Background: Cesarean section operation with spinal anesthesia is one of the most frequently performed surgical operations worldwide. Perioperative shivering is a problem that often happens during surgery with spinal anesthesia, with an incidence that can be up to 50%. Nevertheless, this shivering condition still receives less attention in the literature and daily clinical practice. Paracetamol lowers hypothalamic temperature set points to reduce postoperative shivering by centrally inhibiting prostaglandins. By lowering thermoregulatory set points and IL-6 levels, paracetamol has also been demonstrated to lessen postoperative stress.
Methods: This study was designed as a double-blind, randomized, controlled trial involving 34 participants randomly distributed between two groups. Group 1 (n=17) will receive paracetamol 15 mg/kg body weight, and group 2 (n=17) will receive 100 mL of 0.9% sodium chloride solution. Shivering is assessed using the Bedside Shivering Assessment Score at 0, 15, 30, 45, 60, and 120 minutes after injecting the drug into the subarachnoid space. Interleukin-6 (IL-6) levels will be taken by taking peripheral blood samples 3 times (1 hour before surgery, 1 hour after surgery, and 6 hours after surgery) and then examined using the Enzyme-Linked Immunosorbent Assay (ELISA) method in pg/dL.
Results: The statistical analysis showed no significant difference (P>0.05) in the IL-6 comparison between the paracetamol and control groups. However, compared with the control group, the paracetamol group's average IL-6 levels were lower. Statistical analysis revealed a significant difference (P = 0.038) in the incidence between those receiving paracetamol and those in control groups. The paracetamol group demonstrated a lower incidence of shivering (35.3%) than the control group (76.5%). Significant variations (P = 0.038) were also observed in the onset of shivering between the paracetamol and the control group. The paracetamol group experienced shivering at a later time (between minutes 45 and 120) than the control group (between minutes 30 and 60).
Conclusion: Administration of 15 mg/kg BW paracetamol significantly reduced shivering incidents, shivering onset, and the need for rescue pethidine compared to the control group that received 100 ml of 0.9% sodium chloride after a cesarean section with spinal anesthesia but did not significantly reduce IL-6 levels.

Background: Transcatheter aortic valve implantation (TAVI) stands for a significant advancement in the treatment of patients suffering from aortic valve stenosis (AS). TAVI offers a significantly less invasive approach for aortic valve replacement compared to traditional thoracic surgery. Nonetheless, the anesthesiology component of TAVI remains underexplored. Consequently, our objective in this paper has been to explore this matter.
Methods: This trial is a unicenter observational study involving 32 patients undergoing TAVI with two methods of anesthesia, including general anesthesia and sedation. The study was conducted at Imam Hossein Hospital. The primary goal was to compare anesthesia methods regarding cardiac arrest and mortality, stroke, and thromboembolic events.
Results: This study included a total of 32 patients. 84.4% of the patients were male, while 15.6% were female. The average age of the patients participating in this study was 80.06±6.0 years. The most common comorbidities included hypertension, ischemic heart disease, diabetes, and hyperlipidemia, with prevalence rates of 62.5%, 56.3%, 46.9%, and 46.9%, respectively. 78.1% of patients underwent TAVI solely due to AS, whereas 21.9% underwent TAVI for AS together with other cardiovascular diseases. Nearly half of the patients, 46.9%, underwent general anesthesia, and 53.1% received sedation. 12.5% of patients experienced side effects following the procedure, which included atrial fibrillation rhythm, left bundle branch block, atheroembolism, and cardiac arrest. The occurrence of cardiac arrest was recorded at 3.1%.
Conclusion: This key report illustrates the safety of TAVI along with various anesthesia techniques, such as general anesthesia and sedation. General anesthesia was associated with more side effects than sedation. Nonetheless, further research is essential to establish the causal relationships between variables, side effects, and mortality.

Background: Bimalleolar fractures, which often necessitate surgery due to instability, are linked to considerable postoperative pain. Selective cyclooxygenase-2 (COX-2) inhibitors, like celecoxib, have demonstrated potential in alleviating pain and decreasing the need for opioids. However, the optimal dosing regimen remains unclear. This study compares the efficacy of two celecoxib regimens in reducing postoperative pain after ankle fracture surgery.
Methods: A double-blind, randomized controlled trial was carried out with 240 patients undergoing bimalleolar fracture surgery under spinal anesthesia. The participants were split into three groups: a placebo group, a group receiving 400 mg of celecoxib (Group 400), and a group receiving 600 mg of celecoxib (Group 600). Pain levels were evaluated using the Visual Analog Scale (VAS) at specific time points (0, 6, 24, and 72 hours after surgery). Additionally, total morphine consumption, the time until first analgesic use, patient satisfaction, and side effects were documented.
Results: Patients in Group 600 experienced significantly lower pain scores and delayed morphine use compared to the placebo group (P < 0.05). Both celecoxib groups consumed less morphine overall, with higher patient satisfaction scores reported in Group 600. Adverse events were minimal and comparable across all groups.
Conclusion: The preemptive use of celecoxib, particularly at a 600 mg dose, significantly reduces postoperative pain and opioid use while enhancing patient satisfaction with minimal side effects. These results suggest that COX-2 inhibitors are a practical alternative to opioids for managing pain after ankle fracture surgery.

