Abstract- Colonoscopy is a painful, embarrassing and short-term procedure that needs temporary sedation and rapid recovery. The aim of this study was to compare the sedation and analgesia effect and hemodynamic changes due to bolus intravenous injection of dexmedetomidine and ketamine during elective colonoscopy. This clinical trial was conducted on 70 patients aged 20-70 years, candidates for elective colonoscopy, who randomly divided into two equal groups. For all patients 0.03 mg/kg midazolam 10 min before procedure was injected. Fentanyl 1 µ/kg was administrated in both groups 5 min before procedure, and one min before colonoscopy. K group received 0.5 mg/kg ketamine and D group received 1 µ/kg dexmedetomidine. Then, the normal saline infusion was used as maintenance. Fentanyl 25-50 µg was prescribed as the rescue dose if needed during the procedure. Hemodynamic changes, sedation level during procedure, patients and colonoscopists satisfaction were recorded in recovery. The mean heart rate and mean blood pressure was significantly less in the dexmedetomidine group than in the ketamine group. All of the patients in the ketamine group were deep to moderately sedated during colonoscopy, and the amount of fentanyl required in this group is much less than dexmedetomidine group (68.02±25.63 vs 91.45±38.62 µg P-0.003). In terms of satisfaction, only 42% of patients in the dexmedetomidine group were completely satisfied with colonoscopy, while 65% of Ketamine group had complete satisfaction with colonoscopy (P=0.001). The level of colonoscopist satisfaction during colonoscopy was similar in both group, and complete satisfaction was 43%. In patients undergoing colonoscopy, IV bolus injection of dexmedetomidine in comparison with ketamine provides less patients satisfactory and low level of sedation with supplemental multiple doses of fentanyl during the procedure.

BACKGROUND Colonoscopy is an uncomfortable and short procedure needing brief sedation with fast emergence. METHODS This research is going to measure intravenous dexmedetomidine against propofol-fentanyl combination in terms of sedation-analgesia and hemodynamic changes in non-obligatory colonoscopy procedures. 70 colonoscopy candidates aged between 20 to 70 years were enrolled in this study while separated into two random equal-sized groups (p stands for propofol- & D stands for dexmedetomidine groups). All patients were premedicated with 0.03 mg/kg midazolam and 1 µ/kg fentanyl, 10 minutes and 5 minutes before the colonoscopy process, respectively. 0.5-1 mg/kg propofol for the P group and 1 µ/kg dexmedetomidine for the D group were infused in one minute before the initiation of the procedure following by normal saline as maintenance liquid and boluses of 25-50 µg fentanyl as needed. RESULTS These variables were entered into a datasheet: hemodynamic changes, sedation-analgesia level throughout the procedure, and patients’ and physicians’ contentment. The mean arterial pressure changes were similar and insignificant in the two groups (82.44±12.34 vs. 87.63±22.45 p=0.2). The D group had lower heart rates in comparison with the P group (72.51±16.7 vs. 81.56±15.71 p=0.001). The P group was deeply to moderately sedated and required a significantly lower doses of fentanyl rescue treatment (71.02±25.63 vs. 91.45±38.62 µg p=0.003). The P group was associated with a high incidence of apnea and was significantly superior to the D group in the matter of satisfaction (43% against 77%). CONCLUSION Colonoscopists’ contentment rates were identical in both groups. Propofol infusion is more satisfactory yet having more respiratory depression possibility in comparison with dexmedetomidine infusion in colonoscopy candidates.

Background: Traditionally normal saline is the most common crystalloid solution that is used in transplant surgery. Normal saline (NS) because of the higher risk of acidosis and higher levels of serum chloride may have more deleterious effects in kidney transplant recipients Thus; the aim of this study was to determine the safety of ringer lactate normal saline combination if used during a renal transplant. Methods: One Hundred adults undergoing kidney transplantations were enrolled in a double-blinded randomized prospective clinical trial. They were divided into two groups in order to receive RL& NS and NS infusion as intraoperative IV fluid replacement therapy. All patients received 40 ml/kg fluid during surgery. Serum chloride, sodium, Cr and BUN were checked before operation and 6hour after surgery. Urine output BUN and Cr was also checked in 1, 3 and 7 day after surgery. At the end of surgery, we corrected the acid base status with bicarbonate according to base excess< -15 or PH<7.15 if needed in both groups. Results: There was a significant difference in the serum chloride level (p= 0.001) and urine output (p= 0.003) between the two groups at the 6 hours after transplantations. Postoperative BUN and Cr level at 2,3 and 7 days in RL&NS group was significantly lower than group of NS (P= 0.011). Also, urine output during this study time was significantly higher in RL&NS group (p=0.001). Conclusion: Combination of Ringer lactate &normal saline crystalloid solutions are associated with higher urinary output and most favorited out come in the early post-operative days after renal transplantation surgeries.