Background: The goal of this study is to compare the effects of the TAP (transversus abdominis plane) block, guided by ultrasound, before the commencement of surgery and after its completion, on reducing postoperative pain in patients undergoing laparoscopic cholecystectomy.
Methods: The present study was conducted as a randomized, double-blind clinical trial. The study population included patients scheduled for laparoscopic cholecystectomy at Imam Khomeini Hospital in Sari, Mazandaran, Iran. Patients were randomly assigned to two groups: TAP block before the operation and after the operation. The pain intensity and consciousness level at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery, as well as the time of the first analgesic request, time of first pain expression after surgery, and the amount of morphine consumption within 24 hours for each patient, were documented.
Results: 120 patients were included in this study; 60 of them were in the pre-op group and 60 in the post-op group. There was no statistically significant difference in terms of duration of surgery and total morphine consumed between the study groups. The time of the first analgesic request and the time of the first pain expression were significantly longer in the post-op group. Pain intensity was significantly lower in the post-op group.
Conclusion: Bilateral ultrasound-guided TAP block after surgery in patients undergoing laparoscopic cholecystectomy leads to a reduction in pain intensity and incidence of vomiting and an increase in the time of analgesic request and pain expression after surgery.

Background: Laryngoscopy and intubation cause transient hemodynamic changes within thirty seconds after intubation. Dexmedetomidine, a selective alpha 2 adrenoceptor agonist, has been used to blunt this response via routes like intravenous, intranasal, and nebulization. The efficacy of nebulized dexmedetomidine in reducing the response to laryngoscopy and tracheal intubation with the additional benefit of reducing the propofol dose was evaluated during this study. Entropy monitoring was used to achieve adequate anesthetic depth.
Methods: This prospective, randomized, and comparative study was conducted on 120 ASA 1-2 patients. Patients were nebulized with dexmedetomidine 1 μg/kg body weight in 5 ml normal saline in group D and only 5 ml normal saline in group C twenty minutes before induction of anesthesia. Anesthesia was induced with an injection of propofol under entropy guidance. Hemodynamic parameters were noted at baseline, after nebulization, immediately after intubation, and up to 10 minutes. The incidence and severity of sore throat were noted in the postoperative period.
Results: Demographics were comparable. After laryngoscopy and intubation, the increase in heart rate and blood pressure was much lower in the dexmedetomidine group compared to the saline group. Furthermore, the requirement of propofol to achieve an entropy of 40–50 and the incidence and severity of postoperative sore throats in the dexmedetomidine group were significantly lower than in the normal saline group.
Conclusion: Administration of nebulized dexmedetomidine 1 µg/kg preoperatively effectively attenuates the hemodynamic response to laryngoscopy and intubation, with more stable hemodynamics and no side effects.

Background: Propofol and dexmedetomidine have a mitigating effect on postoperative nausea and vomiting (PONV). However, their efficacy in preventing PONV in patients following ureteroscopic operations remains uncertain. This study evaluated the efficacy and safety of infusions of dexmedetomidine versus propofol with respect to the incidence of PONV in patients scheduled for ureteroscopic surgeries under spinal anesthesia.
Methods: This randomized controlled trial included 72 adult patients scheduled for ureteroscopic surgery under spinal anesthesia with multiple risk factors for PONV (female, history of PONV, non-smoker). The patients were randomized into three groups (24 patients each). The propofol, dexmedetomidine, and control groups received intravenous infusions of propofol, dexmedetomidine, and normal saline, respectively. The study outcomes were the incidence of PONV (primary outcome) as well as the time and need for antiemetics, Ramsay Sedation Scale, and incidence of intraoperative hemodynamic changes (secondary outcomes).
Results: Dexmedetomidine infusion resulted in significantly lower PONV scores and heart rates during and after surgery compared to the propofol and control groups. Both intervention groups had significantly deeper sedation, but dexmedetomidine was more sedating than propofol (p = 0.001) in comparison to the control group. At 40 and 60 minutes intra- and postoperatively, both the propofol and dexmedetomidine groups had a significant reduction in mean blood pressure in comparison to the control group. Mean blood pressure was similar in the two groups.
Conclusion: During ureteroscopic procedures under spinal anesthesia, dexmedetomidine effectively and safely reduces the incidence of PONV in highly susceptible patients. It also provides deeper sedation and better hemodynamic control compared to propofol.

