Effect of Low-Dose Intravenous Ketamine on Prevention of Headache After Spinal Anesthesia in Patients Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial Study

Objectives: Controlling the complications of anesthetics (e.g., succinylcholine) seems necessary since they are greater for nulliparous women who undergo elective cesarean section (C-section). The present study aimed to investigate the effects of magnesium sulfate on the complications of succinylcholine administration in nulliparous women undergoing elective C-section. Materials and Methods: This double-blind clinical trial was conducted on 60 nulliparous women during 2012-2013. The women were randomly assigned to A and B groups. Before inducing the rapid anesthesia with succinylcholine, patients in the intervention group received 30 mg/kg of magnesium sulfate within 10 minutes and then the hemodynamic status and the side effects of succinylcholine were recorded in a special form. Statistical tests were performed using repeated-measures ANOVA, chi-square test, and one-way ANOVA tests and the level of significance was determined to be P<0.05. Results: There was no significant difference between the two groups in terms of demographic data (P>0.059). However, the results indicated that there was a significant difference between the 2 groups regarding the myoglobin level (P=0.010). Contrarily, the results showed that most patients in the intervention (n=23) and control (n=15) groups experienced no or mild and severe fasciculation, respectively (P<0.001). Conclusions: In general, magnesium sulfate can greatly control and reduce the complications of succinylcholine administration, including fasciculation.

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Intravenous Ketamine for the Prevention of Post Anesthetic Shivering in Spinal Anesthesia: A Randomized Double-Blind Placebo-Controlled Trial

ACTA MEDICA IRANICA ◽

10.18502/acta.v58i10.4909 ◽

2020 ◽

Author(s):

Farzad Sarshivi ◽

Ebrahim Ghaderi ◽

Arman Sarshivi ◽

Shoaleh Shami ◽

Karim Nasseri

Keyword(s):

Spinal Anesthesia ◽

Low Dose ◽

Controlled Trial ◽

Saline Group ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Elective Cesarean ◽

To Receive ◽

Intravenous Ketamine

Spinal anesthesia (SA) may impair thermoregulatory control, which may result in shivering, which is a potentially harassing complication. The aim of the current study was to evaluate the prophylactic effects of intravenous ketamine on the prevention of shivering in patients who underwent elective cesarean section (CSs) under SA. In this double-blind, randomized placebo controlled trial, a total of 90 parturients under SA using hyperbaric bupivacaine 12.5 mg were allocated in two groups to receive ketamine 0.3 mg/kg or 0.9% saline following delivery. After induction of SA, patients were observed for the incidence and intensity of shivering using a four-point scale. Shivering was observed in 24 patients (53.3%) in the saline group and 15 patients (33.3%) in the ketamine group. Median (quartiles 1 and 3) of the intensity of shivering was 1 (0-2) and 0 (0-2) in saline and ketamine groups, respectively. Time from spinal anesthesia to the beginning of shivering was 33.1±11.7 min in saline versus 41.6±20.7 min in the ketamine group. The incidence of nausea, vomiting, hypotension, and bradycardia was not different between the groups. A significantly higher incidence of nystagmus and sedation was observed in the ketamine group when compared with the saline group administration of low dose i.v. Ketamine (0.3 mg/kg) was effective in lowering shivering intensity during CSS under spinal anesthesia, though side effects such as nystagmus and sedation may restrict its effectiveness.

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