Background: Providing adequate sedation in patients undergoing cataract surgery, can create analgesia and sedation during injection and retrobulbar surgery in order to prevent eye movement during open eye surgery. This study was aimed at assessing the effects of melatonin premedication on the quality of sedation and pain control during cataract surgery.
Methods: The study was a triple-blind randomized clinical trial that was performed in Isfahan on 40 patients. The patients were allocated randomly into two groups of 20 subjects, one group receiving 3 mgs of sublingual melatonin pill and another group 3mgs of placebo. This was done 60 minutes prior to surgery.
Hemodynamic parameters, level of pain, and sedation were measured at specific intervals. In order to measure the level of pain and sedation, the VAS score and Richmond scales were used, respectively.
Results: Surgery duration (P value=0.059), duration of anesthesia (P value=0.14), duration of recovery (P value=0.34), ASA (P value=0.27), Richmond scale (P value=0.45), oxygen saturation level (P value=0.12), and PR (P value=0.87) did not show a significant difference between the two groups. The changes in mean arterial pressure (P value=0.02) and pain intensity (P value=0.04) were significantly higher in the placebo group compared to the melatonin group.
Conclusion: Premedication with oral melatonin was beneficial in providing better pain control and hemodynamic stability in patients undergoing cataract surgery under sedation and local anesthesia.

Background: Exploring risk factors for the development of COVID-19 in vital organs of the body is necessary to improve patient survival and reduce disability and morbidity due to disease progression. By identifying these underlying risk factors and controlling them, it is possible to prevent extra-pulmonary involvement and even alleviate pulmonary involvement in patients, resulting in a significant reduction in mortality and morbidity rates. This study aimed to identify the underlying risk factors associated with pulmonary and extrapulmonary organ complications of COVID-19.
Methods: This study was a cross-sectional descriptive-analytical study. Patients with a definitive diagnosis of COVID-19 who were admitted to the intensive care unit of Imam Khomeini Hospital in Tehran due to respiratory distress and poor clinical condition were included in the study population and were clinically followed up on. Patients' information was collected by reviewing patients' records and the hospital information system.
Results: A total of 123 patients were included in the study (63.4% were male, mean age = 58.87 ± 12.37). Using ROC curve analysis, the calculated risk score is considered statistically significant for diagnostic accuracy (AUC = 0.862 [0.797–0.927], P value < value<0.001). A risk score cutoff greater than 1.5 (sensitivity 89.9%, specificity 38.9%) favors an increased likelihood of in-hospital mortality. According to multiple linear regression (F (9,93).369, P value=0.001), chronic obstructive pulmonary disease, asthma, diabetes, SOFA score on days 2 & 3, and ventilation support were predictors of ICU length of stay.
Conclusion: A history of chronic heart failure with renal impairment, liver cirrhosis with liver complication, and any underlying disease are associated with pulmonary complications in COVID-19 patients.

Background: The skill of intubation is one of the most important technical skills for anesthesia nurses, as it can be a lifesaver in times of crisis. Learning by observation (a method in which the learner observes the teacher and learns the skill through watching) and self-directed learning (the learner identifies their needs using their creativity, sets goals, and learns the desired skill through trial and error) are effective methods for learning technical skills. This semi-experimental study aimed to compare two methods, observational learning and self-directed learning, in improving technical skills in nurse anesthetists.
Methods: Nurse anesthesia students (n=60) were divided into two groups: Group A (n=30) and Group B (n=30). Group A experienced learning through the self-directed method, while Group B learned through observation and attempted to acquire skills by observing the instructor. All students were then evaluated and scored using the intubation checklist. The collected data were analyzed using SPSS version 16.0 software and presented as mean ± standard deviation (P value< 0.05).
Results: The data showed that there was no significant difference between the two groups in terms of demographic indicators. According to the results, both observational learning and self-directed learning can improve the learning of intubation skills in students. Self-directed learning led to a greater improvement in intubation scores for students (P value=0.001). But there was no significant difference between the two methods in terms of the need for frequent intubation.
Conclusion: Both observational and self-directed learning methods can be useful in improving students' technical skills, but the use of self-directed methods may be more effective.

Background: This study aimed to investigate mortality risk factors among severe COVID-19 patients admitted to the intensive care unit (ICU) to inform better management strategies and reduce mortality rates.
Methods: A descriptive-analytical, cross-sectional, and retrospective study, was conducted between March 2022 and April 2023 at the intensive care unit of Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. The study included patients admitted to the ICU with severe COVID-19. The main variables were demographic factors (age, gender), pre-existing medical conditions (smoking, diabetes, hypertension), disease severity markers (CT-scan scores, inflammatory and coagulation parameters), and mortality outcomes.
Results: The study included 395 eligible patients. The mortality rate was 57.72%, with no significant difference in hospital stay duration between deceased and survived patients. Smoking, diabetes mellitus, and hypertension were significantly associated with higher mortality. Males exhibited a higher mortality rate, although not statistically significant. Patients over 65 years old had significantly higher mortality. Winter showed a significant increase in mortality, likely due to the Omicron sub-variant. Higher CT-scan scores and elevated inflammatory/coagulation markers correlated with increased mortality risk.
Conclusion: Pre-existing conditions, demographic factors, and disease severity markers are crucial predictors of mortality in severe COVID-19 patients. Tailored interventions targeting these risk factors are essential to improve outcomes.

Background: In this study, the effect of different doses of magnesium sulfate on the consumption of anesthetic drugs during surgery and pain after spine surgery has been investigated. In complex spine surgeries, a large amount of sedative and analgesic drugs is prescribed, which will have various systemic effects during and after the operation.
Methods: This study was a double-blind clinical trial, and 80 patients who were candidates for posterior spinal fusion surgery at Luqman Hakim Hospital were included in the study. Patients were randomly divided into four groups (20 people in each group): Group M received magnesium sulfate in three doses (M1=10mg/kg/hr), (M2=15mg/kg/hr), and (M3=20mg/kg/hr). and group S received normal saline. Due to a drop in blood pressure and severe bradycardia in the M3 group, we had to stop the infusion, so the M3 group was excluded from the study, and 60 patients from the M1, M2, and S groups were studied.
Results: The M2 group experienced a decrease in bleeding volume, intraoperative fentanyl consumption, and postoperative pain score compared to the M1 and S groups.
Conclusion: In this study, we showed that the administration of magnesium sulfate during surgery can have positive and protective effects on the quality of anesthesia and the postoperative period. The recommended dose of magnesium was 15 mg/kg/hr because it has the lowest amount of narcotic consumption during the operation and the lowest amount of narcotic and analgesic consumption after the operation, and on the other hand, it has good hemodynamic stability. At the same time, doses higher than 15 mg/kg/hr are not recommended due to the drop in HR and MAP.

Background: Clinical competence is an essential attribute for anesthesia nurses, as it directly influences patient safety, minimizes medical errors, and enhances surgical outcomes. In Iran, ensuring the clinical competence of anesthesia nurses is vital to addressing the growing demands of modern healthcare. However, evidence suggests a persistent gap between academic education and clinical practice, potentially undermining the readiness of graduates to meet professional expectations. This study aimed to evaluate the clinical competence of anesthesia students at Jundishapur University of Medical Sciences in 2023, identifying areas of strength and weakness to inform improvements in educational programs and foster clinical preparedness.
Methods: This descriptive cross-sectional study included 62 anesthesia students, selected through a census method, who were enrolled in the third and fifth terms of their academic program. A common clinical assessment tool was used to evaluate students' competencies. Statistical analysis was performed using SPSS version 26.
Results: This study demonstrated that most students exhibited strong competence in patient safety and anesthesia care, with a mean score of 19.79 (SD = 3.26, range: 12–24) and an overall clinical competence score of 70.83 (SD = 11.34, range: 44–88). Additionally, GPA significantly influenced clinical competence scores, with higher GPAs associated with better clinical outcomes (P value= 0.015). However, students showed lower competence in professional communication and collaboration. Only one student was classified as "Not applicable," while 40.32% were categorized as   "Competent and proficient to enter practice."
Conclusion: The findings highlight the importance of academic performance in enhancing clinical competency. While most students demonstrated readiness for clinical practice, improvements are needed in areas such as professional communication and teamwork. Future research should focus on long-term evaluations and interventions to enhance these competencies, ensuring better preparation for clinical practice.