Background: Post-surgical pain (PSP) can persist from the immediate post-operative period up to 6 months following surgery. The purpose of this study was to evaluate the prevalence of PSP and identify factors influencing its intensity in pediatric and adolescent patients.
Methods: This cross-sectional study included 120 patients aged 3-17 years who had undergone surgery in hospitals. The data for this study were collected by reviewing patients’ clinical records and observing patient behavior. The FLACC scale was used to assess pain in children, and the APPT scale was used to assess pain in adolescents. Demographic data extracted from patients’ clinical records, along with pain data from the FLACC and APPT scales, were entered into SPSS 20 software, and data analysis was performed.
Results: The study included 120 patients with a mean (SD) age of 11.21 (4.03) years, of whom 64 (53.3%) were female. Regarding pain severity in the pediatric group, 2 (3.3%) reported no pain, 14 (23.3%) reported mild pain, 30 (50%) reported moderate pain, and 14 (23.3%) reported severe pain. In the adolescent group, 2 (3.3%) reported no pain, 7 (11.7%) reported little pain, 12 (20%) reported medium pain, 15 (25%) reported large pain, and 24 (40%) reported the worst possible pain. There was no statistically significant relationship between pain status, type of surgery, and gender in either the pediatric or adolescent group (P > 0.05).
Conclusion: Given the high reported rates of post-surgical pain in pediatric and adolescent patients, targeted interventions are recommended to mitigate pain severity and improve patient outcomes.

Background: The readmission of a patient to the intensive care unit means a patient's return to the hospital for a certain period of time after discharge for planned or unplanned reasons. Therefore, this study aimed to investigate the risk factors for readmission after appendectomy in hospital.
Methods: In this retrospective study, the records of patients who underwent appendicitis in hospitals were reviewed. In order to identify readmissions, a list of patients with a history of readmission was extracted from the hospital's Health Information Technology Unit. Then, the researchers studied the patients' clinical records and extracted data using a researcher-made checklist. To analyze the data, first the data were entered into SPSS version 16 software and then analyzed using descriptive and analytical statistical tests.
Results: According to the findings, the mean (SD) age of the patients in the readmitted group was 14.1 (2.8) years, and in the non-readmitted group was 13.9 (2.1) years. In the readmitted patient’s group, 52.4% of the patients were male, 19% of the patients had underlying diabetes, 9.5% had asthma and allergies, and 100% of the surgeries were performed by a specialist. Also, the results showed the reasons for readmission of patients were 4.8% due to intra-abdominal abscess, 42.9% due to wound infection, 14.3% due to abdominal pain, 23.8% due to paralysis/ileus, and 14.3% due to other causes.
Conclusion: Given that patient readmission has various complications for the patient, the patient's family, and the healthcare system, it is necessary to take necessary preventive measures regarding the factors affecting it.

Background: Airway management is a routine part of any type of anesthesia; therefore, the present study was designed to compare the effect of transtracheal dexmedetomidine and transtracheal lidocaine in patients undergoing bronchoalveolar lavage and other adverse events.
Methods: Individuals aged 18 to 65 years that were candidates for bronchoalveolar lavage in three groups were included in the study. All three groups of patients underwent a standard treatment with the same anesthesia method with the same treatment group. Patients were administered lidocaine (4 cc 2% lidocaine), dexmedetomidine (0.5 g/kgµ dexmedetomidine), and lidocaine + dexmedetomidine (4 cc 2% lidocaine + 0.5 g/kgµ dexmedetomidine) groups.
Results: A total 150 patients with a mean age of 57.2±16.32 were evaluated in three equal groups. The clinical status of the patients showed that the patients in the combined use of dexmedetomidine and lidocaine group underwent sedation significantly more than the other two groups. The incidence of cough in dexmedetomidine and lidocaine group of patients was significantly lower than in the other groups.
Conclusion: The simultaneous use of transtracheal lidocaine and dexmedetomidine significantly reduces the incidence of cough in patients undergoing bronchoalveolar lavage.

Background: The most severe complication of type 1 diabetes mellitus is diabetic ketoacidosis (DKA). Hypokalemia, a common electrolyte disturbance in DKA, can be life-threatening and often worsens during treatment. A significant clinical debate exists regarding the optimal route of potassium administration—central versus peripheral lines. Current guidelines recommend aggressive potassium replacement but lack consensus on the safest administration method. This study investigated the safety and complications of high-concentration peripheral potassium administration in pediatric DKA patients within an intensive care setting.
Methods: This observational study, conducted at the PICU of Bahrami Children's Hospital, enrolled 55 pediatric patients with DKA requiring high-concentration potassium supplementation (50, 60, or 70 mEq/L) through peripheral veins. Potassium chloride was administered in normal saline with dosing stratified by serum potassium levels checked every 2 hours. Primary analyses examined associations between infusion-related complications (phlebitis, pain, erythema, burning sensation) and potassium concentration, infusion duration, DKA severity, and patient characteristics.
Results: Among 55 patients (mean age: 8.7 ± 4.1 years; 52.7% male), 32 patients (58.2%) received 50 mEq/L, 21 patients (38.2%) received 60 mEq/L, and 2 patients (3.6%) received 70 mEq/L. Of these, 25 patients (45.5%) required infusion duration exceeding 6 hours. Hypokalemia occurred in 30.9% of patients, with higher prevalence in severe DKA (44.4%). A total of eight patients (14.5%) experienced a total of 10 infusion-related complications. These included one case of phlebitis (1.8%), five cases of injection site pain (9.1%), and four cases of burning sensation (7.3%). Infusion duration exceeding 6 hours significantly increased complication risk (OR: 5.7; 95% CI: 2.01-16.56; p=0.042), with combined high concentration and extended duration showing elevated risk (adjusted OR: 3.1; 95% CI: 1.86-5.24; p=0.003).
Conclusion: In pediatric DKA patients receiving care in the PICU setting, peripheral potassium infusion at concentrations up to 60 mEq/L demonstrates acceptable safety outcomes when administration duration remains under 6 hours and rigorous monitoring protocols are implemented. However, for infusions exceeding 6 hours, our findings suggest careful consideration of alternative approaches may be warranted, particularly at higher concentrations.

