Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 348 353 Shikhar Verma Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Ranvinder Kaur Department of Critical Care Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Usha Yadav Department of Obstetrics & Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India. Rupesh Yadav Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Nisha Kachru Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2022 02 18 2022 04 04 Background: Spinal anaesthesia is the most common technique used for lower segment caesarean sections(LSCS). but it has own disadvantages too. Maternal haemodynamic changes is more profound in pregnant population. Aim of the study was to compare the maternal haemodynamic changes with crystalloid preloading and co-loading in patients undergoing elective lower segment caesarean section under spinal anaesthesia. Methods: 80 obstetric patients with period of gestation (POG) more than 37 weeks, in the age between 18 to 35 years, belonging to ASA class I and II and scheduled for elective LSCS were randomized into two groups. Group P - Patient receiving preloading with Ringer Lactate at a dose of 15ml/kg. Group C – Patient receiving Co-loading with Ringer Lactate at a dose of 15ml/kg. Primary objectives of the study were haemodynamic changes like Heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) and these parameters were recorded baseline, at 1 min interval for first 10 minutes, after that at 5 minutes till 20 minutes and then every 15 min till completion of procedure. Results: The demographic data were comparable in group P and group C. The mean (SD) HR was significantly higher in group P as compared to group C at 5,6,7,8 and 9 minutes (p <0.05). The mean (SD) SBP, DBP and MBP was significantly lower in group P as compared to group C at 5,6 and 7 minutes (p <0.05). Significant difference was seen in the distribution of nausea/vomiting score between group P and C. (p value<.05). Conclusion: We conclude that co-loading with crystalloids is provide more Maternal Hemodynamics stability after subarachnoid block rather than preloading with crystalloids. https://aacc.tums.ac.ir/index.php/aacc/article/view/488

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 354 357 Seyed Mohammad Mireskandari Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Jalil Makarem Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Kaveh Hedayati Emami Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Afshin Jafarzadeh 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. Shahram Samadi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Babak Eslami Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ali Movafegh Department of Anesthesiology and Critical Care and Pain Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2022 06 08 2022 07 02 Background: The change in patients' positions has a bold effect on the ventilation and hemodynamic parameters during surgery. In this study, we evaluated the changes in hemodynamic and ventilator values resulting from conversions in the position of patients under the thoracotomy from supine to lateral position and vice versa, to determine the most favourable position with the best hemodynamic stability and ventilation conditions. Methods: In this pre and that post interventional clinical trial, 50 patients scheduled for thoracotomy were included. Following general anesthesia induction and 5 minutes later, hemodynamic data before thoracotomy and after the surgical intervention was measured, the patient was placed in the supine position and all hemodynamic data were recorded. Then, the position of the patient was slightly changed to the lateral recumbent position. Then, at the end of the surgery, the position was changed to supine. Results: Regarding the change in study indices (including HR, SBP, DBP, MAP, SVV, CO, and PVI), changes in supine to lateral status led to only a decrease in systolic blood pressure, diastolic blood pressure, and mean blood pressure and other indicators did not show a statistically significant change. Similarly, the change in the above indices by changing the lateral to the supine state was only an increase in systolic blood pressure, diastolic blood pressure, mean blood pressure, and other data remained unchanged. Conclusion: Changing the position of patients during surgical thoracotomy from supine to lateral position or vice versa is associated only with significant changes in patient's blood pressure and has no significant effect on other ventilatory and cardiovascular parameters. https://aacc.tums.ac.ir/index.php/aacc/article/view/575

