Background: One of the most prevalent procedures involving general anesthesia (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). We conducted this study to assess and compare the effectiveness of preoperatively administered nebulized ketamine and dexmedetomidine in alleviating POST.
Methods: We randomly divided the patients into two groups, each containing 151 patients. Group-K patients were nebulized with 50 mg (1 ml) with 3 ml normal saline, while Group-D patients were nebulized with dexmedetomidine 50 mcg (0.5 ml) with 3.5 ml normal saline, preoperatively. GA was administered 15 min post-nebulization. POST was graded at 4, 6, 12, and 24 h after extubation on a four-point scale (0-3). The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 17.0.
Results: In the present study, the overall incidence of POST was 32.5%. among which 39 patients (25.8%) in the ketamine group and 59 patients (39.1%) in the dexmedetomidine group experienced POST at 4h, following extubation (P value=0.014). A significantly higher incidence of POST in the dexmedetomidine group was noticed as compared to the 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 the dexmedetomidine group had more severe POST than in the ketamine group, at 4h following extubation (p-value <0.05). There was no significant rise in systolic and diastolic blood pressure in either group.  However, the ketamine group had a significantly higher mean heart rate after extubation compared to the dexmedetomidine group.
Conclusion: Ketamine nebulization significantly decreases the incidence and severity of postoperative sore throat during the early postoperative period with minimum hemodynamic changes.

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

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

Background: Non-cardiac surgery in patients with cardiovascular risk can lead to postoperative complications. Troponin T, a cardiac biomarker, is proposed as an indicator of cardiac risk in these patients. This study evaluates troponin T levels before and after non-cardiac surgery and their association with postoperative complications.
Methods: This prospective cohort study included 46 patients selected through consecutive sampling. Demographic data and troponin T levels were recorded before and 24 hours after surgery.
Results: Postoperative complications included cardiac events (15.21%), such as myocardial infarction (4.34%), heart failure (4.34%), and arrhythmia (6.52%), and non-cardiac events (17.39%), such as sepsis (4.34%), bleeding (4.34%), surgical site infection (6.52%), and respiratory insufficiency (2.17%). The average patient age was 50.15 ± 8.81 years, with 60.9% being male. There was a significant relationship between troponin T levels and the incidence of cardiac complications after surgery.
Conclusion: Elevated postoperative troponin T levels may serve as a prognostic indicator for cardiac complications in non-cardiac surgery patients. Routine monitoring could aid in early detection and improved postoperative management.

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

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

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

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

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

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

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

Background: The optimal dosing regimen of tranexamic acid (TXA) for minimizing blood loss during supratentorial brain tumor resection remains undefined. This study compared two dosing protocols to evaluate efficacy and safety.
Methods: In this double-blind, randomized trial (September 2020–September 2021), 60 patients aged 18–60 years undergoing supratentorial tumor surgery were allocated to receive either TXA1 (20 mg/kg bolus + 1 mg/kg/h infusion) or TXA3 (20 mg/kg bolus + 3 mg/kg/h infusion). Primary outcomes included intraoperative blood loss; secondary outcomes encompassed transfusion needs, surgical duration, hospitalization length, and thromboembolic complications.
Results: The TXA3 group demonstrated an 18% reduction in mean intraoperative blood loss compared to TXA1 (402.93 mL vs. 470.61 mL; mean difference −67.68 mL, 95% CI −139.4 to 3.9; p = 0.053). Transfusion requirements were lower in the TXA3 cohort (0.43 ± 0.9 vs. 0.64 ± 1.2 units; p = 0.34), though not statistically significant. Surgical duration was prolonged in the TXA3 group (p = 0.047), but hospitalization was shorter (p = 0.049). Thromboembolic event rates were comparable between groups (p > 0.05).
Conclusion: Higher intraoperative TXA infusion rates were associated with reduced blood loss and shorter hospital stays without elevating thromboembolic risk. These findings support TXA’s utility in improving perioperative outcomes and resource efficiency for supratentorial tumor resection.

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

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

Background: Postoperative emergence agitation in children is so common. Isoflurane and propofol are evaluated for agitation, but results were contradictory. This study aimed to compare the effect of isoflurane and propofol for emergence agitation in children under three years old.
Methods: This double-blinded, randomized clinical trial was performed on 104 children under three years’ old who were candidates for nasolacrimal probing. The children were anesthetized by sevoflurane and then were divided into isoflurane and propofol groups. After transfer to the recovery room, at first, 4 and 8 minutes, the degree of agitation of the child was measured according to the Watcha sedation criteria.
Results: The demographic parameters were not different. The mean duration of anesthesia (from LMA insertion to extubation) in isoflurane was significantly shorter than in propofol (p = 0.001). Also, the recovery time in the isoflurane group was significantly shorter than that of the propofol group (P=0.02). The prevalence of agitation was 7.69% in the propofol and 59.61% in the isoflurane, and the difference was significant (P = 0.001). Agitation scores at first, 4 and 8 minutes in the recovery room, showed less agitation in the propofol group (P=0.001).
Conclusion: Our study showed that propofol in children reduces the incidence of emergence agitation compared to isoflurane. But emergence and recovery time in the isoflurane group was less than in the propofol group.

