Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients.
Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted.
In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA.
Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B.
Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA.

Background: Herniorrhaphy is the most common inguinal surgery in children. Several methods such as caudal block, ilioinguinal iliohypogastric block, and wound infiltration have been studied for postoperative pain management in these patients. Caudal block is common in pediatrics. However, ilioinguinal iliohypogastric block is effective and less invasive. Previous studies have shown different comparative results regarding these blocks. This study compares the analgesic effect of caudal and bilateral ilioinguinal iliohypogastric block with ropivacaine in children.
Methods: This study is a randomized double-blind clinical trial. A total number of 66 patients aged between 1-7 years that volunteered for bilateral inguinal hernia repair were randomly assigned to two groups. After general anesthesia, caudal block with 1cc/kg ropivacaine 0.2% was performed for 33 patients and sonography-guided ilioinguinal iliohypogastric block with 0.1 cc/kg ropivacaine for each side was considered for another group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) during anesthesia, pain score (CHEOPS), delirium score (PAED), nurses’ satisfaction score (RN), need for additional narcotic, recovery time, and complications were compared in these two groups.
Results: There was no statistically significant difference between the two groups in terms of hemodynamic parameters during the anesthesia process. Furthermore, the two groups had no statistically significant difference in CHEOPS score (6.27 in ilioinguinal block and 5.70 in caudal block, P=0.061), PAED score (5.64 vs 5.30, P=0.144), and RN satisfaction score. However, the need for narcotics, mean recovery time, and block complications were comparable in two groups.
Conclusion: Caudal block and ilioinguinal block are equally effective for post herniorrhaphy pain and emergence agitation management in pediatrics. Additionally, no differences were observed in complications. It is recommended that the study be performed with a larger sample size.

Background: The effect of using high flow oxygen delivery through the nasal cannula (HFNC) in COVID-19 patients has been associated with different results. This study aimed to evaluate the effect of different HFNC temperatures in COVID-19 patients.
Methods: Patients were randomly divided into three groups under high current oxygenation with temperatures of 31, 34, and 37. Except for the temperature, other device settings were set equally. After 24 hours, clinical conditions were on the agenda and compared with the conditions before the intervention.
Results: Fever, sore throat, malaise, diarrhea in patients of 31 degree group and indicators of nausea, cough, body pain, headache have changed the most in 37 degree group. Abdominal pain has shown the greatest change in the 34 degree group. PR, DBP, and SpO2 indices changed the most at 31 degrees and RR and SBP at 37 degrees. PR, RR, SBP and SPO2 indices showed significant values in intra-group comparison, and in inter-group comparison, only PR, RR indices had significant differences. In intra-group analysis, PaCO2, WBC, CRP, ESR and ferritin had significant changes, and in inter-group comparison, none of the indicators had significant differences.
Conclusion: Based on the results of the present study, reducing the temperature in the use of HFNC can improve the clinical conditions of patients with COVID-19.

Background: Preoperative anxiety in children is a common problem that can affect the anesthesia and postoperative period. Numerous methods, mainly pharmacological ones, have been used for controlling preoperative stress. Acupressure is a simple, noninvasive, and cost-effective method that has been used as a perioperative medicine for controlling pain or preventing postoperative nausea and vomiting. The present study aimed to comparatively investigate the effect of acupressure and oral midazolam on preoperative anxiety control.
Methods: 76 patients were randomly included in the study before surgery. Whereas in one group, 0.5 mg/kg oral midazolam was prescribed 15 minutes before the induction, in another group, acupressure of EXHN-3 point was applied for 15 minutes. In both groups, the patients’ separation anxiety level, Ramsay score, recovery length, and RN satisfaction factor were recorded and compared.
Results: Children aged 1–7 years received either oral midazolam or acupressure. Although the children in the midazolam group had lower rates of preoperative anxiety and showed easier separation from their parents, the difference was not statistically significant P= (0.076). Ramsay sedation scale, was compared in the two groups. The overall difference was not statistically significant. The satisfaction of the PACU nurse was recorded using a 4-point scale. The two groups were statistically comparable in this regard (P=0.155). The only variable with a significant difference between the two groups was the mean recovery time, which was significantly shorter in acupressure group (P<0.001).
Conclusion: Acupressure can reduce preoperative anxiety in children; however, this effect is less than the effect of oral midazolam.

Background: Electrolyte imbalance is one of the influential causes in determining the outcome of traumatic patients. One of the electrolytes that get less attention from healthcare providers is magnesium. Therefore, this study investigated the frequency of hypomagnesemia in trauma patients hospitalized in the intensive care unit.
Methods: The descriptive-cross-sectional study was conducted after approval at Zahedan University of Medical Sciences on 118 patients with multiple traumas from 2021 to 2022. Patients were selected by convenience sampling method according to the inclusion criteria. Age, sex, weight, body mass index, level of consciousness, and level of blood serum electrolytes were measured and recorded on the first and fifth days after hospitalization. The data were analyzed and compared using descriptive statistics, chi-square, and independent t-test.
Results: Of 118 patients studied, 81 (68.6%) were male, and 38 (31.4%) were female. On the fifth day after hospitalization, the mean serum magnesium level of the patients was 1.4 ± 0.81 mg/dL. 87 patients (73.7%) had normal magnesium serum levels, 27 patients (29.9%) had hypomagnesemia, and 4 patients (3.4%) had severe hypomagnesemia. No statistically significant relationship existed between hypomagnesemia and gender, age group, and comorbidity diseases. The level of other blood serum electrolytes on the fifth day after hospitalization, age, weight, body mass index, and status of consciousness was not statistically significant between the two groups of patients with hypomagnesemia and without hypomagnesemia.
Conclusion: Trauma and the subsequent treatment measures lead to decreased magnesium serum levels in intensive care patients. Therefore, the normal serum level of other electrolytes should not be considered a diagnostic indicator for the normality of magnesium serum level. Magnesium should be measured along with other electrolytes to make a timely decision to replace magnesium supplements in a patient with hypomagnesemia.

Background: The effect of ozone therapy in reducing inflammation and radicular pain with lumbar transforaminal epidural steroid has not been sufficiently investigated. This study compares the effectiveness of transforaminal steroid injection with or without ozone therapy on radicular (leg) pain.
Methods: In a double-blind clinical trial, 40 patients with chronic radicular pain whose pain did not respond to conservative treatments were selected and randomly assigned to two treatment groups of A and B. Group A underwent transforaminal epidural steroid injection with ozone and group B underwent transforaminal epidural steroid injection without ozone. The intensity of pain with the Numerical Rating scale (NRS) scale and the degree of disability with the Oswestry Disability Index (ODI) questionnaire were compared in both groups of patients before treatment, 24 hours after treatment, 1 and 3 months after treatment.
Results: Both groups of A and B were similar in terms of age, gender, pain duration, pain intensity and disability before treatment (P>0.05). In treatment groups of A and B the mean of pain score 24 hours after treatment was 6.95±2.50 and 6.15±3.50 (P=0.495), one month after treatment it was 4.10±2.59 and 3.25±2.32 (P=0.355) and the third month of treatment was 3.85±3.01 and 3.55±3.25 (P=0.429). respectively. The mean of ODI 24 hours after treatment was 22.50±10.78 and 18.95±15.24 (P=0.401), one month after treatment it was 19.40±7.76 and 7.95±5.42 (P <0.001) and three months after treatment it was 17.40±7.26 and 13.55±8.70 (P=0.137).
Conclusion: It seems that adding ozone to corticosteroids has very little effect in reducing pain, and it did not have a significant effect at least in the study. One of the reasons may be the limitation of the sample size in the study, so it is suggested to conduct more studies in this field.