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 358 363 Saeideh Sadat Mousavi Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran. Morteza Karami Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran. Seyed Mohammad Mireskandari Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Shahram Samadi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2022 02 22 2022 04 04 Background: This study aimed to assess the effect of virtual reality technology on knowledge, attitude, and skills of first-year anesthesia residents in spinal anesthesia procedure training. Methods: 25 anesthesia residents were enrolled in this experimental study. They were randomly divided into two groups of virtual reality (n =11) and conventional training (n = 14). The virtual reality (VR) group received a combined virtual and clinical training environment while the conventional group received only a clinical training environment for one month. A Similar content (herein, spinal anesthesia procedure) was trained to the both groups. The participants were the anesthesia residents in the academic year 2020-2021. Similar exams assessed knowledge, attitudes, and skills in both groups and data were analyzed using t-test and ANCOVA. Results: The mean knowledge score acquired by residents in the VR group was higher than the conventional learning group (16.45 ± 2.5 vs 13.57 ± 2.1). The method of training had also a significant effect on the post-test score; F (1) = 6.16, P = 0.02. In addition, the mean attitude score acquired by residents in the VR group was higher than the conventional learning group (110.63 ± 14.7 vs 107.64 ± 12.3), although the method of training had not a significant effect on residents’ attitude score; T (23) = 0.55, P = 0.58). The mean skills score acquired by residents in the VR group was higher than the conventional learning group (100.4 ± 3.17 vs 88.14± 11.8); While the method of training had a significant effect on residents’ skill score. T (23) = 3.34, P < 0.05), too. Conclusion: The combined virtual and clinical training environment was superior to a conventional method for enhancement of knowledge and skill in spinal anesthesia procedure training in anesthesiologist residents. This study can help the educational designers of the University of Medical Sciences to improve the competence of residents by using a combined learning environment. https://aacc.tums.ac.ir/index.php/aacc/article/view/490

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 364 369 EN Swarnamba U Nagappa Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubballi, India. Shashidhar Kallappa Department of Oncosurgery, Karnataka Institute of Medical Sciences, Hubballi, India. Mallikarjun Policepatil Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubballi, India. Veena Katappa Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubballi, India. 2022 02 23 2022 04 04 Background: Despite advances in anaesthesia care postoperative nausea and vomiting (PONV) remains a vexing problem. Objectives to determine the efficacy of Granisetron and Granisetron plus dexamethasone in preventing the incidence of PONV, also assess the requirement of rescue antiemetic and adverse effects in the postoperative period AIM: To determine the efficacy of Granisetron and Granisetron plus dexamethasone in preventing the incidence of Nausea and Vomiting in 70 patients undergoing Laparoscopic Surgeries. Methods: Prospective, Randomized, Double Blind Study among 70 Patients aged between 18 to 50 years, ASA class Grade I and II was conducted. 35 patients were recruited in two groups using randomization method. Post operatively data was collected using a questionnaire at 4 hrs and 24 hrs. Episodes of PONV were recorded by three points ordinal scale (TPOS). Intensity of nausea graded verbally with an eleven-point score (0-10). Results: In group G, at 0-4 hours 11.4% patients had nausea and 25.7% had vomiting/retching. In group G+D, 8.6% had nausea and 2.9% had vomiting/ retching. There was significant difference (p =0.018) on Three point ordinal scale (TPOS) between the two groups.      In group G, at 4-24 hours 5.7% patients had nausea and 20.0% had vomiting and retching. In group G+D 11.4% had nausea and there was no vomiting / retching.  There was significant difference (p =0.017) on Three point ordinal scale (TPOS) between the two groups. Conclusion: We concluded that Granisetron + Dexamethasone had lower incidence of PONV compared to Granisetron group alone in Laparoscopic surgeries. https://aacc.tums.ac.ir/index.php/aacc/article/view/491

