Archives of Anesthesiology and Critical Care

Relationship between Depth of Anesthesia and Interleukin-6 with the Incidence of Postoperative Delirium (POD) in Geriatric Patients Undergoing General Anesthesia

Natalina Manalu — 2025-12-02

Background: The incidence of postoperative delirium (POD) in geriatric patients is aged 3-61%. The combined effects of inflammatory factors and depth of anesthesia can affect neurotransmitters and receptors in the central nervous system that affect POD. To analyze the relationship between depth of anesthesia and IL-6 with the incidence of POD in geriatric patients undergoing general anesthesia.
Methods: A prospective cohort study was conducted in geriatric patients undergoing general anesthesia. Patients were divided into two groups based on the bispectral index (BIS): BIS 40-45 and BIS 51-60. POD was measured using the Confusion Assessment Method (CAM) and Mini-Mental State Exam (MMSE) 24 hours postoperatively. Serum IL-6 measurements were also performed before and 24 hours postoperatively.
Results: A total of 22 patients were collected with the results that the MMSE score decreased insignificantly at 24 hours postoperatively, and there was no difference in MMSE scores based on BIS (p > 0.05). The depth of anesthesia was significantly associated with CAM (p < 0.05). Delirium incidence was more frequent in BIS 40-45. IL-6 levels increased significantly at 24 hours postoperatively (p < 0.05). IL-6 levels were not significantly associated with MMSE and CAM scores (p > 0.05).
Conclusion: BIS 40-45 has the potential to be a predictor of POD in geriatric patients with general anesthesia.

The Effect of Using Virtual Reality on Pain and Comfort in Breast Cancer Patients Undergoing Chemotherapy

Hanie Dahmardeh — 2025-11-15

Background: Breast cancer can lead to pain and reduced comfort in individuals and affect their lives. Therefore, planning to maintain or improve the level of comfort and pain management in these patients with training focused on virtual reality seems necessary. Therefore, the present study aimed to investigate the effect of using virtual reality on pain and comfort in breast cancer patients undergoing chemotherapy in Zahedan.
Methods: This randomized clinical trial was conducted on 90 patients undergoing chemotherapy at Khatam Al-Anbiya Hospital in Zahedan. Participants were randomly assigned to two intervention groups (n=45) and control groups (n=45). The intervention group used Samsung Gear VR in the first 15 minutes of chemotherapy, while the control group did not receive any intervention. Data collection included the McGill Pain Questionnaire (MPQ) and the Hospital Comfort Questionnaire (HCQ), which were administered before and after chemotherapy. Data were analyzed using SPSS 21 software with paired and independent t-tests.
Results: The mean pain score in the intervention group decreased significantly after using VR (pre: 42.00 ± 12.99, post: 30.77 ± 11.6, p=0.0001), while no significant change was observed in the control group (p>0.05). Similarly, the comfort level in the VR group improved significantly compared to the control group (p<0.05).
Conclusion: The use of virtual reality significantly reduced pain and increased comfort in chemotherapy patients. Implementing VR as a non-pharmacological method in pain management protocols can improve the quality of life and treatment experience of cancer patients.

The Impact of Insulin Glargine on Blood Glucose Control during On-Pump Beating Coronary Artery Bypass Surgery in Diabetic Patients: A Single-Blind Randomized Controlled Trial

Raheleh Ganjali — 2025-12-02

Background: Diabetes mellitus in subjects of coronary artery bypass grafting (CABG) surgery is associated with increased morbidity and mortality. Therefore, in recent years, glycemic monitoring and control have been the focus of clinical research. This study aimed to determine the impact of insulin glargine on the management of blood glucose during the perioperative period of on-pump coronary artery bypass graft in diabetic patients.
Methods: In a randomized clinical trial, 80 patients with type 2 diabetes, candidates for elective CABG with a cardiopulmonary pump, were randomly separated into two groups. The intervention group received 0.2 units/kg of insulin glargine 2 hours before induction of anesthesia plus usual care. The control group received usual care. Usual care included injection of regular insulin before, during, and after surgery in accordance with a changed Van den Berghe code. Blood glucose (BG) level, ICU and hospital length of stay (LOS), creatinine, white blood cell count (WBC), and postoperative complications, including infection and dehiscence, were evaluated between two groups.
Results: The BG of patients upon entrance (p=0.04), 16 (p=0.01), 20 (p=0.01), and 24 (p=0.01) hours after admission to the ICU was significantly lower in the intervention than in the control group. There was a significant difference in the average BG levels at different times (p<0.001), so the highest and lowest BG levels were observed 4 and 20 hours after ICU administration in the intervention group and 4 hours and immediately after ICU admission in the control group. Average creatinine (p=0.01), regular insulin used until the end of the first day after surgery (p=0.01), ICU length of stay (LOS) (p=0.009), and hospital LOS (p=0.001) were significantly lower in the intervention group than the controls.
Conclusion: Insulin glargine plus regular insulin is able to maintain BG at a controlled level up to 24 hours after surgery. It also showed significant control over postoperative complications. This study revealed the therapeutic effectiveness of both insulin glargine and regular insulin in achieving adequate BG control for type 2 diabetes patients during the critical postoperative period of on-pump CABG.

