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Material and methods: This is a Double blind Randomized clinical trial study which was performed on 66 children of 2-7 years of age who had been referred for first time, for nonbrain non-liver elective surgery (class 1 Anesthesia). This study was designed to define the efficacy of oral ketamine on Anxiety and Agitation and crying of children after separation from these parents, toleration of Anesthesia mask and IV needle. Sleeping before Anesthesia and entry into the operating room samples were divided in to two groups, cases and control. 5mg/kg of ketamine plus 0.2cc/kg of fruit juice was given to the case group while only 0.2cc/kg of fruit was given to the control group 30 minutes before the operation.
Results: Our results showed that 78.8% of children in the case group did not cry when they were separated from their parents and 78.8% of them did not show any resistance. 34.4% of children in the case group showed no response and 59.4% also had low response. Only 6.1% of children in the control group had no response while 78.8% of them had responses such as intense body movements and pulling of hand. 69.7% of the case group were cooperative when putting on the anesthesia mask while 75.8% of the control group refused to wear the mask, 81.8% of the children in the case group were asleep before Anesthesia while all of the children in the control group were awake and uneasy.
Conclusion: These findings indicate that ketamine can be used as a preanesthetic drug to decrease the anxiety and fear of children and to calm them before their transfer to the operating room.

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Introduction: Oral Ketamine is used as a low side effect analgesic in comparison with opioids, in different pain syndromes. This study is designed to evaluate the effect of oral Ketamine in renal colic treatment. Materials and Methods: In this clinical trial study 104 patients with renal colic, hospitalized in emergency department, were divided in to two groups by Random block design. Group B received Pethidine (1 mg/kg up to 100 mg) and placebo, and group A received Pethidine with the same dose and Ketamine (0.5 mg/kg). All patients were assessed for pain by using VAS chart, for nausea by a 0-3 scale and for the number of vomiting at baseline and 1, 2 and 3 hours after taking drug. The results were analyzed by t-test. Results: Average pain score and vomiting in all times and nausea score in one and three hours after receiving drugs were reduced significantly in patients who took Pethidine and Ketamine comparing patients who took Pethidine and placcbo(p < 0.05). Conclusion: Regarding the significant effect of Ketamine in reduction of pain, nausea and vomiting without side effects, it is possible to use Ketamine as an adjuvant drug in treatment of renal colic and to reduce narcotic dosage.

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Background: Pain following propofol injection was reported between 28- 90 %. Ketamine have lesser cardiovascular depression effect and also local anesthetic effect. In this study effect of ketamin were analyzed when it given before propofol injection. Methods and Materials: In a randomized double blind clinical trial selected 120 ASA I, II Ptients with 15-65 years old. They were candidated for elective surgery, in half of the patients 100 µg/kg ketamine in 2 ml volume and in another half, 2 ml distilled water were given before propofol injection. Severity of injection pain was evaluated according to 4 scale criteria (none, mild, moderate, or severe) fifteen seconds after injection of 25% of the calculated dose of propofol. Heart rate (HR) and noninvasive blood pressure were recorded before and after propofol injection, immediately and 3 minutes after intubation. The data were analysed by Mann Whitney U, Pooled t-Test and the Chi-squared test. Results: Pain was not sensed in 51.56% and 75% of control and case groups respectively. In cases group showed little decrease in systolic and diastolic pressures after anesthetic induction (p=0.012 and p=0.005). There were upper diastolic pressures after intubation (p=0.00) and 3 minutes after intubation (p=0.000). During intervention heart rate changes had not significant difference between two groups. Conclusion: Ketamine pre-treatment was an effective method in reducing pain and providing hemodynamic stability after propofol induction.

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Background: Postoperative shivering is a common problem with multiple complications. This study was compared effect of low doses of Ketamine with Pethidine for controlling postoperative shivering. Methods and Materials: This clinical trial was done on 189 elective cesarean section with ASA class I or II who had postoperative shivering. Patients with grade 2 or higher were divided in three groups and were injected 0.3mg/kg Ketamine and 0.5mg/kg Pethidine intravenously. In 5th and 10th minutes after injection, they were investigated for shivering intensity. Results: After 5 minute of injection drugs rate and intensity of shivering in Pethedine group was less than ketamine group. Ketamine with 0.5 mg/kg was more effective than 0.3mg/kg dose of it and Ketamine(p=0.041). In group with 0.5mg/kg dose of Ketamine, rate and intensity of postoperative shivering was more reduce than group with 0.3mg/kg of it in recovery(p=0/007). In Pethedine group rate and intersity of shivering was more reduce then 0.5mg/kg dose of Ketamine(p<0/001). This demonstrated that Pethedine is more effective than Ketamine. Conclusion: Although 0.5mg/kg dose of Ketamine has considerable effect on control of shivering but Pethedine is still a better choice for this side effect.