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 370 376 Poonam Ghodki Department of Anaesthesiology, Deenanath Mangeshkar Hospital, Pune, India. Priyanka Kulkarni Department of Anaesthesiology, SKNMC&GH, Pune, India. Aakruti Prabhu Department of Anaesthesiology, SKNMC&GH, Pune, India. Akshay Dhamdhere Department of Anaesthesiology, SKNMC&GH, Pune, India. 2022 02 23 2022 04 04 Background: Exaggerated hemodynamic response has been linked to laryngoscopy and intubation. This reaction might have negative consequences on the respiratory system, the nervous system, and the heart. It might show up as tachycardia, hypertension, and dysrhythmias. The oral, pharyngeal, and laryngeal axes, all need to be aligned, which is largely responsible for the laryngoscopy reaction. Hence video laryngoscope was developed to overcome this response which does not require the alignment of these three axes. Thus, it can provide this ameliorating effect with less suspension and distension force, which will probably result in less hemodynamic changes during laryngoscopy. Comparing the hemodynamic response during laryngoscopy and intubation using the conventional McIntosh direct laryngoscope and the Truview® video laryngoscope was the primary objective of this study. Intubation time and glottic opening using Cormack Lehane grade were the secondary objectives. Methods: This randomized controlled trial was conducted in 60 patients who were scheduled to undergo elective surgeries requiring conventional GA. Random allocation into two groups was done. Patients in Group ML (n=30) underwent laryngoscopy and intubation using a conventional McIntosh laryngoscope. Patients in Group VL (n=30) underwent laryngoscopy and intubation using a Truview video laryngoscope. Before and after endotracheal intubation, as well as 2, 5, and 10 minutes later, both groups were monitored for changes in hemodynamic parameters such as heart rate, systolic and diastolic pressure, and mean arterial pressure. Intubation time and glottic view was also assessed using the Cormack Lehane grade. Results: Heart rate, systolic blood pressure, mean arterial blood pressure, and intubation time were significantly different between the two groups (p=0.00). The diastolic blood pressure did not significantly differ between the two groups (p=0.203). There was no statistically significant correlation between the type of laryngoscopy and the glottic view with Cormack Lehane Grade favouring certain groups (p=1). Conclusion: We conclude that tracheal intubation with Truview video laryngoscope is advantageous in preventing cardiovascular stress response but with longer intubation time. https://aacc.tums.ac.ir/index.php/aacc/article/view/492

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 377 382 Indu Verma Department of Anaesthesia, SMS Medical College and Hospital, Jaipur, India. Priyanka Beelwal Department of Anaesthesia, SMS Medical College and Hospital, Jaipur, India. Chandan Verma Department of Pharmacology, SMS Medical College and Hospital, Jaipur, India. Chand Vyas Department of Anaesthesia, SMS Medical College and Hospital, Jaipur, India. 2022 02 25 2022 04 04 Background: Off-pump coronary artery bypass grafting (OPCABG) is associated with hemodynamic fluctuations which usually require the use of various vasoactive drugs like norepinephrine and phenylephrine The aim of this study was to evaluate the effect of low dose vasopressin on hemodynamics in patients undergoing Off-pump Coronary Artery Bypass Graft Surgery (OPCABG). Methods: Sixty patients undergoing elective Off pump coronary artery bypass grafting (CABG) having triple vessel coronary artery disease (CAD). were randomly divided into two groups: group A (n=30), patients received Vasopressin 0.03 IU/min via infusion pump (diluted in 50 ml syringe) during the LIMA extraction and continued till the end of surgery; group B (n==30), patients received normal saline infusion pump during the LIMA extraction and continued till the end of surgery. The anesthetic technique was the same in both the groups. Hemodynamic parameters were recorded at various time intervals during the surgery. Results: HR, CO and CI were lower and MAP, SVR and SVRI were higher in vasopressin group. CVP was stable with no significant difference in SV and SVV. Conclusion: To achieve better intra operative hemodynamic stability during the triple vascular coronary anastomosis and to cope up with post-operative vasodilatory shock, low dose vasopressin infusion is a safe option. https://aacc.tums.ac.ir/index.php/aacc/article/view/494

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 383 386 EN Alireza Bameshki Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Majid Razavi Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Zohreh Roohandeh Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Mehryar Taghavi Gilani Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2022 02 26 2022 04 04 Background: In this study, we try to determine which of this two criteria (height or weight) is a better for determining the appropriate size of the laryngeal mask airway for Iranian women. Methods: This randomized controlled trial was performed on 300 females with ASA I-II who were candidate for eye surgery. In the weight group, the size of the laryngeal mask airway was selected according to the classical method and in the height group (height less than 170 cm: size 3, height above 170 cm: size 4) based on researcher’s experience. Number of attempts, leakage and complications were evaluated during surgery, recovery and 24 hours later. Data was analyzed with SPSS v.16 and P<0.05 was meaningful. Results: There weren't significant difference between 2 groups for demographic parameters. Our study shows significant decrease in the number of laryngeal mask airway insertion attempts, the amount of air leakage, the sore throat at recovery and the day after the surgery, and the bloody laryngeal mask airway cuff, in the height group than weight group. Conclusion: We concluded that laryngeal mask airway size based on the patients’ height leads to faster and easier application and fewer side effects than choosing the size based on the patients’ weight. https://aacc.tums.ac.ir/index.php/aacc/article/view/453