Background: The University of Washington quality of life questionnaire (UW-QOL) is widely used to evaluate the quality of life for head and neck cancer patients. The purpose of this study is translation of the UW-QOL questionnaire's into Persian.
Methods: After translation and cultural adaptation of the UW-QOL, the questionnaire was distributed among 100 head and neck cancer patients. Internal reliability of the translated UW-QOL was determined using Cronbach's alpha coefficient. The validity was determined by Spearman correlation coefficient between UW-QOL and 12-Item Short Form Survey (SF-12). The test – retest reliability was measured by Intraclass Correlation Coefficient (ICC) after one week.
Results: Cronbach's alpha coefficient was more than 0.75 and ICC coefficient was more than 0.80 in all variables. The UW-QOL questionnaire composite score had a positive significant association with SF-12 questionnaire total score (Spearman's Correlation Coefficient= 0.70, P< 0.0001).
Conclusion: In conclusion Persian translation of the UW-QOL questionnaire has acceptable reliability and validity and is as valid as the original English version in evaluating the quality of life for patients with head and neck cancer.

Background: The ideal endotracheal tube cuff pressure to prevent aspiration is 20-30cmH2O. Lower pressures will result in aspiration and high pressures will lead to tracheal mucosal injuries. Change in patient position may also lead to change in cuff pressures. Our study mainly aims at measuring the cuff pressures in supine, Trendelenberg, reverse Trendelenberg, neck flexion and rotation to one side.
Methods: This prospective observational study was conducted after obtaining ethical clearance and patient consent. 50 patients of ASA Classes I and II were included. All patients were intubated with Romson cuffed endotracheal tubes of size 7.5mm for females and 8.5mm for males. The cuff was inflated and cuff pressure set at 28cm H2O using CuffillsR syringe. With head in neutral position, cuff pressure was measured in 15 degree Trendelenberg and reverse Trendelenberg positions. Using angle meter app, the angles were fixed for flexion, extension, and rotation to one side at 30 degrees. The cuff pressure was recorded after 120 seconds after placing the patient in all these positions.
Results: The cuff pressure increased by 12.48cm H2O flexion and the cuff pressure increased to 33.22cm H2O in extension. The cuff pressure increased to 38.10cmH2O on rotation, increased by 10.58cmH2O from neutral position in Trendelenberg position and increased by 8.74cmH2O in reverse Trendelenberg position.
Conclusion: The cuff pressure changed significantly in all the positions.

Background: Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach.
Methods: 72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12.
Results: There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P>0.05), although DBP fluctuation>20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively).
Conclusion: The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.

Background: Anesthesia techniques significantly impact the long-term and short-term outcomes after cancer surgery such as cancer recurrence, post-discharge hospitalizations, and duration of hospitalization, probably by decreasing the neuroendocrine stress response during surgery, reducing opioid requirement, reducing post-operation nausea vomiting, and pain, and interacting with the immune system. Research in recent years has provided ample evidence that epidural anesthesia produces better post-operation outcomes compared to general anesthesia. The purpose of this study was to evaluate the effects of epidural anesthesia on cancer recurrence after surgery in gastrointestinal cancer patients.
Methods: To perform this study medical records from the archive of gastrointestinal cancer patients who have undergone surgery at Imam Khomeini Hospital Complex (IKHC) from the years 1390 to 1400 were used. The variables required for the study were obtained from the records. The data obtained were analyzed by the SPSS software and the significance value of < 0.05 was considered.
Results: Our study included 8987 patients out of which 1673 patients received epidural anesthesia. Cancer recurrence was reported after 90 days and 180 days and for the type of surgery (using or not using epidural anesthesia) B value for 90 days and 180 days was 0.079 and 0.018 respectively. Thus causality was not established for the type of surgery with recurrence of cancer.
Conclusion: The findings of our study indicate that the rate of gastrointestinal cancer recurrence after surgery is not influenced by having or not having epidural anesthesia.

Background: Breast surgeries can be associated with acute postoperative pain which if left untreated might lead to chronic pain therefore pre-emptive treatment post surgery can be favourable. The aim of our study was to evaluate the analgesic efficacy of PECS 2 compared to SAB to reduce post operative pain in breast surgeries done under general anaesthesia.
Methods: A total of 50 patients belonging to ASA 1 & 2 undergoing elective breast surgery were randomly assigned into two groups. Pectoralis nerve block 2 group received 25ml of 0.5% Ropivacaine and Serratus anterior plane block group received 25ml of 0.5% Ropivacaine under ultrasound guidance post induction. The primary outcome was to compare the duration of post operative analgesia with PECS 2 and SAB. Other outcome parameters observed were total rescue analgesic requirement, change in post operative hemodynamic parameters and complications if any.
Results: There was a significant difference in duration of post operative analgesia between two groups with Mean Duration of post operative Analgesia in PECS 2 being 510±32.6mins and SAB being 316±26.5mins (p=0.036). The VAS score as well as number of rescue analgesic requirement with PECS 2 was lesser when compared to SAB.
Conclusion: Ropivacaine in ultrasound guided PECS 2 block provided superior analgesic profile when compared to SAB.

Background: Whether in a hospital setting or in the community, medical students are exposed to cardiac arrests. Fast response and effective resuscitation are main determinants for decreasing mortality and morbidity due to cardiac arrests. We assessed the effectiveness of anesthesiology rotation in acquiring cardiopulmonary and cerebral resuscitation for medical students.
Methods: A pre-test/post-test quasi experimental design was undertaken, comprising A fortuitious sample of medical students who were undergoing anesthesiology rotation at Tehran University of Medical Sciences hospital complexes during the academic year 2021-2022 using a self-administered questionnaire to evaluate their theoretical comprehension, knowledge, skills and before and after the rotation.
Results: The study revealed an increase in theoretical scores (mean dif +2.6/20), increased in self-assessment knowledge scores (mean dif + 0.84/5), as well as an increased in self-assessment skill scores (mean dif +0.96/5). The highest scored were witness in students with previous cardiopulmonary resuscitation (CPR) experience.
Conclusion: It is of extreme importance for medical students to participate in anesthesiology rotations. It is essential for possessing the appropriate knowledge and skills to provide effective resuscitation care and gain confidence to perform CPR.