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

Background: Etomidate is an anesthetic induction medicine that is the first choice, particularly in elderly and cardiovascular patients, due to its favorable hemodynamic stability. There are some complications with etomidate administration nevertheless. Created pain during the injection, for instance, may be bothering.
Methods: 60 patients who were candidates for general anesthesia with Etomidate were divided into 3 groups randomly. After infusing 300 ml of normal saline for each patient, 2 minutes before induction, Ondansetron 8mg, Ondansetron 4mg, and normal saline were administered to groups first, second, and third, respectively. Then Etomidate was given to all patients in the form of 10 ml ampoules containing 20 mg of Etomidate equally. The pain score was rated using the FPRS criterion, which is from 0 to 10. Collected data were analyzed and interpreted.
Results: The factor of sex wasn’t an effective element in the level of pain, but height (p = 0.034) and age affected this level; patients who were in their seventh decade of life had no complaints (59.4%). There was no significant difference in the mean arterial blood pressure, the mean heart rate, and the mean arterial oxygen saturation between the three groups. The level of pain was considerably different in the study groups (p = 0.000), and the 8 mg ondansetron group had the lowest pain.
Conclusion: Ondansetron can reduce the injection pain of Etomidate, and the greatest effect is related to the 8 mg dose of Ondansetron.

Background: The procedure of endoscopic retrograde cholangiopancreatography (ERCP) requires deep sedation for procedural success and patient safety. Propofol is commonly used due to its rapid onset and recovery, but its administration method significantly impacts its effectiveness and safety. This study compares Target Controlled Infusion (TCI) and Manual Controlled Infusion (MCI) of propofol in ERCP patients.
Methods: A single-blind randomized controlled trial was conducted with 22 ERCP patients, who were randomly assigned to either the TCI group (n=11) or the MCI group (n=11). In the TCI group, propofol was administered using the Schnider pharmacokinetic model, targeting effect sites, with an initial effect-site concentration set at 2.5 mcg.kg^-1. In contrast, the MCI group received an initial propofol bolus of 2 mg.kg^-1, followed by 20 mg increments every 10 seconds. The study analyzed propofol induction time, hemodynamic stability, and total propofol consumption, with hemodynamic parameters recorded every five minutes.
Results: The TCI group had a significantly longer induction time (10.00 ± 2.05 min vs. 3.45 ± 1.21 min; p < 0.001) but required a lower total dose of propofol (2.30 ± 0.43 mg.kg^-1.h^-1 vs. 3.69 ± 0.69 mg.kg^-1.h^-1; p < 0.001). Hemodynamic stability was comparable between both groups.
Conclusion: TCI provides similar hemodynamic stability to MCI while reducing total propofol consumption. Despite a longer induction time, TCI may be a more cost-effective and controlled method for propofol administration in ERCP.

Background: This study was conducted with the aim of comparing the sedation rate of Propofol and Lidocaine -Propofol combination in patients undergoing bronchoscopy.
Methods: In this clinical trial study, 60 patients undergoing bronchoscopy were divided into two groups of 30 people, in the first group 1 mg/kg of Propofol and in the second group 1 mg/kg of Propofol together with 1.5 mg/kg of Lidocaine were injected. And the hemodynamic parameters, depth of sedation, consumption of Propofol and midazolam, and pain intensity after the operation were evaluated and compared between two groups.
Results: Patients in the propofol-Lidocaine group had better hemodynamic stability and the trend of sedation score changes was significantly different between the two groups (P=0.042). In terms of pain intensity during recovery, propofol-Lidocaine recipients had less pain intensity (P<0.001). Patients receiving propofol-Lidocaine received less Propofol (P=0.028) and midazolam (P=0.01).
Conclusion: The results of the present study show that the use of injectable Lidocaine with Propofol is associated with more favorable hemodynamic stability, reduction of Propofol consumption, better sedation, and less postoperative pain, so it seems that the use of Lidocaine with Propofol is beneficial. It is preferable to Propofol alone.

Background: This study aimed to evaluate the effectiveness of machine learning (ML) models in predicting difficult intubation among maxillofacial surgery patients by using clinical data from a previous study involving 132 patients. The study sought to enhance anesthesiologists' ability to identify patients at risk of difficult intubation, a critical concern in surgical settings.
Methods: The research applied various ML algorithms, including decision trees (DT), random forests (RF), Naive Bayes (NB), neural networks (NN), support vector machines (SVM), K-nearest neighbors (KNN), and ensemble voting methods, to the existing clinical dataset. This dataset contained a range of factors potentially associated with DI, such as the Mallampati score, Upper Lip Bite Test (ULBT) results, facial angle, and other relevant variables. A comprehensive approach was taken to explore the impact of different data preprocessing techniques, with a particular focus on feature selection and normalization methods.
Results: The study found that the combination of mutual information-based feature selection and robust scaler normalization consistently yielded high predictive accuracy. Notably, the decision tree algorithm achieved an accuracy of 0.84 and precision, sensitivity, and specificity scores of 0.95. The analysis also highlighted the strength of ensemble learning, which, by combining multiple classifiers, achieved an accuracy of 0.82. The results suggest that ML models, especially random forests and ensemble voting methods, can be highly accurate in predicting difficult intubation when trained on existing clinical data.
Conclusion: The research underscores the importance of data preprocessing in enhancing algorithmic performance, particularly the effectiveness of mutual information-based feature selection combined with robust scaler normalization. However, the study also indicates the need for further research to refine these models, ensuring their applicability and reliability in real-world clinical settings.