Background: A hernia is defined as the protrusion of an organ, tissue, or part of an organ through a structure that normally contains it. Inguinal hernias are a type of hernia that causes pain.
Methods: In this study, 62 individuals aged 4 to 18 years who met the inclusion criteria were enrolled. The tools used included a demographic characteristics form, a patient clinical characteristics form, and the Widder Scale questionnaire. After completing the questionnaires, data related to CPIP (likely an abbreviation for a pain assessment measure, but further information is needed for confirmation) and its influencing factors were entered into SPSS version 18 software and analyzed.
Results: According to the findings, out of 62 patients studied, 3 (4.8%) patients had CPIP, with the prevalence of CPIP being higher in men than in women. Also, none of the postoperative complications, including readmission, hydrocele, infection, and recurrence status, were observed in the patients. Also, regarding the duration of pain, it was shown that the pain of 36 patients was within the time range of up to one week, and the pain of 19 patients was within the time range of one week to one month.
Conclusion: It is essential to follow up on factors affecting CPIP in children undergoing hernia surgery on an ongoing basis or even one year after surgery.

Background: Every year, sepsis is the most common cause of death in hospitalized individuals. Various studies have investigated whether a procalcitonin-guided protocol could optimize the therapeutic approaches in sepsis patients. The evaluation of procalcitonin is a predictive marker for sepsis in individuals admitted to the emergency room or intensive care unit.
Methods: Cross-sectional observational analysis was conducted in the anesthesia department and intensive care unit. It included 100 adult patients enrolled in this study within inclusion criteria for those who have sepsis and septic shock and were admitted to intensive care. A diagnosis of sepsis was taken in a patient with suspected or proven infection. Blood samples from peripheral blood were collected from all patients at admission to measure procalcitonin levels. Follow-up continued until the outcome was determined as discharged well, morbidity occurred, or death was documented.
Results: The higher source of infection was due to a wound (23%). About 55 of the studied patients have a GCS between 13 - 15. The average procalcitonin level when patients were admitted was much higher in those who died or had complications compared to those who were discharged in good health, with a key level of 17.0 µg/L.
Conclusion: Patients with sepsis and other markers can use procalcitonin as a prognostic factor. Lower PCT levels were significantly associated with favourable prognosis.

Background: Cardiac catheterization is an essential procedure in managing pediatric congenital heart disease, providing a less invasive alternative to thoracotomy. However, adverse events remain a concern, especially in high-risk patients. The CRISP (Cardiac Risk in Pediatric) score, developed by the Congenital Cardiac Intervention Study Consortium (CCISC), predicts serious adverse events (SAEs) in pediatric cardiac catheterization. Despite its reliability, CRISP has not been implemented in Indonesia. This study evaluates its predictive ability at Dr. Wahidin Sudirohusodo Hospital, Makassar.
Methods: A prospective cross-sectional study was conducted from November 2024 to January 2025. Pediatric patients (<18 years) undergoing elective cardiac catheterization were assigned CRISP scores pre-procedure, and adverse events were recorded. The relationship between CRISP categories and SAE incidence was analyzed.
Results: Among 70 patients, the majority of patients were categorized as CRISP I (67.1%), followed by CRISP II (21.4%), CRISP III (5.7%), and CRISP IV (5.7%), with no CRISP V cases. There were 6 cases (8.6%) of serious adverse events identified, consisting of 4 cases (5.71%) of cardiac arrest and 2 cases (2.89%) of bleeding. A significant correlation was found between higher CRISP risk categories and SAE incidence (p < 0.001). SAEs occurred exclusively in CRISP III (50% incidence) and CRISP IV (100% incidence) patients.
Conclusion: The CRISP score effectively stratifies risk in pediatric cardiac catheterization. Higher CRISP categories correlate with increased SAE incidence, supporting its predictive validity. Routine CRISP implementation could enhance pre-procedural planning, risk mitigation, and patient safety in Indonesia. Further studies with larger sample sizes are recommended.