Background: Nausea While elderly patients are at an increased risk of perioperative morbidity and mortality; old age alone is not a contraindication for surgery. General factors that should be considered in preoperative risk assessments include age, functional status, cognition, nutritional status, and comorbidities, such as cardiac, pulmonary, renal, and endocrine disorders. Induction of anesthesia is a critical step in surgery, particularly for elderly patients and those with a high physical status. Commonly used drugs for this purpose include etomidate and propofol. Therefore, this study aimed to compare the impact of Ketofol versus etomidate alone on the hemodynamic status of patients who fall under the ASA class II or higher.
Methods: The study was a prospective randomized double-blind clinical trial, with a study population of age of ≥65 years, ASA physical status class II or higher, that were randomized into two groups. Ketofol (n=45) and, Etomidate (n=45) groups. Patients followed for clinical outcomes including their hemodynamic status during the induction period.
Results: The present study showed that, the examination of hemodynamic parameters up to 10 minute after laryngoscopy showed that none of these parameters were significantly different between the two groups, while immediately after anesthesia induction, heart rate and blood pressure were found to be significantly different. However, there was no significant difference in terms of SPO2 among the two groups in any given interval.
Conclusion: The results of the present study revealed that Ketofol resulted in better regulation and stability of blood pressure and heart rate in patients undergoing endotracheal intubation, compared to etomidate alone.

Background: Major surgeries cause metabolic stress and insulin resistance, leading to postoperative hyperglycemia and increased morbidity and mortality in diabetic patients. Therefore, this study aimed to assess blood sugar level changes in diabetic patients undergoing elective surgery and its confounding factors.
Methods: A cross-sectional study compared blood sugar levels (BS) in 100 diabetic patients undergoing elective surgeries. Demographic data, medical history, surgery type, and anesthetic technique were documented. Laboratory assessments included fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1C). Statistical analysis used SPSS software and nonparametric tests.
Results: Postoperative blood sugar levels significantly increased compared to preoperative levels (mean change 11.40 ± 14.356 mg/dL). Age over 60 and general anesthesia were significant factors associated with elevated blood sugar.
Conclusion: This study reveals a significant postoperative increase in blood glucose levels in diabetic patients, particularly those aged over 60 and under general anesthesia.

Background: Sedation plays a crucial role in the care of intensive care unit (ICU) patients, addressing the challenges presented by factors such as agitation, anxiety, and delirium, particularly during mechanical ventilation (MV). Dexmedetomidine and propofol are commonly used sedatives, each with its unique characteristics and side effects. Combining these agents has been proposed to optimize effectiveness and minimize adverse effects. This study aims to compare the efficacy of the dexmedetomidine-propofol combination with dexmedetomidine alone and propofol alone for sedation during mechanical ventilation in ICU patients.
Methods: A triple-blinded clinical trial was conducted in Isfahan, Iran, involving patients eligible for spinal fusion surgery and mechanical ventilation. Patients were randomized into three groups: dexmedetomidine alone (DO), propofol alone (PO), and a combination of both drugs (DP) dexmedetomidine-propofol (ProDex). Various dosages and infusion protocols were carefully administered, and patients were assessed for demographic and clinical variables. Hemodynamic parameters and sedation levels were monitored, and statistical analysis was performed.
Results: The study involved 87 patients, with the ProDex group demonstrating the shortest mechanical ventilation duration. Hemodynamic stability was observed in the ProDex group, with significantly lower systolic blood pressure and heart rate compared to other groups. Sedation scores did not differ significantly among groups, suggesting similar sedative effects. The ProDex group exhibited favorable outcomes despite differences in hemodynamic variables.
Conclusion: The dexmedetomidine-propofol combination appears effective in minimizing side effects associated with monotherapy sedation, leading to favorable clinical outcomes. This study contributes valuable insights into optimizing sedation strategies for mechanically ventilated ICU patients.

Background: Control of hemodynamic changes and blood loss is a daily challenge in general anesthesia for patients undergoing septorhinoplasty. This study aimed to evaluate the effects of magnesium sulfate and clonidine on the control of hemodynamic factors and bleeding volume during this procedure.
Methods: This double-blind, randomized clinical trial study was conducted on 60 patients undergoing septorhinoplasty at 5th Azar Medical & Educational Centre of Gorgan in 2021-2022. Patients were divided into two intervention groups (50 mg/kg of magnesium sulfate) and control group (5 μg/kg of clonidine) with permutation random block allocation. All patients underwent induced hypotension. Before induction of anesthesia and every 5 minutes afterwards, blood pressure was recorded. Blood loss volume was calculated at the end of the surgery.
Results: In the magnesium group, 36 individuals were evaluated, while in the clonidine group, 24 individuals were examined. There were no statistically significant differences in baseline characteristics of patients in the two groups and the duration of surgery. Both drugs were equally effective in inducing hypotension, however blood pressure changes in magnesium group were more trivial than clonidine group. The bleeding volume in the magnesium sulfate and clonidine groups was 139.44 ml and 141.25, respectively and this difference was not statistically significant (p-value=0.634).
Conclusion: The results of this study showed that magnesium sulfate can be effectively used as an alternative to clonidine in controlling hemodynamic changes and ultimately reducing blood loss volume during septorhinoplasty surgery. In addition, magnesium is at least as effective as clonidine in stabilizing hemodynamic changes.

Background: Magnesium sulphate (MgSO4) is one of the commonly used adjuvant in regional blocks and proved its analgesic efficacy. However, the exact dose of the drug for perineural administration is still debatable. We compared two different doses of Magnesium Sulphate (150mg and 250mg) as an adjuvant to local anesthetics in ultrasound guided supraclavicular block.
Primary objective was to compare block parameters along with postoperative analgesia duration and secondary objectives were comparison of total analgesic requirement and side effects.
Methods: 90 patients posted for elective upper limb surgeries under supraclavicular block with 12 ml 2% adrenalized lignocaine,12 ml 0.5% bupivacaine were divided in two groups. Group M1 received 150 mg and Group M2 received 250 mg magnesium sulphate.
Results: With addition of 250 mg of Magnesium, the duration of sensory (530.37 ± 67.33 min) as well as motor block (492 ± 80.52 min) was prolonged as compared to sensory (478 ± 72.6 min) and motor (442 ± 83.980 min) block durations with 150 mg. Duration of postoperative analgesia was also prolonged with 250 mg (485.33 ± 79.19 min) as compared to 150 mg (538 ± 67.2 min) respectively. Total number of postoperative analgesic doses were lesser with 250 mg magnesium.
Conclusion: Magnesium sulphate as an adjuvant in supraclavicular block in the dose 250 mg significantly prolonged the duration of sensory as well as motor block, duration of postoperative analgesia with reduction in analgesic requirement postoperatively as compared to the 150 mg with no significant side effects.

Background: A Caudal epidural block is considered as one of the most common regional techniques in pediatric anesthesia. The latest addition to the group of adjuvants for caudal analgesia is α2 agonists namely Clonidine and Dexmedetomidine. This study includes a comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in caudal epidural anesthesia for postoperative pain relief in the pediatric population.
Methods: This study was performed on 60 children, aged 1 year to 6 years, of ASA physical status I and II, undergoing elective infra-umbilical surgeries under general anesthesia. The patients were assigned randomly into two groups of 30 patients each, caudal epidural was given in all patients according to their group, after giving general anaesthesia. Group A (n=30) - patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Dexmedetomidine. Group B (n=30)- patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Clonidine. The patients were observed postoperatively for the duration and effect of caudal analgesia, (using the CHEOPS Score - Children’s Hospital of Eastern Ontario Pain Scale), frequency and total dose of supplementary analgesic required, sedative effect (Modified Ramsay Sedation Score), perioperative hemodynamic parameters, and complications.
Results: The duration of Caudal analgesia without the need of supplementary analgesic is significantly higher in dexmedetomidine group (743 ± 73.6 min) than clonidine group (181.7 ± 53.60 min) and the total dose of supplementary analgesic (Inj. Paracetamol 15mg/kg i.v) required is significantly higher in clonidine group (491.5 ± 134.55 mg) as compared to dexmedetomidine group (236.5 ± 113.68 mg).
Conclusion: Addition of dexmedetomidine (0.5 mcg/kg) to caudal 0.125% bupivacaine (1ml/kg) produces a significantly longer duration of postoperative analgesia, less frequency, and dose of rescue analgesic required for postoperative analgesia in children, aged between 1 to 6 yrs as compared to a similar dose of clonidine used in caudal epidural for infra umbilical surgeries.