Background: Postoperative emergence agitation in children is so common. Isoflurane and propofol are evaluated for agitation, but results were contradictory. This study aimed to compare the effect of isoflurane and propofol for emergence agitation in children under three years old.
Methods: This double-blinded, randomized clinical trial was performed on 104 children under three years’ old who were candidates for nasolacrimal probing. The children were anesthetized by sevoflurane and then were divided into isoflurane and propofol groups. After transfer to the recovery room, at first, 4 and 8 minutes, the degree of agitation of the child was measured according to the Watcha sedation criteria.
Results: The demographic parameters were not different. The mean duration of anesthesia (from LMA insertion to extubation) in isoflurane was significantly shorter than in propofol (p = 0.001). Also, the recovery time in the isoflurane group was significantly shorter than that of the propofol group (P=0.02). The prevalence of agitation was 7.69% in the propofol and 59.61% in the isoflurane, and the difference was significant (P = 0.001). Agitation scores at first, 4 and 8 minutes in the recovery room, showed less agitation in the propofol group (P=0.001).
Conclusion: Our study showed that propofol in children reduces the incidence of emergence agitation compared to isoflurane. But emergence and recovery time in the isoflurane group was less than in the propofol group.

Background: This study was conducted with the aim of comparing the sedation rate of Propofol and Lidocaine -Propofol combination in patients undergoing bronchoscopy.
Methods: In this clinical trial study, 60 patients undergoing bronchoscopy were divided into two groups of 30 people, in the first group 1 mg/kg of Propofol and in the second group 1 mg/kg of Propofol together with 1.5 mg/kg of Lidocaine were injected. And the hemodynamic parameters, depth of sedation, consumption of Propofol and midazolam, and pain intensity after the operation were evaluated and compared between two groups.
Results: Patients in the propofol-Lidocaine group had better hemodynamic stability and the trend of sedation score changes was significantly different between the two groups (P=0.042). In terms of pain intensity during recovery, propofol-Lidocaine recipients had less pain intensity (P<0.001). Patients receiving propofol-Lidocaine received less Propofol (P=0.028) and midazolam (P=0.01).
Conclusion: The results of the present study show that the use of injectable Lidocaine with Propofol is associated with more favorable hemodynamic stability, reduction of Propofol consumption, better sedation, and less postoperative pain, so it seems that the use of Lidocaine with Propofol is beneficial. It is preferable to Propofol alone.

Background: Delivery and assuming the parental role, especially for mothers, are often accompanied by anxiety and stress, conditions that are significantly aggravated by the birth of a premature infant. The aim of our study is to "determine the effect of COVID-19 prevention training on the stress levels of mothers with premature infants admitted to the NICU."
Methods: This is a quasi-experimental study. The sample consisted of 100 mothers (50 in the experimental group and 50 in the control group) of premature infants hospitalized in the Neonatal Intensive Care Unit (NICU). Participants were randomly assigned to the two groups. The experimental group received an educational program on preventing respiratory infection transmission, with a focus on the coronavirus, delivered through individual face-to-face sessions lasting between 45 to 90 minutes over three sessions. Data for both groups were collected in two phases, before and after the intervention, using a standard Parental Stress Scale questionnaire. Data were analysed using descriptive and analytical statistical tests and SPSS software.
Results: According to the findings of our study, the mean age of mothers in the control and intervention groups was 26.88±0.32 and 27.10±0.30 years, respectively (T=-3.482, d=9.98, P=0.527). Also, the mean age of infants in the control group was 34.90±0.30 weeks and in the experimental group was 35.12±0.52 weeks (T=-2.582, d=9.98, P=0.114). The overall stress score in the intervention group after the intervention (93.82±7.15) significantly decreased compared to before the intervention (135.98±0.51) (P<0.001), and this significant decrease was also observed in all stress subscales (P<0.001).
Conclusion: Finally, the findings of our study showed that mothers whose infants are hospitalized in the ICU experience high levels of stress. The COVID-19 prevention training leads to a significant reduction in mothers' stress.