Background: Reflex Given the critical role of anatomical airway structures in tracheal intubation, this study aimed to predict the difficulty of mask ventilation and laryngoscopy using ultrasound-based airway evaluation criteria.
Methods: This cross-sectional study involved 205 patients undergoing tracheal intubation. During intubation evaluation based on the Cormack-Lehane classification, neck ultrasound was performed. The diagnostic value of neck sonographic parameters was assessed using receiver operating characteristic (ROC) analysis.
Results: According to the Cormack-Lehane classification, intubation was easy in 170 patients (82.9%) and difficult in 35 patients (17.1%). Ultrasound findings revealed statistically significant differences in all parameters, including neck circumference, between the easy and difficult intubation groups. All measured values were higher in the difficult intubation group.
Conclusion: The findings suggest that ultrasound is a useful, practical tool for predicting difficult intubation. However, due to study limitations such as the small sample size, further research is recommended.

Background: Vitamin D plays a vital role in bone metabolism, immune function, and overall health. Healthcare professionals, particularly those working indoors, may be at increased risk for deficiency due to limited sunlight exposure. This study aimed to evaluate serum vitamin D levels and explore associated factors among anesthesiology residents.
Methods: A retrospective cross-sectional study was conducted among 50 anesthesiology residents at Dr. Wahidin Sudirohusodo General Hospital in Makassar from January to February 2025. Data were collected through self-administered questionnaires and medical records. Serum 25-hydroxyvitamin D [25(OH)D] levels were used to determine vitamin D status. Statistical analysis was performed using SPSS version 26, with P values < 0.05 considered significant.
Results: Among the 50 participants, 76% were found to be vitamin D deficient. No significant associations were found between vitamin D levels and sex, age, or BMI. However, vitamin D deficiency was more common among residents with obesity and younger age groups. Vitamin D supplementation (p = 0.022) and duration of sunlight exposure (p = 0.029) showed significant associations with serum vitamin D levels. Dietary intake and comorbidities were not significantly related to vitamin D status.
Conclusion: A high prevalence of vitamin D deficiency was observed among anesthesiology residents, likely due to occupational limitations on sun exposure. Supplementation and regular sun exposure appear to be protective factors. Targeted strategies, including routine screening and preventive interventions, are recommended for at-risk healthcare workers.

Background: Non-cardiac surgery in patients with cardiovascular risk can lead to Spine surgery often leads to significant postoperative pain, inflammation, and hemodynamic instability, necessitating opioid use, which increases the risk of side effects. Dexmedetomidine (DEX) and magnesium sulfate (MgSO₄) are anesthetic adjuvants that may enhance recovery and reduce opioid consumption. This study aimed to compare the effects of DEX and MgSO₄ as an anesthetic adjuvant on interleukin-6 (IL-6) levels, hemodynamic stability, postoperative recovery, and opioid consumption in spine surgery.
Methods: A randomized controlled trial was performed on 24 patients undergoing spine surgery under general anesthesia. Participants were randomly divided into two groups: Group 1 received DEX (a 1 µg/kg bolus followed by a continuous infusion of 0.3–0.5 µg/kg/h), while Group 2 was given MgSO₄ (a 30–50 mg/kg bolus followed by an infusion of 10–20 mg/kg/h). Hemodynamic parameters, IL-6 levels (pre- and postoperatively), opioid use, and recovery outcomes were analyzed.
Results: IL-6 levels decreased significantly in both groups (p=0.001), with a greater reduction in the DEX group (-60.5 pg/dL vs. -24.9 pg/dL), though not statistically significant. Hemodynamic stability was comparable, but DEX provided better pulse rate control. Opioid consumption was lower in the DEX group at 24 and 48 hours postoperatively (p < 0.05). The DEX group also showed higher Aldrete scores (p<0.05) and shorter hospital stays (3.75 vs. 4.83 days, p<0.05).
Conclusion: DEX provides superior anti-inflammatory effects, hemodynamic stability, reduced opioid use, and improved recovery compared to MgSO₄ as an anesthetic adjuvant in spine surgery patients.

Background: Caesarean section is associated with postoperative pain that results in patient dissatisfaction and necessitates the use of various analgesics. In this study, the effect of gabapentin on post-Caesarean-section pain relief was evaluated.
Methods: A total of 50 parturients undergoing spinal anesthesia for cesarean section were randomly assigned into intervention and control groups in this randomized clinical trial between 2022 and 2023. Patients in the case group received gabapentin 300 mg capsules one hour before surgery, while the control group received an identical placebo. The postoperative pain intensity and need for analgesics, as well as nausea, vomiting, and drowsiness, were evaluated at 0, 6, 12, and 24 hours after surgery.
Results: The mean age of patients in the gabapentin and placebo groups was 26.42±6.15 and 26.5±65.91, respectively (P=0.34). A significant difference was found in postoperative pain intensity and the need for analgesics between the case and control groups at zero (P=0.001 and P=0.003), six (P=0.007 and P=0.002), 12 (P=0.005 and P=0.001), and 24 (P=0.004 and P=0.021) hours after surgery. No significant differences were seen in the rates of nausea, vomiting, and drowsiness between the two groups at the different time points (P>0.05).
Conclusion: According to our findings, prescribing gabapentin 300mg before a cesarean section effectively reduces postoperative pain severity and the need for analgesics. This dose is also safe for the neonate.