Comparison of Pulmonary Compliance Measured by Multiple Linear Regression Versus Traditional Methods in Mechanically Ventilated Patients

Mohammad Reza Habibzadeh — 2025-11-18

Background: Pulmonary compliance measurement is a critical component of monitoring mechanically ventilated patients with respiratory failure. The traditional method calculates compliance by dividing delivered tidal volume by the resultant airway pressure (plateau pressure minus positive end-expiratory pressure [PEEP]). However, this approach requires intermittent ventilator disconnection, limiting its frequency. A novel method using multiple linear regression (MLR) analysis of continuous pressure and flow waveforms enables breath-to-breath compliance measurement without disrupting ventilation. This study compares pulmonary compliance values obtained by MLR and traditional methods.
Methods: In this clinical study, pulmonary compliance was measured and compared in consecutive mechanically ventilated patients using both traditional and MLR methods. MLR-derived compliance was obtained using the ventilator’s integrated monitoring function, while traditional compliance was calculated as tidal volume divided by (plateau pressure – PEEP).
Results: Among 200 enrolled patients, the two methods showed strong correlation (*r* = 0.9, *p* < 0.01). However, MLR-derived compliance values were consistently lower than those from the traditional method (44.74 ± 21.78 mL/cmH₂O vs. 57.95 ± 26.64 mL/cmH₂O, *p* < 0.01).
Conclusion: MLR is a reliable alternative for continuous pulmonary compliance monitoring, though its systematically lower values—likely reflecting dynamic rather than static compliance—may necessitate a correction factor. The method’s ability to provide breath-to-breath measurements offers significant clinical advantages over traditional intermittent assessments.

Hepatic Safety of 1200 Milligrams of Rifampicin in Combination With Colistin for Multidrug-Resistant Acinetobacter Baumannii in Critically Ill Patients: A Retrospective Cross-Sectional Study

Hossein Karballaei Mirzahosseini — 2025-11-18

Background: Infection with multidrug-resistant Acinetobacter baumannii has a high mortality rate. Some studies support the use of combination therapy with rifampin and colistin in the treatment of resistant Acinetobacter baumannii, but there is concern about the liver toxicity of high doses of rifampin in critically ill patients. Critically ill patients are more susceptible to liver side effects of drugs. The present cross-sectional study seeks to investigate the hepatic safety of rifampicin at a 1200 mg daily dose in combination with colistin.
Methods: Following the acquisition of approval from the hospital's ethics committee, a cross-sectional study was conducted to assess the prevalence of hepatotoxicity associated with a daily dosage of 1200 mg of rifampicin. Patients who were treated with a rifampicin-colistin regimen and were admitted to the ICUs of Sina Hospital between April 2017 and February 2021 were identified for this study. Patients were screened for drug-related liver complications using the updated Roussel Uclaf Causality Assessment Method (RUCAM). Then the data was assessed using the SPSS software.
Results: 60 patients were included in this study with an average age of 51.76 years. 40 patients (66.66%) were male and 20 (33.33%) were female. The studied patients had a mean weight of 72.56 kg, and their average rifampicin dose (based on their body weight) was 17.03 mg/kg. Results of ANOVA and Chi-square tests indicated that the values of main hepatic parameters like baseline aspartate aminotransferase (AST) (with a mean and standard deviation (SD) of 84.27±68.30), baseline Alanine transaminase (ALT) (with a mean and SD of 86.27±75.25), and baseline total Bilirubin (TBIL) (with a mean and SD of 1.16±0.788) were significantly related to the occurrence of drug-induced hepatotoxicity (P≤0.001).
Conclusion: Critically ill patients take many drugs, some of which are categorized as hepatotoxic drugs and increase the risk of hepatic complications depending on the patient's underlying diseases. Results indicated that patients with elevated baselines of AST, ALT, and TBIL were more likely to suffer from drug-induced liver injury (DILI). It seems that a 1200 mg daily dose of rifampicin has a safe hepatic profile until meeting normal hepatic baseline requirements.

