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Background and Aims: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect endocrine system by changing the level of stress hormones and hemodynamic of the patient. The purpose of this study was to compare the effects of propofol and isoflurane on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery. Material and Methods: Seventy patients of elective LC were included in this study. Patients were randomly divided into two equal groups of 35 patients; group P received propofol (70–120 μg/kg/min) and group I received isoflurane (mac: 1.28%) as anesthesia maintenance. The following parameters were monitored, checked, and recorded from preanesthesia period to 10 min after PACU entry according to a planned method: hemodynamic parameters (heart rate and mean atrial pressure), level of blood sugar, and serum epinephrine level. Results: Heart rate and mean atrial pressure changes did not show significant differences between the two groups in all stage (P > 0.05), but isoflurane group tolerated lower fluctuating changes. Blood glucose and serum epinephrine level rise in the isoflurane group were significantly higher than the propofol group (P < 0.05). Conclusion: Maintenance anesthesia by inhalation gas base on isoflurane has not shown a significant difference with total intravenous anesthesia base on propofol on hemodynamic parameter. However, propofol has a consistent effect on decreasing stress hormone and suggested for LC surgery. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to select the best calibration model for determination of propofol plasma concentration by high-performance liquid chromatography method. Methods: Determination of propofol in plasma after deproteinization with acetonitrile containing thymol (as internal standard) was carried out on a C18 column with a mixture of acetonitrile and trifluoroacetic acid 0.1% (60:40) as mobile phase which delivered at the flow rate of 1.2 mL/minute . Fluorescence detection was done at the excitation and emission wavelengths of 276 and 310 nm, respectively. After fitting different equations to the calibration data using weighted regression, the adequacy of models were assessed by lackof- fit test, significance of all model parameters, adjusted coefficient of determination (R²adjusted) and by measuring the predictive performance with median relative prediction error and median absolute relative prediction error of the validation data set. Results: The best model was a linear equation without intercept with median relative prediction error and median absolute relative prediction error of 4.0 and 9.4%, respectively in the range of 10-5000 ng/mL. The method showed good accuracy and precision. Conclusion: The presented statistical framework could be used to choose the best model for heteroscedastic calibration data for analytes like propofol with wide range of expected concentration. [ABSTRACT FROM AUTHOR]

Background: This study aimed to prevent and control the pain after arthroscopy that leads to patient satisfaction, rehabilitation, and return to normal life as soon as possible. It is hypothesized that there is no difference between intra-articular injection of dexmedetomidine and placebo after knee arthroscopy regarding pain level., Methods: This double-blind randomized clinical trial was conducted on 70 patients aged 18-60 years who were candidates for elective knee arthroscopic surgery with the American Society of Anesthesiologists Classification I-II. All patients underwent spinal anesthesia equally and were randomly divided into two groups of 35 cases per group. The drug group (D) received 2 μg/kg dexmedetomidine with 0.9% normal saline reached to a volume of 20 ml, and 20 ml of 0.9% normal saline was injected into the knee joint through the cannular sheath in the control group (C). Postoperative pain intensity was recorded 1, 2, 4, 8, 16, 24 h after injection using the Visual Analogue Scale. The time of requesting the first analgesic and the amount of analgesics consumed were recorded after 24 h., Results: There was no significant difference between the two groups in terms of age, height, weight, duration of spinal anesthesia, and duration of surgery ( P>0.05 ). In group D, there was a decrease in postoperative pain, a decrease in the amount of analgesic consumed, and an increase in the time of the first analgesic request, compared to group C ( P<0.05 )., Conclusion: This study showed that intra-articular injection of dexmedetomidine relieved postoperative pain, reduced analgesic consumption, and increased the time of first analgesic request after knee arthroscopy., Competing Interests: The authers declare there was no conflict of interest.

Purpose: The aim of this study was to select the best calibration model for determination of propofol plasma concentration by high-performance liquid chromatography method., Methods: Determination of propofol in plasma after deproteinization with acetonitrile containing thymol (as internal standard) was carried out on a C18 column with a mixture of acetonitrile and trifluoroacetic acid 0.1% (60:40) as mobile phase which delivered at the flow rate of 1.2 mL/minute . Fluorescence detection was done at the excitation and emission wavelengths of 276 and 310 nm, respectively. After fitting different equations to the calibration data using weighted regression, the adequacy of models were assessed by lack-of-fit test, significance of all model parameters, adjusted coefficient of determination (R(2) adjusted) and by measuring the predictive performance with median relative prediction error and median absolute relative prediction error of the validation data set., Results: The best model was a linear equation without intercept with median relative prediction error and median absolute relative prediction error of 4.0 and 9.4%, respectively in the range of 10-5000 ng/mL. The method showed good accuracy and precision., Conclusion: The presented statistical framework could be used to choose the best model for heteroscedastic calibration data for analytes like propofol with wide range of expected concentration.

Background: Postoperative pain is a common complication that can lead to serious morbidities and delayed recovery., Objectives: The aim of this study was to investigate the effect of low-level laser therapy on acute pain after tibial fracture surgery., Patients and Methods: In this randomized clinical trial, 54 patients who were candidate for tibial fracture surgery were allocated randomly to two groups, namely, control and laser therapy. Both groups had the same type of surgery and technique of spinal anesthesia. Patients in laser group were treated with the combination of two lasers (GaALAs, 808 nm; and GaALInP, 650 nm) at the end of the surgery while control group received laser in turn-off mode with the same duration as laser group. Patients were evaluated for pain intensity according to the visual analogue scale (VAS) and the amount of analgesic use during 24 hours after surgery., Results: Laser group experienced less pain intensity in comparison with control group at second, fourth, eighth, 12(th), and 24(th) hours after surgery (P Value < 0.05). In addition, the amount of consumed opioid in laser group was significantly less than the control group (51.62 ± 29.52 and 89.28 ± 35.54 mg, respectively; P Value, 0.008)., Conclusions: Low Level Laser Therapy is a proper method to reduce postoperative pain because it is painless, safe, and noninvasive and is easily accepted by patients.

Background: Although opioids are the main choice for acute postoperative pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control postoperatively when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain postoperatively, this study was planned to assess whether paracetamol is able to provide effective analgesia as a sole analgesic at least in the first few hours post operatively., Objectives: We evaluated the effect of intravenous Paracetamol on postoperative pain in patients undergoing laparoscopic cholecystectomy., Patients and Methods: This is a randomized double- blind clinical trial study. 30 patients ASA class I, aged 18 to 50 years, candidate for laparoscopic cholecystectomy were recruited, and randomly divided into two equal groups. Group A (paracetamol group) received 1 gr paracetamol and group B received placebo ten minutes after the induction of anesthesia. 0.1 mg/Kg Morphine was administered intravenously based on patients compliant and pain score >3. Pain score and the opioids consumption were recorded in the first six hours postoperative. Patient's pain was measured by the VAS (Visual Analog Scale)., Results: The pain score was lower in group A (P= 0.01), but the morphine consumption showed no significant difference between the groups (P= 0.24) during the first 6 hours postoperatively., Conclusions: Although paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone.