Yafteh

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Background: Induction of anesthesia in patients that undergo cardiac surgery has more risk than others, because of specific cardiovascular effects of the anesthetic drugs and the preoperative state of these patients, so the hemodynamic stability is very important in these patients. It seems that midazolam have less cardiovascular side effects than thiopentone. In this study, the effects of midazolam and thiopentone on cardiovascular system were compared. Materials and methods: Sixty patients in ASA class 2,3 that underwent coronary artery bypass grafting were randomly divided into two groups, all patients were pretreated similarly. Anesthesia induction was performed by a bolus injection of midazolam (0.25 mg/kg)in first group and thiopentone (5 mg/kg) in second group, and succinylcholine (1.5mg/kg) in both groups. Their trachea were intubated. Heart beat rate and arterial blood pressure were measured in following times: before (base) and after anesthesia induction, during intubation and 3, 5 and 8 minutes after intubation. Findings: The data showed that administration of both drugs decreased blood pressure during induction of anesthesia and changed heart beat rate minimally. However after intubation, blood pressure and heart beat rate increased in both groups. But, midazolam had less effects than thiopentone. Conclusions: Hemodynamic effects of midazolam is similar to thiopentone. Midazolam is a water-soluble, safe and effective inductive anesthetic with short- term effects, much lesser venous irritation, and it can be used instead of thiopentone in patients with cardiac diseases or those patients which thiopentone is contraindicated for whom.

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Background: Ketamine is one of the most common drugs that used in general anesthesia. Water solubility, high efficacy for Anesthesia induction and low cardiac and respiratory side effects make it suitable drug for general anesthesia. But this drug has side effects such as increased airway secretion, ICP, IOP, IGP that can be managed comfortably. The most common side effect of ketamine is postoperative hallucination with incidence of 5 to 30% in adult. This problem has no treatment but can be prevented using benzodiazepines. In this study we assessed the effects of prophylaxis with diazpam and midazolam for ketamine induced postoperative hallucination. Materials and methods: This double-blind clinical trial study was done on 50 patients who were candidate for ketamine administration. Patients were divided into two groups. In the first group diazepam, was administrated on premedication and in the other group, midazolam was administrated, then occurring of hallucination assessed in both groups and comparried with each other. Results: Incidence of hallucination in the first group is 36% and in the other group is 8%. Chi- Square test demonstrates a significant statistical difference between the two groups (p.v=0.017 and K.sq=5.71). Conclusions: Analysis of data demostrated that midazolam is more effective than diazpam for prevention of ketamine induced postoperative hallucination. According to the above although postoperative hallucination induced by ketamine has no effective treatment but can be prevented effectively using benzodiazepines especially midazolam.