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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Nurses, as professionals in the caring profession, try to perform safe and effective nursing interventions all the time and support patients to achieve the most favorable treatment outcomes. Nowadays, one of the important and international issues in nursing is distress tolerance. This study aimed to determine distress tolerance and affecting it among nurses working in the COVID-19 intensive care unit.
Methods: This cross-sectional study was conducted in 2021 on 128 nurses working in the Intensive Care Units (ICU) of Ziaian Hospital in Tehran.We used a convenience random method to select the samples, based on the inclusion criteria. Data were collected using demographic questionnaires and the standard distress tolerance scale (DTS). We analyzed the data using SPSS-25 software, employing both descriptive and inferential statistical tests. P<0.05 was considered the level of significance.
Results: The results of this study showed that the mean age of the samples was 34.95±6.77 years. The highest scores of distress tolerance subscales included appraisal (17.89±3.62), tolerance (8.97±2.60), absorption (8.83±2.30), and regulation (2.25 ±8.39), respectively. The statistical test of linear regression showed that service history and shift work have a significant power to predict nurses' distress tolerance.
Conclusion: The distress tolerance of nurses working in the ICU units was low. Factors such as service history and shift work influence their distress tolerance. Accordingly, it is necessary to plan to improve nurses' distress tolerance.

Background: In addition to the serious physical health impacts on nurses, COVID-19 has brought about significant psychological distress. Considering that spirituality as a strong foundation can be a powerful factor in controlling stressful conditions, this study was conducted with the objective of determining the effect of spiritual self-care education on the resilience of nurses working in COVID-19 intensive care units.
Methods: We conducted this randomized clinical trial study on 128 nurses working in COVID-19 intensive care units. Samples were initially selected through convenience sampling and then randomly allocated to two groups: intervention (64 nurses) and control (64 nurses). The research group received a spiritually based educational program in 6 sessions of 45 minutes each, held as a one-day event. Five relevant faculty members and the research team examined and approved the validity of the educational content. Data were collected using demographic questionnaires and a standard questionnaire on distress tolerance, before and after the intervention in both groups. We conducted data analysis using SPSS version 25 software, employing independent t-test, paired t-test, Fisher test, and Chi-square test statistical analyses. A p-value of less than 0.05 was considered significant.
Results: The mean age in the intervention group was 34.95 ± 6.77 years, and in the control group was 35.23 ± 7.68 years. The independent t-test showed a significant difference between the average distress tolerance score and all its subscales (tolerance, absorption, evaluation, regulation) between the intervention and control groups after the implementation of spiritual self-care training (P<0.001). The level of distress tolerance in the intervention group after the intervention (50.40±5.71) increased significantly compared to before the intervention (44.39±5.23) (P<0.001).
Conclusion: Spiritual self-care education increases the distress tolerance of nurses working in COVID-19 intensive care units. Therefore, we recommend implementing a spiritual self-care program and planning for nurse participation in spiritual activities to enhance their psychological well-being.

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

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

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

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

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

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

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

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

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

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

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