Background: Lumbosacral radiculopathy due to disc herniation is a leading cause of chronic pain and disability worldwide. While fluoroscopic-guided epidural steroid injections (ESIs) are widely used for symptom relief, their efficacy is variable, and the long-term benefits remain controversial. Ozone therapy has emerged as a promising adjunct to steroid injections due to its anti-inflammatory, analgesic, and oxygenating effects. This study aimed to compare the efficacy and safety of fluoroscopic-guided caudal epidural steroid injections with and without ozone therapy in patients with lumbosacral radiculopathy.
Methods: A randomized, single-blind clinical trial was carried out with 40 adults diagnosed with radicular pain from lumbar disc protrusion at L4-L5 or L5-S1. They were randomly placed into two equal-sized groups. The first group (n=20) received a caudal injection containing dexamethasone (8 mg), lidocaine (5 mL, 1%), and saline (3 mL). The second group (n=20) received the same injection along with 5 mL of ozone (10 µg/cc). Fluoroscopy was used to guide all procedures. Pain and physical function were tracked using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), both before treatment and again after one, three, and six months.
Results: Improvements were seen in both groups over time. Still, the ozone group reported stronger pain relief and better functional scores at every follow-up. At one month, VAS and ODI scores were significantly lower in the ozone group (VAS: 1.85 ± 0.75 vs. 2.40 ± 0.90, p = 0.029; ODI: 22.3 ± 4.5 vs. 26.7 ± 5.1, p = 0.025). The difference held steady at three months (VAS: p = 0.022; ODI: p = 0.021) and at six months (VAS: p = 0.017; ODI: p = 0.015). No major side effects occurred, and mild ones cleared up on their own.
Conclusion: The addition of ozone therapy to fluoroscopic-guided caudal epidural steroid injections significantly enhances pain relief and functional recovery in patients with lumbosacral radiculopathy compared to steroid injections alone. This combination therapy represents a safe, minimally invasive, and effective treatment option for individuals with refractory radicular pain. Further large-scale, multicenter trials with long-term follow-up are warranted to validate these findings and optimize treatment protocols.

Background: Patients admitted to the intensive care unit (ICU) are at high risk of gastrointestinal (GI) mucosal injury and stress ulcers, which may lead to gastrointestinal bleeding, due to their critical condition and use of mechanical ventilation. Stress ulcer prophylaxis drug regimens, including proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs), are commonly used to prevent these complications. However, there are concerns about the side effects of these drugs, including an increased risk of ventilator-associated pneumonia (VAP). This study aimed to compare the effects of pantoprazole and famotidine on clinical outcomes and the risk of VAP in patients admitted to the ICU.
Methods: This study was designed as a single-center randomized clinical trial conducted in the Intensive Care Unit (ICU). The study population included 138 patients admitted to the ICU who required mechanical ventilation. The treatment regimens studied included two groups: group 1 received intravenous pantoprazole (40 mg daily), and group 2 received intravenous famotidine (20 mg twice daily). The study's primary outcome measure was the incidence of VAP, which was assessed according to ATS/IDSA and CDC guidelines. Other clinical variables included ICU length of stay, APACHE score, and incidence of adverse events.
Results: The results showed that in the famotidine group, ICU length of stay and APACHE II score were significantly shorter than in the pantoprazole group. However, no statistically significant differences were observed in variables such as age, weight, drug administration duration, and intubation duration. In addition, the frequency of death and pneumonia incidence in the famotidine group was lower than in the pantoprazole group, although this difference was not statistically significant.
Conclusion: This study showed that both famotidine and pantoprazole are effective in the prophylaxis of stress ulcers in critically ill ICU patients, but famotidine may be associated with more favorable clinical outcomes, including reduced length of stay and severity of illness. Also, the use of gastric acid suppressant drugs is associated with an increased risk of VAP, which requires more attention to drug selection and patient management. The findings of this study can help in better decision-making regarding the use of SUP drugs in ICU patients.

Background: Cardiovascular diseases are the leading cause of mortality worldwide. Numerous risk factors contribute to cardiovascular diseases. Identifying individuals at high risk and ensuring they receive appropriate treatment can prevent premature deaths. This study aimed to "determine cardiovascular risk factors and some clinical parameters in patients admitted to the cardiac surgery intensive care unit."
Methods: This study employed a cross-sectional design and was conducted on 109 patients admitted to the cardiac ICU of a central Tehran hospital. Samples were selected using convenience sampling based on inclusion criteria. Data were collected using a researcher-developed questionnaire and analyzed using SPSS version 25 with statistical tests.
Results: The average age of the participants was 61.05±8.5 years. The majority of the sample was male (73.3%). The prevalence of diabetes and hypertension in the patients was 66.1% and 45.9%, respectively. The average BMI of the patients (25.9±3.6) was above the normal range. The mean blood glucose (153.26±36.65), cholesterol (151.7±36.2), triglycerides (135.85±51.9), kidney enzymes, and arterial blood gases were within acceptable ranges.
Conclusion: Risk factors for cardiovascular diseases (particularly high weight and obesity, diabetes, and hypertension) are prevalent in patients undergoing cardiac surgery. Accordingly, planning and education are recommended to control and reduce cardiovascular disease risk factors in these patients.