A Comparative Study on Three Different Doses of Intrathecal Hyperbaric Prilocaine with Fentanyl in Elderly Patients Undergoing Day Case Lower Abdominal and Urologic Surgeries: A Randomized Clinical Trial

Hagar Hassanein Refaee — 2025-12-15

Background: The objective of this work had been to identify the minimum effective and safest dosage of intrathecal hyperbaric prilocaine 2% in combination with 25 µg of fentanyl necessary for day-case lower abdominal and urologic procedures.
Methods: This randomized, parallel-group, double-blind clinical study included 45 individuals, aged 65 to 80 years, of both sex, planned for elective day-case lower abdomen or urologic surgeries. Patients were randomly placed in three groups. All groups were administered 25 µg of fentanyl (0.5 mL) with intrathecal prilocaine 2%, with dosages of 30 mg (1.5 mL) for group P1, 40 mg (2 mL) for group P2, and 50 mg (2.5 mL) for group P3.
Results: The time length of motor blockage and complete regression of sensory block were considerably prolonged in group P3 contrasted to groups P1 and P2. Intraoperative SBP and MAP were substantially elevated at 15, 30, 45, and 60 minutes in group P1 contrasted to group P3. The length of stay in the post-anaesthesia care unit (PACU) was markedly reduced in groups P1 and P2 compared to P3. Hypotension and bradycardia exhibited no significant differences across all groups
Conclusion: In elderly individuals having lower abdominal and urologic surgery, a low dose of prilocaine combined with fentanyl yields a reduced duration of block and a shorter PACU stay, along with improved hemodynamic stability, compared to a higher dose of prilocaine with fentanyl.

Clinical Characteristics and Survival Outcomes of Invasive Mechanically Ventilated COVID-19 Patients: A Single-Center Study from Iran

Naghmeh Ahmadi — 2025-11-15

Background: COVID-19 patients requiring invasive mechanical ventilation represent the most severe cases with high mortality rates. This study aimed to analyze survival outcomes and identify prognostic factors in a cohort of invasive mechanically ventilated COVID-19 patients in Iran.
Methods: In this retrospective cohort study, we analyzed 639 adult COVID-19 patients who underwent invasive mechanical ventilation at Al-Zahra Hospital's ICUs in Isfahan. Survival analysis and Cox regression models were used to identify factors associated with mortality.
Results: Among 639 mechanically ventilated patients, mortality was 87.9%. The mean age was 63.01±16.4 years. 59.8% of participants were male. Hypertension (42.6%), diabetes (33.8%), and cardiovascular disease (25.0%) were the most prevalent comorbidities. The overall median survival time was 35 days. Cox regression analysis identified significant mortality predictors, including male sex (HR=3.489, 95% CI: 1.150-10.585), age (HR=1.064, 95% CI: 1.024-1.106), cardiovascular disease (HR=1.445, 95% CI: 1.096-1.905), higher APACHE IV score (HR=1.028, 95% CI: 1.005-1.051), and delayed mechanical ventilation after disease onset (HR=1.111, 95% CI: 1.031-1.196).
Conclusion: COVID-19 patients with invasive mechanical ventilation demonstrated high mortality rates. Older age, male sex, cardiovascular disease, higher APACHE IV score, and delayed mechanical ventilation after symptom onset were significant predictors of mortality. These findings highlight the importance of timely intervention in high-risk patients and may help optimize resource allocation during future pandemic waves.