Background: One of the most prevalent procedures involving general anaesthesia (GA) is endotracheal intubation, which can lead to a variety of airway complications. Patients undergoing GA with tracheal intubation may experience a common complication, known as postoperative sore throat (POST). This study was undertaken to evaluate and compare the efficacy between nebulized ketamine and dexmedetomidine administered preoperatively in alleviating POST.
Methods: Patients were randomized into two groups with 151 patients in each group. Group-K patients were nebulized with ketamine 50mg (1ml) with 3ml normal saline, while Group-D patients were nebulized with dexmedetomidine 50mcg (0.5ml) with 3.5ml normal saline, preoperatively. GA was administered 15 min post-nebulization. POST was graded at 4,6,12 and 24h after extubation; on a four-point scale (0-3). The statistical analysis was performed using statistical package for social science (SPSS) software version 17.0.
Results: In the present study, the overall incidence of POST was 32.5%. POST was experienced by 39 patients (25.8%) in ketamine and 59 patients (39.1%) in dexmedetomidine group (P value=0.014) at 4h, following extubation. Significantly higher incidence of POST in dexmedetomidine group was noticed as compared to ketamine group (P value <0.05). But, at 6h, 12h and 24h, the difference was not statistically significant between the two groups. A significantly larger percentage of cases in dexmedetomidine group had more severe POST than in ketamine group, at 4h following extubation (p-value <0.05). There was no significant rise in systolic and diastolic blood pressure in either groups. However ketamine group had a significantly higher mean heart rate after extubation compared to dexmedetomidine group.
Conclusion: Ketamine nebulization significantly decreases the incidence and severity of post operative sore throat, during the early postoperative period with minimum hemodynamic changes.

Background: One of the surgeries that led to the hospitalization of the patient in the ICU and the creation of postoperative delirium (POD) is neurosurgery. We conducted this study to investigate the relationship between preoperative diabetes and delirium in patients undergoing neurosurgery in the ICU.
Methods: In this study, before performing the surgery, the checklist designed by the researchers was completed by interviewing the patients, and the necessary information was completed through clinical examination, interviewing the patient, and studying the documents in the patient's file. Then, the research tool to identify POD was reviewed and completed on a daily basis from the time the patient entered the ICU until the time the patient was discharged. In order to investigate delirium, the researchers conducted a clinical examination, observed the patient's clinical record, and completed the CAM-ICU-7 questionnaire. After completing the research tools, the data were entered into SPSS software, and their analysis was done using version 16 data analysis.
Results: Results showed, in patients with diabetes, the prevalence of POD in patients with a history of smoking, high creatinine, agitation, and intubation was higher than in other patients (P value < 0.05). Also, the prevalence of POD diabetic patients was 54 (38.57%), which is 38 (54.28%) in diabetic patients and 16 (22.85%) in non-diabetic patients.
Conclusion: Considering that a significant relationship was observed between diabetes and the prevalence of POD, it is important to carry out the necessary prevention in this field.

Background: Ventilator-Associated Pneumonia (VAP) is one of the most common nosocomial infections that occurs after intubation in patients with mechanical ventilation.
Methods: This cross-sectional descriptive study was conducted in a group of patients admitted to the ICU with a sample size of 120 patients. patients were visited daily at the beginning of admission to the ICU and the study began by considering the entry and exit criteria. To achieve the research objectives, researchers visited the ICI department daily and identified eligible patients. Also, in this study, the demographic profile form of the patients was designed, and their information was completed by the researchers according to the information in the patients' clinical records. The questions of the demographic profile form were completed using an interview with the patient's companion and a study of the patient's hospitalization records. The data from this study were entered into SPSS version 18 and analysed using chi-square, regression, Mann-Whitney and other statistical tests.
Results: According to the findings, 120 patients admitted to the ICU were included in the study, of which 48.3% were male and 51.7% were female. The incidence of VAP in 24 patients (20%) was reported. most of the VAP Group patients were male with a rate of 70.8%, age group 70-80 years with a rate of 66.7%, a history of smoking with a rate of 100% and consciousness above 9 with a rate of 70.8%. Also, in patients with VAP, 91.7% of patients with cancer and 41.7% of patients with rheumatoid arthritis had comorbidities, which was significant compared to the No-VAP Group (P value<0.05).
Conclusion: Given the high prevalence of VAP and its role in patient mortality, preventive interventions are recommended to reduce the incidence of VAP.

Background: Cancer patients are admitted to the ICU due to their poor clinical condition, and patients admitted to these units suffer. Given the prevalence of cancer, the aim of this study was to determine the clinical characteristics of cancer patients admitted to the ICU.
Methods: In this study, 90 patients admitted to the ICU due to underlying cancer were included in the study; and patients who were discharged, died, or discharged within the first 24 hours of admission were excluded from the study. The researchers collected information and completed a researcher-made checklist form by visiting the ICU and studying the patient's clinical record, interviewing the patient, and performing a clinical examination. For data analysis and reporting in the findings section, all extracted information was reviewed, and if the patient's data were completely completed and there was no incomplete information in this regard, it was entered into SPSS software. Then, data analysis was performed with descriptive and analytical statistical tests.
Results: The findings showed that the rate of delirium in patients who died, had a history of smoking, had pressure ulcers, were older, and had a longer duration of stay in the ICU was higher than in other patients, and this difference was statistically significant (P value < 0.05).  Also, the result showed the prevalence of pressure ulcers was higher in patients with a history of smoking, lung cancer, older age, and longer duration of stay in the ICU than in other patients, and this difference was statistically significant.
Conclusion: Identifying the clinical characteristics of cancer patients can help health policymakers and medical staff to improve the health status of patients. Also, the prevalence of delirium and pressure ulcers was high in this study, which requires necessary interventions in this field.

Background: The fetal head station plays a crucial role in determining its location in the birth canal, estimating the time and manner of delivery, and detecting the upcoming steps in both the fetus and mother. This information helps medical staff deal with these steps more accurately and effectively. The aim of this study is to determine the effect of the fetal head station at epidural placement on the labor outcome.
Methods: Based on the inclusion criteria, we selected 234 healthy women, all of whom requested and received epidural analgesia. Before inserting the epidural, we made a list of all the signs of labor. Next, 16 ml of 0.125% isobaric bupivacaine mixed with 50 micrograms of fentanyl was injected into the samples to make labor painless. Blood pressure, O₂ saturation, and heart rhythm of the samples (mothers) were measured non-invasively every 5 minutes (first half an hour) and also every quarter of an hour, and careful monitoring was performed by the treatment team. The treatment team also performed fetal heart monitoring. We recorded other parameters as well. Data were analyzed using chi-square and one-way ANOVA tests. We considered a P-value of less than 0.05 as the threshold of significance.
Results: In total, 234 women received epidural analgesia; most had normal deliveries (198), and only 36 of them had cesarean sections.  no significant relation between both station and mode of delivery, by using a chi-square test with a range of (P value = 0.4581). The relationship between station and cervical dilation between groups is significant (P = 0.0147). The duration of the labor procedure between station groups is significant (P value = 0.0005).
Conclusion: Fetal head station usage for determining epidural analgesia start for women in labor shows more accuracy than using cervical dilation alone; epidural analgesia helps the labor procedure to be less painful, has a minimal effect on labor duration, and helps increase the rate of normal delivery.

Background: Cognitive disorders are emerging as critical determinants of surgical outcomes, particularly among middle-aged and elderly patients. This study aimed to investigate the prevalence of cognitive impairment and its associated risk factors in patients aged 40 years and above attending a pre-anesthesia clinic.
Methods: In this cross-sectional study, 300 patients were assessed using the Mini-Cog test at Hospital's pre-anesthesia clinic between January 2023 and June 2024. Comprehensive demographic data, including educational levels and medical histories, were recorded. Statistical analyses were conducted to evaluate the association between cognitive impairment and clinical variables such as diabetes and hypertension.
Results: Cognitive impairment was prevalent in 71% of the participants, with lower educational attainment being a significant predictor (P value < 0.001). Diabetic patients exhibited a higher prevalence of cognitive impairment compared to non-diabetics (P value= 0.092). No statistically significant association was found between hypertension and cognitive impairment (P value= 0.4).
Conclusion: The study highlights a high prevalence of cognitive impairment in preoperative patients, particularly among those with limited educational backgrounds and diabetes. The findings emphasize the need for routine cognitive screening using tools like the Mini-Cog in preoperative assessments, allowing for early identification of at-risk patients and the implementation of tailored interventions to enhance surgical outcomes.

Background: Rheumatic diseases can lead to increased mortality and decreased quality of life. Therefore, we conducted this study to determine the clinical characteristics of patients with rheumatic diseases hospitalized in the ICU.
Methods: In this study, which was conducted in Tehran province, patients who were diagnosed with underlying rheumatic diseases and were admitted to the ICI department were included in the study. Thus, the study encompassed 120 patients diagnosed with rheumatic diseases. In this study, the researchers extracted the list of hospitalized patients by referring to the ICU department. Then, a history was taken from the patients, and if they were suffering from underlying rheumatic disease according to the history taken (from the patient or the patient's companion), they were included in the study. The tools used included a demographic profile form and a patient clinical information checklist. The data obtained from this study were analyzed using SPSS software version 16.
Results: The results showed there was a significant relationship between gender, history of hospitalization, smoking, pressure ulcer, and age with the mortality of ICI patients (P value < 0.05). Also, a higher mortality rate was reported in all patients who had at least one type of underlying disease (P value < 0.05). Therefore, the ICU hospitalized the older patients for longer periods of time.
Conclusion: Variables such as age, sex, and underlying diseases were effective in the clinical condition of patients with RA. For this reason, it is necessary to pay attention to this issue in providing clinical care.