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 387 392 EN Sreenivasulu Kattamanchi Department of Anaesthesia & Critical Care, Government Medical College, Kadapa, India. Balaji Tharigonda Department of Anaesthesia & Critical Care, Government Medical College, Kadapa, India. Ganesh Sree Meenakshi Department of Anaesthesia & Critical Care, Government Medical College, Kadapa, India. Kaki Neelakrishnaveni Department of Anaesthesia & Critical Care, Government Medical College, Kadapa, India. 2022 03 01 2022 04 04 Background: Hip fractures in elderly patients is common and occurs with trivial fall. Continuous epidural anesthesia (CEA) and Continuous spinal anesthesia (CSA) are available modalities for lower extremities surgeries. This study was done to compare the effectiveness of CEA and CSA. Methods: A prospective open-label randomized control trial was carried out in the Department of Anaesthesiology and Critical care at GMC, Kadapa, from January 2019 to July 2020. One hundred patients were enrolled and divided into Group A and B, with 50 participants in each group. Group A received continuous spinal anesthesia, and Group B was given continuous epidural anesthesia. VAS score, Onset of sensory block, the Onset of motor block and no. of rescue analgesia, etc., were considered as the primary outcome variable. coGuide statistical software was used for analysis. Results: There was a statistically significant difference between the study groups (Group A vs. Group B) in the Onset of sensory block (7.6 ± 1.6 min, 17.5 ± 1.62 min), the start of motor block (10.1 ± 1.11 min,20.28 ± 1.36 min), duration of sensory block (108.7 ± 16.84 min, 147.4 ± 20.39 min), duration of motor block (175.8 ± 12.47 min, 219.4 ± 18.56 min) and analgesia duration (199.2 ± 11.92 min, 327.6 ± 18.8 min) respectively. The Difference in the number of rescue analgesia in 24 hrs between the study group was significant with a P-value of <0.001. Conclusion: The current study revealed that CSA is more effective than CEA in Hip surgeries. https://aacc.tums.ac.ir/index.php/aacc/article/view/487

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 393 398 Anshu Shettigar Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India. Sandesh Udupi Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India. Deepika Tekchandani Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India. 2022 03 02 2022 04 04 Background: Intubation and laryngoscopy may raise blood pressure and heart rate unnecessarily. To investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: A Prospective Observational study was carried out in academic year December 2013 to July 2015 on 60 ASA physical status I or II patients undergoing elective surgery under general anesthesia at tertiary care hospital. 60 patients were divided into two equal groups of 30 each who received either fentanyl (Group A) or oral Pregabalin 150 mg (Group B) 1 hour prior to surgery. Pulse rate, Systoli and diastolic blood pressure were recorded preoperative, and 0,1,3,5 and 10 minutes after induction. Confidentiality of the subject was maintained. Descriptive and inferential statistics for quantitative and categorical variables were analysed using IBM SPSS version 22. Results: SBP, DBP, and MAP rise during laryngoscopy and during intubation in a similar way in both groups at laryngoscopy (BL) and at 1 and 3 minutes following laryngoscopy before levelling off after 10 minutes in both groups. At baseline and one minute after laryngoscopy, HR increased in both groups. At 3 min, 5 min, and 10 min following laryngoscopy, the rise was reduced in the FL group, however the differences were statistically significant, p 0.005. Conclusion: Oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation. https://aacc.tums.ac.ir/index.php/aacc/article/view/498

