Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 1 2 Zahid Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Surender Malhotra Department of Anaesthesiology, MM Institute of Medical Sciences and Research, Mullana, Ambala, India. 2021 12 18 The definition of the word ‘Robot’ was first given by Josef Capek in 1920; who used the word in the title of a play by the name of “Rossum’s Universal Robots” As per the definition of Encyclopaedia Britannica robot is "any automatically operated machine that replaces human effort, though it may not resemble human beings in appearance or perform functions in a humanlike manner". The role of robots in surgery and anaesthesia is now a reality. Since the approval by FDA in year 2000, surgeons have been using Da Vinci surgical robot in more than 1500 hospitals in USA. In the last 20 years, surgeons have shifted to small incision surgical procedures with the help of surgical robot among other techniques. https://aacc.tums.ac.ir/index.php/aacc/article/view/451

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2021 12 17 3 10 Ali Labaf Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. & Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Fariba Asghari Medical Ethics and History Research Center, Tehran University of Medical Sciences, Tehran, Iran. Shahram Samadi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Atefeh Abdollahi Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyran Zobeiry Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Kamyar Molavi Private Researcher, Urmia, Iran. 2021 06 24 2021 07 06 Background: Tracheal intubation is a life-saving action in situations such as respiratory failure. However, this therapeutic approach may produce a series of side effects and physiological stress, such as pain, insomnia, anxiety, fear, etc. Methods: The present study is a qualitative research with a content analysis method conducted for a period of two years. This study's required information has been collected using non-structured face-to-face interviews with 22 patients hospitalized in emergency and intensive care units. The data were analyzed using open coding and MAXQDA 12. Results: Findings from the interviews' were divided into two main categories of mental and physical experiences. Mental experiences are divided into 12 sub-categories and physical experiences into 7 sub-categories, each of them is also divided into further categories. Inability to speak is the most frequent complaint of patients in this study. The pain was the most common physical complaint of patients, mostly due to pain in the organs and pain due to blood sampling. Conclusion: Despite special training of medical staff in emergency and intensive care units to take care of patients and to obviate their special needs, it is observing that some patients under certain conditions such as intubation still face many unmet needs. https://aacc.tums.ac.ir/index.php/aacc/article/view/373

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 60 67 Zahid Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ahmed AL-Dulaimi Department of Anesthesia and Intensive Care Unit, Al-Furat Al-Awsat Hospital, Health and Medical Technical College, Al-Furat Al-Awsat Technical University, Najaf, Iraq. Hesam Aldin Varpaei Islamic Azad University Tehran Medical Sciences, Tehran, Iran. Parsa Mohammadi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Mohammadi Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences 2021 07 14 2021 07 31 Background: Novel coronavirus 2019 is the cause of the 2020 pandemic that was announced by the world health organization in March 2020. Coronavirus attacks the respiratory system and causes mild to severe hypoxemia. Therefore, a fraction of COVID-19 patients may need intubation and mechanical ventilation. Methods: We performed a narrative review via searching in articles that were published in PubMed, Google Scholar, Scopus, web of scenic, Cochrane library, and Embase that mentioned to time of intubation COVID-19 patients and intubation techniques, manual searching was also completed. All the selected reviews and studies were limited to humans and the English language. Results: First data from China mention that 5% of patients requiring intubation and mechanical ventilation (MV), there has been substantial debate about the time of intubation to patients with acute respiratory failure and intubation technique. At first, the specialists recommended early intubation. Although we are more familiar with the pathophysiology of coronavirus, the drawbacks versus the benefits of early intubation are still controversial. In addition, the intubation process itself is an aerosol-generating procedure and a high risk for patients and health care providers. In this review, we aim to review the previous studies and guidelines recommendations related to the time of intubation and intubation technique for COVID-19 patients. Conclusion: Some previous studies suggested early tracheal intubation in severe COVID-19 patients may have the priority, while other studies advocate late intubation due to poor outcomes of intubation and weaning difficulties. However, intubation timing should be based on personalized medicine and case by case decision making to keep the best care and benefit of patients. And relying only on theoretical justification may have not good consequences. https://aacc.tums.ac.ir/index.php/aacc/article/view/378