Background: Spinal anesthesia in orthopedic surgeries presents challenges, especially concerning the choice of anesthetic agents and their adjuncts, which affect analgesia quality and potential side effects. This study was conducted with the aim of determining the effects of intrathecal bupivacaine, meperidine and magnesium sulfate on hemodynamic parameters, onset and duration of sensory/motor block in spinal anesthesia in patients with lower limb fractures.
Methods: This double-blind, randomized clinical trial included 130 patients who were candidates for planned lower limb orthopaedic surgery. They were divided into four groups: 1: bupivacaine 10 mg, 2: meperidine (1 mg/kg), 3: bupivacaine 10 mg + magnesium sulfate of 100 mg, and 4: meperidine (1 mg/kg) + magnesium sulfate with (100 mg). Parameters measured included hemodynamic status and sensory and motor block onset and duration. The level of sensory block was assessed via the pinprick sensation method, while the Bromage scale was used to evaluate motor block.
Results: No clinically significant differences in hemodynamic parameters were observed across the groups. The onset of sensory block (P value= 0.235), onset of motor block (P value= 0.097), and duration of motor block (P value= 0.135) were statistically similar across the groups. However, significant differences were found in the duration of the sensory block (P value= 0.035). Magnesium sulfate increased the duration of motor block in the meperidine group (80.93 ± 30.28 minutes). However, it reduced the duration in the bupivacaine group (75.23 ± 38.56 minutes) Motor block onset was prolonged in groups receiving magnesium sulfate, with a significant difference between the meperidine and meperidine with magnesium sulfate groups (CI = 1.10 to 12.52, P value = 0.04).
Conclusion: The intrathecal drugs used did not produce significant side effects, suggesting that they can be used interchangeably... However, magnesium sulfate, as an adjuvant, did not enhance the length or quality of the block in spinal anesthesia when used with meperidine and bupivacaine.

Background: Spinal cord trauma (SCT) is one of the types of traumas that causes many complications. In order to identify these complications, it is necessary to check the results of laboratory tests and radiology tests.
Methods: This study was conducted with the aim of determining the relationship between serum lactate of patients and the severity of injury caused in trauma patients. The study included 190 hospitalized patients with SCT. The researchers’ enrolled patients with SCT injuries who met the inclusion criteria by visiting the hospital daily.
Results: Results showed that out of 190 examined patients, 32 (16.8%) patients died and 158 (83.2%) were discharged from the hospital. Also, 160 (84.2%) of the patients were male, and 30 (15.8%) of them were female. Regarding the injury mechanism, it was shown that 98 (51.6%) of the patients were due to road traffic accidents, 33 (17.4%) of the patients were due to falls, and only 8 (4.2%) were due to sports accidents. Also, the result showed the amount of lactate in the survivors group was 1.2 (0.8-2.6), and in the non-survivors group it was 3.9 (2.8-6.6).
Conclusion: Considering that there were laboratory changes in patients with TSCI, it is recommended to use the results of this study as a clinical guide for doctors.

Background: Nurses, as professionals in the caring profession, try to perform safe and effective nursing interventions all the time and support patients to achieve the most favorable treatment outcomes. Nowadays, one of the important and international issues in nursing is distress tolerance. This study aimed to determine distress tolerance and affecting it among nurses working in the COVID-19 intensive care unit.
Methods: This study is cross-sectional. The sample consisted of 128 nurses working in the intensive care unit. A non-randomized convenience sampling method was used to select the samples based on the inclusion criteria. The data collection instruments included two questionnaires: a demographic characteristics questionnaire and a standardized distress tolerance questionnaire. The data were analyzed using SPSS software version 25, employing both descriptive and inferential statistical tests.
Results: The mean age of the samples was 34.95 ± 6.77 years. The highest scores of distress tolerance subscales included appraisal (17.89±3.62), tolerance (8.97±2.60), absorption (8.83±2.30), and regulation (2.25 ±8.39), respectively. The statistical test of linear regression showed that service history and shift work have a significant power to predict nurses' distress tolerance.
Conclusion: The distress tolerance of nurses working in the ICU units was low. Factors such as service history and shift work influence their distress tolerance. Accordingly, it is necessary to plan to improve nurses' distress tolerance.

Background: In addition to the serious physical health impacts on nurses, COVID-19 has brought about significant psychological distress. Considering that spirituality as a strong foundation can be a powerful factor in controlling stressful conditions, this study was conducted with the objective of determining the effect of spiritual self-care education on the resilience of nurses working in COVID-19 intensive care units.
Methods: We conducted this randomized clinical trial study on 128 nurses working in COVID-19 intensive care units. Nurses were selected using convenience sampling. They were then randomly divided into two groups: intervention (64 nurses) and control (64 nurses). The research group received a spiritually based educational program in 6 sessions of 45 minutes each, held as a one-day event. Five relevant faculty members and the research team examined and approved the validity of the educational content. Two questionnaires (demographic characteristics and distress tolerance) were used to collect data. These questionnaires were completed by both groups before and after the intervention. Finally, the data were analyzed using SPSS.25 software and statistical tests including the t-test, chi-square, and Fisher's exact test.
Results: The mean age of nurses in the control and intervention groups was 35.23 ± 7.68 and 34.95 ± 6.77 years, respectively. The results of the independent samples t-test showed a statistically significant difference in the mean distress tolerance score and all its subscales (tolerance, absorption, evaluation, regulation) between the intervention and control groups after the intervention (P < 0.001). The level of distress tolerance in the intervention group after the intervention (50.40±5.71) increased significantly compared to before the intervention (44.39±5.23) (P<0.001).
Conclusion: Ultimately, the results indicated that spiritual self-care training increases distress tolerance in nurses. Therefore, we recommend implementing a spiritual self-care program and planning for nurse participation in spiritual activities to enhance their psychological well-being.

Background: Adherence to drug treatment means taking drugs, following a diet, or implementing changes in lifestyle in accordance with the programs recommended by healthcare workers.
Methods: This cross-sectional descriptive study included 530 cancer patients referred to Tehran medical centers, clinics, and private practices. If the cancer patients could read and write as well as understand the questions in the questionnaire, all the questionnaires were completed by the patients in a self-reported form. Otherwise, the researchers completed the questionnaire by interviewing the patients. The tools used include the Medication Compliance Questionnaire (MCQ) and the Pain and Opioid Analgesic Beliefs Cancer Scale (POABS-CA). We analyzed the data from this study using SPSS version 16 software.
Results: The result indicated that the M(SD) score of the MCQ scale was equal to 30.72 (8.03) and the POABS-CA score was equal to 18.58 (8.40). Furthermore, the score of adherences to drug treatment was higher in people with an age less than 45 years, with male gender, diploma and sub-diploma education, and this difference was statistically significant (p<0.05). Patients who held more positive beliefs demonstrated a higher level of drug treatment compliance.
Conclusion: Considering that the obtained score related to compliance with drug treatment was not at a high level, it is necessary to carry out necessary interventions in this field.

Background: Traumatic Brain Injury (TBI) is a type of trauma that can be caused by various factors. The aim of the study is to determine the prevalence and outcome of acute respiratory distress syndrome (ARDS) in TBI.
Methods: This study is part of the Iran ICU Registry (IICUR) Australian and New Zealand ICU (ANZICS). This study included TBI patients admitted to Hospital's surgical ICU, excluding those who died within 48 hours. The diagnosis of ARDS was based on the Berlin scale. Also, the data collected were collected using the IICUR and ANZICS registry data checklist. The data were entered into SPSS 18 software, and data analysis was performed using regression analysis.
Results: The findings showed that out of 350 patients with a diagnosis of TBI, 32 (9.1%) had ARDS symptoms. There was also a significant difference between ARDS status and mortality (P=0.000), smoking (P=0.004), hospital LOS (P=0.009) and median APACHE II (P=0.000).
Conclusion: Since ARDS patients had a higher mortality rate, therapeutic interventions must be implemented to reduce ARDS incidence in TBI patients.