Background: Cesarean section operation with spinal anesthesia is one of the most frequently performed surgical operations worldwide. Perioperative shivering is a problem that often happens during surgery with spinal anesthesia, with an incidence that can be up to 50%. Nevertheless, this shivering condition still receives less attention in the literature and daily clinical practice. Paracetamol lowers hypothalamic temperature set points to reduce postoperative shivering by centrally inhibiting prostaglandins. By lowering thermoregulatory set points and IL-6 levels, paracetamol has also been demonstrated to lessen postoperative stress.
Methods: This study was designed as a double-blind, randomized, controlled trial involving 34 participants randomly distributed between two groups. Group 1 (n=17) will receive paracetamol 15 mg/kg body weight, and group 2 (n=17) will receive 100 mL of 0.9% sodium chloride solution. Shivering is assessed using the Bedside Shivering Assessment Score at 0, 15, 30, 45, 60, and 120 minutes after injecting the drug into the subarachnoid space. Interleukin-6 (IL-6) levels will be taken by taking peripheral blood samples 3 times (1 hour before surgery, 1 hour after surgery, and 6 hours after surgery) and then examined using the Enzyme-Linked Immunosorbent Assay (ELISA) method in pg/dL.
Results: The statistical analysis showed no significant difference (P>0.05) in the IL-6 comparison between the paracetamol and control groups. However, compared with the control group, the paracetamol group's average IL-6 levels were lower. Statistical analysis revealed a significant difference (P = 0.038) in the incidence between those receiving paracetamol and those in control groups. The paracetamol group demonstrated a lower incidence of shivering (35.3%) than the control group (76.5%). Significant variations (P = 0.038) were also observed in the onset of shivering between the paracetamol and the control group. The paracetamol group experienced shivering at a later time (between minutes 45 and 120) than the control group (between minutes 30 and 60).
Conclusion: Administration of 15 mg/kg BW paracetamol significantly reduced shivering incidents, shivering onset, and the need for rescue pethidine compared to the control group that received 100 ml of 0.9% sodium chloride after a cesarean section with spinal anesthesia but did not significantly reduce IL-6 levels.

Background: Chronic spinal pain can be managed through various approaches, including surgical options and interventional techniques like epidural injections and trigger point injections. However, there is a notable lack of comparative research addressing the effectiveness of these two specific methods in alleviating chronic low back pain. This study aimed to evaluate and compare the pain relief outcomes associated with caudal epidural steroid injections and trigger point steroid injections in patients suffering from chronic low back pain.
Methods: Sixty patients aged between 20 and 75 years, who had been dealing with chronic low back pain for more than 12 weeks and had a Visual Analog Scale (VAS) score exceeding three, were randomly assigned into two groups of thirty. One group received caudal epidural injections, while the other group was treated with trigger point injections. In the caudal epidural group, a mixture of corticosteroid and 2 mg of ropivacaine was administered under ultrasound guidance at the caudal epidural site. Similarly, the trigger point injection group received the same dosage of corticosteroid and local anesthetic, injected into the identified trigger points under ultrasound guidance. Participants were monitored for six weeks after the injections, with pain levels evaluated at weeks 2, 4, and 6 using the VAS. A two-way ANOVA analysis was conducted to identify differences in pain relief between the two groups.
Results: The findings showed significant differences in pain levels between the two groups. Patients who received caudal epidural injections reported a more substantial reduction in pain compared to those who received trigger point injections. Additionally, the caudal epidural group exhibited a continuous decrease in pain levels at the follow-up assessments from weeks 2 to 6.
Conclusion: This study indicates that caudal epidural steroid injections are a safe and effective method for managing and reducing chronic low back pain. Given these results, caudal epidural injections should be considered a viable treatment option for patients experiencing chronic low back pain.

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: Radical cystectomy (RC) remains the standard of care for high-risk bladder cancer despite being associated with elevated perioperative morbidity. The procedure commonly results in substantial intraoperative blood loss, frequently requiring perioperative blood transfusions (PBT), which are associated with adverse events including transfusion-related complications and heightened healthcare expenditures. Pharmacological interventions such as tranexamic acid (TXA) and fibrinogen may decrease transfusion requirements, though TXA's potential thrombogenic effects raise safety concerns. This randomized controlled trial (RCT) aims to investigate the efficacy of combined fibrinogen and TXA delivery protocol in minimizing surgical blood loss and enhancing postoperative recovery in RC patients.
Methods: This randomized controlled trial (RCT) enrolled 140 participants scheduled for elective radical cystectomy (RC) procedures. Eligible individuals were randomly allocated to four study arms: one administered fibrinogen concentrate, a second receiving tranexamic acid (TXA), a third assigned to a lower-dose combination of both agents, and a control group receiving placebo. Primary outcomes evaluated perioperative blood loss (intraoperative and postoperative), while secondary outcomes encompased vital physiological markers and the incidence of postoperative adverse events.
Results: Patients administered fibrinogen, TXA, or a combination of both demonstrated a marked decrease in postoperative hemorrhage (1,437–1,463 mL vs. 2,727 mL in controls). Furthermore, surgical timeframes showed significant contraction in the intervention groups (4.76–4.79 hours) compared to controls (5.58 hours). These treatments were also associated with shorter hospital stays and reduced transfusion volumes of packed red blood cells and fresh frozen plasma (FFP). No statistically significant variations in acidosis or hemoglobin concentrations were observed across groups. Conversely, fibrinogen and TXA delivery protocol substantially elevated fibrinogen levels, though no clinically relevant differences emerged between the intervention patient groups.
Conclusion: The trial demonstrates that adjusting fibrinogen and TXA dosage protocols effectively reduces surgical bleeding during radical cystectomy. While combination therapy showed comparable efficacy to individual agents, these pharmacological strategies decreased transfusion dependency and hospitalization duration without increasing thromboembolic risks.