The Effect of Dexmedetomidine and Ketamine on Core Body Temperature Changes in Children Undergoing Sedation during MRI

Farnaz Shahabi — 2025-10-18

Background: Magnetic resonance imaging (MRI) is widely used for diagnosing various diseases. This technique may lead to an elevation in temperature within the targeted imaging area, while intravenous anesthetics may induce hypothermia, particularly in pediatrics. The impact of different anesthetics on core body temperature in children undergoing such procedures has been partially explored with agents such as propofol and ketamine; however, findings associated with dexmedetomidine remain contentious. Therefore, this study aimed to investigate the influence of dexmedetomidine and ketamine on core body temperature in the pediatric population during MRI procedures.
Methods: This study was a prospective, randomized, double-blind clinical trial conducted on children aged 6 months to 10 years who underwent MRI and anesthesia at Mofid Hospital (Tehran, Iran) in 2025. Patients were randomly assigned to receive ketamine and dexmedetomidine for performing an MRI. Demographic, hemodynamic, and sedation data were compared between the two groups. The significance level was considered less than 0.05.
Results: Twenty-six pediatrics were assessed in each group receiving dexmedetomidine and ketamine. The sedation scores did not demonstrate significant differences between the two groups (P value: 0.55). Dexmedetomidine exhibited significantly lower heart rates (P value: 0.001) and core body temperatures (P value: 0.02).
Conclusion: Dexmedetomidine significantly reduces heart rate and core body temperature compared to ketamine in pediatrics undergoing MRI.

Designing and Evaluating the Applicability of a Web-Based Training Program for Anesthesiology Staff and Students in Burn Patients

Parisa Moradi Majd — 2026-01-13

Background: Burn patients present unique anesthetic challenges: massive fluid shifts, airway edema, and hypermetabolism that demand rapid, evidence-based management. Although web-based learning can deliver standardized, on-demand education, anesthesia technologists rarely have access to rigorously developed burn-specific resources. To design, implement, and evaluate the usability and short-term educational impact of a web-based burn-anesthesia program for practicing anesthesia technologists.
Methods: We conducted a four-phase mixed-methods study (September 2023 – April 2025). Phase 1 mapped required content through a scoping review (2014–2024) and a two-round Delphi survey of 15 experts. Phase 2 converted the validated content into a conceptual model and low-fidelity prototype, iteratively refined by two focus groups. Phase 3 produced the final application using a Python/Django back-end, a React front-end, and a PostgreSQL database. Phase 4 assessed real-world use over four weeks by 45 technologists at two Iranian teaching hospitals. Outcomes included the 27-item Questionnaire for User Interaction Satisfaction (QUIS; 0–9) and 20-item pre/post knowledge tests, analyzed with paired t-tests (α = 0.05).
Results: Forty-eight learning objects spanning eight modules (airway, fluid therapy, analgesia, pharmacology, burn pathophysiology, monitoring, nutrition, and postoperative care) met Delphi validity thresholds. The mean overall QUIS was 7.12 ± 0.78 (“good”), with subdomain means of 7.25 (overall reaction), 7.09 (screen design), 7.07 (terminology), 7.18 (learnability), and 7.00 (system capabilities). Knowledge increased from 63.4 ± 9.2 to 83.1 ± 7.6 (Δ = 19.7 ± 8.5 points; t = 14.2; p < 0.001; Cohen’s d = 2.29). No serious technical issues arose; the median weekly log-ins per user was four.
Conclusion: A systematically developed, user-centered web curriculum produced high usability scores and substantial knowledge gains among anesthesia technologists. The model offers a scalable solution for closing critical educational gaps in burn anesthesia, particularly where formal training is limited. Future research should examine long-term retention, effects on clinical performance, and patient outcomes.

Comparison of Blood Pressure and Arterial Oxygen Saturation in Dependent and Non-Dependent Limbs in Lateral Position during Nephrectomy Procedures

Naeimeh Naeimi Bafghi — 2026-01-01

Background: With advancements in medical technology, surgery has become a primary therapeutic option for numerous diseases. A successful surgical procedure requires proper anesthesia and accurate monitoring of vital signs, particularly blood pressure and arterial oxygen saturation. In the lateral decubitus position (LDP), hydrostatic forces may cause differences in blood pressure between the dependent and non-dependent limbs. This study aims to investigate non-invasive blood pressure (NiBP) and arterial oxygen saturation positional differences between dependent and non-dependent limbs.
Methods: 17 males and 22 females undergoing nephrectomy with convenience sampling, aged 18–70 years, with ASA physical status I or II were selected. Patients with peripheral vascular disease, cardiac disorders (e.g., atrial fibrillation, coarctation), inability to measure BP in one arm, significant preoperative BP asymmetry, uncontrolled hypertension, and refusal to participate were excluded. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Arterial Oxygen Saturation (SpO₂) were pre-specified and were consistently measured using non-invasive monitors.
Results: A significant difference was observed in systolic, diastolic, and mean arterial pressures between the two arms following the lateral positioning (p < 0.001). However, oxygen saturation levels did not differ before and after positioning.
Conclusion: The findings indicate a significant variation in blood pressure between dependent and non-dependent limbs in LDP, but no change in oxygen saturation. This emphasizes the importance of choosing the correct arm for accurate blood pressure measurement and hemodynamic management.