Background: Respiratory infections are a widespread and rapidly spreading disease that plays an important role in the mortality of children and adults. This study aimed to determine the prevalence, contributing factors, and outcomes of LRTI in patients with TBI.
Methods: In this study, 140 patients who were admitted to the ICU with a diagnosis of TBI were included in the study. Patients who had respiratory infections, including hospital-acquired pneumoniae (HAP), ventilator-associated tracheobronchitis (VAT), and ventilator-associated pneumoniae (VAP), were included in the group of patients with LRTI. The diagnosis of LRTI is based on laboratory indicators and the methodology of previous articles. The tool used in this study was a checklist including the data registry. This checklist was completed by the researchers and by visiting the department daily. In all stages of this study, the instructions issued by the Ethics Committee were followed. Also, data analysis was performed with the help of SPSS 18 software.
Results: In this study, out of 140 patients admitted to the ICU, 47 (33.6%) patients had LRTI and 93 (66.4%) patients had no symptoms of LRTI. The result showed that most patients were male (73.6%), had no history of pregnancy (99.3%), had no bedsores (81.4%), were admitted from the Emergency Department (52.9%), and had blunt trauma (79.3%). Also, the M(SD) age of the patients was 45.05 (11.1), the M(SD) length of hospital stay was 6.25 (1.8), and the mean (SD) consciousness score was 7.82 (2.22). Regarding the relationship between the status of the variables studied and the rate of LRTI, it was shown that there was a significant relationship between ICU LOS and age with LRTI status. So that the M(SD) of ICU LOS in patients with LRTI was 5.38 (2.21) and in patients without LRTI was 3.55 (1.45), (95% CI: 2.11 (1.98-2.23)). Also, the M(Sd) age of patients in the LRTI group was 46.76 (13.47), and in the No LRTI group was 44.19 (9.65) (95% CI: 1.87 (1.51-2.22)). Also, the mortality rate in patients with LRTI was 36.2%, which was higher than the mortality rate of non-LRTI patients with a mortality rate of 8.6%.
Conclusion: Given the high incidence of LRTI, preventive measures are recommended in this regard. Also, patient age and ICU LOS were identified as two important variables in the incidence of LRTI, which requires these patients to be prioritized for preventive care in order to reduce the incidence of LRTI.

Background: One type of trauma is penetrating abdominal trauma (PAT). For this reason, given the importance of PAT and the management of these patients, this study aimed to determine the clinical characteristics of patients with PAT admitted to the ICU.
Methods: This retrospective study was conducted by reviewing and studying the medical records of patients. Researchers reviewed the records of patients who were hospitalized in the ICU with a diagnosis of PAT and extracted the relevant information. Inclusion criteria included being between the ages of 10 and 60, having a diagnosis of PAT, and being hospitalized in the ICU. Patients whose records were incomplete for any reason were excluded from the study. The research checklist included relevant information. In this study, ethical principles in research were observed in the study of the doctors' clinical records. Additionally, after extracting the data into SPSS version 16 software, data analysis was performed.
Results: Results showed 86.2% of the patients were male and 13.8% were female. Additionally, most of the patients were in the age range between 31-40 years, with 37.9%. The majority had a high school diploma (70.7%) and multiple traumas with 60.3%. The mean (SD) of mortality in the first 24 h was 1.82 (0.38), hospital mortality was 1.74 (0.44), and ICU length of stay (day) was 6.48 (4.2). Additionally, the results showed that most of the radiograph findings included air under the diaphragm at a rate of 6.9%, and the highest rate of complications observed in patients included surgical site infection at a rate of 24.13%.
Conclusion: The results of this study showed that infection is one of the important complications of hospitalization of patients with PAT in the ICU. Therefore, it is essential to carry out the necessary interventions in this area.

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: This study aimed to determine the effect of adding low doses of dexmedetomidine as an adjuvant to lidocaine in regional intravenous anesthesia in patients receiving surgery.
Methods: In the present clinical trial, 120 patients' candidates for upper extremity orthopedic surgery with regional venous anesthesia in 4 groups of 30 people distributed in groups respectively 0.6, 0.5 and 0.4 micrograms/kg of dexmedetomidine plus 0.5 lidocaine were injected and in the fourth group, an equal volume of normal saline was administrated. Patients were examined and compared before drug injection and 1, 5, 10, 15, 30, 45 and 60 minutes after drug injection in terms of time of onset and recovery of sensory and motor block, hemodynamic parameters, postoperative pain intensity and analgesic consumption.
Results: The average pain intensity during the research in the four dexmedetomidine groups was 0.6, 0.5, 0.4 and the control group, respectively, 2.12 ± 1.33, 2.82 ± 0.76, 2.26 ± 2.3, and 4.4 ± 1.5, and the difference between the groups was significant (>0.001). P). In the two-by-two analysis of the groups, the average pain intensity was significant between the two groups: dexmedetomidine 0.6 and control (P<0.001), dexmedetomidine 0.5 and control (P=0.003), and dexmedetomidine 0.4 and control (P<0.001).
Conclusion: Using a dose of 0.6 micrograms/kg of dexmethomidine along with lidocaine leads to a decrease in the severity of the postoperative period, a decrease in the need for painkillers, and also an increase in the time of postoperative pain relief in patients.

Background: Sore throat after tracheal intubation is one of the unpleasant experiences of patients under general anesthesia, which can affect the patient's recovery and postoperative satisfaction. It is more common in the female sex after gynecological and obstetric surgeries. Physiological and anatomical changes during pregnancy result in intubation difficulty and subsequent sore throat. One of the prevention methods of this condition is the use of dexamethasone, which is a glucocorticoid with anti-inflammatory properties. This study aims to compare the effectiveness of two different dexamethasone doses (4 mg and 8 mg) in reducing post-operative sore throat after caesarean section.
Methods: In a double-blinded randomized controlled trial (RCT), 90 candidates of caesarean section under general anesthesia were randomized to three groups receiving 8 mg of dexamethasone IV (Group I), 4 mg of dexamethasone IV (Group II), and 2 ml of normal saline (Group III) as a control group after the umbilical cord clamp. Then, through the VAS questionnaire, the rates of sore throat at one, 6, 12, and 24 hours after extubation were recorded and compared in three groups.
Results: The average time of extubation in the 8 mg IV dexamethasone receiving group was significantly shorter than the normal saline receiving group (1.59 ± 5.13, P=0.007). The average severity of the sore throat at 6, 12, and 24 hours postoperatively was significantly different between the three groups. The severity of the sore throat in a group receiving 8 mg and 4 mg dexamethasone was significantly less than in the normal saline group (0.59 ± 0.19, P= 0.003 and 0.41 ± 0.19, P=0.036), respectively. Patient satisfaction was higher in the 8 mg dexamethasone-receiving group than in the other groups.
Conclusion: Two doses of 8 and 4 mg of intravenous dexamethasone are effective in reducing the rate and severity of post-intubation sore throat after cesarean section under general anesthesia, and the dose of 8 mg is more effective than 4 mg, but this difference was not statistically significant.

Background: The advantages of using saddle block anesthesia have been established in certain surgical procedures; however, its application in patients undergoing dilation and curettage (D&C) has not yet been thoroughly investigated. Given the urgent nature of this procedure, it was necessary to compare the patient’s sitting time. Accordingly, the present study was conducted to compare saddle block anesthesia with three different sitting times in patients undergoing D&C.
Methods: The current randomized, double-blind clinical trial was conducted at Shahid Beheshti Hospital in the city of Isfahan in 2024. Forty-five patients were randomly allocated to three groups. In the first group, patients remained seated for 3 minutes; in the second group, for 4 minutes; and in the third group, for 5 minutes following the injection of Marcaine (bupivacaine). Data were collected using a checklist and analyzed using SPSS version 26.
Results: There were no significant differences among the three groups in terms of age, gestational age, length of hospital stay, and maximum sensory block level (P > 0.05). However, a significant difference was observed between gestational age and pain intensity among the three groups (P < 0.05). Blood pressure (systolic and diastolic) and heart rate showed no significant differences among the three groups (P > 0.05).
Conclusion: Sitting patients undergoing D&C after saddle block anesthesia for 3, 4, or 5 minutes had no significant effect on any of the measured variables, including pain, systolic blood pressure, diastolic blood pressure, and heart rate. Notably, according to the results, if a pregnant woman is beyond 15 weeks of gestation, it is advisable for her to remain seated for 5 minutes after the saddle block to minimize pain intensity, as shorter sitting times will culminate in greater pain intensity.

Background: One of the groups at risk for Deep Vein Thrombosis (DVT) is pregnant women. Considering the importance of pregnancy complications, the aim of this study was to determine the risk factors affecting DVT in the ICU.
Methods: In this study, pregnant women admitted to the ICU were included in the study, and instruments used in this study included a registry checklist that included questions. In this study, the clinical records of people with DVT were placed in 2 groups. The sample size included 28 patients with a diagnosis of DVT (case group) and 33 patients without a diagnosis of DVT (control group). Then, the data were analysed with SPSS 16.
Results: Results showed, in the 28 patients studied for whom the diagnosis of DVT was confirmed, the M(SD) of age status was 37.64 (2.57). There was also a significant association between DVT status with a history of thrombocytopenia, chronic diseases, diabetes, and high blood pressure (BP). (P<0.05).
Conclusion: In DVT, variables such as chronic diseases, diabetes, high blood pressure, and thrombocytopenia were effective. For this reason, it is essential to pay due attention to the factors affecting the development of DVT in clinical care for these patients.

