Background: Some studies have reported the effects of anesthesia induction using a single propofol dose and low ketamine doses in short-term outpatient operations. Objectives: In this study, we aimed to evaluate the intra and post-operative hemodynamic effects of ketamine-propofol mixture (Ketofol) infusion in comparison with propofol infusion. Methods: This study was performed on 54 class I and II of the American Society of Anesthesia patients aged 15 to 45 years who were candidates for leg fracture surgery. The patients were randomly assigned to propofol and ketofol groups. In the propofol and ketofol groups, propofol infusion (100 µg/kg/min) and propofol-ketamine infusion (50 µg/kg/min propofol + 25 µg/kg/min ketamine) were used for the maintenance of anesthesia, respectively. Heart rate and systolic, diastolic and mean blood pressure before, immediately after the induction of anesthesia and at 10-minute intervals were measured and recorded. Pain, nausea, and vomiting were recorded immediately after surgery and each 2 hours until 6 hours. Results: Systolic, diastolic and mean blood pressure were significantly higher in the ketofol group than in the propofol group at 10 -60 min intervals (P < 0.05). There was no significant difference, however, between the two groups in terms of the severity of nausea and pain and vomiting frequency. Conclusions: Infusion of hypnotic doses of ketofol leads to increase in diastolic and systolic blood pressure and improves blood pressure stability in addition to inducing more as compared with propofol infusion, but it leads to higher risk of nausea and vomiting.

Background: Some studies have reported the effect of nitroglycerin on the reduction of pain after surgery. Objectives: The primary goal of the current study was to evaluate the addition of nitroglycerin (as a nitric oxide donor) to morphine in patient-controlled analgesia. Besides, its effects on the reduction of pain and stability in hemodynamic indices after abdominal surgery are also investigated. Methods: The current study was performed on 60 patients as candidates for abdominal surgery. Morphine (0.75 mg/mL) and nitroglycerin plus morphine (morphine 0.5 mg/mL + TNG 15 μg/mL) infusions were used for control and case groups, respectively, with the same induction of anesthesia. The severity of postoperative pain, hemodynamic indices of systolic blood pressure, diastolic pressure, heart rate, respiratory rate, and nausea were measured after surgery (immediately, 2, 6, 12, and 24 hours after surgery). Results: The pain score decreased for both groups almost similarly. The mean systolic blood pressure was highly reduced in both groups. However, the mean diastolic blood pressure in the control group was considerably lower than that of the case group. Besides, the respiratory rate in the case group dramatically diminished and approached the normal value. Conclusions: Combined administration of nitroglycerin and morphine had no synergistic effects on reducing postoperative pain. However, it led to more stable hemodynamic indices and improved breathing, without any side effects.

Background: Delayed hyponatremia is a common phenomenon following transsphenoidal surgery. Recent evidence suggests that the risk of developing intensive care unit-acquired hyponatremia is high following cardiac surgery. Herein, we report management of persistent hyponatremia after offpump coronary artery bypass in a patient with diabetes and hypothyroidism who was on diuretics. Case description: An 81-year-old man with diabetes and hypothyroidism was admitted to Valiasr hospital in Birjand (Iran) with history of typical chest pain and dyspnea since a month ago. Coronary angiography revealed a critical triple vessel disease, and therefore, the patient was considered a candidate for coronary artery bypass grafting. His pre-operative sodium level was normal but decreased to 128mEq/L on sixth postoperative day. Conclusion: When hyponatremia is detected in a patient with hypothyroidism, even if severe, in the absence of myxedema coma, it may not be directly associated with the lack of thyroid hormones. Thus, other possible etiologies should be considered.

Introduction: Regarding the progress in surgeries, the mortality rate of coronary artery bypass grafting surgery is still low, despite advanced age and comorbidities. One of the independent causes of mortality rate is low ejection fraction (EF). This study aimed to assess mortality after coronary artery bypass grafting (CABG) operation in patients with ejection fraction under 30%. In the present study the experience of 20 patients with an EFbelow 30% and 20 patients with an EF above 30% was investigated in Birjand in which only three of the patients died within 2 years after the operation. Methods: This crross-sectional descriptive study was conducted on 40 patients in Birjand Vali-e-aser Hospital. Out of the 40 cases, 20 patients had EF below 30% and 20 subjects had EF above 30 %. The files of all the cases undergoing heart surgery with an EF were obtained since 2015 to 2017, and then their demographic features, such as addresses and phone numbers were collected. Afterwards, they were called and their mortality was checked and the data were analyzed with independent-samples t-test. In addition, the ratios were examined in SPSS Software (version 22) and P-value considered higher than 0.05. Results: From 2015 to 2017, the two groups, including 20 patients with EF<30% and 20 patients with EF>30%, undergone CABG surgery in Birjand University of Medical Science, 65% of which were men and 35 % were women with the age range of 64.7 for the cases with EF<30 and 62.5 for the subjects EF>30. One of the patients died with an EF above 30% and two subjects died with EF below 30%. Conclusions: The mortality rate can be reduced with providing appropriate care despite the fact that an EF<30% is an independent cause of mortality and according to the results of the present study which showed three patients died after the CABG operation.