Background: Transcatheter aortic valve implantation (TAVI) stands for a significant advancement in the treatment of patients suffering from aortic valve stenosis (AS). TAVI offers a significantly less invasive approach for aortic valve replacement compared to traditional thoracic surgery. Nonetheless, the anesthesiology component of TAVI remains underexplored. Consequently, our objective in this paper has been to explore this matter.
Methods: This trial is a unicenter observational study involving 32 patients undergoing TAVI with two methods of anesthesia, including general anesthesia and sedation. The study was conducted at Imam Hossein Hospital. The primary goal was to compare anesthesia methods regarding cardiac arrest and mortality, stroke, and thromboembolic events.
Results: This study included a total of 32 patients. 84.4% of the patients were male, while 15.6% were female. The average age of the patients participating in this study was 80.06±6.0 years. The most common comorbidities included hypertension, ischemic heart disease, diabetes, and hyperlipidemia, with prevalence rates of 62.5%, 56.3%, 46.9%, and 46.9%, respectively. 78.1% of patients underwent TAVI solely due to AS, whereas 21.9% underwent TAVI for AS together with other cardiovascular diseases. Nearly half of the patients, 46.9%, underwent general anesthesia, and 53.1% received sedation. 12.5% of patients experienced side effects following the procedure, which included atrial fibrillation rhythm, left bundle branch block, atheroembolism, and cardiac arrest. The occurrence of cardiac arrest was recorded at 3.1%.
Conclusion: This key report illustrates the safety of TAVI along with various anesthesia techniques, such as general anesthesia and sedation. General anesthesia was associated with more side effects than sedation. Nonetheless, further research is essential to establish the causal relationships between variables, side effects, and mortality.

Background: Cardiovascular diseases are the leading cause of mortality worldwide. Numerous risk factors contribute to cardiovascular diseases. Identifying individuals at high risk and ensuring they receive appropriate treatment can prevent premature deaths. This study aimed to "determine cardiovascular risk factors and some clinical parameters in patients admitted to the cardiac surgery intensive care unit."
Methods: This study employed a cross-sectional design and was conducted on 109 patients admitted to the cardiac ICU of a central Tehran hospital. Samples were selected using convenience sampling based on inclusion criteria. Data were collected using a researcher-developed questionnaire and analyzed using SPSS version 25 with statistical tests.
Results: The average age of the participants was 61.05±8.5 years. The majority of the sample was male (73.3%). The prevalence of diabetes and hypertension in the patients was 66.1% and 45.9%, respectively. The average BMI of the patients (25.9±3.6) was above the normal range. The mean blood glucose (153.26±36.65), cholesterol (151.7±36.2), triglycerides (135.85±51.9), kidney enzymes, and arterial blood gases were within acceptable ranges.
Conclusion: Risk factors for cardiovascular diseases (particularly high weight and obesity, diabetes, and hypertension) are prevalent in patients undergoing cardiac surgery. Accordingly, planning and education are recommended to control and reduce cardiovascular disease risk factors in these patients.

Background: Supportive and palliative care is recognized as an important and vital component of cancer patient care. Utilizing an appropriate instrument can identify these needs. This study aimed to "design and psychometrically evaluate an instrument for assessing the supportive and palliative care needs of cancer patients."
Methods: This study is a methodological research with both qualitative and quantitative components. Participants included 210 cancer patients. Questionnaire items were extracted through qualitative study methods and literature review, and subsequently, an initial questionnaire was designed. The validity of this questionnaire was evaluated through content, construct, and face validity assessments. Internal consistency and stability of the questionnaire were also examined to determine its reliability.
Results: 59 items were extracted from the qualitative section and literature review. Subsequently, the Item Impact Score (values above 1.5) was calculated. The CVI (above 0.79) and CVR (above 0.56) were assessed, resulting in the selection of 35 items. Exploratory factor analysis yielded four factors: symptom and pain control (6 items), psychological and social needs (17 items), spiritual needs (4 items), and education and awareness (8 items). Finally, a 35-item questionnaire was designed, demonstrating acceptable reliability (α=0.90).
Conclusion: The questionnaire designed in this study has acceptable and confirmed psychometric properties (validity and reliability). Therefore, the use of this instrument is recommended for Iranian patients with cancer.

Background: Delivery and assuming the parental role, especially for mothers, are often accompanied by anxiety and stress, conditions that are significantly aggravated by the birth of a premature infant. The aim of our study is to "determine the effect of COVID-19 prevention training on the stress levels of mothers with premature infants admitted to the NICU."
Methods: This is a quasi-experimental study. The sample consisted of 100 mothers (50 in the experimental group and 50 in the control group) of premature infants hospitalized in the Neonatal Intensive Care Unit (NICU). Participants were randomly assigned to the two groups. The experimental group received an educational program on preventing respiratory infection transmission, with a focus on the coronavirus, delivered through individual face-to-face sessions lasting between 45 to 90 minutes over three sessions. Data for both groups were collected in two phases, before and after the intervention, using a standard Parental Stress Scale questionnaire. Data were analysed using descriptive and analytical statistical tests and SPSS software.
Results: According to the findings of our study, the mean age of mothers in the control and intervention groups was 26.88±0.32 and 27.10±0.30 years, respectively (T=-3.482, d=9.98, P=0.527). Also, the mean age of infants in the control group was 34.90±0.30 weeks and in the experimental group was 35.12±0.52 weeks (T=-2.582, d=9.98, P=0.114). The overall stress score in the intervention group after the intervention (93.82±7.15) significantly decreased compared to before the intervention (135.98±0.51) (P<0.001), and this significant decrease was also observed in all stress subscales (P<0.001).
Conclusion: Finally, the findings of our study showed that mothers whose infants are hospitalized in the ICU experience high levels of stress. The COVID-19 prevention training leads to a significant reduction in mothers' stress.