Background: This double-blind clinical trial aimed to investigate the effectiveness of splanchnic nerve blocks using different medication combinations on pain severity and duration of pain relief in patients with pancreatic cancer-related abdominal pain.
Methods: Thirty eligible patients were randomly assigned to either a control group receiving splanchnic blocks with Ropivacaine/Depo Medrol/Saline or an intervention group receiving splanchnic blocks with Ropivacaine/Depo Medrol/Fentanyl. Pain severity was assessed using the Numeric Rating Scale (NRS) at 2, 6, and 24 hours and one week post-intervention. Statistical analysis included independent t-tests, Friedman tests, and False Discovery Rate (FDR) correction.
Results: Prior to intervention, no significant difference in NRS scores was observed between groups (p = 0.0642). However, at the 6-hour and one-week intervals, the case group exhibited significantly lower NRS scores than the control group, indicating the efficacy of the intervention in reducing pain levels. The case group showed a substantial decrease in NRS scores from a pre-intervention mean of 7.8 to 0.5 at 2 hours, while the control group experienced a reduction from 9.083 to 2.583. The mean duration of pain relief was longer in the case group (5.429 days) compared to the control group (3.25 days). Friedman tests revealed significant differences in pain scores across time intervals within both groups (p < 0.001).
Conclusion: Splanchnic nerve blocks using Ropivacaine/Depo Medrol/Fentanyl combination demonstrated significant pain reduction effects, particularly at 6 hours and one-week post-intervention, compared to the control group. These findings showed that the addition of fentanyl in pharmaceutical combination as a opioid to the splanchnic block has reduced the pain score and increase the duration of pain relief in patients being involved in pancreatic cancer with abdominal pain.

Background: The purpose of this study is to investigate the rate of allogeneic transfusion after the administration of intravenous iron in patients who are candidates for intertrochanteric fracture surgery.
Methods: Patients who were candidates for intertrochanteric surgery referred to the orthopedic surgery and trauma department of Shahada Tajrish Hospital were included in the study after providing full explanations and obtaining written consent. The 80 patients were randomly divided into control group (No: 40) and intervention (No: 40). Patients in the intervention group were prescribed 600 mg of Venofer drug by ViforCo. This is while patients in the control group were not injected with Venofer before surgery. The results were evaluated using t-test and SPSS21 software.
Results: Based on the results, the 1 hour after surgery, three indicators of systolic blood pressure, pulse rate, breathing rate, RBC showed a significant decrease in patients undergoing intervention (P<0.05). However, the oxygenation index showed a significant increase in the patients of this group (P>0.05). Meanwhile, in the period of 1 week after the surgery, we also see a significant decrease in the two indices of average hemoglobin and PTT time in the mentioned patients compared to the control subjects (P=0.030, P=0.037). The amount of blood consumed significantly lower in the patients of the intervention group than in the control group.
Conclusion: The administration of injectable iron in patients with intertrochanteric fracture surgery candidates can improve some of the patients' clinical indicators in addition to a significant reduction in allogeneic blood transfusion.

Background: Sufentanil is extensively used as a powerful painkiller for both initiating and sustaining general anesthesia, thanks to its advantages like potent prolonged action, analgesic effect, and hemodynamic stability. Nonetheless, it's important to consider sufentanil's negative side effects, such as postoperative nausea and vomiting (PONV), during the surgical period. Additionally, Naloxone, an antagonist for opioid receptors, is frequently utilized to counteract the lingering effects of opioids after surgery. Hence, we examined the preventative use of low-dose naloxone on PONV and studied its potential mechanism of action.
Methods: After ethical approval and receiving IRCT code, 64 patients were evenly assigned to the naloxone and ondansetron groups prior to surgery. We also monitored the occurrence and intensity of PONV and the use of antiemetic medication within the first 24 hours after surgery. The main focus of our study was to analyze the PONV profile.
Results: The mean age was 49.8±15.5 years, the mean weight 71.8±23 kg, and the mean BMI was 23.5±5.2 kg/m2. No significant difference was detected regarding mean oxygen saturation and arterial pressure between the groups at admission, 15, 30, 60, and 90 min after surgery (p> 0.05). Adverse reactions showed no significant difference during the recovery time between the groups (p> 0.05). The PONV severity and incidence are significantly higher in the naloxone group.
Conclusion: Naloxone can be used as an antiemetic medicine, besides the ondansetron, and using this agent individually cannot prevent nausea and vomiting effectively.

Background: Bleeding management during and after urgent heart surgery is always challenging in patients who are taken anticoagulants especially antiplatelet ones. The present study was conducted with the aim of investigating the role of intraoperative hemoperfusion in the active removal of Plavix in patients undergoing on-pump CABG surgery.
Methods: The present study recruited patients on Plavix who underwent urgent CABG surgery. All patients have discontinued consuming Plavix less than 36 hours before surgery. During cardiopulmonary bypass, hemoperfusion set was added to the circuit and the surgery was done according to the standard open heart surgery protocols. The patients were transferred to the intensive care unit at the end of surgery and amount of bleeding was recorded in the ICU sheet hourly and calculated after 24 hours.
Results: In our study, the average age of participating patients was 73,625 years. 5 patients out of 8 (62.5%) were male and 3 (37.5%) were female. Hypertension and blood type O were the most prevalent among the patients. The average amount of bleeding was 425 in the first day after surgery and the average units of transfused blood for patients was 0.125, which is acceptable and less than the values reported in other studies that do not use the hemoperfusion.
Conclusion: The use of hemoperfusion during urgent CABG surgery, can reduce the postoperative bleeding and blood products consumption in patients on preoperative Plavix.

Background: Currently Awake fibreoptic intubation - (AFOI) is the gold standard for the management of patients with an anticipated difficult airway. Various medications have been used to perform intubation during AFOI. The ideal drug for AFOI must provide comfort, cooperation, amnesia and hemodynamic stability along with maintenance of spontaneous respiration. The study aimed to compare fentanyl, clonidine and dexmedetomidine in providing favourable intubating conditions along with hemodynamic stability during AFOI.
Methods: This prospective and randomized trial was carried out in 90 patients who were scheduled for elective surgery and required awake fibreoptic intubation. The patients were randomly divided into three different groups; Group A: Received Injection Dexmedetomidine-1ug/kg over 10 minutes; Group B: Received Injection Clonidine -2ug/kg over 10 minutes; and Group C: Received Injection Fentanyl- 2ug/kg over 10 minutes. Cough score, post-intubation score, Ramsay sedation score (RSS) and the changes in hemodynamic, were used to evaluate the effectiveness of the intubation condition and the results were then compared among the groups.
Results: Demographic variables such as gender, age, weight and American Society of Anaesthesiologists-Physical Status ASA-PS (I/II) were comparable among the three groups and not statistically significant. The cough score and the post intubation score were lower in Group A. RSS was noted to be higher in Group A and there was a lower incidence of desaturation. Hemodynamic parameters were also favourable in Group A.
Conclusion: Dexmedetomidine was found to be more effective than clonidine and fentanyl in those undergoing awake fibreoptic intubation.  There were fewer adverse effects such as coughing, discomfort, oxygen desaturation, and intolerance to intubation.