Background: The optimal dosing regimen of tranexamic acid (TXA) for minimizing blood loss during supratentorial brain tumor resection remains undefined. This study compared two dosing protocols to evaluate efficacy and safety.
Methods: In this double-blind, randomized trial (September 2020–September 2021), 60 patients aged 18–60 years undergoing supratentorial tumor surgery were allocated to receive either TXA1 (20 mg/kg bolus + 1 mg/kg/h infusion) or TXA3 (20 mg/kg bolus + 3 mg/kg/h infusion). Primary outcomes included intraoperative blood loss; secondary outcomes encompassed transfusion needs, surgical duration, hospitalization length, and thromboembolic complications.
Results: The TXA3 group demonstrated an 18% reduction in mean intraoperative blood loss compared to TXA1 (402.93 mL vs. 470.61 mL; mean difference −67.68 mL, 95% CI −139.4 to 3.9; p = 0.053). Transfusion requirements were lower in the TXA3 cohort (0.43 ± 0.9 vs. 0.64 ± 1.2 units; p = 0.34), though not statistically significant. Surgical duration was prolonged in the TXA3 group (p = 0.047), but hospitalization was shorter (p = 0.049). Thromboembolic event rates were comparable between groups (p > 0.05).
Conclusion: Higher intraoperative TXA infusion rates were associated with reduced blood loss and shorter hospital stays without elevating thromboembolic risk. These findings support TXA’s utility in improving perioperative outcomes and resource efficiency for supratentorial tumor resection.

Background: Chronic spinal pain can be managed through various approaches, including surgical options and interventional techniques like epidural injections and trigger point injections. However, there is a notable lack of comparative research addressing the effectiveness of these two specific methods in alleviating chronic low back pain. This study aimed to evaluate and compare the pain relief outcomes associated with caudal epidural steroid injections and trigger point steroid injections in patients suffering from chronic low back pain.
Methods: Sixty patients aged between 20 and 75 years, who had been dealing with chronic low back pain for more than 12 weeks and had a Visual Analog Scale (VAS) score exceeding three, were randomly assigned into two groups of thirty. One group received caudal epidural injections, while the other group was treated with trigger point injections. In the caudal epidural group, a mixture of corticosteroid and 2 mg of ropivacaine was administered under ultrasound guidance at the caudal epidural site. Similarly, the trigger point injection group received the same dosage of corticosteroid and local anesthetic, injected into the identified trigger points under ultrasound guidance. Participants were monitored for six weeks after the injections, with pain levels evaluated at weeks 2, 4, and 6 using the VAS. A two-way ANOVA analysis was conducted to identify differences in pain relief between the two groups.
Results: The findings showed significant differences in pain levels between the two groups. Patients who received caudal epidural injections reported a more substantial reduction in pain compared to those who received trigger point injections. Additionally, the caudal epidural group exhibited a continuous decrease in pain levels at the follow-up assessments from weeks 2 to 6.
Conclusion: This study indicates that caudal epidural steroid injections are a safe and effective method for managing and reducing chronic low back pain. Given these results, caudal epidural injections should be considered a viable treatment option for patients experiencing chronic low back pain.

Background: Etomidate is an anesthetic induction medicine that is the first choice, particularly in elderly and cardiovascular patients, due to its favorable hemodynamic stability. There are some complications with etomidate administration nevertheless. Created pain during the injection, for instance, may be bothering.
Methods: 60 patients who were candidates for general anesthesia with Etomidate were divided into 3 groups randomly. After infusing 300 ml of normal saline for each patient, 2 minutes before induction, Ondansetron 8mg, Ondansetron 4mg, and normal saline were administered to groups first, second, and third, respectively. Then Etomidate was given to all patients in the form of 10 ml ampoules containing 20 mg of Etomidate equally. The pain score was rated using the FPRS criterion, which is from 0 to 10. Collected data were analyzed and interpreted.
Results: The factor of sex wasn’t an effective element in the level of pain, but height (p = 0.034) and age affected this level; patients who were in their seventh decade of life had no complaints (59.4%). There was no significant difference in the mean arterial blood pressure, the mean heart rate, and the mean arterial oxygen saturation between the three groups. The level of pain was considerably different in the study groups (p = 0.000), and the 8 mg ondansetron group had the lowest pain.
Conclusion: Ondansetron can reduce the injection pain of Etomidate, and the greatest effect is related to the 8 mg dose of Ondansetron.

Background: The procedure of endoscopic retrograde cholangiopancreatography (ERCP) requires deep sedation for procedural success and patient safety. Propofol is commonly used due to its rapid onset and recovery, but its administration method significantly impacts its effectiveness and safety. This study compares Target Controlled Infusion (TCI) and Manual Controlled Infusion (MCI) of propofol in ERCP patients.
Methods: A single-blind randomized controlled trial was conducted with 22 ERCP patients, who were randomly assigned to either the TCI group (n=11) or the MCI group (n=11). In the TCI group, propofol was administered using the Schnider pharmacokinetic model, targeting effect sites, with an initial effect-site concentration set at 2.5 mcg.kg^-1. In contrast, the MCI group received an initial propofol bolus of 2 mg.kg^-1, followed by 20 mg increments every 10 seconds. The study analyzed propofol induction time, hemodynamic stability, and total propofol consumption, with hemodynamic parameters recorded every five minutes.
Results: The TCI group had a significantly longer induction time (10.00 ± 2.05 min vs. 3.45 ± 1.21 min; p < 0.001) but required a lower total dose of propofol (2.30 ± 0.43 mg.kg^-1.h^-1 vs. 3.69 ± 0.69 mg.kg^-1.h^-1; p < 0.001). Hemodynamic stability was comparable between both groups.
Conclusion: TCI provides similar hemodynamic stability to MCI while reducing total propofol consumption. Despite a longer induction time, TCI may be a more cost-effective and controlled method for propofol administration in ERCP.

