengthen these findings.

The severity of postoperative pain and hemodynamic changes during and post-cesarean section have a direct effect on the neonatal and maternal condition. This study aimed to compare pain severity, hemodynamic changes, and patient satisfaction following two anesthesia techniques in elective cesarean section. In this blinded study, 60 women who were candidate for cesarean section were allocated into two equal groups of general anesthesia (GA) and spinal anesthesia (SA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and O2 Saturation at pre cesarean (T0), the uterine incision time (T1), end of surgery (T2), 6h (T3), 12h (T4), and 24 hours post-cesarean (T5) were measured. A Visual Analog Scale assessed post-cesarean pain, 6, 12, and 24 hours post-cesarean. Gender, birth weight, first- and fifth- minutes’ apgar score was recorded in the checklists. The VAS score was significantly higher in the GA group at 6h, 12h, and 24 hours post-cesarean (P=0.014, P=0.002, P=0.017, respectively). SBP and DBP at T1 in the GA group were significantly higher than in the S.A group (P<0.001). The heart rate at T0 and T1 in the GA group was lower than the SA group (P=0.001, P=0.045 respectively). The difference between the apgar scores of the two groups was not significant. SA for cesarean section was associated with lower postoperative pain, systolic and diastolic blood pressure. However, the two groups had no significant difference in terms of patients’ satisfaction and apgar scores. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):424-429.

Background: In the recent years, many studies have been done on the drug combination of ketamine and propofol (ketofol). Ketamine, due to increase in blood pressure, improves hemodynamic changes of propofol. On the other hand, propofol has antiemetic effects and through strong sedative effect reduces the psychiatric side effects of ketamine. Studies have used the combination of propofol and ketamine (within a syringe) as a new drug called ketofol. Objectives: Because of the possible drug interactions between these two drugs, this study was conducted to compare the effects of ketofol with the effect of ketamine plus propofol on hemodynamic status of patients undergoing transurethral lithotripsy (TUL). Methods: This quasi-experimental study was carried out on patients undergoing TUL, during year 2015. After considering the inclusion and exclusion criteria, the sample size for each group was determined as 20 subjects, who were randomly assigned to one of the treatment groups. In the patients of the ketofol group, 1 mg/kg of propofol and 1 mg/kg of ketamine were drawn in a syringe and then injected. In the patients of ketamine plus propofol group, 1 mg/kg of propofol and 1 mg/kg of ketamine was drawn in separate syringes and were injected consecutively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and arterial blood oxygen-saturated hemoglobin (O2Sat) were recorded at 1, 5, 10 and 15 minutes after endotracheal intubation. Data was analyzed using descriptive and analytical statistics (mean, frequency, and Independent t-test). Results: Males constituted 75% of patients. The mean age of participants was 37.34 ± 8.33 years and the age group of 31 to 45 years accounted for the highest percentage. There were no significant differences in mean ± SD of SBP, DBP, MAP, HR, and O2Sat at different times of surgery in the groups of ketofol and ketamine plus propofol. Conclusions: According to the non-significant mean SBP, DBP, MAP, HR, and O2Sat at different times of surgery in the groups of ketofol and ketamine plus propofol, there is no need to combine the two drugs. Thus, possible complications and drug interactions of the combination of ketamine and propofol can be prevented (ketofol).

Cesarean section (CS) is an important challenge for a pregnant woman and her newborn. The most common anesthesia techniques used for CS are general anesthesia (GA) and spinal anesthesia (SA). This study was designed to compare the modulation of genes whose expression level is indicative of the immune system following exposure to GA and SA. The present study was performed on 40 women who were scheduled for elective CS receiving GA or SA. The expression levels of the relative mRNA of Interleukin (IL)-4, IL-6, IL-10, IL-17, Interferon (IFN)-γ, and tumor growth factor (TGF)-β before anesthesia (T0) and 24 hours post-anesthesia (T1) were analyzed by real-time polymerase chain reaction (RT-PCR) technique. Twenty-four hours post-anesthesia, the expression levels of IL-10, IL-17, and IFN-γ genes were decreased while the expressions of IL-4, IL-6, and TGF-β genes were upregulated in two groups, however, the differences were not significant. The mRNA level of IL-4 was increased in the SA group significantly. The post-CS mRNA levels of IL-4 in the SA group may indicate that SA is more appropriate than GA for the initiation of tissue repair pathways.

BACKGROUND The control of hemodynamic status is important because it can affect intraocular pressure (IOP) in patients undergoing eye surgery. We wanted to compare IOP changes in patients undergoing cataract surgery based on local anaesthesia and general anaesthesia with laryngeal mask and laryngoscopy types. METHODS In this double-blind non-randomized controlled trial; 170 patients 40-80 years old (ASA class I-II) candidates for elective cataract surgery enrolled to the study by convenience sampling method. After informed consent, patients were allocated to five groups A, B, C, D and E respectively. A) local anaesthesia, B) Macintosh laryngoscope, C) McCoy laryngoscope, D) video GlideScope and E) laryngeal mask airway. Systolic and diastolic blood pressures, mean arterial pressure, oxygen saturation and IOP were measured before, immediately and 5 minutes after airway intervention. IOP was measured with a Tono-Pen. Data was analysed by SPSS-16 using repeated measure ANOVA (Analysis of Variances), post hoc Tukey and chi-square tests. p-Value less than 0.05 was considered statistically significant. RESULTS 115 patients (67.6%) were female and 55 (32.4%) were male. In the local anaesthetic group, mean of IOP decreased significantly after airway intervention (p= 0.001). In laryngeal mask, Macintosh laryngoscope, McCoy laryngoscope and video GlideScope groups, IOP increased immediately and decreased 5 minutes after airway intervention (p = 0.001). Before the airway intervention, the mean of IOP in local anaesthetic group was higher than other groups (p= 0.012). Immediately and 5 minutes after air intervention, mean of IOP of the Macintosh laryngoscope was higher than other groups respectively (p< 0.001, p= 0.029). CONCLUSIONS Our results showed that Macintosh laryngoscopy has more effects on IOP in patients undergoing cataract surgery in comparison to other anaesthetic methods. HOW TO CITE THIS ARTICLE: Domari AA, Sarkoohi A, Taghavi Y, et al. Comparison of intraocular pressure changes in patients undergoing cataract surgery, based on local and general anaesthesia with laryngeal mask airway and laryngoscopy types. J.