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 74 78 Farahnaz Fallahian Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arezoo Ahmadi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2021 07 31 2021 08 31 Clinical manifestations of COVID 19 is still unknown. We performed this study to determine the occurrence of pulmonary barotrauma as a complication of this disease. In this retrospective study, a total of 955 COVID 19 patients with respiratory insufficiency requiring oxygen support or invasive ventilation admitted to ICU of Sina Hospital from 20 March 2020 to 9 June 2021, were included and their chest imaging reviewed. Here, we report results of chest imaging of first 92 patients of this group. Barotrauma (pneumothorax, pneumomediastinum, pneumopericardium) occurred in 11 (11.9%) of 92 patients with coronavirus disease 2019 (COVID-19) infection requiring ICU admission for respiratory support and monitoring. It seems barotrauma is a common complication of COVID 19 disease. The role of increased respiratory efforts, patient or ventilation induced lung injury, viral and host response should be assessed. It needs to consider the occurrence of barotrauma in Patients with COVID-19, before expansion of dead space treatment and limiting the ventilation effects. https://aacc.tums.ac.ir/index.php/aacc/article/view/385

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 89 90 EN Ali Jabbari Ischemic Disorders Research Center of Golestan University of Medical Sciences, Gorgan, Iran. & Department of Anesthesiology and Intensive Care Medicine, Golestan University of Medical sciences, Gorgan, Iran. Seyed Said Hoseini Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran. Iran. Alireza Jahangirifard Lung Transplantation Research Center, National Research Institute of Tuberculosis and lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ayesheh Enayati Ischemic Disorders Research Center of Golestan University of Medical Sciences, Gorgan, Iran. Vahid khori Ischemic Disorders Research Center of Golestan University of Medical Sciences, Gorgan, Iran. 2021 08 19 2021 08 31 Extracorporeal membrane oxygenation (ECMO) is a kind of extracorporeal life support for prolonged hemodynamic and respiratory Assist to persons whose cardio vascular and respiratory system are unable to support basic metabolic needs of the body. ECMO re­mains an option for the treatment of patients with refractory hypoxemia in SARS-CoV-2 disease despite advanced cardiopulmonary support. It is very sophisticated intensive procedure and dependent to the operator skills and experience, but could be a life-saving treatment. This method of treatment could not be suggested as a solution, but since this strategy is the only way left to prevent on witness patient death so, it is still noticeable as a rescue therapy. https://aacc.tums.ac.ir/index.php/aacc/article/view/394

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 87 88 EN Mostafa Mohammadi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Parsa Mohammadi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Reza Mollazadeh Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Alii Esmaeili Vardanjan Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. &Department of Critical Care Nursing, Faculty Member, Hamadan University of Medical Sciences, Hamadan, Iran. 2021 08 23 2021 09 07      https://aacc.tums.ac.ir/index.php/aacc/article/view/398

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 11 17 Prashant Bankar Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi Nisha kachru Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi Rupesh Yadav Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2021 07 06 2021 07 31 Background: Laryngoscopy and intubation cause activation of the sympathetic nervous system and can results in tachycardia, arrhythmias and hypertension. Hypertensive patients demonstrate a relatively greater rise in catecholamine secretion and an increased sensitivity to them. Aim of the study is to compare the haemodynamic stress response associated with orotracheal intubation using videolaryngoscope or Macintosh laryngoscope in controlled hypertensive patients. Methods: Sixty hypertensive, American Society of Anesthesiologist’s class II, patients were randomly divided in to two groups. In group V (videolaryngoscope), intubation was done with i-scope videolaryngoscope. In group M (Macintosh), intubation was done using Macintosh laryngoscope. Primary objectives of the study pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) were noted immediately after and at 1, 2, 3, 5 and 10 minutes after intubation. Results: The demographic data were comparable in both groups. There was no significant difference at baseline for mean (SD) PR, SBP, DBP and MBP at baseline and after induction/before intubation (p>0.05). The mean (SD) PR, SBP, DBP and MBP were significantly higher in Macintosh laryngoscope group as compared to i-scope videolaryngoscope immediately after intubation, 1, 2, 3, 5 and 10 minutes after intubation (p<0.001). Conclusion: We found that intubation with the use of i-scope videolaryngoscope results in less haemodynamic stress response than Macintosh laryngoscope in controlled hypertensive patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/380

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 1 2022 01 03 68 73 Zahid Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Kasra karvandian Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sajjad Almrihj School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2021 07 17 2021 08 14 Background: With the outbreak of COVID19, acute lung injury has been detected as the main etiology for intensive care admission and high mortality rate. Among the infected population, there is some percentage of those who tend to develop acute respiratory distress syndrome and respiratory failure. Thus, the intensivist and anesthesiologist must be aware of the of incidence rate of ARDS, risk factors, and try to take measures to reduce its incidence. To define the rate of incidence of acute lung injury and ARDS among COVID 19 patient. Methods: We peresthesia was equally effective to supra inguinal FICB. https://aacc.tums.ac.ir/index.php/aacc/article/view/427