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Background: Pain following tonsillectomy is common in children, and its elimination due to its subsequent complications is essential. Therefore, this study was conducted with the aim of obtaining the best method of administering ketamine for reducing pain following tonsillectomy with the greatest efficiency and the least side effects. Materials and Methods:This study was a double-blind clinical trial which was conducted on 92 children, aged 3-9, who had been admitted for tonsillectomy. The patients were randomly divided into oral ketamine and ketamine injection groups (each containing 46 patients). Thirty minutes before the operation, all the patients were given apple-juice ketamine injection group received normal apple juice without ketamine, whereas the oral ketamine group received 5mg/kg ketamine with the apple juice. Three minutes before tonsillectomy, 0.5 mg/kg ketamine was injected to the peritonsillar area in ketamine injection group while the same volume of saline was injected to the oral ketamine group. Data were registered, gathered, and, then, analyzed using Wilcoxon, Man Whitney, and t tests. Results: Demographic data and blood pressure before and after the operation did not have significant differences in the 2 groups. In terms of the duration of operation time, a significant difference was observed between the two groups the operation time in the ketamine injection group was shorter (p=0.006). Also, pain score in the ketamine injection group was less than the oral ketamine group. Conclusion: Ketamine is effective in reducing the pain after tonsillectomy operation. Peritonsillar injection of ketamine is more effective than its oral usage.

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Background: Postoperative pain brings about undesirable effects such as medical complications, increased healthcare costs, and the need for opioids administration. The aim of this study was to determine the effect of low dose (0.15 mg/kg) ketamine in comparison with the placebo on postoperative pain and analgesics consumption after cesarean section. Materials and Methods: In a randomized clinical trial, 120 women undergoing elective cesarean section were randomly divided into case and control groups. Ketamine (0.15 mgkg-1) or an equal volume of normal saline were administered intravenously immediately after initiating spinal anesthesia to the case and control groups, respectively. The anesthesia and surgery techniques were the same for both groups. Data were analyzed using SPSS version 11. Results: Means of age in the case and control groups were 28.85±4.81 and 28.87 ±5.62 years, respectively. Analgesics consumption, pain scores, homodynamic signs, drowsiness of the mothers, and the neonates’ Apgar scores after cesarean section were similar in both groups and no significant differences were found between them (P>0.05). The mean of postoperative arterial pressure in the early hours in the ketamine group showed a significant decrease compared to the placebo group (P>0.03). The means of the first time of request for analgesics after surgery in the ketamine and placebo groups were 99.75±68.88 and 96.1±52.59 minutes, respectively (P>0.05). Conclusion: It seems that the administration of 0.15 mg/kg dose of ketamine (0.15mg/kg) does not have a significant impact on decreasing the postoperative pain in cesarean section. Therefore, in order to obtain the desirable analgesic effects of this drug, further studies should be conducted with greater doses of this drug and its use in combination with other opioids.

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Background: Post-anesthetic shivering is the most common cause of patient discomfort during recovery with a prevalence of 5 to 65%. Post-anesthetic shivering can increase pain, oxygen consumption, and cardiac output. The aim of this study was to compare the efficacy of various classes of drugs for preventing post-anesthetic shivering.

Materials and Methods: In this double-blind clinical trial, patients undergoing elective laparotomy were randomly divided into six groups, 40 each. The patients, respectively, received hydrocortisone, ketamine, tramadol, magnesium sulfate, pethidine, and normal saline. All patients were observed for body temperature and shivering for 20 minutes after arrival to recovery room.

Results: Seventy patients in the pethidine group did not have shivering upon arrival to recovery room which was significantly higher than other groups (&chi2=0.00002). Also, the patients in the pethidine group did not shiver 10 and 20 minutes after arrival to recovery room that was significantly lower than other groups.