Cisatracurium Compared to Atracurium for the Prevention of Postoperative Delirium in Colorectal Cancer Surgery: Protocol of a Double-Blind, Randomized, Clinical Trial

Kousha Farhadi — 2026-04-29

Background: Non-depolarizing neuromuscular blocking agents have been shown to play a role in postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). Cisatracurium is known for its higher potency, lower induction dose, anti-inflammatory activity, lower histamine release, and better hemodynamic stability compared to atracurium, all of which may benefit postoperative cognitive function. This study aims to assess the preventive effects of cisatracurium compared with atracurium on POD incidence in patients undergoing colorectal surgery.
Methods: This single-center, randomized, controlled trial will be conducted at a tertiary care hospital of Sina (Tehran, Iran) from November 2025, assessing the preventive effects on POD of 0.2 mg/kg cisatracurium compared to 0.5 mg/kg atracurium induction dose with subsequent similar drug maintenance on a total of 200 patients undergoing mass resection surgery of colorectal cancers. Patients will be randomly assigned to a 1:1 allocation to each group. The primary outcome will be the prevalence of POD, assessed twice daily from the night after surgery until day 5, using the intensive care delirium screening checklist (ICDSC). The secondary aims are clinically relevant outcomes, including POCD, as measured by the Montreal Cognitive Assessment (MoCA), postoperative pain using a visual analogue scale (VAS), POD severity using the ICDSC, and duration of hospitalization.
Conclusion: This paper provides the protocol for the study comparing the activity of two neuromuscular blocking agents in preventing POD in colorectal cancer surgeries based on the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guideline.

A Comprehensive and Analytical Review of the Airway Pathology, Assessment, and Management

Zahid Hussain Khan — 2026-06-26

The human airway has since long remained a subject of debate and controversies; thus, to arrive at a subtle and acceptable solution, airway assessment tests, innovative techniques, and devices have been introduced to solve the enigma. Although human endeavors have made significant advances since time immemorial, the difficult airway still poses a major challenge even in the best of hands and the best centers.

The Effect of Rectal Midazolam on Clinical Conditions in Pediatric Dentistry: A Systematic Review Study

Masoud Kashefizadeh — 2026-05-23

Background: Before dental procedures, children often require mild to moderate sedation. This study was conducted to determine the effect of rectal midazolam on pediatric dental pain using a systematic review method.
Methods: In this systematic review study, articles published from 2000 up to the beginning of 2025 that focused on the effect of rectal midazolam on the clinical condition of pediatric patients undergoing dental services were included. The search was conducted by both authors of the article: one holding a specialization degree in pediatric dentistry and the other being a pharmacist. The search keywords included "pediatrics," "tooth," "dentistry," "dental services," "midazolam," "rectal midazolam," "children," and "clinical indicators." The search was performed across all international databases, including PubMed, Scopus, Web of Science, Embase, EBSCO, and the Google Scholar search engine. After searching for the articles, the relevant data were extracted using a checklist designed by the researchers, and the findings were reported in table format using a descriptive method.
Results: The result showed the initial search yielded 189 articles. After reviewing and evaluating the articles based on research objectives, methodology, the type of drug prescribed to patients, the method of drug administration, the manner of reporting findings, the language of publication, and the availability of the full article files, 5 articles proceeded to the systematic review stage. Also, in all extracted studies, the administration of rectal midazolam resulted in a positive effect on the clinical conditions of the patients, and the administration of this drug caused no side effects in the patients.
Conclusion: The administration of midazolam rectally has proven effective in achieving the study objectives, including maintaining stable clinical conditions for the patients and resulting in no significant clinical side effects. Therefore, the rectal administration of this drug is recommended.