Background: Despite advances in pain management, the incidence of postoperative pain remains a concern. In addition, analgesics have many side effects. Therefore, non-pharmacological interventions aimed at reducing the dosage of analgesics seem necessary, whether as a complementary or independent medication. In this regard, the present study was conducted with the aim of investigating the impact of music and acupressure on the pain intensity in the conscious patients hospitalized in intensive care units (ICU).
Methods: The present quasi-experimental study was conducted on conscious patients undergoing laparotomy surgery who were hospitalized in the surgical ICU of hospitals affiliated with Shahid Beheshti University in 2023. We randomly assigned 90 patients to one of three groups: nature music, acupressure, or combined. The data collection tools consisted of patients' demographic information form and the visual pain assessment scale, which was measured once before the intervention and over five time points after it. For participants in the nature music group, sounds of rivers, birds, and waterfalls were played using an MP3 player device and headphones for 20 minutes on one occasion. For the participants in the acupressure group, pressure was applied to L14 or Hogo for 10 seconds of pressure, followed by 2 seconds of rest, for a duration of 20 minutes, so that the patient could feel heat, numbness, and heaviness. We simultaneously performed nature music and acupressure for the participants in the combined group. SPSS version 19 was used for data analysis.
Results: Three groups of participants were homogeneous, with no statistically significant differences in terms of demographic characteristics (P value < 0.05). There was no statistically significant difference in the pain intensity of the patients among the three groups before the intervention. However, there was a significant difference among the three groups at 30 minutes, 60 minutes, 2 hours, 3 hours, and 4 hours after the intervention, and the combined and concurrent use of music therapy and acupressure proved to be more effective in reducing the pain intensity.
Conclusion: The results indicated the effectiveness of both nature music and acupressure when used alone or in combination. Their combined and concurrent implementation is more effective. Therefore, we recommend that nurses adopt combined care programs for pain management in ICU patients.

Background: Patients undergoing Coronary Artery Bypass Grafting (CABG) frequently experience fatigue and physical activity tolerance as post-operative complications. The early mobilization technique is one of the beneficial nursing intervention programs that amend patients' outcomes, intercept immobilization, and increase quality of life. This study aimed to assess the effect of the early mobilization (EM) protocol on fatigue and physical activity tolerance in patients who underwent CABG.
Methods: We designed this study as a quasi-experiment with a control group. Participants involved patients who underwent CABG at the Intensive Care Unit (ICU) of Tehran Shahid Modarres Hospital in Iran between April and September 2023. The study included 96 patients, with 48 patients each in the intervention and control groups. Two distinct time points were used to select intervention and control groups (the initial three months and the following three months). Both the control and intervention groups received standard hospital care, but the intervention group also received an EM protocol education. We dedicated three days to intervention education and employment: day 0 (immediately after extubation), day 1 (24 hours later), and day 2 (48 hours later). We collected data were using the Visual Analog Scale-Fatigue (VAS-F) and the Borg scale at two time points (day 0 and day 2). We performed a paired t-test, an independent sample t-test, and an ANCOVA  to analyse data.
Results: 56.3% of participants were men and 43.7% were women. The mean age of participants was 52.7±8.8. In both groups, hypertension (29.2%), hyperlipidemia (27.1%), and diabetes (20.8%) were the most prevalent CVD risk factors. The intervention group's mean fatigue decreased significantly on day 2 (4.40±0.94) compared to day 0 (6.65±1.12) while the mean PA tolerance increased significantly on day 2 (11.82±1.90) compared to day 0 (7.31%±1.20) (P<0.001). The control group did not experience any statistically significant intragroup changes (P>0.05). Significant intergroup changes were observed in the mean fatigue and PA tolerance values on day 2 (P<0.001) while there were no statistically significant intergroup changes in them on day 0 (P>0.05).
Conclusion: This study highlighted that early mobilization was an effective and safe inhibition program to meliorate fatigue and physical activity tolerance in CAD patients.

Background: Lumbosacral radiculopathy due to disc herniation is a leading cause of chronic pain and disability worldwide. While fluoroscopic-guided epidural steroid injections (ESIs) are widely used for symptom relief, their efficacy is variable, and the long-term benefits remain controversial. Ozone therapy has emerged as a promising adjunct to steroid injections due to its anti-inflammatory, analgesic, and oxygenating effects. This study aimed to compare the efficacy and safety of fluoroscopic-guided caudal epidural steroid injections with and without ozone therapy in patients with lumbosacral radiculopathy.
Methods: A randomized, single-blind clinical trial was carried out with 40 adults diagnosed with radicular pain from lumbar disc protrusion at L4-L5 or L5-S1. They were randomly placed into two equal-sized groups. The first group (n=20) received a caudal injection containing dexamethasone (8 mg), lidocaine (5 mL, 1%), and saline (3 mL). The second group (n=20) received the same injection along with 5 mL of ozone (10 µg/cc). Fluoroscopy was used to guide all procedures. Pain and physical function were tracked using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), both before treatment and again after one, three, and six months.
Results: Improvements were seen in both groups over time. Still, the ozone group reported stronger pain relief and better functional scores at every follow-up. At one month, VAS and ODI scores were significantly lower in the ozone group (VAS: 1.85 ± 0.75 vs. 2.40 ± 0.90, p = 0.029; ODI: 22.3 ± 4.5 vs. 26.7 ± 5.1, p = 0.025). The difference held steady at three months (VAS: p = 0.022; ODI: p = 0.021) and at six months (VAS: p = 0.017; ODI: p = 0.015). No major side effects occurred, and mild ones cleared up on their own.
Conclusion: The addition of ozone therapy to fluoroscopic-guided caudal epidural steroid injections significantly enhances pain relief and functional recovery in patients with lumbosacral radiculopathy compared to steroid injections alone. This combination therapy represents a safe, minimally invasive, and effective treatment option for individuals with refractory radicular pain. Further large-scale, multicenter trials with long-term follow-up are warranted to validate these findings and optimize treatment protocols.