Background: To evaluate the decision-making proficiency among medical residents at Tehran University of Medical Sciences in the year 2022-2023.
Methods: A structured online web-survey via national approved services Author’s designed questionnaire was used to collect the relative data based on variables of the study and was developed by the authors of the study by reviewing the previously conducted studies. The forms were sent to the medical residents at Tehran University of Medical Sciences as a link via electronic mail and social media; assistance was offered via direct or indirect contact upon request.
Results: In this study, 88 medical residents of Tehran University of Medical Sciences were evaluated. Out of 88 participants, the frequency of females was 52(59.09%) and frequency of males was found out to be 36(40.91%). The frequency of the first- year residents was 28(37.50), second year residents was 33(21.59), third year residents was 19(9.09) and the fourth- year residents was found out to be 8(31.82). The frequency of different specialties were: Pathology 1(1.14%), Infectious diseases 1(1.14%), Cardio vascular diseases 1(1.14%), Emergency medicine 1(1.14%), Orthopedics2(2.27%), Psychiatry 3(3.41%), ENT 12(13.64%), Internal Medicine 13(14.77%), Pediatrics13(14.77%), OB&GYN 19(21.59%), Anesthesiology19(21.59%), Dermatology 2(2.27%), General Surgery 1(1.14%).
Conclusion: There is a significant relationship based on linear regression between not having self - reported availability bias and surgical residency specialties. The surgical specialty is less prone to the availability bias. A difference of communication exists between the surgical and nonsurgical speciality and the nonsurgical specialties need to confirm their decision using other methods to prevent the patient harm.

Background: Using novel educational methods in teaching medical sciences is very important. The SCORPIO model is one such method that can be used as an interactive educational station and a combination of other educational methods. The purpose of this study was to determine the effectiveness of the SCORPIO model in the acquisition of knowledge and skills of airway management during peri-anesthesia induction among undergraduate nursing anesthesia students.
Methods: The present study was a randomized controlled study with a pre-test-post-test design including an intervention and a control group. The participants were undergraduate nursing anesthesia students studying in the 3rd and 5th semesters. Sixty students were selected using convenience method and were randomly assigned to intervention and control groups. In order to collect data, a researcher-made questionnaire was used to assess the students’ knowledge and an OSCE test to assess their skills. The intervention group attended three 2-hour training sessions where the knowledge and skills of airway management during peri-anesthesia induction was taught using the SCORPIO model. The control group, on the other hand, received the same content through conventional teaching methods including lectures and the use of manikins in three 2-hour sessions.
Results: There was no statistically significant difference between the two groups in terms of demographic characteristics (p<0.05). The mean score of students' knowledge of airway management during peri-anesthesia induction before the intervention was (1.83) 12.47 in the intervention group and (1.71) 12.63 in the control group. Also, the mean score of students' skill of airway management during peri-anesthesia induction before the intervention was (1.44) 12.07 in the intervention group and (1.43) 12.43 in the control group, which indicated no statistically significant difference according to independent t-test (p=0.71 and p=0.32, respectively). After the intervention, however, the results of the paired t-test showed a statistically significant difference between the two groups in terms of the knowledge and skill scores, with the students in the intervention group obtaining higher scores of knowledge and skills (p<0.001), while this was not the case in the control group (p=0.26 and p=0.64, respectively).
Conclusion: The SCORPIO model improves the knowledge and skills of airway management peri-anesthesia induction in undergraduate nursing anesthesia students

Background: The goal of this study is to assess oral and intravenous administration of tranexamic acid's (TXA) on intra-operative bleeding during endoscopic sinus surgery and to compare with control group.
Methods: Forty-eight patients who were scheduled for endoscopic sinus surgery were chosen and randomly assigned to three groups. In first group 20mg/kg intravenous tranexamic acid, in second group 1000 mg 4 times daily for 48 hours and in third group 10 ml of normal saline were administered. The quality of the surgical field was estimated every 15 minutes by Boezaart scale. Volume of bleeding, pre and postoperative hematocrit, surgeon’s satisfaction by likert scale and duration of the surgical procedure were evaluated. Data was analyzed by SPSS v21 and P<0.05 was significant.
Results: Demographic parameters were not different among three groups. The surgical field quality at 15th minute was grade I-II in 25, 68.75 and 75 percent of the patients in the control, intravenous and oral groups, respectively. And also, no patients in the intervention groups and 42% of the patients in the control group were in grade IV. At 15 minute following surgery, there was a significant difference between the tranexamic groups and the control group (P = 0.002). at 30th minute 25, 50 and 56% of the patients in the control intravenous and oral groups, respectively were in grade I-II and difference was significant (P = 0.003). But at 45th minutes quality of surgical field was not different significantly (P = 0.163). The intraoperative average bleeding was 95.46, 94.32 and 190.64 ml for intravenous, oral and control patients that difference was significant (P = 0.001). The satisfaction of the surgeon was higher in the intravenous and oral TXA groups than the control group (P = 0.012). In comparison to the control group, the tranexamic group's surgical time were considerably lower (P 0.001). Hematocrits and drug side effects did not differ significantly among groups.
Conclusion: Systemic tranexamic acid (intravenous or oral) during endoscopic sinus surgery enhances surgical field quality, decreases intra-operative hemorrhage, and shortens operation duration.

Background: The importance of cerebral perfusion during congenital cardiac surgery, especially after hypothermic cardiopulmonary bypass (CPB) strategy, has remained a debate. In this study, we evaluated the effect of mild hypothermic CPB strategy on cerebral oximetry near-infrared spectroscopy in congenital heart defects surgery.
Methods: In a randomized prospective study, the pediatrics aged two months and six years with RACHS categories I-Ⅱ for congenital heart defects surgery were randomly divided into normothermic and mild hypothermic CPB groups. The NIRS was measured in all patients via the INVOS ™ cerebral oximetry system. The perfusion and anesthesia strategies during the study were followed as standard methods. A p-value below 0.05 is considered to be a significant level.
Results: Regarding cerebral oximetry, the results showed no significant difference between normothermic and mild hypothermic CPB groups.
Conclusion: It can be concluded that optimizing cerebral oxygen saturation monitoring during congenital cardiac surgery can improve patient outcomes as a protective strategy.