A Man Who Takes 26 Warfarin Pills a Day! A Case Study on Warfarin Resistance

Hossein Karballaei Mirzahosseini — 2025-11-15

In certain patients, particularly those receiving mechanical aortic valve replacement, warfarin is the sole permitted anticoagulant. Some individuals exhibit resistance to warfarin for a variety of reasons, necessitating extremely high and occasionally fatal doses of the medication for their survival. This report details a patient who demonstrates warfarin resistance and investigates the fundamental causes of this phenomenon. The case report emphasizes the possible role of genetic polymorphism in elucidating the mechanisms behind warfarin resistance.

Anesthetic Management for Rhinoplasty in a Patient with a History of Bilateral Adrenalectomy Due to Controlled Cushing’s Syndrome: A Case Report

Fatemeh Eftekharian — 2025-11-06

Bilateral adrenalectomy, in the event of elective surgery, poses problems for an anesthetic manager due to hemodynamic instability, glucocorticoid replacement dependency, adrenal insufficiency, or a whole series of their associated endocrine disorders, one of which is hypothyroidism. This case report deals primarily with the perioperative considerations and management of the patient with Cushing's syndrome, who was planned for elective rhinoplasty following bilateral adrenalectomy. A 33-year-old woman who underwent bilateral adrenalectomy in childhood due to Cushing's syndrome came for elective rhinoplasty to correct post-traumatic nasal septal deviation. The preoperative workup revealed severe hair loss, dry skin, symptoms of orthostatic hypotension, and a systolic blood pressure reading consistently below 80 mmHg. Laboratory investigations gave evidence of elevated TSH (18.9 mIU/L), suggestive of hypothyroidism. Therefore, she was referred to an endocrinologist, and treatment with levothyroxine and fludrocortisone was initiated. An improvement in thyroid function was established a month later (TSH: 1.9 mIU/L), and hypotension was controlled. Surgery was scheduled after getting approval from the anesthesiology team and a detailed risk discussion with an informed patient consenting to proceed. During surgery, constant monitoring of the patient's vitals was carried out. Everything went on very well, and the patient was discharged, stable. Among challenging patients such as those with adrenal insufficiency, careful preoperative evaluation, hormone imbalance correction, and proper steroid supplementation play a vital role in avoiding adrenal crisis states during or after surgery. Effective teamwork is achieved between anesthesiologists, endocrinologists, and surgeons in endeavoring to make a surgical outcome safe and successful.

Avoiding the Tracheostomy Trap: A Case for Submental Intubation in Facial Fracture Repair

Chhaya Suryawanshi — 2026-03-24

Submental intubation presents a practical alternative to tracheostomy for airway management in maxillofacial trauma, especially when nasal and oral routes are not viable. We present a 24-year-old male who sustained bilateral parasymphysis fracture along with right zygomaticomaxillary complex (ZMC), and nasomaxillary complex fractures. He was posted for open reduction and internal fixation (ORIF) under general anesthesia. For clear surgical access while maintaining a secure airway, submental intubation was performed. This case highlights the safety and effectiveness of submental intubation in selected cases of facial trauma.

Complications of Nausea, Vomiting, and Headache after Epidural Steroid Injection in Two Elderly Patients after Multilevel Lumbar Surgery: A Case Series

Sogol Asgari — 2026-02-04

Epidural steroid injection is an effective method for controlling spinal radicular pain. However, in elderly patients with a history of lumbar fusion surgery, anatomical changes can lead to complications such as headache, nausea, and vomiting after the injection. In this report, two patients, 70 and 75 years old, with a history of multilevel lumbar fusion surgery who developed these complications after epidural injection are presented. Conservative treatment, including furosemide and 3% hypertonic saline, was associated with complete improvement of symptoms.

Airway Management in Pediatric MPS: A Case Report

Hasanali Ahmadi — 2026-01-06

Mucopolysaccharidoses (MPS) refer to a group of disorders classified as congenital metabolic defects, characterized by airway management challenges because of facial deformities, macroglossia, short neck, hypertrophic tonsils and adenoids, kyphoscoliosis, an immobile jaw, narrowed nasal passages, and atlantoaxial instability. In this report, we present a case of successful management of a difficult airway in a pediatric patient with MPS.

Navigating the Unknown: Clinical Pace Notes as a Metaphor for Safer Procedural Learning

Nasrin Aghazadeh — 2026-01-13

Beyond the Numbers: Redefining Patient Monitoring in Anaesthesiology: An Indian Perspective

Paayal Chandrashekar — 2026-01-31