Background: Gestational diabetes mellitus (GDM) causes various complications for the patient.
Methods: This study included patients admitted to the women’s ICU. These patients were divided into a case and control group. Vitamin D was measured in all patients using the same laboratory kit and the results were categorized as Vit D insufficiency, Vit D deficiency and Vit D severe deficiency. Data This study was conducted using a registry checklist that included questions on Serum vitamin D levels, Anemia, Education, Age and Body mass index (kg/m2) which was completed using information available in the patient's clinical record.
Results: Result showed, in the Case Group, the mean (SD) age was 28.96 (1.54), BMI was 24.6 (0.81), and 48% of the mothers had anemia. Also, in the control group, the mean (SD) age was 29.2 (1.22), BMI was 25.96 (1.69), and 28% of the mothers had anemia. also, the findings showed that in the Case Group, 56% of mothers had Vit D deficiency, 16% had Vit D insufficiency, and 28% had severe Vit D deficiency. Also, in the Control Group, 32% of mothers had Vit D deficiency, 56% had Vit D insufficiency, and 12% had severe Vit D deficiency. Also, different vitamin D percentages were reported in the two groups studied(p<0.05).
Conclusion: Given the relationship between vitamin D and GDM, it is recommended that necessary preventive measures be taken in this regard to prevent pregnant mothers from contracting the disease.

Background: D-dimer levels in the blood are analyzed to diagnose conditions such as deep vein thrombosis, aortic rupture, certain types of acute headaches resulting from vascular disorders, and pulmonary embolism. D-dimer levels can also be a determining factor in the prognosis of various cancers. This study aimed to compare D-dimer changes in women with gestational diabetes mellitus (GDM) to those in healthy women following elective cesarean section.
Methods: This study, based on the Iran ICU Registry (IICUR), collected data on women hospitalized in the women’s ICU. Data were extracted from the registry using a standardized checklist. The study method involved extracting information on women with GDM and healthy women from the registry checklist and patient clinical records, including laboratory results. All D-dimer measurements were performed using a standardized laboratory kit within the hospital and were documented in the patients’ clinical records.
Results: The findings showed no significant difference in D-dimer levels on the first day after the CS. Additionally, there was a positive correlation between D-dimer levels and both advanced maternal age and higher BMI, with D-dimer levels rising as age and BMI increased among the study participants.
Conclusion: Higher levels of D-dimer were detected in patients with gestational diabetes mellitus (GDM) compared to healthy women after cesarean delivery. These results indicate a potentially elevated risk of deep vein thrombosis (DVT) in women with GDM undergoing elective CS, underscoring the importance of targeted preventive and therapeutic measures.

Background: Nursing interventions in neonatal intensive care units of hospitals can occasionally turn into futile and costly measures, bringing about ethical conundrums. The aim of the present study was to investigate the relationship between futile care and moral sensitivity among nurses working at the neonatal intensive care units (NICU) of teaching medical centers in Gorgan city, North of Iran.
Methods: This 2024 descriptive-analytical study was conducted on 100 NICU nurses enrolled by quota sampling. Data collection tools included a demographic information questionnaire, the Lutzen moral sensitivity questionnaire, and a futile care questionnaire developed based on the Corley moral distress scale. The data gathered were entered into SPSS version 21 software and analyzed using descriptive (tables, mean, and standard deviation) and inferential (Pearson correlation coefficient) statistics.
Results: According to the results, the participants acquired the mean score of 62.12 ± 4.08 for moral sensitivity and 44.16 ± 5.81 for futile care. The Pearson correlation coefficient showed no significant association between moral sensitivity and futile care (r = - 0.12, P = 0.2).
Conclusion: Regarding the impact of nurses’ moral sensitivity and perception of futile care on the quality of health service provision, authorities are advised to consider plans and solutions (such as professional ethics training courses) to improve nurses’ awareness of ethical dilemmas, moral sensitivity, and attitudes towards futile care.

Introduction: Postoperative complications are a major problem in rhinoplasty surgery. The purpose of this study is the evaluation of the effects of dexmedetomidine with different doses on various complications after surgery.
Methods: Patients (N=60) were randomly divided into 3 groups; in the first group, 1 mg/kg of dexmedetomidine was prescribed before the end of the operation, and then 0.5 mg/kg of infusion was given in recovery. In the second group, 1 mg/kg of dexmedetomidine was received, then a 0.7 mg/kg infusion, and in the third group, an equal volume infusion of normal saline and then was administered as an infusion. Finally, demographic data and the duration of surgery, anesthesia, and hospitalization in the recovery room were analyzed. Also, complications caused by surgery were evaluated.
Results: It was found that dexmedetomidine in both doses of 0.5 and 0.7 mg/kg can reduce the incidence of pain at different times in the recovery room. Also, the amount of pain medication in the dexmedetomidine groups was significantly lower compared to the N/S group (P value ≤ 0.05), and this drug caused a significant decrease in systolic and diastolic blood pressure as well as an incidence of nausea and vomiting in the dexmedetomidine groups compared to the control group (P value ≤ 0.05).
Conclusion: Administration of dexmedetomidine infusion in patients undergoing surgery can be effective in improving hemodynamic parameters and reducing pain and nausea and vomiting. Also, dexmedetomidine had an effective role in reducing the use of analgesics after surgery.

Background: Coronary artery bypass graft (CABG) is a common surgery aimed at treating coronary artery disease. A vital aspect of CABG is managing hemodynamics during the cardiopulmonary bypass (CPB) phase, especially in terms of maintaining appropriate mean arterial pressure (MAP). Studies indicate that MAP levels during CPB can affect postoperative recovery, particularly regarding respiratory outcomes; however, the optimal MAP for enhanced recovery remains uncertain. This research examines the impact of two MAP targets (60 mmHg and 80 mmHg) on respiratory recovery after CABG surgery.
Methods: Eighty-six patients selected for elective on-pump CABG were grouped based on intraoperative MAP: 43 with a MAP of 60 mmHg and 43 with a MAP of 80 mmHg. We compared perioperative and postoperative metrics, such as mechanical ventilation duration, ICU stay, and re-intubation requirements. Statistical analysis used SPSS version 23, with a significance threshold of p < 0.05.
Results: Patients with a mean arterial pressure (MAP) of 80 mmHg experienced a significantly reduced duration of mechanical ventilation, averaging 8.23 ± 1.54 hours, in contrast to the 60 mmHg group, which averaged 10.02 ± 2.14 hours (p = 0.001). Additionally, the ICU stays were significantly shorter for the high MAP group, with a markedly lower re-intubation rate at 4.7%, compared to 27.9% in the lower MAP group (p = 0.007).
Conclusion: Sustaining a MAP of 80 mmHg during CPB enhances respiratory recovery after CABG. This is demonstrated by shorter mechanical ventilation durations and reduced ICU stays. These results indicate that effectively managing MAP during surgery could facilitate recovery by improving tissue perfusion and reducing ischemic injury, which in turn may lead to improved pulmonary outcomes

Background: Spinal anesthesia is widely used for cesarean deliveries due to its effectiveness and safety. However, it often causes post-anesthesia hypotension, which poses risks to both the mother and baby. Fluid preloading is a common method to prevent hypotension, yet the ideal type and volume of fluid remain uncertain. This research investigates how crystalloid and colloid preloading influence sensory block levels and hemodynamic stability during spinal anesthesia for cesarean sections.
Methods: Conducted as a randomized, double-blind, controlled trial at Imam Hossein Hospital in Tehran, Iran, from January to June 2022, this study involved 141 women undergoing elective cesarean sections under spinal anesthesia. Participants were randomly divided into three groups: normal saline, Ringer's lactate, or 6% hydroxyethyl starch (130/0.4). Sensory block levels were assessed every 5 minutes for the first 30 minutes and then at 60 and 90 minutes post-anesthesia. Continuous monitoring of hemodynamic parameters, such as systolic blood pressure and heart rate, was performed throughout the procedure.
Results: The findings revealed that normal saline achieved the highest maximum sensory block level. Hydroxyethyl starch (HES) showed a slightly longer duration of the block and a reduced incidence of hypotension. Despite these trends, the observed differences among the groups were not statistically significant.
Conclusion: This study demonstrates that the choice of preload fluid influences sensory block characteristics and hemodynamic stability during spinal anesthesia for cesarean sections. Additional research with larger sample sizes is necessary to refine fluid management strategies in this context.

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: Epistaxis can result from surgery, trauma, hypertension, hereditary hemorrhagic telangiectasia, or unknown reasons and can be treated in various ways. This study examined the pain severity related to epistaxis management in the emergency department of a tertiary otolaryngology facility.
Methods: This study was a descriptive and analytical cross-sectional analysis involving 129 patients. These patients were chosen from those referred to the emergency otolaryngology department for treatment of epistaxis. The treatment method was selected based on the severity of the epistaxis and whether a bleeding vessel was visible. Patients were categorized into nose pinching, anterior nasal packing, and bipolar electrocautery groups. For reducing pain from electrocautery and nasal packing, a mesh instilled with lidocaine and epinephrine is used before procedures. We assessed pain levels using a visual analog scale ranging from 0 to 10. We also studied the impact of xylocaine-prilocaine cream on reducing discomfort from anterior nasal packing in 42 patients who came to the emergency department with nosebleeds.
Results: The mean age of patients was 53.67 ± 19.96 years; 76 (57.6%) were male. Anterior nasal packing was the most common procedure for controlling epistaxis, with a mean pain severity of 6.61 (± 2.3). The pain score in the nostril-pinching group was significantly lower than in the other groups (P<0.001). In the second part of the study, the mean pain score in the xylocaine-prilocaine cream group was 4.52 ± 2.3, significantly lower than in the group without the cream (P<0.001).
Conclusion: According to the results, nasal packing was the most prevalent procedure for controlling epistaxis, which causes severe pain for patients. Application of xylocaine-prilocaine cream can reduce the severity of pain in comparison with lidocaine solution alone.

