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Background and purpose: Painful stimulation during laryngoscopy and endotracheal intubation results in increased hemodynamic side effects. The aim of current study was to compare the effects of intranasal dexmedetomidine and remifentanil on reduction of hemodynamic changes following endotracheal intubation in children undergoing general anesthesia.
Materials and methods: A double-blind clinical trial was performed in 104 children aged 6-12 years old, undergoing general anesthesia in Isfahan Imam Hossein Hospital, Iran, 2017-2018. Patients were randomly assigned into three groups to receive intranasal (IN) remifentanil 4µg/kg, dexmedetomidine 2µg/kg (IN), or normal saline 1mL, 0.9% (IN) before the induction of anesthesia. Hemodynamic changes were recorded at one and five minutes following intubation. ANOVA and Chi-square were applied to analyze the data.
Results: Heart rate was higher in patients receiving normal saline and lower in patients
receiving dexmedetomidine (p=0.22). Mean arterial blood pressure (p=0.98) and arterial oxygenation (p=0.81) were not significantly different between the three groups. No significant side effects were observed in any group.
Conclusion: Administration of pre-intubation intranasal dexmedetomidine, results in heart rate stabilization following intubation.
 
(Clinical Trials Registry Number: IRCT20160301026866N7)
 
 

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Background and purpose: Postoperative nausea and vomiting is a common complication of anesthesia. The aim of this study was to compare the effect of midazolam, ondansetron and their combination in prevention of nausea and vomiting after strabismus surgery.
Materials and methods: In this randomized double-blind clinical trial, 140 patients undergoing strabismus surgery were divided into four groups (n=35 per group). The patients received midazolam 0.75 mg/kg (M), ondansetron 4 mg (O), midazolam 0.75 mg/kg + ondansetron 4 mg (MO), and saline 0.9% iv. (S) before anesthesia. Follow-up was done in the first 24 hours after surgery and incidence and severity of nausea and vomiting and other postoperative complications were compared between the four groups.
Results: In this study, 10 patients (37%) in group S, 6 (19.4%) in group O, 8 (28.6%) in group M, and 2 (6.3%) in group MO developed nausea indicating significant differences between the four groups (P=0.019). The study showed no significant differences between the groups in incidence of vomiting (P= 0.18); 6 patients (22.2%) in group S, 5 (16.1%) in group O, 4 (14.3%) in group M, and 1 patient (3.1%) in group MO had vomiting. The severity of postoperative nausea and vomiting was significantly different between the four groups and group MO was found to have less severe nausea and vomiting two hours (P= 0.009) and 24 hours after surgery (P< 0.001).
Conclusion: Combination of midazolam and ondansetron reduces the incidence of postoperative nausea and vomiting compared to midazolam or ondansetron alone and leads to greater patient satisfaction. According to the higher effect of MO and lack of adverse effects on hemodynamic parameters it is recommended in patients undergoing strabismus surgery.

(Clinical Trials Registry Number: IRCT20180416039326N8)

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Background and purpose: The most common method of anesthesia in Cesarean section is spinal anesthesia (SA). Post-Dural puncture headache (PDPH) is one of the complications of SA. The aim of this study was to evaluate the effect of intravenous administration of atropine and neostigmine in prevention of PDPH following Cesarean section.
Materials and methods: This study was performed in 62 candidates of elective Cesarean section with SA in Isfahan Shahid Beheshti Hospital. Patients were randomly assigned into the two groups (n= 31 per group) using Random Allocation Software. After umbilical cord clamping, experimental group received neostigmine 0.5 mg and atropine 0.5 mg (i.v.), while the control group received 10 ml i.v. infusion of normal saline. The incidence and severity of headache were compared between the two groups in the first 48 hours and followed up for one week.
Results: In this study, one patient in experimental group (3.2%) and five patients in control group (16.1%) reported PDPH which can be clinically important (P=0.195). Headache was seen in two patients (1 in each group) at recovery and in four at ward in control group (P=0.11). The mean severity of headache was 5 and 4.2±0.45 in experimental group and control group, respectively (P= 0.18). The interval between spinal anesthesia and first onset of headache was one hour in experimental group and 20.8 ± 11.1 hours in control group (P=0.18).
Conclusion: According to the present study, the neostigmine (0.5mg) + atropine (0.5mg) is associated with a non- significant reduction in the incidence of headache and its severity after spinal anesthesia that are clinically important. 

(Clinical Trials Registry Number: IRCT20210324050762N1)