Anesthesiology and critical care are experiencing a paradigm shift where technology, epidemiologic needs, and patient expectations are string collectively redefining the scope of practice rapidly. For many years, perioperative and critical care management was essentially reliant upon experiential care, protocol-driven management, and post hoc analysis. But with the growing complexity of patients, such as due to an aging population with multimorbidities, increased surgery rates, or increased rates of sepsis, trauma, or non-communicable diseases, there arises an urgent need to pivot towards personalized, data-driven, and predictive management. And such need is not merely a need in developed nations but in resource-limited settings where margins are small but the payoff of optimal management can make or break the future (1).

The trend towards precision medicine has already entered the realm of anesthesiology and critical care. Artificial intelligence in the form of machine learning algorithms has made it possible to predict hemodynamic instability and individualize drug dosages in real time. Closed-loop systems, where computer algorithms titrate the dosages of anesthetic or vasoactive drugs based on constant physiological feedback, are already in the pipeline and showing promising early returns. These computer-assisted care platforms help practitioners predict an impending adverse event based on dynamic changes in vital signs, lab parameters, and waveform analysis, warning them of potential hemodynamic instability in advance of the onset of apparent clinical events (2). These computer-assisted care technologies aim to support, rather than supplant, the critical care physician or anesthesiologist.

Implications in resource-limited environments are even more far-reaching. Although a lack of equipment and staff in traditional care settings can hinder the execution of traditional care environments, data-driven care can bolster precision as well as optimize the reduction in waste brought about by less optimal care. AI-assisted ultrasound technology can help in regional anesthesia, vascular access, and critical care diagnoses, even in less skilled practitioners. Furthermore, predictive analysis can help in triaging, ventilatory management, and septic care in environments where specialized ICU facilities are absent (3). Most importantly, it provides the hospital settings an opportunity to gain meaningful insight from internal data analysis, eliminating the need to refer to evidence from developed countries.

Regional Anesthesia illustrates how precision strategies can revolutionize perioperative services in resource-limited settings. Ultrasound-assisted blocks result in less opioid consumption, faster recovery, and simplified postoperative care, all of which contribute significantly in settings where pain management services, intensive care facilities, and rehab facilities are not readily available. New technology involving AI-assisted visualization of the needle, computer-driven identification of ultrasound anatomy, and simulator-based education can help close gaps in expertise and make superior regional anesthesia accessible in all settings. Similarly, recovery programs can dramatically reduce in-hospital stay, especially in our busy government-run facilities.

The use of digital technology in education and simulation offers much promise. Virtual reality, augmented reality, or high-fidelity simulation allows trainees to gain practical experience in dealing with crises, ultrasound procedures, or airway management in a very cost-effective and scalable manner. In environments where there are few trained faculty members and large numbers of trainees per specialist, these technologies can offer sustainable alternatives.

However, there are challenges in the adoption of precision and data-driven care. These include inadequate information technology support, issues regarding data privacy, lack of integration in the Health Information System, and challenges in changing the long-established medical culture. An algorithm developed in developed nations may not work in the same manner in low- and middle-income countries because of variations in disease epidemiology, availability of resources, and patient population characteristics (4).

It is important to build data registries in the region and support medical research so that developments can lead to actual improvements in patient care. Going forward, the future of anesthesia and critical care in resource-scarce environments will depend largely on the extent to which they can harness precision technologies. Ideally, the long-term goal in these settings is not to re-create the model of care in developed nations; rather, it is to innovate in such a manner as to make the most of what they have. At the current point in the development of data-driven methods, there is certainly potential in these technologies to reduce risk in surgery, optimize care in the ICU, and produce postoperative benefits.

In these times of accelerated and global transformation, anesthesiologists and critical care experts practicing in resource-constrained environments offer an unusual perspective. By capitalizing on the precision medicine paradigm, harnessing low-cost digital innovations, and developing relevant evidence in these environments, these medical experts can dramatically change the manner in which care can be delivered. The future will not merely be shaped by technology but rather by the intelligent use of such technology—turning challenges into innovation catalysts in bringing about a new dawn in the perioperative and critical care era of precision.

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

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

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

Abstract

Background: Refractory angina remains a major therapeutic challenge when revascularization options are unavailable. Stellate ganglion block (SGB) may reduce sympathetic tone, improve coronary perfusion, and alleviate ischemic chest pain. This study evaluated the effects of SGB on the severity of chest pain and ST-segment deviation during exercise testing.

Methods: This before–and–after interventional study included patients with confirmed coronary artery disease and refractory angina. Baseline treadmill testing assessed angina index and ST-segment deviation. SGB was performed under ultrasound guidance using 0.25% bupivacaine and dexamethasone. Treadmill testing was repeated 24–48 hours after the block.

Results: Sixteen patients participated (56% male; mean age 60.7±9.7 years). The angina index significantly improved (1.90±0.34 to 0.50±0.32; P < 0.001). ST-segment deviation decreased modestly but significantly (1.0±0.4 to 0.9±0.3 mm; P=0.041). No major complications occurred.

Conclusion: SGB significantly reduced chest pain severity and improved ischemic ST-segment abnormalities in patients with refractory angina. It may serve as a safe and effective adjunct therapy.

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

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

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

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

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

Background: 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.

Sepsis is a dynamic and heterogeneous syndrome characterized by a dysregulated host response to infection, leading to concurrent hyperinflammation and profound immunosuppression. Early recognition of pathogen- and damage-associated molecular patterns triggers extensive activation of NF-κB, JAK/STAT, and MAPK pathways, resulting in a cytokine storm, metabolic reprogramming, and endothelial dysfunction. Mitochondrial impairment, glycocalyx degradation, and excessive neutrophil activity further propagate organ injury and microcirculatory collapse. Simultaneously, widespread apoptosis and exhaustion of lymphocytes culminate in immune paralysis and increased susceptibility to secondary infections. Advances in transcriptomics, proteomics, metabolomics, and machine-learning–based classification have uncovered distinct immune endotypes of sepsis, providing the foundation for precision medicine. Emerging immunomodulatory therapies—including IL-7, GM-CSF, and immune checkpoint inhibitors—aim to restore immune function in selected subgroups. Ultimately, sepsis must be viewed as a multifaceted immunometabolic disorder requiring individualized diagnosis, monitoring, and treatment approaches.

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

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

Background: 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.

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.

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.

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.

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.