Background: Considering the epidemiological importance of COVID-19 disease, the high percentage of hospitalization, and the need to prevent morbimortality caused by this disease in children, this study was undertaken to determine the clinical manifestations of COVID disease in critically ill children who need hospitalization in a pediatric intensive care unit (PICU).
Methods: In this retrospective cross-sectional study, the population included critically ill children with COVID-19 who were hospitalized in the PICU of Firozabadi Hospital (Tehran, Iran) between 2020 and 2021. The study patients were examined in terms of clinical manifestations, laboratory results, course of the disease, and duration of hospitalization. From the patients' clinical records, the required information was extracted based on the variables and recorded in a pre-designed form. The obtained data were finally entered into SPSS software version 26 for statistical analysis.
Results: Among 80 patients examined, 44 (55%) were male, and 36 (45%) were female. The average age of the examined patients was 9.9±5.3 years (1-18 years). In terms of COVID-19 symptoms, the fever had the highest frequency in 65 patients (81.3%), followed by gastrointestinal, respiratory, and neurological symptoms in 41 (51.3%), 39 (48.8%), and 29 (36.3%) cases, respectively. Also, 13 (16.2%) patients had an underlying disease, and 17 (21.3%) patients died from COVID-19. Investigating the relationship between the underlying disease and patients’ deaths showed to be statistically significant (P = 0.002); in other words, having an underlying disease was significantly associated with a high mortality percentage (53.8% vs. 14.9%).
Conclusion: This study suggest that children with underlying diseases show higher mortality from COVID-19; therefore, it is necessary to prioritize the provision of medical services to children with underlying diseases in health system policies and patient management.

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: Stroke is one of the leading causes of annual mortality and disability for many individuals worldwide. Ischemic stroke has a high incidence and mortality rate, which significantly affects the quality of life and places an overwhelming mental and financial burden on the patients' families. Melatonin has a neuroprotective effect on patients with acute ischemic stroke. This study aimed to develop the employment of melatonin on clinical features of acute ischemic stroke.
Methods: This double-blind, placebo-controlled clinical trial was conducted on 70 patients with acute ischemic stroke not eligible for reperfusion therapy who were admitted to Bu-Ali Hospital. The consent form was taken, and all of the patients received routine management. Participants were divided into two groups. The 35 patients received 10 mg of melatonin once daily for five days, and others received 10 mg of placebo. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were recorded for all patients before treatment and after on days 5, 30, and 90.
Results: The 70 patients included in this study were based on inclusion criteria. The severity of stroke and the functional status of patients were compared in both groups. The melatonin group showed a significant reduction in the NIHSS score from day five up to day thirty compared to the placebo group (P = 0.001). There was no difference in the mRS score between the two groups in this study (P > 0.05). The relative frequency of the adverse event of sleepiness in patients receiving melatonin was significantly higher than in patients receiving placebo (P = 0.022).
Conclusion: Patients who receive melatonin early after stroke have better improvement in post-stroke recovery and disabilities. These findings verify the results of other studies.

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: 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: 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: 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: Delirium is a clinical neuropsychiatric syndrome, the main characteristic of which is a disturbance of consciousness affecting the patient's psychological state, and various factors are effective in causing it. The aim of the study is the prevalence of delirium in Iran.
Methods: This study investigated the prevalence of delirium in a group of patients hospitalized in Iranian hospitals. The search was including PubMed, Scopus, ISI, Science Direct, and Google Scholar search engines in Farsi and English languages. The researchers designed a checklist and then analyzed the extracted results using the CMA software.
Results: This study's initial search yielded 766 articles, of which the initial screening eliminated 458. 98 articles were excluded from the study due to repetition in the search, and finally, 25 articles were included in the analysis stage. According to the findings, the overall delirium prevalence is 22% (CI: 16.8-28.3%), the overall delirium prevalence in heart surgery patients is 20.2% (CI: 12.7-30.6%), and the delirium prevalence in the elderly is 44.3% (CI: 20.7-70.8%).
Conclusion: It is necessary to conduct preventive studies in this field to reduce this amount.

Background: Acute kidney injury (AKI) after cardiac surgery leads to serious outcomes, including higher mortality and increased risk of chronic kidney disease. The pathophysiology includes hemodynamic changes, inflammation, and direct renal damage. Key risk factors are chronic kidney disease, older age, diabetes, hypertension, and surgical issues like cardiopulmonary bypass (CPB) and nephrotoxic agents. CPB can cause inflammation, worsening renal blood flow and glomerular filtration rate (GFR). Preventing AKI requires a comprehensive approach that encompasses preoperative optimization, intraoperative management, and postoperative care. Important strategies include optimizing the CPB circuit, using blood cardioplegia for better myocardial and renal protection, and managing fluid balance. This study aimed to examine the factors leading to acute kidney injury during heart surgery and to identify strategies for addressing it.
Methods: Research articles from information sources and databases over the past five years were analyzed using keywords. The studies were classified and summarized according to the disease's pathophysiology and management strategies, and clinically evaluated. The findings were assessed based on clinical evidence and compiled into a review article.
Results: Amino acids are essential for renal protection, as they enhance blood flow, improve GFR, scavenge reactive oxygen species (ROS), modulate inflammation, support cellular energy, inhibit apoptosis, aid in protein synthesis, and maintain renal autoregulation. Specific amino acids, including L-Arginine, L-Citrulline, L-Carnitine, Taurine, L-Glutamine, L-Cysteine, L-Methionine, L-Ornithine, L-Tyrosine, and Branched-Chain Amino Acids (BCAAs), have demonstrated protective effects. These amino acids can enhance postoperative GFR and potentially lower the risk of AKI by bolstering renal functional reserve and stimulating local renal growth factors.
Conclusion: A comprehensive strategy incorporating preoperative, intraoperative, and postoperative measures, along with the judicious use of amino acids, is essential for preventing AKI and improving outcomes in patients undergoing cardiac surgery.

Background: Shivering is prevalent in 65% of patients undergoing spinal anesthesia, resulting in adverse outcomes and increased healthcare expenses. Ketamine, an N-methyl-D-aspartate receptor antagonist, and tramadol exhibit analgesic properties, potentially mitigating post-spinal shivering. This scoping review aims to explore the existing literature on the intravenously administered ketamine and tramadol in reducing the incidence of shivering subsequent to spinal anesthesia.
Methods: This scoping review, conducted from April to June 2024, examined studies on intravenous ketamine and tramadol for shivering post-spinal anesthesia. Using MeSH terms, researchers searched Scopus, Web of Science, PubMed, Cochrane, Google Scholar, Iran SID, and Iran ISC. After excluding duplicates and irrelevant studies, six pertinent studies were included.
Results: The search strategy identified 1316 articles, with 1258 remaining after removing 58 duplicates. Title and abstract screening excluded 6 conference papers, 42 systematic reviews, 94 book chapters or animal studies, and 2 theses. Full-text review of 97 studies resulted in excluding 78 unrelated cases, 1 language discrepancy, and 11 without full-text availability. Ultimately, 6 studies (5 randomized controlled trials and 1 prospective cohort) from Iran, Pakistan, India, Egypt, and Ethiopia found ketamine more effective than tramadol in preventing shivering.
Conclusion: Ketamine is more effective than tramadol in preventing post-spinal anesthesia shivering, with fewer adverse effects like nausea, vomiting, and bradycardia. These findings support its use for shivering management. Future research should optimize dosing to reduce hallucinations, explore other side effects, and prioritize diverse study parameters and safety evaluations.

Background: Nowadays perioperative adjuvants become popular, and they can decrease post-operative opioid consumption gradually, Lidocaine is one of those. It is sodium channel blocker and has a multimodal effect. It is a local anesthetic that has analgesic, antiarrhythmic, anti-hyperalgesic, anti-inflammatory, and anti-neuropathic effect. With these descriptions, can decreases hospital staying period, ameliorate pain scores with post-operative analgesia with opioid-sparing effect, and finally has cost efficiency. It is available, inexpensive, simple, safe, and its’ consumption is easy, making faster bowel habits return and better rehabilitation after the surgeries. This narrative review has been written to evaluate these properties of Lidocaine.
Methods: The aim of this narrative review was assess the significance of peri-operative lidocaine as an adjuvant to manage acute postoperative pain. The manuscript has been presented as a comprehensive search that was conducted across several major databases, included: PubMed, Scopus, Web of Science, and Google Scholar. The search focused on studies published between 1990 and 2024 to provide a broad perspective on both historical and current evidence.  
Results: This review has reported the results of several articles. It can be obvious perioperative Lidocaine consumption as an adjuvant reduce post-operative pain perception, improve returning bowel habits, and post-surgical better rehabilitation and pain control.
Conclusion: Review of these articles illustrated;perioperative systemic lidocaine  as an adjuvant with efficiency of reducing post-operative pain perception, has an opioid-sparing effect,  improving intestinal activity and decreasing post-operative recovery period. Finally bring more comfort for patients and accompanying, less pressure on staff and most importantly is economical for both sides.