Conclusion: According to the results, it can be concluded that pethidine is more effective than other drugs in prevention of post-anesthetic shivering.

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Background: Pain is a complex medical problem creating which inadequate control pain results adverse effects on the patients physiological, metabolic and mental conditions.The aim of this study was comparison effect of Ketamin-propofol with Alfentanil-propofol on creating analgesia and sedation during cystoscopy and comparing the side effects of two drugs and patient and physician satissfaction.

Materials and Methods: In this double- blind clinical trial 140 person who were candidate for cystoscopy were randomly divided into two groups The first group received 1mcg/kg alfentanil with 1mg/kg propofol and the second group received 0.5 mg/kg ketamin with 1mg/kg propofol. Sedation score ,pain score, time of cystoscopy and hemodynamic changes determined and data were analyzed by SPSS.

Results: The mean of sedation in alfetanil group was significantly more than ketamin group(p=0.001) . The mean of pain score in alfetanil group was significantly less than ketamin group( p=0.001) .The time of cystoscopy in cystoscopy in alfetanil group was significantly less than ketamin group (p=0.001).

Conclusion: Results showed that alfentanil-propofol compare to ketamin-propofol reduced pain score and increased time of sedation with less side effects during cystoscopy .So this study supports the preference alfentanil compare to ketamin.

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Background:  Schizophrenia is a chronic debilitating psychiatric disorder affecting 1% of the population worldwide. As for key role of free radicals in the development of this disease and that Quince leaf is a natural source of antioxidant substances, this study was aimed to evaluate the protective effects of Quince leaf extract on locomotor activity and anxiety-like behaviors by an intraperitoneal injection of ketamine in male mice in a ketamine model of schizophrenia.

Materials and Methods: In the experimental research, male adult mice were divided into six groups including: control, Sham (received water orally and saline intraperitoneally), psychosis group (received 10 mg/kg/day ketamine i.p. for 10 days) and treated psychosis groups (received 50, 100 and 150 mg/kg/day). Treated groups received hydroalcoholic Quince leaf extract orally for 3 weeks before injection of ketamine. Extract gavages continue for 5 days after the last ketamine injection. Locomotor activity and anxiety-like behavioral changes were measured in the open-field test.

Results: The results showed that chronic administration of ketamine increases horizontal locomotor activity and anxiety like behaviors (p≤0.001) and pretreatment of Quince leaf extract effectively decreases horizontal locomotor activity (p<0.001) and increases duration that spends in middle area of Open field (p<0.01) and vertical ocomotor activity(p<0.001).

Conclusion: The results of this research showed that chronic administration of Quince leaf extract improves locomotor disorder and induced anxiety-like behaviors by having antioxidant properties in a ketamine model of schizophrenia.

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Background: Hysterectomy is one of the most common surgical procedures. Only after cesarian section, hysterectomys considered as second major surgical procedure. Problems such as severe pelvic pain, irregular or heavy bleeding and uterine cancer are cases that hysterectomy is used to care them. Abdominal pain after abdominal hysterectomy is one of the most common complaints of patients undergoing this type of surgery. This study aimed to compare the effects of bupivacaine into the subcutaneous tissue and skin ketamine to control pain after surgery in patients undergoing abdominal hysterectomy under general anesthesia.

Materials and Methods: This study is a randomized, double-blind clinical trial involving 99 women candidating for TAH referred to Taleghani center in Arak who were divided into three groups. The average duration of analgesia and pain and pain score were recorded.

Results: The average duration of analgesia in ketamine group, in the bupivacaine group and in the placebo group was 65.1±8.8, 65.4±8.7, and 57.6±5.5, respectively. According to p≤0.01, there was a significant difference between the three groups. The duration of analgesia in the placebo group was significantly lower than ketamine and bupivacaine groups, while that between ketamine and bupivacaine in terms of the average duration of analgesia, no significant difference was observed.

Conclusion: The results of our study indicate that the use of bupivacaine and cutaneous ketamine is effective in reducing postoperative pain in patients undergoing abdominal hysterectomy and further doses of ketamine and bupivacaine single dose resulted in a significant reduction of postoperative pain in patients compared to the placebo group.