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 03 12 129 133 Ebrahim Espahbodi Pain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Reza Atef Yekta Pain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Hossein Majedi AuthorPain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Alireza Manafi Rasi Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hasan Shakiba Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Pooya Kalani Pain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. 2022 01 29 2022 02 01 Background: Peritrochantric fracture is common especially in elderly patients. Very often we are faced with elderly and fragile patients with several comorbidities. In these cases a careful anesthetic technique is crucial to reduce comorbidity and mortality. Currently the pericapsular nerve group (PENG) block are introduced as an analgesic technique. We used PENG block for purpose of hip surgical Anesthesia. Methods: In this single-centre, case series, patients undergoing gama nailing for peritrochanteric fractures. The PENG block was performed with the patient in the supine position using ultrasound guidance. Pain scores were measured by numeric rating score (NRS) at rest and with a straight leg raise of the affected limb to 15 degrees before and 30 minutes after block performance. Results:  Totally, 10 patients of ASA Grades II, III and were included who came with peritrochantric hip fracture and were scheduled for gamma nailing. The mean age of the study participants was 77 years. Significantly, pain scores reduced as compared with baseline. No such adverse events were recorded for any of the patients. Conclusion: In this article the PENG block has been determined to be safe and effective as an anesthetic technique in gamma nailing of peritrochantric fractures but more research in larger-sized studies are needed to better assess the PENG block. https://aacc.tums.ac.ir/index.php/aacc/article/view/475

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 04 09 134 138 Kalyani Patil Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. Jyoti Deshpande Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. Rajlaxmi Menghal Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. Lavina John Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. 2021 11 09 2021 12 21 Background: Interscalene block is a commonly performed procedure for surgery of shoulder and upper arm, however very few studies have studied the effect of magnesium sulphate when added in interscalene block. Aims: The primary aim was to compare block characteristics along with postoperative analgesia and the secondary aim was to study the side effect profile and postoperative analgesic requirements. Methods: We randomly recruited 60 American Society of Anaesthesiologists (ASA) physical status I and II patients, undergoing surgeries of the shoulder to receive ultrasound-guided interscalene block with 1 mL normal saline or 150 mg Magnesium sulphate added to 20ml of 0.5% ropivacaine. Statistical analysis used: Statistical Package for Social Sciences (SPSS version 21.0) was used for analysing the data. Chi-square test or Fisher’s exact probability test were used for categorical variables; while the continuous variables were compared by unpaired t-test or Mann-Whitney U test. Results: With the addition of magnesium sulphate, onset of sensory (10.03 ± 1.03 vs 12.73 ± 1.14 min) and motor block (15.17 ± 2.02 min vs 17.87 ± 1.41) was hastened. The duration (sensory 528.00 ± 14.98 min vs 376.83 ± 13.16 min, motor 429.83 ± 11.57 min vs 319.97 ± 6.800 min) and postoperative analgesia (527.77 ± 21.96 min vs 402.97 ± 12.83 min) (p < 0.001) were all prolonged by magnesium sulphate, with resultant decrease in requirement of postoperative analgesic dosage. Conclusion: Magnesium when added to local anaesthetics in interscalene block, effectively improves all characteristics of block and provides better postoperative analgesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/429

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 04 10 139 143 Sepideh Aarabi Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Ali Ziaee Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrad Aghili Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. & Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mahdi Zangi Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. & Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. Elnaz Vahidi Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. & Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. Morteza Saeedi Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2022 02 05 2022 02 12 Background: Acute respiratory failure (ARF) is an important presentation in emergency department (ED). Intubation and mechanical ventilation (MV) are sometimes the ultimate decisions in such emergent situations. Many of these patients are unfortunately managed in an ED. This may endanger their outcome. This study was aimed to compare the outcome of critically ill patients with ARF under MV admitted to ED with patients admitted to ICU. Methods: All critically ill patients with ARF who were intubated and placed under MV were enrolled in this study. Cases were either admitted to ED or ICU. Demographic data, initial diagnosis, final diagnosis, length of hospital stay, one-month mortality rate, number of times patient was intubated and number of times patient was resuscitated were all recorded and compared between the 2 groups. Results: Out of all 172 patients admitted to ED and ICU, 74 (43%) were females and 98 (57%) were males. Patients had a mean±SD age of 64.2±18.1 years. ICU patients (85 patients (49.4%)) had a significantly longer hospital stay (p=0.048). ICU patients had significantly more resuscitation process (p=0.006). Mortality rate in ICU was significantly higher than ED. In the meanwhile, more patients in ED finally survived (p=0.004). Conclusion: In the present study, ICU patients were admitted longer to the ward than ED patients. Overall, ED mortality rate was lower than ICU. More patients finally survived in ED in comparison to ICU. https://aacc.tums.ac.ir/index.php/aacc/article/view/482