Background: End-tidal carbon dioxide (EtCO₂) can approximate the arterial pressure of carbon dioxide (PaCO₂) in children without underlying congenital heart defects. However, EtCO₂ may underestimate PaCO₂ in these children, especially during repair procedures. The PaCO₂ to EtCO₂ difference (Δ PaCO₂-EtCO₂) may be significant in children with congenital heart disease (CHD) and can be notably influenced by surgical procedures. Postoperatively, the Δ PaCO₂-EtCO₂ might not remain consistent; thus, arterial blood gas (ABG) analysis may need to be repeated regardless of capnography findings. This hypothesis was tested in our study on children with cyanotic and acyanotic heart defects undergoing corrective surgeries.
Methods: In this cross-sectional study, hospital records of all children under 12 years of age with ASA II-III and cyanotic or acyanotic heart defects who were candidates for elective angiography were reviewed. EtCO₂ was measured by lateral aspiration capnography. Simultaneous measurements of EtCO₂ and PaCO₂ were collected before and after the intervention.
Results: Significant changes were observed in serum HCO₃ concentration and the PaO₂/FiO₂ ratio, both of which significantly decreased after the repair surgery. However, the change in Δ PaCO₂-EtCO₂ remained insignificant postoperatively. In the cyanotic group, in addition to a significant reduction in serum HCO₃ value and an increase in the PaO₂/FiO₂ ratio after the intervention, we found a significant decrease in Δ PaCO₂-EtCO₂.
Conclusion: Arterial blood gas analysis during repair surgery should be repeated in the cyanotic congenital heart defects group due to the intraoperative variability of Δ PaCO₂-EtCO₂, but not in the acyanotic heart defects group due to the stability of this difference. Therefore, EtCO₂ assessed by capnography can estimate PaCO₂ in children with acyanotic heart defects, but not in those with cyanotic heart defects.

Background: Levobupivacaine’s superior clinical profile and shorter block duration make it an intriguing substitute for other local anesthetics. In order to intensify block and offer postoperative analgesia, intrathecal opioids have been employed as additives. This study compares the effectiveness of levobupivacaine alone and in combination with fentanyl. The effect on hemodynamics, duration of postoperative analgesia, and complications were also compared.
Methods: Fifty patients in the age group of 18-65 years with ASA grade I or II posted for elective surgery under subarachnoid block were enrolled in this prospective double-blind study and randomly allocated into two groups. Group 1 (n=25) patients received 3.0 ml (15 mg) of 0.5% levobupivacaine plus 0.5 ml of normal saline, and Group 2 (n=25) patients received 3.0 ml (15 mg) of 0.5% levobupivacaine plus 0.5 ml (25 mcg) of fentanyl intrathecally. Hemodynamics, features of sensory and motor block, postoperative need for rescue analgesia within 24 hours, and adverse events were documented.
Results: Sensory block onset was earlier in group 2 (4.31±0.58) minutes than in group 1 (6.51±0.62). Likewise, group 2 experienced the onset of motor block earlier (2.91±0.39) than group 1 (5.62±0.50), and group 2 saw a faster regression of the motor block (153.00±13.23) than group 1 (186.00±20.82). Hemodynamic and side effects were comparable in both groups. Group 2 required considerably fewer postoperative rescue analgesics in the first 24 hours (p < 0.05).
Conclusion: Fentanyl added to levobupivacaine provides a relatively faster initiation of block and earlier recovery of motor power, improving the chances of early patient mobilization.

Background: Considering the importance of controlling post-surgical pain in individuals and the limitation in number, in addition to the variations in the results of the clinical research studies focused on pain management outcomes of very low dose naloxone, the present evaluation aims to investigate the role of ultra-low dose naloxone on the severity of pain after the procedure, nausea, vomiting and pruritic.
Methods: In this double-blind controlled randomized clinical trial, 60 patients were selected for laparoscopic cholecystectomy surgery, with class 1 and 2 anesthesia (ASA) by available method, and were allocated to the intervention and control groups using randomization. Every participant underwent general anesthesia with a specific anesthesia protocol. After the operation, PCA was implanted for all patients to control pain. The internal composition of the PCA pump included 20 mg of morphine and naloxone at a specified dosage of 0.25 μg/kg for the intervention group and 20 mg of morphine and placebo for the control arm. Pain intensity, episodes of nausea and emesis and pruritic of patients were evaluated and compared based on VAS criteria within the two groups being analysed, during the immediate postoperative period and then 2, 6, 12 and 24 hours following the surgical procedure.
Results: There was no meaningful variation between therapeutic and standard arms in terms of age, sex, BMI, duration of surgery, duration of anesthesia, and dose of intra-operative fentanyl injection. Also, with respect to the level of pain during the immediate postoperative period and 2, 6, 12, and 24 hours following the surgical procedure, and the intensity of nausea, vomiting, and pruritic during recovery, statistical analysis revealed no remarkable discrepancy between the arms. In both groups, the severity of pain showed a significant decline at each of the examined time points in comparison with the pre-intervention phase (p <0.001, for both groups). Comparing the trend of changes in pain intensity during the postoperative period between the two study groups did not show a statistically meaningful variation (p = 0.569).
Conclusion: The simultaneous prescription of naloxone and morphine in patients undergoing laparoscopic cystectomy does not demonstrate a meaningful influence on achieving relief from post-surgical pain levels, nausea and vomiting and pruritic compared to morphine alone, so the use of naloxone to reduce postoperative pain and complications of opioids is not recommended.