Background: Concept mapping and debriefing are educational strategies used to create motivation and meaningful learning. This study compared the effect of teaching incorporating these two techniques on learning and achievement motivation in anesthesia management of neurosurgery among anesthesia students.
Methods: This was a quasi-experimental study involving two experimental groups (concept mapping and debriefing) and one control group. The statistical population included all 5th- and 7th-semester undergraduate students of anesthesia at Ahvaz Jundishapur University of Medical Sciences. Census sampling yielded 51 participants, who were then randomly assigned to three groups: 17 in the concept mapping group, 17 in the debriefing group, and 17 in the control group. The experimental groups were exposed to group concept mapping and debriefing, while the control group received traditional instruction. Data were collected using the Hermans Achievement Motivation Questionnaire and a standard learning questionnaire. Data were analyzed using analysis of covariance (ANCOVA) and t-tests.
Results: Covariance analysis demonstrated that teaching interventions, using both group concept mapping and debriefing, significantly increased achievement motivation and learning outcomes in anesthesia students (p < 0.05). Furthermore, concept mapping yielded a statistically significant increase in achievement motivation as well as meaningful and deep learning compared to debriefing. Regarding learning levels, after two months of intervention, students taught using concept mapping exhibited significantly higher scores (30.41 ± 0.732) than both the debriefing group (29.17 ± 0.772) and the control group (28.78 ± 0.771, p < 0.05).
Conclusion: This research suggests that educational stakeholders should integrate concept mapping into anesthesia curricula, focusing on its motivational components, to significantly boost student achievement and learning outcomes.

Background: In perioperative care, patient satisfaction is a key quality indicator; however, very little information exists on anesthetic-specific satisfaction among cardiac surgery ICU patients. Patients admitted to the cardiac surgery intensive care unit (ICU) were evaluated in this study for their level of satisfaction.
Methods: Between 2019 and 2020, this cross-sectional analytical research included 186 consecutive adult patients undergoing open-heart surgery at Golestan Hospital, Ahvaz, Iran. The verified Evaluation du Vécu de l'Anesthésie Générale (EVAN-G) scale (score range: 0-100) measured anesthesia satisfaction 48 hours post-extubation. Multivariable linear regression identified predictors of satisfaction.
Results: The mean satisfaction score was 73.8 ± 14.2. High satisfaction (≥80) was reported by 52.7% (n=98). Significant predictors included: Preoperative anxiety therapy (β=8.6, p=0.003), Effective pain control (VAS<4) (β=12.1, p<0.001), Clinician communication quality (β=9.3, p<0.001) and, Absence of PONV (β=7.2, p=0.011). The regression model accounted for 63% of satisfaction variation (R²=0.63, p<0.001).
Conclusion: Modified variables linked with anesthesia satisfaction in patients in a cardiac ICU are active communication, pain management, and preoperative counseling.

Background: Postoperative cognitive dysfunction (POCD) is a major concern in anesthesia, leading to increased morbidity and longer hospital stays. Our study aimed to evaluate the efficacy of target-controlled infusion (TCI) dexmedetomidine in reducing the incidence of POCD following laparotomy surgery.
Methods: A single-blinded, randomized controlled trial involving 107 patients aged >18 years old undergoing laparotomy surgery was conducted. Patients were randomly assigned to 54 patients in Group D (TCI dexmedetomidine with a target plasma of 1 ng/ml) and 53 patients in Group I (sevoflurane at 0.8% concentration).
Results: Our study showed subjects whose anesthesia was maintained by TCI dexmedetomidine had a lower chance of developing POCD (p=0.043) and experienced less pain at 12 hours (p=0.049) and 24 hours (p=0.049) in the postoperative period, compared to the control group. There were no significant differences between both groups in intraoperative MAP (p=0.290) and HR (p=0.453).
Conclusion: Maintaining anesthesia using Conox®-guided TCI dexmedetomidine reduces the incidence of POCD and postoperative pain in laparotomy patients who underwent general anesthesia.