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 399 406 Alireza Saliminia Department of Anesthesiology Pain, and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Reza Atef Yekta Department of Anesthesiology Pain, and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Omid Azimaraghi Department of Anesthesiology Pain, and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Shamabadi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Sina Naderi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ali Movafegh Department of Anesthesiology and Critical Care and Pain Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2022 03 10 2022 04 04 Background: The term “surgical stress response” refers to the physiologic response to surgery. The study aimed to evaluate effects of transversus abdominal plane (TAP) block on post-surgical stress responses. Methods: This is a randomized, parallel-group clinical trial consisting of 60 patients undergoing laparoscopic cholecystectomy. Participants were randomized into two groups receiving either general anesthesia or general anesthesia plus TAP block. Blood samples for stress responses evaluating were obtained before anesthesia induction, 6 hours after extubation, and 24 hours after surgery termination. Pain levels were assessed after discharge from the recovery room and at intervals of 6, 12, and 24 hours after surgery. Results: The trend in mean levels of blood sugar, cortisol, and WBC in each group was significant in the course of 24 hours. The mean levels of blood sugar and CRP was not significantly different between two groups; however, serum cortisol and WBC levels were different. Moreover, levels of IL-1 at 6 and 24 hours after surgery were significantly lower in the TAP block group. In Spearman’s rank-order correlation analysis, age, BMI, pain level, cortisol, baseline IL-1, and TNF-α level had a significant linear correlation with IL-1 levels. There was a significant difference in pain scores between the two groups at 6 and 12 hours; however, at 24 hours, the difference was not statistically significant. The mean opioid consumption was significantly lower in the TAP block group. Conclusion: This study showed the remarkable effects of TAP block on stress responses and pain scores. https://aacc.tums.ac.ir/index.php/aacc/article/view/395

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 407 412 Namrata Sadafule Department of Anesthesiology, Smt.Kashibai NavaleMedical College and General Hospital, Pune, Maharashtra, India. Jyoti Deshpande Department of Anesthesiology, Smt.Kashibai NavaleMedical College and General Hospital, Pune, Maharashtra, India. Kalyani Patil Department of Anesthesiology, Smt.Kashibai NavaleMedical College and General Hospital, Pune, Maharashtra, India. 2022 02 03 2022 04 04 Background: In present anaesthesia practice to prolong postoperative analgesia use of various adjuvants is routinely done. Magnesium sulphate is one of the widely used adjuvant used in different routes along with regional anaesthesia to prolong postoperative analgesia. We compared perineural magnesium sulphate and intravenous magnesium sulphate when used as an adjuvant with bupivacaine in   supraclavicular block under USG guidance for upper limb surgeries. Methods: We enrolled ninety patients with physical status I or II, age ranging from 20-60 years, scheduled for upper limb surgeries under USG guided brachial plexus block were categorised into 3 groups (n-30). In study all patients were received 28 ml 0.5% injection Bupivacaine in addition patients in Group 1 and 2 were received 2 ml of Normal Saline (NS) and in Group 3 were received 1.5 ml of NS with 250 mg of Magnesium sulphate. Along with this intravenously 30 minutes prior to block patients in Group 1 and 3 were received 100 ml of 0.9% of NS and patients in Group 2 were received 100 ml of 0.9% normal saline with injection Magnesium Sulphate 50 mg/kg. They were evaluated for block characteristics and total dose of rescue analgesic required in post-operative period for 24 hours were noted. Results: We found that sensory, motor block and postoperative analgesia duration was significantly longer in both study groups (2 and 3) compared to group 1 (control) but significantly prolonged in perineural group compared to intravenous group. Postoperative analgesic consumption was less in both study group with insignificant difference between them. Conclusion: We concluded that in supraclavicular block magnesium sulphate was more effective when used perineurally  as compared to intravenous route as an adjuvant to Bupivacain 0.5% regarding to provide prolong duration of postoperative analgesia with insignificant side effects. https://aacc.tums.ac.ir/index.php/aacc/article/view/480