Background: Innovative teaching methods can equip undergraduate anesthesia students with the skills to perform advanced cardiac life support (ACLS) confidently and proficiently. Therefore, this study aimed to compare the impact of role-playing and traditional teaching methods on teamwork and self-efficacy in performing ACLS among undergraduate anesthesia students at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Methods: This randomized controlled study was conducted on 47 third- and fourth-year undergraduate anesthesia students selected through a census sampling method. It involved a pre-test and post-test design. Participants were randomly divided into control and intervention groups. The intervention group received role-playing training, where they were divided into groups of six and each was assigned a role based on an ACLS scenario, which they enacted in interaction with other students. The control group, on the other hand, received traditional training, encompassing lectures and the use of mannequins. Teamwork performance was assessed using a scale developed by Sigalet et al., and the Resuscitation Self-efficacy Scale checklist was employed to evaluate students' ACLS skills. Ultimately, covariance analysis was conducted using SPSS version 26 to analyze the data.
Results: The two groups were homogeneous in terms of demographic characteristics (P value< 0.05). A comparison of post-test scores using ANCOVA revealed a significant difference between the groups. Specifically, after receiving role-playing training, the overall score of intervention group students in the post-test demonstrated a significant increase compared to the pre-test across three teamwork subscales and three self-efficacy subscales (P value= 0.001), unlike the control group (P value = 0.001). However, the recognition subscale did not exhibit significant results (P value = 0.347).
Conclusion: When compared to traditional training, role-playing training can significantly enhance self-efficacy and improve teamwork among undergraduate anesthesia students with regard to advanced cardiopulmonary resuscitation. Therefore, it is recommended to integrate role-playing into the anesthesia curriculum.

Background: Patients admitted to the intensive care unit (ICU) are at high risk of gastrointestinal (GI) mucosal injury and stress ulcers, which may lead to gastrointestinal bleeding, due to their critical condition and use of mechanical ventilation. Stress ulcer prophylaxis drug regimens, including proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs), are commonly used to prevent these complications. However, there are concerns about the side effects of these drugs, including an increased risk of ventilator-associated pneumonia (VAP). This study aimed to compare the effects of pantoprazole and famotidine on clinical outcomes and the risk of VAP in patients admitted to the ICU.
Methods: This study was designed as a single-center randomized clinical trial conducted in the Intensive Care Unit (ICU). The study population included 138 patients admitted to the ICU who required mechanical ventilation. The treatment regimens studied included two groups: group 1 received intravenous pantoprazole (40 mg daily), and group 2 received intravenous famotidine (20 mg twice daily). The study's primary outcome measure was the incidence of VAP, which was assessed according to ATS/IDSA and CDC guidelines. Other clinical variables included ICU length of stay, APACHE score, and incidence of adverse events.
Results: The results showed that in the famotidine group, ICU length of stay and APACHE II score were significantly shorter than in the pantoprazole group. However, no statistically significant differences were observed in variables such as age, weight, drug administration duration, and intubation duration. In addition, the frequency of death and pneumonia incidence in the famotidine group was lower than in the pantoprazole group, although this difference was not statistically significant.
Conclusion: This study showed that both famotidine and pantoprazole are effective in the prophylaxis of stress ulcers in critically ill ICU patients, but famotidine may be associated with more favorable clinical outcomes, including reduced length of stay and severity of illness. Also, the use of gastric acid suppressant drugs is associated with an increased risk of VAP, which requires more attention to drug selection and patient management. The findings of this study can help in better decision-making regarding the use of SUP drugs in ICU patients.

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

Background: Nowadays, Artificial Intelligence (AI), as one of the advanced and rapidly growing technologies, has had widespread effects on various aspects of human life. In the healthcare sector, the adoption of AI methodologies has gained significant momentum, particularly in enhancing patient care, with anesthesiology emerging as a field keenly embracing these technological advancements. The use of AI in anesthesia is accompanied by specific ethical and social issues that require careful examination and deep understanding. The objective of this scoping review was to compile existing literature about the ethical considerations surrounding the utilization of artificial intelligence (AI) in anesthesiology.
Methods: This scoping review was conducted within the first three months of 2024. The research question was, "What are the ethical issues in the application of AI in anesthesia?" Based on the research question, researchers initially extracted relevant keywords using Medical Subject Headings (MeSH) and independently conducted preliminary searches in databases including Scopus, Web of Science, PubMed, Cochrane, and Google Scholar. The study selection process was guided by predetermined inclusion and exclusion criteria. The inclusion criteria were studies relevant to the research question. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was utilized to report the research procedure.
Results: The search strategy yielded a total of 327 articles. Consequently, the full text of 4 studies was examined. Of these, two studies were not considered to be included in the research due to their lack of connection with the primary research question. In total, 2 studies (both in English) were included in this review. Both of these studies were cross-sectional studies that examined the opinions of anesthesiologists regarding the ethical implications of using artificial intelligence in anesthesia.
Conclusion: The ethical integration of AI into anesthesia holds promise for improving patient care outcomes while upholding principles of safety, fairness, and accountability. Additional training programs and updated protocols are necessary for ensuring data security, collection, and processing. Additionally, Appropriate legal regulations concerning data processing should be developed.

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

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

Background: In cardiopulmonary bypass (CPB), there is a need to better maintain appropriate anesthesia due to the physiological and hemodynamic alterations induced by CPB. This review aimed to explore the effects of sevoflurane versus propofol in the management of patients undergoing cardiac surgeries with CPB.
Methods: The literature search was conducted in the international databases, including Cochrane, Science-Direct, Scopus, PubMed, and Google Scholar, from January 2012 to July 2024.
Results: According to the studies, sevoflurane was associated with a significantly shorter time to extubation, eye-opening, and command compliance with better intraoperative hemodynamic stability. It was superior in reducing oxygen demand and may be associated with less hypoxia in the aortic cross-clamp phase. In addition, sevoflurane produces more prominent myocardial protection, attenuates inflammatory response, and has a lower impact on cognitive function. On the other hand, propofol decreased the incidence and intensity of acute kidney injury and may be preferred over sevoflurane in patients at risk of postoperative nausea.
Conclusion: It seems in adults undergoing cardiac surgery with CPB, the class of sevoflurane is superior to propofol with regard to many perioperative and postoperative outcomes. However, more studies with larger sample sizes are needed to clarify this issue.