Background: Non-cardiac surgery in patients with cardiovascular risk can lead to postoperative complications. Troponin T, a cardiac biomarker, is proposed as an indicator of cardiac risk in these patients. This study evaluates troponin T levels before and after non-cardiac surgery and their association with postoperative complications.
Methods: This prospective cohort study included 46 patients selected through consecutive sampling. Demographic data and troponin T levels were recorded before and 24 hours after surgery.
Results: Postoperative complications included cardiac events (15.21%), such as myocardial infarction (4.34%), heart failure (4.34%), and arrhythmia (6.52%), and non-cardiac events (17.39%), such as sepsis (4.34%), bleeding (4.34%), surgical site infection (6.52%), and respiratory insufficiency (2.17%). The average patient age was 50.15 ± 8.81 years, with 60.9% being male. There was a significant relationship between troponin T levels and the incidence of cardiac complications after surgery.
Conclusion: Elevated postoperative troponin T levels may serve as a prognostic indicator for cardiac complications in non-cardiac surgery patients. Routine monitoring could aid in early detection and improved postoperative management.

Background: Supportive and palliative care is recognized as an important and vital component of cancer patient care. Utilizing an appropriate instrument can identify these needs. This study aimed to "design and psychometrically evaluate an instrument for assessing the supportive and palliative care needs of cancer patients."
Methods: This study is a methodological research with both qualitative and quantitative components. Participants included 210 cancer patients. Questionnaire items were extracted through qualitative study methods and literature review, and subsequently, an initial questionnaire was designed. The validity of this questionnaire was evaluated through content, construct, and face validity assessments. Internal consistency and stability of the questionnaire were also examined to determine its reliability.
Results: 59 items were extracted from the qualitative section and literature review. Subsequently, the Item Impact Score (values above 1.5) was calculated. The CVI (above 0.79) and CVR (above 0.56) were assessed, resulting in the selection of 35 items. Exploratory factor analysis yielded four factors: symptom and pain control (6 items), psychological and social needs (17 items), spiritual needs (4 items), and education and awareness (8 items). Finally, a 35-item questionnaire was designed, demonstrating acceptable reliability (α=0.90).
Conclusion: The questionnaire designed in this study has acceptable and confirmed psychometric properties (validity and reliability). Therefore, the use of this instrument is recommended for Iranian patients with cancer.

Background: This study aimed to evaluate the effectiveness of machine learning (ML) models in predicting difficult intubation among maxillofacial surgery patients by using clinical data from a previous study involving 132 patients. The study sought to enhance anesthesiologists' ability to identify patients at risk of difficult intubation, a critical concern in surgical settings.
Methods: The research applied various ML algorithms, including decision trees (DT), random forests (RF), Naive Bayes (NB), neural networks (NN), support vector machines (SVM), K-nearest neighbors (KNN), and ensemble voting methods, to the existing clinical dataset. This dataset contained a range of factors potentially associated with DI, such as the Mallampati score, Upper Lip Bite Test (ULBT) results, facial angle, and other relevant variables. A comprehensive approach was taken to explore the impact of different data preprocessing techniques, with a particular focus on feature selection and normalization methods.
Results: The study found that the combination of mutual information-based feature selection and robust scaler normalization consistently yielded high predictive accuracy. Notably, the decision tree algorithm achieved an accuracy of 0.84 and precision, sensitivity, and specificity scores of 0.95. The analysis also highlighted the strength of ensemble learning, which, by combining multiple classifiers, achieved an accuracy of 0.82. The results suggest that ML models, especially random forests and ensemble voting methods, can be highly accurate in predicting difficult intubation when trained on existing clinical data.
Conclusion: The research underscores the importance of data preprocessing in enhancing algorithmic performance, particularly the effectiveness of mutual information-based feature selection combined with robust scaler normalization. However, the study also indicates the need for further research to refine these models, ensuring their applicability and reliability in real-world clinical settings.