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 03 28 144 150 Mohammad Hassani Department of Vascular and Endovascular Surgery, Aiatolla Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Peyman Bakhshaei shahrbabaki Department of Vascular and Endovascular Surgery, Aiatolla Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Bashir Mirtajani Lung transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammadreza Moshari Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Pouya Tayebi Department of Vascular and Endovascular Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. 2021 10 11 2021 11 09 In the last days of 2019, a novel strain of coronaviruses reported in Wuhan and spread rapidly all over the world which called 2019 novel coronavirus (2019- nCoV). Almost a few months later in the early 2020 (January 2020), the WHO declared the outbreak of COVID-19 a Public Health Emergency which Compared with the other SARS- CoV, has a stronger transmission capacity. Although respiratory problems are the main clinical symptoms of COVID-19, some patients also experience other conditions and injuries, such as severe vascular damage. Therefore, it can be said that understanding the damage caused by this infection to the vascular system and its underlying mechanisms is of great importance. https://aacc.tums.ac.ir/index.php/aacc/article/view/412

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 04 10 151 158 Bharat Shete ACPM Medical College, Dhule, Maharashtra, India. Rucha Gulhane PDMMC College, Amravati. Maharashtra, India. Rahul Hantodkar Dr. D. Y. Patil Medical College, Pune, India. 2021 11 08 2021 12 21 A wound could happen at any accident or surgery. Generally, bleeding wounds, serious wounds and infectious wounds need to be taken care for recovery and in case of germ infection, wound recovery and management is a complicated process. The process including wound pre-cleaning, wound healing, infection prevention, germ treatment and dressings. The application of wound dressings play a very critical role in wound healing and infection prevention. When a wound is exposed to the pathogens and foreign substances but results in no signs of infection, it is then called as a contaminated wound. The colonized wounds are chronic, where in there are multiple pathogens present in the wound. This occurs frequently in patients who have diabetic foot and pressure ulcers. Hence, management of the diabetic involves great acceleration of foot ulceration. Ideally, dressing should alleviate symptoms, provide wound protection and healing. No single dressing fulfills all the requirements of patient with an infected foot ulcer and other contaminated wounds. However, every category of dressings has specific characteristics that aid selection. There are various types of wound dressings such as, foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. The hydrogel wound dressing treatment facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing iodine and silver encourage in managing wound infection and it is more efficient. For infected wounds occlusive dressings should be avoided. For the wound inspection all dressings require frequent change. Deeply exudating ulcers need regular change to reduce maceration of surrounding skin. Dressing choice should be guided by the characteristics of the ulcer, the requirements of the patient, and the involved in wound care cost. These dressings display their own advantages and disadvantages in the wound treatments. As a physician has to deal with many patients with different types of wound like acute, chronic, burn and foot ulcers conditions every day. It is thereby very important and helpful to have a good knowledge about the right type of dressing for particular wound and also the right time for wound dressings for patient’s prognosis. In this review, we will discuss the different wound dressings and its comparative effectiveness on contaminated wound and ulcer. https://aacc.tums.ac.ir/index.php/aacc/article/view/428

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 03 12 159 161 Jyoti Deshpande Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. Merlin Jacob Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. 2021 08 17 2021 08 31 Choosing appropriate anesthetic modality in patients with compromised cardiac function with the administration of peripheral nerve block ensures hemodynamic stability. We present the case of a 63y, male patient with an operative history of aortic valvuloplasty, on anticoagulant warfarin. Patient was given general anesthesia and supraglottic airway device, LMA was inserted to prevent intubation response. This was supplemented with USG guided ilioinguinal and iliohypogastric nerve blocks with inj ropivacaine 0.325%, 15ml and inj dexamethasone 2mg as adjuvant. Addition of peripheral nerve blockade to general anesthesia provided perioperative analgesia, so quick emergence and recovery was possible. https://aacc.tums.ac.ir/index.php/aacc/article/view/393