Background: Muscle relaxants are used for two general purposes. One is to ease endotracheal intubation, and the other is provide surgical relaxation.
This study has been designed with the aim of assessing the impact of atracurium and cisatracurium on patients at the anesthesia induction and the neutrophil to lymphocyte ratio.
Methods: This is a randomized clinical trial that was performed in 2022-2023 in Kashani hospital in Isfahan, Iran on patients that were candidates for elective surgery under general anesthesia by atracurium or cisatracurium. A total number of 80 patients entered and were randomized into two group’s one receiving group atracurium 0.5mg/kg, and other group received cisatracurium 0.15mg/kg over 60 seconds as NMB. Blood sample were taken base time, after 3, and 20 minutes following intubation. Qualitative data is reported as frequency with percentage. And quantitative data as average with standard deviation. Statistical analysis was done using SPSS version 25. Qualitative data were analyzed using chi-square tests and quantitative data using independent T test. Significance level was defined as p value <0.05.
Results: Overall, 80 patients were enrolled in this study. 40 of them belonged to the cisatracurium group and 40 to the atracurium group. Average age of the participants was 42.86 (±14.52) years old. Mean arterial pressure (MAP) in cisatracurium group dropped significantly following intubation (p<0.005), while it rose significantly in the atracurium group (p<0.05). However neutrophil to lymphocyte ratio (NLR) was significantly higher in the cisatracurium group following intubation (P<0.05).
Conclusion: While the use of atracurium in patients is still safe, is yet more correlated with pronounced hemodynamic instability compared to cisatracurium.

Background: Brachial plexus block, particularly the supraclavicular approach. The choice of local anesthetic and the addition of adjuvants can significantly impact the quality and duration of the block. This study aimed to compare the effects of three different additives dexmedetomidine, dexamethasone, and sodium bicarbonate when combined with ropivacaine in ultrasound-guided supraclavicular blocks.
Methods: A double-blind randomized clinical trial was conducted with 103 patients undergoing upper limb orthopedic surgery. Patients were divided into four groups, and each group received one of the following combinations: ropivacaine with dexmedetomidine, ropivacaine with dexamethasone, ropivacaine with sodium bicarbonate, or ropivacaine alone (control). The onset and duration of motor and sensory blocks, complications, patient and surgeon satisfaction, and vital signs were assessed.
Results: The study revealed that all additives, particularly dexmedetomidine, significantly influenced the onset and duration of motor and sensory blocks compared to the control group. Dexmedetomidine demonstrated the fastest onset and prolonged the block, while dexamethasone and sodium bicarbonate also had substantial effects. Importantly, the additives did not lead to an increase in complications, and patient and surgeon satisfaction remained consistent across all groups.
Conclusion: The findings of this study suggest that dexmedetomidine is a promising adjuvant for enhancing the quality and duration of supraclavicular blocks.

Background: Inserting a chest tube is a life-saving procedure for patients with chest trauma, but it is often associated with significant pain. To alleviate this discomfort, non-pharmacological methods such as acupressure can be employed. Therefore, this study aimed to determine the effect of acupressure on pain during chest tube removal in patients with thoracic trauma.
Methods: This quasi-experimental study involved the selection of 204 patients with chest tubes following chest trauma in Zahedan in 2022. The through patients were selected purposefully and Non-random allocation divided into two intervention and control groups of 102 people. The intervention group received acupressure treatment, while the control group did not.  Pain levels of the patients were measured using a pain intensity scale on both the day of chest tube insertion and the day of removal. The data were analyzed using statistical test such as independent-t, paired-t and chi-square statistical tests within the SPSS 26 software.
Results: The normality of the main variable was assessed using the Kolmogorov-Smirnov (KS) test. The significance level for the pain variable was found to be less than 0.05 (P<0.001), indicating a non-normal distribution. Therefore, the Mann-Whitney U test was utilized for data analysis. The results of the Mann-Whitney test revealed that before the intervention, the mean pain scores were 9.46±0.69 in the intervention group and 9.47±0.65 in the control group. After the intervention, the mean pain scores were 7.11±0.98 in the intervention group and 9.39±0.90 in the control group. Based on the Mann-Whitney U value obtained from the comparison of the two groups before and after the intervention, it can be concluded that the intervention had a significant effect on reducing pain (Table 2).
Conclusion: The insertion and removal of chest tube after trauma can be an extremely painful experiences for individuals. Considering the crucial role of nurses, non-pharmacological methods such as acupressure can be used to alleviate their pain. Acupressure is a cost-effective, accessible, and readily available approach that can be utilized in this context.

Background: The aim of the present study was to compare the effectiveness of two teaching models (e-learning and discussion-based learning) on the learning process of emergency department interns in relation to the use of the sedatives.
Methods: In this study, 129 interns introduced to the emergency medicine department were included in the study. These interns were randomly divided into two groups, I and II. For both groups, a pre-test based on standard parallel multiple-choice questions (MCQs) was prepared. Then, the electronic software which was prepared was distributed to the first group. For people of group II, six hours of discussion-based training was conducted for 3 consecutive weeks. At the end of the course (after 1 month), a post-test, which was the same questions as the pre-test, was obtained from interns in both groups.
Results: At the end of the study, we found a significant improvement in the learning rate of both groups all aspects of the knowledge including: science related to the use of narcotics in sedation (P=0.01 for e-learning group and P<0.001 for discussion based group), knowledge related to the use of intravenous anesthetics for sedation(P=0.025 for e-learning group P<0.001 for discussion based group), Knowledge related to definition and clinical judgments in sedation and Knowledge related to the use of Neuromuscular blocking agents (NMBAs) for sedation (P<0.001 for both groups). However, for all the investigated results, the learning rate was significantly better in the discussion-based learning group compared to the e-learning group (P<0.001).
Conclusion: According to the results of this study, we found using either e-learning or discussion-based learning methods increase the acquisition of sedation knowledge for emergency department students. However, the discussion-based method have better results on the learning process of the interns.

Background: Oculocardiac reflex is a trigeminovagal reflex that occurs following mechanical manipulation of the orbital cavity. The current study evaluated the preventive effect of atropine and hyoscine on the Oculocardiac reflex in scleral buckling surgery.
Methods: In this triple-blinded randomized controlled clinical trial, a total of 75 patients candidated for scleral buckling surgery were divided into three groups. Intravenous atropine (0.02 mg/kg up to a maximum of 0.5 mg), hyoscine (0.2 mg/kg), and distilled water were injected after intubation for each group respectively with standard monitoring. Heart rate, blood pressure and/or cardiac dysrrythmia were recorded immediately before/after injection and every 10 minutes. Decrease of heart rate more than 20%, or any cardiac dysrrythmia were defined as OCR. P-value <0.05 was significant.
Results: Demographic parameters were not different in three groups. Oculocardiac reflex was observed in hyoscine (34.8%), atropine (31.6%) and control (35.3%) groups (p=0.27). Additive atropine was injected only in two patients of control group. Oculocardiac reflex occurred more in the first ten minutes (35%) and in 30 minutes (55%), and was not observed after 90 minutes. Moreover, atropine and hyoscine increased the heart rate of patients more than control group (P=0.02), but in atropine group was longer than hyoscine group (P=0.03). Systolic blood pressure was not significantly different among the groups.
Conclusion: In this study had been showed that in scleral buckling surgery, atropine is more effective than hyoscine in heart rate increase, but did not reduce oculocardiac reflex more significant than hyoscine and control group. And also oculocardiac reflex was more in first 30 minutes.