Background: Levobupivacaine’s superior clinical profile and shorter block duration make it an intriguing substitute for other local anesthetics. In order to intensify block and offer postoperative analgesia, intrathecal opioids have been employed as additives. This study compares the effectiveness of levobupivacaine alone and in combination with fentanyl. The effect on hemodynamics, duration of postoperative analgesia, and complications were also compared.
Methods: Fifty patients in the age group of 18-65 years with ASA grade I or II posted for elective surgery under subarachnoid block were enrolled in this prospective double-blind study and randomly allocated into two groups. Group 1 (n=25) patients received 3.0 ml (15 mg) of 0.5% levobupivacaine plus 0.5 ml of normal saline, and Group 2 (n=25) patients received 3.0 ml (15 mg) of 0.5% levobupivacaine plus 0.5 ml (25 mcg) of fentanyl intrathecally. Hemodynamics, features of sensory and motor block, postoperative need for rescue analgesia within 24 hours, and adverse events were documented.
Results: Sensory block onset was earlier in group 2 (4.31±0.58) minutes than in group 1 (6.51±0.62). Likewise, group 2 experienced the onset of motor block earlier (2.91±0.39) than group 1 (5.62±0.50), and group 2 saw a faster regression of the motor block (153.00±13.23) than group 1 (186.00±20.82). Hemodynamic and side effects were comparable in both groups. Group 2 required considerably fewer postoperative rescue analgesics in the first 24 hours (p < 0.05).
Conclusion: Fentanyl added to levobupivacaine provides a relatively faster initiation of block and earlier recovery of motor power, improving the chances of early patient mobilization.

Background: The COVID-19 pandemic has been associated with a significant prevalence of thromboembolism. This study aimed to identify the predictive effect of D-dimer and ferritin on thromboembolism occurrences in hospitalized COVID-19 patients.
Methods: This retrospective study examined 304 patients with COVID-19, with a mean age of 62.33 ± 17 years, hospitalized at Modares Hospital from March 2020 to March 2021. The case group (PTE) comprised patients who experienced thrombosis complications during hospitalization (152 patients), while the control group (Non-PTE) consisted of patients who did not encounter thrombosis complications during their hospital stay (152 patients). Demographic data, clinical information, and laboratory findings were gathered and documented from patient records. The study examined the impact of D-dimer and ferritin as predictors of thromboembolism in patients.
Results: In this study, 100 patients died, with 75 (75%) of these fatalities occurring in the PTE group. The results indicated that PTE patients exhibited higher BMI (28.36 ± 1.87 vs. 27.76 ± 1.31 kg/cm², P<0.001), longer hospital stays (11.2 vs. 8.5 days, P=0.0009), increased ICU admissions (61.8 vs. 26.3%, P<0.001), higher smoking rates (21.9 vs. 4.8%, P<0.001), and greater prevalence of chronic lung disease (13.2 vs. 2.6%, P=0.001) compared to non-PTE patients. Analysis of the laboratory findings indicated a significant increase in lymphocyte count (P=0.034) and C-reactive protein (CRP) 3+ levels (P=0.04) in the PTE group compared to the non-PTE group. The D-dimer concentration in the PTE group was 4178.80 ± 1148.78 ng/ml, while in the non-PTE group it was 606.04 ± 656.86 ng/ml (1.03 OR, 95% CI=1.04-1.02, P<0.001). The ferritin level in the PTE group was recorded at 1639.33 ± 514.38, while in the Non-PTE group, a measurement of 420.48 ± 322.65 ng/ml was recorded (OR: 1.06, CI95%=1.07-1.04, P<0.001).
Conclusion: Elevated serum levels of ferritin and D-dimer in COVID-19 patients correlate with an increased risk of thromboembolism. Consequently, elevated concentrations of these parameters in hospitalized patients should serve as a warning to clinicians, necessitating careful attention and prompt treatment interventions.

Background: In the transitional cycle from intrauterine to extrauterine life, with aeration of the lungs, gas exchange shifts from the placenta to the lungs. This is the most fundamental process that the vast majority of term and near-term infants undergo to adapt to extrauterine life (approximately 85%), leaving the rest of the infants unable to perform it without PPV, making birth the most challenging phase of their existence. For neonates depressed by any cause who are unable to establish functional residual capacity (FRC) by replacing the liquid in the alveoli with atmospheric gas through spontaneous breathing and forming a tidal volume (TV) at birth, healthcare providers must intervene with manual ventilation and alveolar ventilation to replace alveolar fluid with atmospheric gas and establish functional residual capacity (FRC). Given that currently self-inflating bags (SIBs) are a central component in any setup related to the neonatal resuscitation program (NRP) and the recent availability of the upright-bag design of SIB, this study investigates the number of ventilations of neonates requiring positive pressure ventilation (PPV) after birth using two approaches: the upright bag and the classic design of SIB, known as the standard bag.
Methods: This is a randomized clinical study. Neonates with a gestational age of 35+0/7 to 36+6/7 weeks who required PPV due to a heart rate of less than 100 bpm after the initial steps of newborn care after birth were divided into two groups, each including 30 neonates (60 in total). Both groups received PPV using SIB, with one group experiencing ventilation using standard bags and the other receiving ventilation using upright bags. Shahid Beheshti Hospital in Isfahan conducted this study from September 2020 to February 2024.
Results: The study showed that the average number of ventilations needed to achieve a heart rate of 100 bpm or higher was significantly lower (P value = 0.029) using the upright bag. The average gas leakage around the mask during ventilation was significantly less (P value = 0.018) using the upright bag. The need for oral and nasal suction with an open mouth was significantly lower (P-value = 0.020) with the upright bag. The requirement for intubation during ventilation was significantly lower (P value = 0.010) using the upright bag. Pneumothorax was also significantly less common (P value = 0.030) in neonates ventilated using the upright bag.
Conclusion: This study suggests that, considering the two available designs of self-inflating resuscitation bags, upright resuscitation bags are more effective in rapidly increasing an infant’s heart rate compared to standard resuscitation bags, offering a superior alternative for neonatal resuscitation.