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 04 10 162 165 Ruchi Kapoor Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India. Ganga Devaraj Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India. Ajeeb Sharahudeen Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India. Jubin Jakhar Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India. 2021 09 01 2021 09 25 Corona Virus Disease (COVID-19) which has a common association with diabetes has led to an epidemic of mucormycosis which has been mainly attributed to rampant use of steroids owing to the severity of the disease. The mucormycosis patients presented with rhino orbital mucormycosis predominantly with or without intracranial extension making it a life-threatening condition mandating urgent debridement as treatment of choice alongside antifungal medications. Injection Amphotericin B is the first-line drug that is nephrotoxic and causes dyselectrolytemia therefore administered under strict supervision. However, we report successful management of two unique cases where patients after surgical debridement after Amphotericin B developed severe life-threatening anaemia postoperatively along with impending respiratory failure requiring Intensive care management including non-invasive ventilation. Thus, serial haematocrit monitoring is of utmost importance while the patient is being administered Amphotericin B even when a patient is receiving the relatively safe preparation that is liposomal Amphotericin B in a dose of 3.5 mg per kg body weight. https://aacc.tums.ac.ir/index.php/aacc/article/view/402

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 03 12 166 168 Abhishek Samprathi Fortis Hospitals,154/9, Bannerghatta Main Road, Opposite IIM, Bengaluru, Karnataka, India. Pooja Sarada Fortis Hospitals,154/9, Bannerghatta Main Road, Opposite IIM, Bengaluru, Karnataka, India. Hamza Dalal Fortis Hospitals,154/9, Bannerghatta Main Road, Opposite IIM, Bengaluru, Karnataka, India. 2021 09 11 2021 10 18 The Covid-19 pandemic has seen the emergence of various vaccines being produced at an unprecedented speed. It is not surprising that new adverse events to these vaccines are still being reported and Immune thrombocytopenic Purpura [ITP] happens to be one among them. Moderna and Pfizer vaccine have been linked to it. Association of ITP with SARS-CoV-2 vaccine is poorly understood. We present to you a case of severe symptomatic thrombocytopenia post ChAdOx1 nCoV-19 vaccination which responded to conventional therapies. Aggressive use of immunosuppressive treatment may jeopardize the intended purpose of SARS-CoV-2 vaccine. Also, the schedule and alternative vaccine for the second dose and the role early use of non-immunosuppressive treatment like Thrombopoietin receptor agonist are unclear. While the universal immunization program needs to continue, vigilance to the occurrence of severe thrombocytopenia due to vaccination is needed. https://aacc.tums.ac.ir/index.php/aacc/article/view/405

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 04 10 169 171 Manisha Kumari Department of Anesthesiology, Pandit Bhagwat Daya. Sharma PGIMS, Rohtak, India. Mayuri Gupta Department of Anesthesiology, Pandit Bhagwat Daya. Sharma PGIMS, Rohtak, India. Ashish Yadav Department of Anesthesiology, Pandit Bhagwat Daya. Sharma PGIMS, Rohtak, India. Manoj Kumar Department of Anesthesiology, Pandit Bhagwat Daya. Sharma PGIMS, Rohtak, India. 2021 09 12 2021 10 18 Foreign body ingestion is quite common in the pediatric age group. A six year old boy was brought by his parents to the hospital with history of foreign body (marble) ingestion. The child had been previously operated for the esophageal atresia. Imaging revealed a foreign body of 1.5cm size in the esophagus at the atretic part. The foreign body removal was initially attempted via rigid esophagoscopy but could not succeed. Hence, the procedure was changed to right thoracotomy for foreign body retrieval in the same sitting. Patient also had intraoperative itragenic trachea-esophageal fistula formation. General anesthesia was planned using single lumen cuffed ETT of 5.0mm ID for ventilation. Caudal catheter was inserted for postoperative pain management and early recovery following thoracotomy. Such cases of foreign body ingestion in an atretic esophagus should always be planned considering the unexpected extend of surgical procedure and peri-operative complications. https://aacc.tums.ac.ir/index.php/aacc/article/view/407

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 2 2022 03 28 172 173 Mohammad Hassani Department of Vascular and Endovascular Surgery, Aiatolla taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Nima Hassanzad Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammadreza Moshari Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2021 10 17 2021 12 28 The prevalence of COVID 19 encouraged physicians and researchers to study the pathology of the disease and changes in patients' immunological factors. What has been proven today is the occurrence of an inflammatory outbreak in the body of patients with this infection, which causes severe immunological reactions in them. Hemoperfusion, as an extracorporeal purification method, has the potential to act as an aid in modulating or controlling this inflammatory phase. Therefore, the present study evaluates the role of hemoperfusion in controlling inflammatory conditions in patients with COVID 19. https://aacc.tums.ac.ir/index.php/aacc/article/view/413

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