Anesthesia in patient care, both in the perioperative period and in the pain clinic, is a challenging field to engage with - this is secondary to the fact that patients are individuals who are influenced by numerous factors, including the bacterial makeup of their microbiome and its parts. With the focus on personalized medicine as the next frontier, this narrative literature review looks at the current trend in individualized medicine, specifically regarding the use of the microbiome and artificial intelligence in the choice of different drugs for the induction and continuation of surgery as well as the management of pain syndromes in patients. This review also includes a summary of the different research directions that can take place based on the most recent data, including microbiome composition testing, therapeutic alterations, and the use of artificial intelligence to select the best drugs for treating the patient.

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

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

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

Background: Disorders of consciousness (DoC), encompassing coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS), result from severe brain injuries that disrupt neural networks responsible for arousal and awareness. Non-invasive brain stimulation (NIBS) techniques, including transcranial direct current stimulation (tDCS) and its variants, such as high-definition tDCS (HD-tDCS) and transcranial alternating current stimulation (tACS), offer promising therapeutic strategies. This review synthesizes evidence on the efficacy of NIBS, focusing on its impact on brain hemodynamics, neurophysiology, and clinical outcomes.
Methods: To this end, we searched the international databases (Web of Science, PubMed, Scopus) and extracted studies using the appropriate keywords. The Newcastle-Ottawa Scale (NOS) was used to assess the methodology and quality of the studies.
Results: Research demonstrates that tDCS and its advanced forms improve EEG patterns, including alpha and theta band power, reduce P300 latency, and enhance cortical-cortical and thalamocortical connectivity, correlating with better behavioral outcomes, as measured by the Coma Recovery Scale-Revised (CRS-R). Moreover, personalized protocols based on MRI simulations and multimodal therapies, such as combining NIBS with music stimulation or robotic rehabilitation, further optimize outcomes by targeting specific brain areas and enhancing network reconfiguration. The dual application of HD-tDCS with transcutaneous auricular vagus nerve stimulation (taVNS) has also shown synergistic effects on EEG microstate dynamics and CRS-R scores in MCS patients.
Conclusion: Overall, NIBS presents a promising approach for enhancing consciousness recovery, though challenges in protocol optimization and understanding the mechanisms of action remain. Future research should continue to explore these techniques' full potential, particularly through personalized, multi-target stimulation strategies.

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

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

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

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

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

The patient was an 11-year-old girl, weighing 25 kg and measuring 125 cm in height, with a history of congenital cleft palate and previous surgeries (including cleft palate repair and cardiac procedures). She was referred for maxillary alveolar closure surgery. She experienced difficulty swallowing and dyspnea when consuming solids and liquids. During the preoperative evaluation, no significant comorbidities were identified, but anatomical changes in the nasopharynx suggested a defect in the previous repair. To ensure safe airway management and avoid nasopharyngeal injury during surgery, a modified intubation technique was employed. We used a flexible armored endotracheal tube that had been autoclaved at 45°C for 2 min. Anesthesia induction included propofol, fentanyl, and cis-atracurium. Intubation was successfully performed without complications. Postoperatively, the patient recovered well, showing no signs of trauma or airway distress. She was discharged on the first postoperative day with appropriate care recommendations.

Gossypiboma is a rare mass caused by surgical instruments left in the body after surgery. A 21-year-old woman with a history of two cesarean sections presented with abdominal pain; initially, she suspected appendicitis. Unexpectedly an ultrasound showed bleeding ovarian cysts and a radiopaque line that looked like surgical sponge that had been left behind. This discovery led to immediate hospitalization and subsequent laparotomy. During surgical intervention, the medical team encountered a hemorrhagic ovarian cyst with a significant mass of tissue with a diameter of 8 cm. Despite carefully exploring the surgical site, the team did not immediately find the suspected surgical sponge. Further investigation revealed nothing, but a detailed dissection of the mass-like tissue ultimately uncovered the sponge inside.

Intraoperative Neurophysiological Monitoring (IONM) refers to the use of various electrophysiological methods to monitor the function of the brain, spinal cord, and related nerves during surgical procedures. IONM involves the use of neurophysiological recordings to detect changes in nervous system function during surgery, allowing doctors to identify potential nerve damage before it occurs. Reported is a 65-year-old male patient with a diagnosis of unruptured aneurysm of the Posterior Communicating Artery (PcomA) and left ophthalmic segment of C5 whose aneurysm was planned to be clipped. The patient was planned to have the aneurysm clipped under general anesthesia. The challenge in the anesthesia process for aneurysm cases is maintaining the pressure in the aneurysm and cerebral perfusion pressure (CPP), protecting the brain during periods of ischemia, and providing as wide an operating field as possible. Post-operatively, the patient showed stable neurological function with no new deficits, highlighting the importance of intraoperative neurophysiological monitoring in achieving a favorable outcome.

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

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

A 68-year-old female patient referred for mandibular reconstruction surgery. He was treated for cancer in the mandible last month. Due to the extent of the mass in the lower jaw area, this patient underwent Mandibulectomy 9 months ago. The patient was admitted to Ba'ath Hospital in Hamadan, his vital signs were stable. Before the surgery, according to his underlying diseases, a cardiovascular consultation was done and no complications affecting anesthesia were reported. The challenge of the anesthesia team in this patient was to establish a safe airway for him. According to the physical condition of the patient's neck and mandible, the patient was intubated using a Fireoptic bronchoscope. The patient's surgery lasted 2 hours and 45 minutes. During the entire period of anesthesia, the patient was under strict respiratory monitoring. After the end of the surgery, the patient was transferred to the recovery room without removing the endotracheal tube, and after ensuring that the patient's condition was stable, he was transferred to the intensive care unit.

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

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

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

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.