Background: Nowadays, Artificial Intelligence (AI), as one of the advanced and rapidly growing technologies, has had widespread effects on various aspects of human life. In the healthcare sector, the adoption of AI methodologies has gained significant momentum, particularly in enhancing patient care, with anesthesiology emerging as a field keenly embracing these technological advancements. The use of AI in anesthesia is accompanied by specific ethical and social issues that require careful examination and deep understanding. The objective of this scoping review was to compile existing literature about the ethical considerations surrounding the utilization of artificial intelligence (AI) in anesthesiology.
Methods: This scoping review was conducted within the first three months of 2024. The research question was, "What are the ethical issues in the application of AI in anesthesia?" Based on the research question, researchers initially extracted relevant keywords using Medical Subject Headings (MeSH) and independently conducted preliminary searches in databases including Scopus, Web of Science, PubMed, Cochrane, and Google Scholar. The study selection process was guided by predetermined inclusion and exclusion criteria. The inclusion criteria were studies relevant to the research question. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was utilized to report the research procedure.
Results: The search strategy yielded a total of 327 articles. Consequently, the full text of 4 studies was examined. Of these, two studies were not considered to be included in the research due to their lack of connection with the primary research question. In total, 2 studies (both in English) were included in this review. Both of these studies were cross-sectional studies that examined the opinions of anesthesiologists regarding the ethical implications of using artificial intelligence in anesthesia.
Conclusion: The ethical integration of AI into anesthesia holds promise for improving patient care outcomes while upholding principles of safety, fairness, and accountability. Additional training programs and updated protocols are necessary for ensuring data security, collection, and processing. Additionally, Appropriate legal regulations concerning data processing should be developed.

Background: Disorders of consciousness (DoC), encompassing coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS), result from severe brain injuries that disrupt neural networks responsible for arousal and awareness. Non-invasive brain stimulation (NIBS) techniques, including transcranial direct current stimulation (tDCS) and its variants, such as high-definition tDCS (HD-tDCS) and transcranial alternating current stimulation (tACS), offer promising therapeutic strategies. This review synthesizes evidence on the efficacy of NIBS, focusing on its impact on brain hemodynamics, neurophysiology, and clinical outcomes.
Methods: To this end, we searched the international databases (Web of Science, PubMed, Scopus) and extracted studies using the appropriate keywords. The Newcastle-Ottawa Scale (NOS) was used to assess the methodology and quality of the studies.
Results: Research demonstrates that tDCS and its advanced forms improve EEG patterns, including alpha and theta band power, reduce P300 latency, and enhance cortical-cortical and thalamocortical connectivity, correlating with better behavioral outcomes, as measured by the Coma Recovery Scale-Revised (CRS-R). Moreover, personalized protocols based on MRI simulations and multimodal therapies, such as combining NIBS with music stimulation or robotic rehabilitation, further optimize outcomes by targeting specific brain areas and enhancing network reconfiguration. The dual application of HD-tDCS with transcutaneous auricular vagus nerve stimulation (taVNS) has also shown synergistic effects on EEG microstate dynamics and CRS-R scores in MCS patients.
Conclusion: Overall, NIBS presents a promising approach for enhancing consciousness recovery, though challenges in protocol optimization and understanding the mechanisms of action remain. Future research should continue to explore these techniques' full potential, particularly through personalized, multi-target stimulation strategies.

Background: In cardiopulmonary bypass (CPB), there is a need to better maintain appropriate anesthesia due to the physiological and hemodynamic alterations induced by CPB. This review aimed to explore the effects of sevoflurane versus propofol in the management of patients undergoing cardiac surgeries with CPB.
Methods: The literature search was conducted in the international databases, including Cochrane, Science-Direct, Scopus, PubMed, and Google Scholar, from January 2012 to July 2024.
Results: According to the studies, sevoflurane was associated with a significantly shorter time to extubation, eye-opening, and command compliance with better intraoperative hemodynamic stability. It was superior in reducing oxygen demand and may be associated with less hypoxia in the aortic cross-clamp phase. In addition, sevoflurane produces more prominent myocardial protection, attenuates inflammatory response, and has a lower impact on cognitive function. On the other hand, propofol decreased the incidence and intensity of acute kidney injury and may be preferred over sevoflurane in patients at risk of postoperative nausea.
Conclusion: It seems in adults undergoing cardiac surgery with CPB, the class of sevoflurane is superior to propofol with regard to many perioperative and postoperative outcomes. However, more studies with larger sample sizes are needed to clarify this issue.