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

Background: Ventilator-Associated Pneumonia (VAP) is a common complication in mechanically ventilated ICU patients and is associated with bacterial colonization in the oral cavity. Poor oral hygiene can increase the risk of bacterial aspiration into the lower airway. Various oral hygiene agents such as chlorhexidine, povidone iodine 1%, and fluoride toothpaste are used to prevent this colonization, but their effectiveness is still variable. This study aimed to compare these three agents on tracheal microorganism growth and antibiotic resistance profile in mechanically ventilated patients.
Methods: This single-blind randomized clinical trial included 45 ICU patients on mechanical ventilation at Dr. Wahidin Sudirohusodo Hospital, Makassar. Subjects were allocated into three groups to receive oral hygiene using chlorhexidine 0.12%, povidone iodine 1%, or fluoride toothpaste twice daily for five days. Tracheal aspirates were collected at baseline (before intervention), Day 3, and Day 5 to assess microbial colony counts and antibiotic susceptibility profiles.
Results: The chlorhexidine group showed the most significant reduction in tracheal microorganism colony counts from 1833.33  566.5 to 1226.7  461.7 CFU/mL on day 5 (p < 0.001), compared to povidone iodine and fluoride. The highest antibiotic resistance was found in Acinetobacter baumannii and Pseudomonas aeruginosa. The chlorhexidine group also had the lowest number of multiresistant isolates.
Conclusion: Among the evaluated oral hygiene agents, chlorhexidine 0.12% was the most effective in reducing tracheal microbial colonization and showed a lower tendency for antibiotic resistance development. It is recommended as a superior oral care agent for preventing VAP in mechanically ventilated ICU patients.

Background: Effective management of postoperative pain in breast cancer surgery is crucial to enhance recovery and quality of life. Regional anesthesia techniques such as Pecs II and Serratus Anterior Plane Block (SAPB) have emerged as alternatives to systemic opioids. To compare the efficacy of single-shot Pecs II block and SAPB in terms of acute and long-term (up-to 2 months) postoperative analgesia following modified radical mastectomy.
Methods: A single-blind, randomized controlled trial was conducted on 46 ASA I-II female patients undergoing MRM, assigned to either Pecs II block (Group P) or SAPB (Group S), each with 30 mL of 0.25% bupivacaine. Numerical Rating Scale (NRS) scores at rest and during movement were recorded perioperatively and during 60-day follow-up. Secondary outcomes included time to first rescue analgesia, number of rescue analgesics in 48 hours, and adverse effects.
Results: Both blocks provided comparable acute pain relief in the first 48 hours (p>0.05). Group P showed significantly lower NRS scores at 15, 30, and 60 days at rest and on movement (p<0.05), indicating better long-term analgesia. There was no significant difference in rescue analgesic requirements or adverse effects.
Conclusion: Both Pecs II and SAPB offer effective acute postoperative pain control following MRM, while Pecs II provides superior long-term analgesia.

Background: Hysterectomy often triggers a systemic inflammatory response, increasing biomarkers like C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR), which can delay recovery and raise complication risks. Ketamine, a common anesthetic, possesses anti-inflammatory properties that may modulate this postoperative response. This study aimed to further examine the effects of ketamine on CRP and NLR levels in patients undergoing hysterectomy.
Methods: This double-blind randomized clinical trial included 28 adult female patients (ASA I–II) undergoing elective abdominal hysterectomy under epidural anesthesia. Patients were randomized to receive either 0.5 mg/kg intravenous ketamine (intervention group) or no ketamine (control group). Serum CRP and NLR were measured preoperatively and at 8 and 24 hours postoperatively. The visual analog scale was used to evaluate pain level, data were processed with the appropriate statistical test, and a p-value < 0.05 is considered significant.
Results: Our study discovers that intravenous ketamine reduced postoperative inflammatory markers significantly. Postoperative measurements at 8 and 24 ours proved that the ketamine group had lower CRP and NLR levels significantly (p<0.05). Patients receiving ketamine showed a non-significant reduction in VAS pain scores compared with controls. No participant in either group needed additional opioids for pain control.
Conclusion: Intravenous ketamine decreased postoperative inflammatory response significantly in hysterectomy patients receiving epidural anesthesia, as proved by lower CRP and NLR.  Ketamine seemed to improve patient comfort by lowering pain intensity. Combining epidural anesthesia with ketamine may be a viable strategy to suppress inflammation and enhance recovery after hysterectomy.

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: Postoperative cognitive dysfunction (POCD) is a relatively common and troubling issue, especially in older adults undergoing surgery. Bispectral index (BIS) monitoring enables anesthesiologists to assess anesthetic depth in real time and adjust dosing accordingly. In this article, we summarize the current evidence on BIS-guided anesthesia in reducing the incidence and severity of POCD in adult surgical patients.
Methods: A structured search was conducted in PubMed and Scopus databases to identify randomized controlled trials, observational studies, and meta-analyses published between 2000 and 2024.
Results: Clinical trials and meta-analyses suggest that BIS monitoring reduces anesthetic exposure, shortens recovery time, and is associated with lower POCD rates. Mechanisms may include optimized drug titration, improved hemodynamic control, and reduced neuroinflammation.
Conclusion: BIS monitoring may represent an effective approach to mitigate POCD, especially in high-risk patients. Further large-scale trials are needed to confirm these findings and refine guidelines.