Background: Ventilator-associated pneumonia (VAP) is a highly prevalent complication of ICU admission. the aim study This systematic review and meta-analysis aimed to determine the effect of an oral care program on oral health (OH) status and prevention of VAP in ICUs in Iran.
Methods: This systematic review and meta-analysis were conducted on the group of articles published on patients hospitalized in ICUs in Iran in 2024. This review included published articles that aimed to assess the effectiveness of care programs or educational interventions in preventing VAP in patients hospitalized in ICUs in Iran. Data search and extraction were performed by two independent researchers in Persian and English between 2004 and 2024. The extracted articles were entered into EndNote software and analyzed using CMA software.
Results: The results showed that, at the beginning of the search, 92 articles were found, and after the final conclusion, five articles entered the meta-analysis stage. Also, VAP prevalence in intervention group was 15% (CI: 6.2-31.9%), and VAP prevalence in control group was 39.5% (CI: 21.1-61.4%).
Conclusion: It is recommended for preventing VAP that OH programs and interventions be carried out in an ICU.

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: Academic medicine depends on mentoring as a way for people to work together to improve their personal and professional lives. However, more clinical, administrative, research, and other educational demands are putting stress on medical faculty mentoring. Therefore, we need to evaluate the evidence supporting the value of mentoring.
Methods: In the present systematic review, 74 related studies were retrieved from international and national databases. In addition, the gray literature was searched via Google Scholar. Out of these, 16 studies were selected for the conduction study. We extracted the necessary data for our study from the research and stored it in Excel. We obtained the variance of the research using the binomial distribution. In addition, heterogeneity of research was done by the I2 index. We evaluated the information using a random effects model.
Results: The results indicated that the mentoring program included three stages: “Targeting and Familiarization with the Implementation of the Mentoring Program,” “Mentoring Program Implementation,” and “Evaluation of the Mentoring Program.” The Traditional One-to-One Mentoring Program, the Peer Mentoring Program, and the Distance Education Mentoring Program were some of the ways that the plan was put into action.
Conclusion: Mentoring is perceived as an important part of academic medicine, but the evidence to support this perception is not strong.

Background: Scorpion stings have been reported to induce inadequate block or block failure in local anesthesia. The present study has reviewed the resistance to local anesthetics in patients with a history of scorpion stings.
Methods: Articles from domestic and foreign journals in databases such as SID, IranMedex, Magiran, Uptodate, Google Scholar, Cochrane, Scopus, and Web of Science from 2010-2024 were searched, and ultimately 13 related high-quality articles based on STROBE were included in this review.
Results: According to the results of the included studies, which have dealt with scorpion sting cases and resistance to local anesthetics, patients with a history of scorpion stings experience significantly prolonged times of onsets for both sensory and motor blocks and the peak of sensory and motor blocks. Some of these patients have failed/inadequate sensory and motor block.
Conclusion: According to the mentioned materials, the prevalence of resistance to local anesthetics is higher in patients with a history of scorpion stings.

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.

Background: Dexmedetomidine, a selective α2-adrenergic receptor agonist, is widely used for sedation and analgesia in critically ill pediatric patients. Its dose-dependent modulation of pre- and postsynaptic receptors induces sympatholysis and vascular effects. While systemic hemodynamic impacts are well-documented, its influence on pulmonary artery pressure (PAP) remains underexplored. This systematic review evaluates dexmedetomidine’s effects on PAP.
Methods: This systematic review analyzes studies from databases including SID, IranMedex, Magiran, Google Scholar, Cochrane, Scopus, and Web of Science (2005–2024). Keywords such as “dexmedetomidine,” “pulmonary artery pressure,” and “pulmonary effects” identified cross-sectional studies assessing PAP changes. Fifteen high-quality articles met inclusion criteria.
Results: Dexmedetomidine’s effects on PAP seem inconsistent. Animal studies have reported both increased PAP with intravenous administration and no significant changes. Paradoxically, some models demonstrated PAP reduction in hypertensive states via suppressed vascular contraction. Human studies have observed transient PAP elevation after bolus dosing, though loading doses have shown no sustained pulmonary vascular effects. Preoperative administration reduced pulmonary vascular resistance and mean arterial pressure. Secondary pulmonary outcomes included improved oxygenation and lung mechanics in restrictive lung disease, though benefits were not universal.
Conclusion: Dexmedetomidine exhibits variable PAP modulation, with evidence suggesting transient pressure spikes after bolus doses but neutral or beneficial effects in controlled administrations. Animal-human discrepancies highlight physiological differences, necessitating further clinical research. Beyond hemodynamics, dexmedetomidine may enhance oxygenation and ventilation-perfusion matching while mitigating pulmonary inflammation, though inconsistent oxygenation outcomes underscore context-dependent variability. These findings emphasize cautious dosing in pulmonary hypertension and identify gaps for future human trials to clarify its role in cardiopulmonary management.

Background: Lung edema is a life-threatening condition associated with prolonged intensive care unit stay and high mortality. The increased extravascular lung water (EVLW) causes impaired lung compliance and refractory hypoxemia. Although there are promising methods for the detection of EVLW, there is not yet a universally accepted one, and a systematic approach to the problem is missing. The discussion in this article is on the potential of the described assessment methods and techniques and reveals the strong and weak points according to their practical application.
Methods: The discussion in this article is on the potential of the described assessment methods and techniques. According to our comparative analysis, the strong and weak points regarding their practical application are presented in a table.
Results: This review article summerizes advantages and disadvantages of the most common methods in clinical practice.
Conclusion: Although there are promising methods for the detection of EVLW, there is not yet a universally accepted one, and a systematic approach to the problem is yet to be found.

Background: Considering the vital role of the mechanical ventilator in providing respiratory support to patients, it is important and necessary to pay attention to and identify the common alarms of this device and to sensitize the medical team to these warnings.
Methods: This integrative review study was conducted in order to evaluate both printed and non-printed studies. Searching was done from 20/09/2010 to 20/09/2023 based on Prisma 2009 guidelines in Scopus, PubMed, Embase, and ProQuest databases. The keywords included "pulmonary ventilator," "mechanical ventilators," "ventilator," "respirators," "alarm," "clinical alarms," and "alarm fatigue," and the articles were selected based on the entry criteria
Results: Out of a total of 264 retrieved articles, 13 articles were included in the study. The obtained results indicated that the most frequent alarms were High PIP, High RR, and High/Low MV, which are not only important alarms, but also have high prevalence in the intensive care unit. Therefore, great attention should be paid while setting the alarm range and reacting to auditory and visual alarms.
Conclusion: Failure to pay attention to alarms and setting them improperly has a significant effect on the medical team’s fatigue, which leads to a decrease in the quality of care. Therefore, using a correct management strategy in order to increase the medical team’s knowledge and reduce unnecessary alarms can play an effective role in improving the quality of the services provided to the patients hospitalized in special care units. Identifying the important alarms of mechanical ventilators and using the appropriate strategy to set the alarms correctly can increase the quality of the care provided for the patients under mechanical ventilation.

Lupus nephritis, a severe complication of systemic lupus erythematosus (SLE), often leads to significant renal impairment requiring intensive care. The management of lupus nephritis in the intensive care unit of Dr. Soetomo General Hospital extends to various patient populations, including adult patients undergoing hemodialysis and lupus nephritis with sepsis. The management of lupus nephritis entails not only renal complications, but also the challenges associated with hemodialysis. Close monitoring of fluid and electrolyte balance is essential, along with adjustments in dialysis parameters to optimize renal function and prevent further complications. Additionally, we may need to tailor immunosuppressive therapy to the patient's renal replacement therapy regimen, taking into account the potential impact on drug clearance and toxicity. Patients with SLE undergoing immunosuppressive therapy are also at risk of developing infections, which can progress to sepsis and require more intensive care. Treatment of lupus nephritis in ICU generally necessitates intensive care, which includes hemodialysis and sepsis control.

