Investigating the effect of opioid free anesthesia on the condition of patients undergoing thoracoscopic surgery

Investigating the effect of anesthesia without drugs on the condition of patients undergoing thoracoscopic chest surgery

In this study, which will be conducted in phase 3 of the clinical trial, a number of 60 patients, according to the entry and non-entry criteria and after obtaining the consent certificate for participation in the study, were randomly (using permuted blocks) and one-sidedly blinded to Two intervention groups (number = 30) and control (number = 30) will be divided. Patients of both groups will be operated by the same surgical and anesthesia team.

This study will be conducted in phase 3 of the clinical trial randomly (using permuted blocks) and one-sidedly blinded on patients who are candidates for thoracostomy surgery referring to Masih Daneshvari Hospital.

Entry requirements Candidate for thoracoscopic surgery - 18 < age < 70 years Non-entry conditions: Sensitivity to ketamine, sensitivity to dexmedetomidine, symptoms of increased ICP or history of cardiovascular diseases, active gastric ulcer, active GIB bleeding, liver and kidney failure, history of drug and alcohol addiction, corticosteroid use in the two weeks leading to surgery

In the control group: induction of anesthesia with the continue method (prescribing fentanyl and midazolam, atracurium and propofol to induce anesthesia and to maintain isoflurane gas) will be used. In the intervention group: induction of anesthesia using midazolam, atracurium, propofol and ketamine and maintenance using isoflurane gas and dexmedetomidine will be done.

Type of medicine used during surgery; Type of medicine used after surgery; duration of surgery; Duration of anesthesia; Recovery time; Duration of hospitalization in ICU; Complications after surgery

The randomization method is Random Permuted Blocks. For this purpose, two treatment groups A and B are defined as groups AB and BA. Then random table numbers are defined in the range of 0 to 9. Therefore, we consider the numbers 0 to 4 for the AB block and the numbers 5 to 9 for the BA group. Then random numbers are selected from the table. The number 0 is related to block AB, and therefore two people enter this block. So that the first person receives treatment A and the second person receives treatment B. In the same way, treatment groups are determined for other people. Although in this method, the number of observations of both groups will be the same, but due to the small size of the blocks, the possibility of predicting the treatment group by the person performing it is high. To solve this problem: the randomization list is done before the start of the study by a blinded person who is outside the treatment team. We will also increase the size of the blocks.

Patients will be blinded to the type of procedure performed.