Background: The gut microbiome has emerged as a notable factor in the field of anesthesiology. It affects different dimensions of anesthesia outcomes, pain control, and recovery following the surgery. A comprehensive understanding of the interplay between gut microbiota and anesthetic methods is imperative for improving patient care.
Methods: This narrative review synthesizes existing scholarly literature on the interactions between gut microbiota and anesthetic agents, examining their implications for drug metabolism, inflammatory responses, and the gut-brain axis.
Results: It highlights clinical trials that explore the effectiveness of probiotics and prebiotics in reinstating microbial equilibrium and augmenting surgical outcomes. A study indicates that alterations in the composition of the gut microbiome can notably influence the pharmacokinetics and therapeutic efficacy of anesthetic agents. So, there are effects on dosage regimens and strategies for controlling postoperative pain. An equilibrated microbiome has been demonstrated to enhance anti-inflammatory mechanisms and bolster immune function; thus, it promotes an optimal recovery trajectory. Also, the gut-brain axis suggests that microbiome profiles may serve as predictors for postoperative cognitive dysfunction and pain perception.
Conclusion: This review emphasizes the relevance of the gut microbiome within anesthesiology and advocates for the adoption of personalized anesthetic approaches that consider individual microbiome characteristics. Prospective research in this field holds significant potential for the development of innovative perioperative care strategies. It may enhance recovery and mitigate complications associated with surgical procedures.

Background: Coronavirus disease 2019 (COVID-19) is an infectious illness resulting from the SARS-CoV-2 virus. The immune system overactivation triggered by this virus results in multiple organ damage. This infection has the potential to cause acute respiratory distress syndrome and may progress to respiratory failure, both of which can be life-threatening. Vitamin C is proposed as a possible treatment for immune system overactivation due to its antioxidant properties.
Methods: This umbrella review seeks to evaluate the effectiveness of vitamin C in the management of COVID-19 infection. To identify pertinent literature, we conducted searches across Embase, PubMed, Scopus, and Web of Science databases. Our analysis incorporated eight systematic reviews and meta-analyses that examined the impact of vitamin C on COVID-19 treatment outcomes.
Results: Our findings revealed that the odds ratio (OR) of mortality in the vitamin C group is 0.55 (0.48-0.63). The duration of hospitalization did not differ between the groups and the need for mechanical ventilation in both groups. This umbrella review discusses the use of vitamin C in COVID-19 patients, highlighting its potential to reduce mortality rates. While the duration and dose of treatment vary There was no notable distinction observed between the vitamin C group and the control groups in hospital length, ICU stay, or mechanical ventilation days.
Conclusion: The study suggests further research to determine its effectiveness in reducing mortality rates and suggests larger studies with a more specific protocol.

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.

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.

The incidence of paraganglioma has been reported between 2-8 cases per million people yearly. Thoracic functional Paragangliomas accounts for 15-20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has high mortality rate challenging anaesthetic management. Undiagnosed paraganglioma have an extremely high mortality rate up to 60%. The present report is a case of successful management of functional paraganglioma excision at the level of T9-T11 feeding from the descending aorta. A 71-year-old male with lower thoracic functional paraganglioma was posted for excision. Pre-anaesthetic evaluation, revealed history of Ischemic Heart Disease, Hypertension and PTCA 1month prior and intake of regular cardiac medication preoperatively, along with regular medications of Tab Propranolol 10mg and Tab Bisoprolol 2.5mg. PR was 84 bpm and BP was 140/90 mmHg in a supine position and 90/60 mmHg on standing. Echocardiography indicated EF 50% with borderline LV function. Epidural and General Anaesthesia was administered. Continuous roller coaster fluctuations in haemodynamics for intraoperative period of 8hrs, risk challenges calibrated by continuous vasopressor and vasodilation infusions. Extubation and post-operative period were uneventful. Careful perioperative management, including preoperative cardiovascular stabilization and intraoperative hemodynamic monitoring, is crucial in functional paraganglioma cases to prevent mortality and complications.

Posterior mediastinal masses pose challenges for anesthesiologists due to their compressive nature. The most frequently used surgical approach is thoracotomy and anesthesia involves awareness of potential complications and airway management strategies. Among different types of foreign bodies (FBs), the esophageal FBs are one of the most common pediatric emergencies among infants and young children and the proximal part is the most common site. Presentation can range from being asymptomatic to symptoms such as vomiting, dysphagia, and drooling, or respiratory issues like coughing, wheezing, choking, or stridor. In this report, we present a case of a posterior mediastinal mass in a child with a history of respiratory disorders and multiple treatment courses.

Lobectomy with one-lung ventilation presents significant anesthetic challenges, particularly in elderly patients with multiple comorbidities. This case report describes the successful anesthetic management of an elderly patient with adenocarcinoma lung undergoing right lower lobe lobectomy. An elderly male with adenocarcinoma of the right upper lobe presented for lobectomy. His complex medical history included chronic kidney disease requiring regular hemodialysis, post-stroke right-sided hemiparesis, hypertension, hypothyroidism, and diabetes mellitus. The anesthetic management involved careful preoperative optimization, use of a left-sided double-lumen tube for one-lung ventilation, and meticulous hemodynamic monitoring. Challenges encountered included a brief episode of hypoxemia during one-lung ventilation and hypertension, which were successfully managed with ventilator adjustments and dexmedetomidine infusion, respectively. The six-hour surgery was completed successfully with minimal blood loss. The patient was extubated postoperatively and maintained stable oxygenation on supplemental oxygen. Pain management was achieved through multimodal analgesia, including a fentanyl patch. This case illustrates that complex thoracic surgery can be safely conducted in high-risk patients through comprehensive preoperative evaluation, careful intraoperative management, and adherence to enhanced recovery protocols. The successful outcome emphasizes the importance of a multidisciplinary approach in managing such challenging cases.