Background: The emergence of COVID-19 in late 2019 swiftly led to a global pandemic, prompting urgent investigation into its multifaceted impacts. While prior studies have highlighted compromised sleep quality in hospitalized COVID-19 patients, this research delves into the enduring effects on sleep patterns for those with severe pulmonary involvement post-intensive care. This study addresses a critical gap in understanding the long-term consequences of the virus, emphasizing the importance of post-recovery care.
Methods: Conducted as a cross-sectional study, we consecutively enrolled COVID-19 patients with over 20% pulmonary involvement admitted to the ICU at Shariati Hospital, Tehran, between June 2021 and January 2022. Demographic and clinical data were extracted from hospital records. After ethics committee approval, participants were contacted six months post-discharge to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Exclusions comprised obstructive sleep apnea patients and those with incomplete records.
Results: Of the 60 eligible post-COVID-19 patients, 56 participated. Three individuals were unresponsive to calls, while one declined. Participants, primarily female (64.3%), had a mean age of 51.7 years. Notably, 80.4% exhibited sleep disorders six months post-discharge. Gender differences were observed, with females reporting higher scores in specific sleep quality components. Intriguingly, single individuals demonstrated a higher preference for sleep medication. These findings underscore the imperative for targeted interventions to improve post-ICU sleep quality in severe COVID-19 cases.
Conclusion: The high prevalence of sleep disorders six months post-discharge underscores the enduring impact of COVID-19 on sleep quality. These findings call for targeted interventions and comprehensive post-ICU care protocols that prioritize sleep health.

Background: Blood glucose control during surgery can decrease the infection, disability, and death rate. The purpose of this study was to determine the effect of preoperative metformin on blood glucose levels in nondiabetic orthopedic surgery.
Methods: This clinical trial was conducted on 176 nondiabetic patients with ASA class I or II who were candidates for orthopedic surgery. The patients were randomly divided into two equal groups. The metformin group received 500 mg metformin tablet orally and the placebo group received placebo tablet 30 minutes before the surgery. Blood glucose was measured every 6-hour to 24 hours and blood urine nitrogen (BUN), creatinine was measured preoperatively and the day after surgery. The data was analyzed by SPSS v21 and P value<0.05 was significant.
Results: Demographic characteristics such as age, sex and body mass index (BMI) had no significant difference in two groups. Creatinine and BUN were similar in two groups. Preoperative blood glucose was 101.8±22.6 mg/dl in the metformin group and 109.7±24.8 mg/dl in the control group without significant difference (p=0.08). However, BS at hours 6, 12, showed a significant difference between the two groups (p<0.001, 0.022) and then blood glucose was similar in two groups (0.8, 0.12 respectively).
Conclusion: Preoperative metformin (500 mg) was effective for blood glucose control in nondiabetic patients undergoing orthopedic surgery. However, additional research is required to determine the efficacy of this therapy.

Background: Shoulder impingement syndrome is a clinical situation that presenting with shoulder pain, difficultly and weakness. Present study designed for evaluating the effect of radiofrequency and corticosteroid injection in longterm treatment follow up for pain reduction and functional evaluation of shoulder joint.
Methods: Sixty patients were analyzed equally in two treatment groups. Post-treatment follow up at one, four and twelve weeks after procedures were carried out using Visual Analog Scale (VAS) for pain relief, Shoulder Pain and Disability Index (SPADI) for shoulder function and Beck Depression Inventory (BDI).
Results: Both treatment groups showed significantly pain reduction (P-value<0.001 for both) in 4 weeks after procedures. In time point comparison between 4 to 12 weeks postoperatively, there were significantly reduced pain in R group (P=0.03), but not significant in C group (P=0.1). Total SPADI score was significantly lower in RF group in time points 1 and 4 weeks (P<0.001), but not significant in 12 weeks of follow up.
Conclusion: Radiofrequency could not be sufficient alone for retrieving function of the shoulder at the long periods of time after procedure, unless good and effective results for first 1 and 4 weeks of follow up.

Background: In this study, our aim is to investigate the complications caused by COVID-19 disease in the period of 1 month and 3 months after infection and recovery in patients aged 20 to 80 admitted to the special care department of Shariati Hospital in Tehran.
Methods: The information of the patients in this research was collected between 1 and 3 months after discharge non-randomly and from among the samples that are available (consecutive), through phone calls and a prospective questionnaire including questions about complications such as fatigue, body pain, joint pain, anorexia, disorders, sleep, headache, depression, dizziness, palpitations, chest pain, cough, diabetes, skin disease, obesity, imbalance, neuropathy, neurological and mental problems, and other cases are collected.
Results: In this study, what was observed was those 4 complications of nausea and vomiting, diabetes, depression, and hypothyroidism were significantly related to hospitalization of COVID-19 patients in the hospital's special care department. The frequency of other complications was also investigated in this study.
Conclusions: According to the conducted study as well as previous studies, what is clear is that the frequency of complications caused by COVID-19 in patients admitted to the intensive care unit after discharge is high, and more studies should be done in order to reduce these complications.

Safe transfer of patients who have undergone anesthesia and surgery is a basic principle to maintain stability, and avoid side effects and preventable errors. Specific scoring systems or criteria may be used to assess and decide whether patients are sufficiently recovered to be safely transferred to another ward or discharged home. This study aims to answer the question, what criteria are appropriate for patient evaluation and discharge in the post-anesthesia care unit? designed.
To find documents related to writing a review article on various scoring systems for patients after anesthesia in Google Scholar, PubMed, Scopus, and ScienceDirect databases and using English keywords post-anesthesia care unit, PACU, recovery room, discharge, scoring system, Assessment was searched.
A total of 168 articles were found by searching the databases. After removing duplicates, 77 articles were evaluated. Finally, 17 articles were selected and included in the study. The included studies included a variety of tools and criteria for evaluating and discharging patients in the post-anesthesia care unit. This article separately describes each of the tools and criteria for the evaluation and discharge of patients in the post-anesthesia care unit along with the method of scoring, advantages and disadvantages of each.
A safe scoring system for discharge from PACU should evaluate important parameters after anesthesia, including alertness, blood pressure, heart rate, ventilation, oxygen saturation, and surgical site bleeding, which can cause serious complications. Considering that one of the goals of PACU is to relieve patients’ pain in the post-surgery phase, the evaluation and control of pain and postoperative nausea and vomiting is effective in the satisfaction and safety of patients.

The safety of the beating heart is a health service that means the absence of clinical errors during the implementation of health care. The period of anesthesia is identified as one of the most critical phases for patients requiring general anesthesia, carrying the potential for critical clinical errors that may have irreversible consequences. This study's main objective was to conduct a concise assessment of the anesthesia checklists utilized to enhance patient safety during general anesthesia procedures. To accomplish this, a comprehensive search was conducted using relevant keywords spanning from 1990 to 2023 across databases including PubMed, Springer, Google Scholar, Web of Science, Scopus, online libraries, and the Cochrane library. Initially, 188 studies were identified at the outset of the research, and among these, 13 studies that focused on the development of checklists for anesthesia safety were scrutinized. Included articles were reviewed separately and divided into 3 categories; Specific vs. Generalized Scope, Single-Stage vs. Multi-Stage, Single-Factor vs. Multi-Factor. According to the findings from these studies, the systematic and proper utilization of all available checklists can contribute to improved safety. However, due to the specialization of surgical procedures and the increasing emphasis on patient safety over the past decade, there has been a shift in the compilation of anesthesia checklists from being broad and general to becoming specific, transitioning from single-stage to multi-stage, and evolving from single-factor to multi-factor checklists.