Decompression sickness (DCS) is a rare but serious risk for divers, characterized by the formation of inert gas bubbles in the bloodstream and tissues due to rapid decompression. This case report highlights a 25-year-old male recreational diver who developed type 2 DCS, presenting with neurological and pulmonary symptoms following a dive. Upon admission to the emergency department, the patient presented with severe shortness of breath, accompanied by nausea, dizziness, numbness and tingling sensations throughout the body, and joint and muscle pain. Physical examination revealed signs of respiratory distress, bilateral upper and lower limb spasticity resembling decorticate posturing, notable hypertonia, and generalized paresthesia. Despite the absence of a hyperbaric chamber facility, the patient was successfully treated with 100% normobaric oxygen (via a Jackson-Rees circuit) and adjunctive medications, including intravenous fluids, dexamethasone, fentanyl, and midazolam, resulting in rapid symptom resolution. The patient was discharged without residual symptoms and remained symptom-free at the one-month follow-up. This case underscores the importance of recognizing DCS and demonstrates that 100% normobaric oxygen therapy and corticosteroids can be effective in treating DCS when a hyperbaric chamber is unavailable.

Maternal morbidity and morbidity are among the most important concerns of the World Health Organization and every country’s healthcare system. Anesthetic management of parturients with a history of acute myocardial infarction (MI) presents unique challenges, particularly in the 3rd trimester when the pregnancy is approaching its end. Herein we will present anesthetic management of a parturient who underwent a cesarean section one week after acute myocardial infarction.

Trigeminal neuralgia (TN) is one of the most severe painful conditions known to man. Contradictory results regarding the effectiveness of pulsed radiofrequency (PRF) treatment of the trigeminal ganglion have been published in the literature. In the past few years, reports in support of prolonged (extended duration) radiofrequency treatment of the trigeminal ganglion have been emerging. Unlike most other interventional procedures that include nerve or ganglion destruction and its resultant potential complications, PRF treatment is believed to be much safer. Working toward the establishment of effective PRF protocols proves highly valuable in the management of TNs refractory to medical treatment. This article showcases the successful control of two cases of refractory trigeminal neuralgia (TN) through extended duration pulsed radiofrequency treatment. Recent studies, however, suggest prolonged PRF ablation may provide a more durable solution. PRF offers a potentially safer alternative to traditional interventions by minimizing nerve destruction.

During surgical procedures, intraoperative neuromonitoring (IONM) allows for real-time assessment of neural structures like the brain, spinal cord, and peripheral nerves. It enables continuous monitoring and early detection of potential damage during surgery. Adequate neuromonitoring is crucial in anesthesiology to maintain optimal brain function and neurological status during procedures. Muscle twitching during IONM is often associated with electromyography (EMG) or motor-evoked potentials (MEPs) and can indicate nerve activation or irritation. Two cases of patients undergoing posterior spinal fusion procedures experienced complications related to muscle twitching during surgery. In the first case, a 45-year-old male patient experienced damage to his lower lips due to muscle twitching in neuromonitoring. In the second case, a 36-year-old man suffered a tongue injury because a mouth guard shifted during surgery. IONM is a crucial component of modern surgical practices, but the cases presented highlight the potential for muscle twitching to cause patient injuries. Surgical teams must prioritize communication and the implementation of protective measures to safeguard against such occurrences. Future research may provide more comprehensive guidelines to enhance patient safety during IONM.

A 45-year-old male patient was diagnosed with papillary thyroid cancer and was scheduled for total thyroidectomy. Three months before, he had undergone laryngeal surgery for squamous cell carcinoma of the larynx. Before the operation, an internal consultation was performed and no respiratory or cardiac complications were reported. Upon visiting Besat Hospital, the patient's vital signs were stable. Establishing a safe airway due to tracheostomy breathing was a challenge. But after consultation with the anesthesia team, the endotracheal tube was successfully inserted. This surgery lasted for 5.5 hours smoothly and without complications. The patient was transferred to the intensive care unit after the operation and was discharged in a stable condition after recovery.

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.

There is a rare genetic disorder called Jervell-Lange Nielsen syndrome that leaves people congenitally deaf and with a long QT interval. This can lead to deadly heart rhythm problems and sudden death. For the treatment of hearing loss, cochlear implants, and for the treatment of heart difficulties, beta-blockers, and in certain circumstances, implantable cardioverter defibrillators, arrhythmias, syncope attacks, and sudden death are recommended. We discuss the case of an 8-year-old child who was referred for cochlear implantation after being diagnosed with Jervell-Lange Nielsen syndrome. In this study, we want to deal with patient management preoperatively and during surgery and describe the side effect of this syndrome.

Neuromuscular disorders are a wide range of conditions that weaken muscles. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an uncommon acquired immune-mediated prejunctional disorder that is not caused by an injury. This case report presents the anesthetic management of a 48-year-old male patient diagnosed with CIDP who required an emergency umbilical herniorrhaphy. The patient, weighing 95 kg and with a height of 172 cm, presented with acute abdominal pain, nausea, and vomiting, and had a notable history of intravenous immunoglobulin (IVIg) treatment and oral opium addiction. Anesthesia was induced using rapid sequence induction techniques, and general anesthesia was maintained with total intravenous anesthesia (TIVA). The operation was completed without complications, despite the patient experiencing transient symptoms of Raynaud's phenomenon during the procedure. Postoperatively, the patient had an uneventful recovery without respiratory complications or exacerbation of CIDP symptoms. This case highlights the complexities of anesthetic management in patients with CIDP due to potential risks associated with neuromuscular weakness, muscle relaxants, and the effects of immunosuppressive therapies. Further research is warranted to standardize anesthetic protocols for this patient population.

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.

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.

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.

Spinal anesthesia with bupivacaine is widely used for cesarean sections but can rarely cause angioedema, a rapid swelling of deep tissues that may lead to airway obstruction. This case report presents the occurrence of angioedema in a pregnant woman with postoperative hyper IgE levels following spinal anesthesia. It highlights the intricate interplay between drug sensitivity, immune dysregulation, and the physiological changes associated with pregnancy. We present a case of a 32-year-old woman with post-operative hyper IgE levels who developed angioedema shortly after getting spinal anesthesia with bupivacaine for a cesarean section. It should be noted that the patient had no prior history of allergic reactions, making the case particularly interesting and challenging. This report's goal is to: 1. Report details of the clinical presentation, management, and outcome of this unusual patient; 2. Investigate the potential etiologies of angioedema, with a focus on the relationship between bupivacaine sensitivity, hyper IgE, and other possible factors; and 3. Highlight the challenges in diagnosis and management when facing angioedema in patients with atypical presentations.

Fat embolism syndrome (FES) is a rare but life-threatening condition often associated with long bone fractures, particularly femoral fractures. It typically manifests within 24–72 hours post-injury, presenting with a combination of neurological, pulmonary, dermatological, and hematological symptoms. This case report describes a 48-year-old male who sustained a femoral fracture in a work-related accident and subsequently developed FES during perioperative management. Despite aggressive interventions, including mechanical ventilation, hemodynamic support, and lipid emulsion therapy, the patient’s condition deteriorated, leading to cardiac arrest and death. The case highlights the diagnostic and therapeutic challenges of FES, emphasizing the need for early recognition, multidisciplinary management, and advanced diagnostic tools. The possibility of inadvertent intrathecal administration of an incorrect drug or local anesthetic systemic toxicity (LAST) further complicates the diagnosis, underscoring the importance of meticulous documentation and verification of administered medications. This report aims to contribute to the growing body of evidence necessary to address these significant research gaps and advance patient care in high-risk perioperative scenarios.

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.

This case report outlines a rare occurrence of accidental intrathecal injection of atracurium during spinal anesthesia for knee arthroscopy in a 22-year-old male patient. The solution intended to be bupivacaine mixed with fentanyl raised concerns after the ampule was discarded before verification. Fortunately, the patient showed no signs of paralysis or analgesia post-injection. The anesthesia team promptly administered high-dose methylprednisolone to reduce potential neurotoxic effects and monitored the patient closely in the Post-Anesthesia Care Unit. After six hours of stability and no neurological deficits, follow-up evaluations confirmed no lasting damage, allowing for safe discharge after 24 hours. This incident underscores the critical need for rigorous drug verification and safety protocols in anesthesia to prevent medication errors.

A 37-year-old male with no significant medical history presented to the hospital following a fall into a pit containing animal feces, resulting in aspiration pneumonia. He was intubated and treated with antibiotics, and after 15 days of hospitalization, he was discharged in stable condition. Four days later, he returned with scrotal pain and swelling, diagnosed as epididymitis, and successfully treated with ceftriaxone. On September 1st, he re-presented with headache, dizziness, and malaise, and imaging revealed a brain abscess. Despite undergoing stereotactic surgery, the patient experienced persistent neurological symptoms, including fluctuating consciousness, nausea, and vomiting. He subsequently developed hydrocephalus, necessitating the placement of an external ventricular drain and transfer to the ICU. The patient was treated with antifungal and antibiotic therapies, but his clinical condition deteriorated. Despite intensive care, he succumbed to his illness after 19 days in the ICU.

Intravenous cannulation can be a challenging issue in hospitalized patients, especially during the perioperative period. Objectives: In this study we will present our experience about an emergency popliteal vein cannulation during surgery. We successfully cannulated the popliteal vein in a prone position with an ultrasound guide in an emergency situation. Conclusion: The popliteal vein can be a safe intravenous access during surgeries in a prone position without significant adverse events.