Pan facial trauma, involving multiple fractures of the facial bones, presents significant challenges in anaesthetic management. These injuries often result from high-impact accidents and can lead to airway compromise, making intubation and ventilation difficult. The anaesthesiologist must navigate potential obstacles such as facial distortion, bleeding, and limited mouth opening, all while maintaining cervical spine precautions. The management of these cases requires a thorough preoperative assessment, careful planning, and often necessitates advanced airway techniques. This case report describes the anaesthetic management of a 50-year-old male patient with pan facial trauma scheduled for reconstructive surgery. It highlights the use of CMAC video laryngoscopy intubation as a safe and effective technique in securing the airway in a patient with anticipated difficult intubation. The report also discusses the rationale behind the anaesthetic choices made and the perioperative challenges encountered. By sharing this experience, we aim to contribute to the existing body of knowledge on managing complex airway scenarios in trauma patients and emphasize the importance of individualized anaesthetic planning in such cases.

Cerebral salt wasting syndrome (CSWS) is a cause of hyponatremia in patients with brain injury, but it often improves in a short time. In this article, a patient with prolonged CSWS after craniotomy for subdural hematoma (SDH) and intracranial hemorrhage (ICH) is presented. A 73-year-old woman was transferred to the ICU due to a decreased level of consciousness (GCS= 9) with a diagnosis of SDH and ICH. The patient had a history of atrial fibrillation. The pupils were mid-sized and reactive. BP= 130/90 mm/Hg, HR=80/min, T=37.3, and initial tests were HB=12.7 gr/dl, Bun=12, Cr=0.7, Na=138 Meq/lit, K=4meq/lit, Ptt=25 Sec, INR=1.1, ESR=10. The patient was intubated 48 hours later due to a decreased level of consciousness and underwent craniotomy and hematoma drainage. From the 4th day after the operation, the patient developed hyponatremia and polyuria, but despite the administration of hypertonic sodium and normal saline, the hyponatremia persisted. On the 8th day after the operation, fludrocortisone was started, one tablet twice a day, and the patient showed a partial response to the treatment after one week, but the hyponatremia was corrected after 2 weeks. CSWS is more common and prolonged in severe and multiple brain injuries, and in these cases, the administration of fludrocortisone in addition to normal sodium and hypertonic sodium is helpful.

Diabetic ketoacidosis (DKA) may become life-threatening when accompanied by acute pancreatitis, sepsis, and acute respiratory distress syndrome (ARDS), resulting in a cascade of inflammation and multi-organ dysfunction. We describe a 70-year-old male with severe DKA complicated by septic shock, ARDS, and multi-organ failure, who required individualized, precision-based fluid therapy. Aggressive but closely titrated resuscitation, guided by dynamic clinical markers, together with early initiation of Continuous Renal Replacement Therapy (CRRT), achieved stabilization. This case highlights the value of adaptive fluid management and timely CRRT in critically ill patients with complex DKA.

Glucose homeostasis disturbance is a common complication among patients in intensive care units (ICUs), frequently resulting in stress-induced dysglycemia. Individuals with diabetes mellitus (DM) are particularly susceptible to hyperglycemia and face a higher risk of severe hypoglycemia due to overtreatment. Particularly for patients on insulin or glucose-lowering drugs, it is crucial to maintain regular meal patterns in terms of timing, food type, and quantity. The 63-year-old female patient in this case study was referred from the neurology department after experiencing diminished awareness and going two days without eating. She had experienced multiple seizures lasting more than five minutes and presented with a nasogastric tube (NGT) insertion showing 150 mL of greenish gastric residual. The patient reported reduced intake over the past week due to nausea and headaches, occasional vomiting, intermittent fever, and a weight loss of 2.2 kg (4.8%) within one week. Medical nutrition therapy (MNT) was initiated to ensure adequate nutrient intake through enteral and parenteral routes, followed by a gradual transition to oral feeding. This approach aimed to improve the patient’s nutritional and metabolic status through personalized and adequate nutritional care. The patient's clinical condition was managed concurrently, with continuous monitoring of intake, anthropometry, and laboratory parameters to evaluate the intervention’s effectiveness. This case highlights that proper medical nutrition therapy for critically ill patients with metabolic encephalopathy, diabetes mellitus, cerebral infarction, and status epilepticus complicated by severe protein-energy malnutrition can lead to significant improvements in clinical outcomes.