In the present manuscript, an 87-year-old man, who was a candidate for knee joint replacement surgery due to severe osteoarthritis of the right knee, was case reported. He underwent neuroaxial anesthesia. Following spinal anesthesia with bupivacaine 0.5% in the fourth and fifth lumbar vertebra, the patient developed myoclonic seizures in the lower limbs and abdomen that lasted during the surgery, as well. Due to the continuation of the seizures, the necessary examinations were performed and an extra-axial tumor in the left parasagittal was detected in the patient’s brain imaging.

Pulmonary embolism can cause cardiac arrest. Fibrinolytic therapy and surgical embolectomy can be used to manage it. This case report presents the clinical course of a patient who experienced intraoperative cardiac arrest resulting from massive pulmonary embolism. The patient encountered three instances of cardiac arrest requiring 35 minutes of cardiopulmonary resuscitation. Subsequent treatment involved the administration of reteplase, a thrombolytic agent. Following resuscitation, the patient developed multiple organ dysfunction in the intensive care unit, necessitating the use of diverse medications. Successful resolution of organ dysfunction led to the patient's transfer to the neurosurgery department. This case highlights the complexities involved in managing pulmonary embolism-induced cardiac arrest and subsequent multiorgan dysfunction, emphasizing the significance of a multidisciplinary approach in the comprehensive care and treatment of these patients.

Familial hypokalemic periodic paralysis is a rare disorder that manifests manifests with the sudden onset of flaccid paralysis that is triggered by low levels of blood potassium, which can be caused by various factors such as, rest after intense exercise, or high-carbohydrate foods. This report presents cases of hypokalemic periodic paralysis attack triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 29-year-old male patient was admitted with quadriparesis, fever, shortness of breath, and sever hypokalemia. The patient had a history of three episodes of Familial hypokalemic periodic paralysis (HPP). Diagnostic tests, such as chest computed tomography scan and polymerase chain reaction test, confirmed SARS-CoV-2 infection. The patient was treated with potassium chloride infusion, spironolactone, and remdesivir, and was eventually discharged from the hospital.in conclusion, SARS-CoV-2 infection can potentially exacerbate HPP and should be considered a risk factor for its occurrence.

Anemia, a common symptom in pregnancy, can lead to life-threatening cardiomyopathy.
A 30-years old gravida 2 para 1 woman was admitted at 34 weeks of gestational age with asymptomatic pancytopenia and vitamin B12 deficiency in the laboratory tests. She also had a diet-controlled gestational diabetes, megaloblastic changes in Bone marrow aspiration and cardiomyopathy shown by echocardiography. The patient recovered from pancytopenia and cardiomyopathy after one week treatment with vitamin B12 and folate.
In this case, cardiomyopathy worsened with anemia. By treating vitamin B12 deficiency, cardiomyopathy can be prevented or controlled during pregnancy. Careful consideration is needed when assessing anemia in pregnant women on vegetarian diet and at higher risk.

Frozen shoulder is a condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings are limited and associated with severe shoulder pain. Frozen shoulder is also referred to as adhesive capsulitis, painful stiff shoulder, and periarthritis. Treatment typically focuses on reducing shoulder pain and restoring joint mobilisation.
In the context of shoulder mobilization, the predominant nerve blocks encompass the interscalene, supraclavicular upper trunk block collectively referred to as the SCUT block, as well as the axillary nerve block. These nerve blocks demonstrate high efficacy in delivering targeted analgesia. However, a notable limitation of these interventions is the concomitant motor blockade and phrenic nerve block induced by them. This motor blockade poses a significant impediment to the initiation of early rehabilitation, thereby delaying the commencement of rehabilitative exercises and intervention.
Shoulder Anterior Capsular Block is a motor sparing block which can be effectively used in shoulder mobilisation.

Aspiration under general anaesthesia is a dreaded complication which can significantly affects the morbidity and mortility in the postoperative period. Factors such as delayed gastric emptying seen in obesity, pregnancy, paralytic ileus, altered consciousness as under general anaesthesia, head injury can predispose the patient to pulmonary aspiration. The two entities aspiration pneumonia and aspiration pneumonitis although difficult to differentiate in the early course of event but it is of crucial importance to know the pulmonary pathology for effective management of the patient. A morbidly obese patient was posted for fracture humerus surgery under GA who landed in cannot ventilate situation, had pulmonary aspiration which was managed efficiently in ICU.

Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthropathy involving spine and sacroiliac joints resulting in characteristic bamboo spine (fused and rigid spine). A 41yr old male patient with Ankylosing spondylitis with history of Left THR presented with periprosthetic fracture posted for ORIF with plating. He had a classical bamboo spine with cervical involvement, MPC- 3 and restricted neck mobility. Preoperative Ultrasound scan (USG) of lumbar region done to identify spinal spaces. Awake Fiberoptic Nasal intubation done to secure difficult airway and induction done with Propofol and Vecuronium. Epidural catheter inserted at L1-L2 space using paramedian approach under USG under General Anesthesia in lateral position and Epidural analgesia given with 1% Ropivacaine. Extubation was done uneventfully with Sugammadex 2mg/kg used as reversal at end of surgery. Anaesthetic challenges in AS were both difficult airway and difficult regional anesthesia which was successfully managed with detailed evaluation and planning with USG.

A 2-month and 13-day-old boy underwent surgery for a right inguinal hernia. During the procedure, a caudal block was performed using 4 mL of 0.25% bupivacaine injected with an epinephrine-soaked syringe. Before the injection, we confirmed that there was no blood or cerebrospinal fluid present. However, shortly after the injection, the patient experienced respiratory apnea and a slow heart rate. The medical team provided respiratory and cardiac support and closely monitored the patient. After a day and a half, the patient was discharged with no further complications.

Tension pneumothorax (TPT) in trauma patients is an uncommon disorder caused by the progressive accumulation of air in the pleural cavity. In pre-hospital and emergencies, if it is not diagnosed and treated on time, it endangers the lives of patients. In this study, we report a patient who developed tension pneumothorax and extensive subcutaneous emphysema due to mild trauma and not going to the hospital in the early hours, which caused an anaphylactic appearance on the patient's face.

A 34-year-old woman was admitted for an emergency cesarean section at 38 weeks of pregnancy. She had no previous surgeries or illnesses. During the pre-operative evaluation, the anesthesia team noticed that the patient had not fasted. However, they decided to use spinal anesthesia for the emergency procedure. While preparing for the spinal examination, they discovered a large mass of hair covering the 3rd, 4th, and 5th lumbar vertebrae. Despite the emergency situation, the absence of fasting, and the risk of aspiration, the anesthesia team carefully considered all aspects of the patient's safety and decided to proceed with spinal anesthesia.

Gestational trophoblastic disease (GTD) is a cluster of tumors which often had a lethal outcome in the past. As the years have passed, with better understanding of the pathophysiology fatalities have reduced and patients have been cured. On an anesthetic stand point these cases can be challenging to manage due to the emergency nature of the surgery and various systemic complications they may present with. We present to you a case of a 29-year-old female with molar pregnancy managed by spinal anesthesia.