Anesthesia in patient care, both in the perioperative period and in the pain clinic, is a challenging field to engage with - this is secondary to the fact that patients are individuals who are influenced by numerous factors, including the bacterial makeup of their microbiome and its parts. With the focus on personalized medicine as the next frontier, this narrative literature review looks at the current trend in individualized medicine, specifically regarding the use of the microbiome and artificial intelligence in the choice of different drugs for the induction and continuation of surgery as well as the management of pain syndromes in patients. This review also includes a summary of the different research directions that can take place based on the most recent data, including microbiome composition testing, therapeutic alterations, and the use of artificial intelligence to select the best drugs for treating the patient.

Gossypiboma is a rare mass caused by surgical instruments left in the body after surgery. A 21-year-old woman with a history of two cesarean sections presented with abdominal pain; initially, she suspected appendicitis. Unexpectedly an ultrasound showed bleeding ovarian cysts and a radiopaque line that looked like surgical sponge that had been left behind. This discovery led to immediate hospitalization and subsequent laparotomy. During surgical intervention, the medical team encountered a hemorrhagic ovarian cyst with a significant mass of tissue with a diameter of 8 cm. Despite carefully exploring the surgical site, the team did not immediately find the suspected surgical sponge. Further investigation revealed nothing, but a detailed dissection of the mass-like tissue ultimately uncovered the sponge inside.

The patient was an 11-year-old girl, weighing 25 kg and measuring 125 cm in height, with a history of congenital cleft palate and previous surgeries (including cleft palate repair and cardiac procedures). She was referred for maxillary alveolar closure surgery. She experienced difficulty swallowing and dyspnea when consuming solids and liquids. During the preoperative evaluation, no significant comorbidities were identified, but anatomical changes in the nasopharynx suggested a defect in the previous repair. To ensure safe airway management and avoid nasopharyngeal injury during surgery, a modified intubation technique was employed. We used a flexible armored endotracheal tube that had been autoclaved at 45°C for 2 min. Anesthesia induction included propofol, fentanyl, and cis-atracurium. Intubation was successfully performed without complications. Postoperatively, the patient recovered well, showing no signs of trauma or airway distress. She was discharged on the first postoperative day with appropriate care recommendations.

A 68-year-old female patient referred for mandibular reconstruction surgery. He was treated for cancer in the mandible last month. Due to the extent of the mass in the lower jaw area, this patient underwent Mandibulectomy 9 months ago. The patient was admitted to Ba'ath Hospital in Hamadan, his vital signs were stable. Before the surgery, according to his underlying diseases, a cardiovascular consultation was done and no complications affecting anesthesia were reported. The challenge of the anesthesia team in this patient was to establish a safe airway for him. According to the physical condition of the patient's neck and mandible, the patient was intubated using a Fireoptic bronchoscope. The patient's surgery lasted 2 hours and 45 minutes. During the entire period of anesthesia, the patient was under strict respiratory monitoring. After the end of the surgery, the patient was transferred to the recovery room without removing the endotracheal tube, and after ensuring that the patient's condition was stable, he was transferred to the intensive care unit.

Intraoperative Neurophysiological Monitoring (IONM) refers to the use of various electrophysiological methods to monitor the function of the brain, spinal cord, and related nerves during surgical procedures. IONM involves the use of neurophysiological recordings to detect changes in nervous system function during surgery, allowing doctors to identify potential nerve damage before it occurs. Reported is a 65-year-old male patient with a diagnosis of unruptured aneurysm of the Posterior Communicating Artery (PcomA) and left ophthalmic segment of C5 whose aneurysm was planned to be clipped. The patient was planned to have the aneurysm clipped under general anesthesia. The challenge in the anesthesia process for aneurysm cases is maintaining the pressure in the aneurysm and cerebral perfusion pressure (CPP), protecting the brain during periods of ischemia, and providing as wide an operating field as possible. Post-operatively, the patient showed stable neurological function with no new deficits, highlighting the importance of intraoperative neurophysiological monitoring in achieving a favorable outcome.

Baclofen functions as a GABA-B receptor agonist and is utilized as a muscle relaxant. Acute baclofen poisoning can lead to significant central nervous system depression, which may occasionally be challenging to distinguish from brain death. Because of the complexities associated with the diagnosis and treatment of baclofen poisoning, we decided to document this case.
We present the case of an 18-year-old female who experienced acute poisoning due to an intentional overdose of baclofen. He was intubated and in a deep coma with no brainstem reflexes. Initial evaluations indicated brain death due to the lack of neurological responses. The patient received intensive supportive care and continuous monitoring. Over the following days, she showed gradual neurological improvement, eventually regaining consciousness and autonomic stability. After an extended hospital stay and a careful reduction of ventilation support, she achieved a full neurological recovery.
Baclofen toxicity may show severe symptoms of brain death, but with the support of the intensive care unit, the symptom may be completely reversible.