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 413 415 Çağla Yazar Başkent University Hospital, Department of Anesthesiology, Ankara, Turkey. Nursultan Akmatov Başkent University Hospital, Department of Anesthesiology, Ankara Coşkun Araz Başkent University Hospital, Department of Anesthesiology, Ankara, Turkey. Nedim Çekmen Başkent University Hospital, Department of Anesthesiology, Ankara, Turkey. 2022 03 02 2022 04 04 Plasminogen (PLG) is a serum protein, a precursor of plasmin, in addition to its functions in the coagulation pathway, it also plays an important role in wound healing. PLG deficiency is a rare condition and has been associated with pseudomembranous (ligneous) lesions on mucous membranes, for example: ligneous gingivitis, endometritis and mostly conjunctivitis in the literature. In our case, the patient was a 30-years-old pregnant woman who was diagnosed with PLG deficiency and was at 39+4 week of pregnancy. We chose the neuraxial anesthesia (NA) to avoid possible airway obstruction due to difficult intubation and mucosal damage of upper airways. So, we administered single shot atraumatic spinal anesthesia (SA) for emergency cesarean section (C/S). Herein, preoperative optimization, a good preliminary assessment and selection of the type of anesthesia are important in terms of preventing complications in these patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/499

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 416 419 Begüm Gökdemir Department of Anesthesiology, Başkent University Ankara Hospital, Ankara, Turkey. Nedim Çekmen Department of Anesthesiology, Başkent University Ankara Hospital, Ankara, Turkey. Nazrin Zülfügarlı Department of Anesthesiology, Başkent University Ankara Hospital, Ankara, Turkey. Adnan Torgay Department of Anesthesiology, Başkent University Ankara Hospital, Ankara, Turkey. 2022 03 14 2022 04 24 Achondroplasia is a congenital autosomal dominant disease which has fibroblast growth factor receptor -3 mutation (FGFR-3). Anesthetic management of achondroplastic patients warrants special anatomical and physiological considerations because of important variations in the airway as well as the spine in regional techniques. In our case, 37-years-old male dwarf with achondroplasia has end stage renal disease (ESRD) and received cadaveric renal transplantation (RT). Preoperative assessment revealed the Mallampati score IV airway with a cervical instability, thoracolumbar kyphoscoliosis and spinal deformities. We aim to highlight anesthetic management of achondroplastic dwarf with difficult airway during operation. https://aacc.tums.ac.ir/index.php/aacc/article/view/502

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 420 422 Pooja Chandran Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Ruby Perween Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Boney John Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Mohammed Shafiq Shajahan Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. Roopesh Ramesh Department of Anaesthesiology and Critical Care, AIIMS, Rishikesh, Uttarakhand, India. 2021 12 27 2022 01 30 In patients with cardiac disease, it’s always a challenge for the anaesthetist to administer general anaesthesia as well as central neuraxial blockade. The major perioperative task in these patients with low cardiac output is maintaining hemodynamic stability. Here, we are discussing a case of successful management of a geriatric patient having ischemic heart disease with ejection fraction of 25% posted for bilateral total knee replacement under graded epidural anaesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/456

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 423 425 Dheeraj Kapoor Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Harpreet Singh Department of Critical Care Medicine, Paras Hospital, Panchkula, India. Deepika Gupta Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Manpreet Singh Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Parul Sood Department of Physiotherapy, Government Medical College and Hospital, Chandigarh, India. 2022 02 24 2022 04 04 Bilateral radial dysplasia is a rare condition and usually associated with familial malformation syndromes and spectrum of cardiac anomalies. These patients often require corrective orthopedic surgeries in early age. Radial dysplasia associated with cardiac abnormalities is particularly seen in certain syndromes such as Holt-Oram (HOS) syndrome and TAR (thrombocytopenia, anemia, and radial aplasia) syndrome. We report a successful management of twelve months old male child with rare combination of bilateral radial dysplasia with isolated patent ductus arteriosus (PDA), for corrective orthopedic surgery. A comprehensive approach, which includes an extensive preoperative evaluation and pre-defined perioperative hemodynamic goals for PDA, plays a pivotal role in its perioperative management. https://aacc.tums.ac.ir/index.php/aacc/article/view/493

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 Supp. 1 2022 11 07 426 427 EN Amit Kumar Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India Uma Hariharan Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India Nidhi Yadav Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India Vijay Nagpal Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India 2022 02 10 2022 04 04   No AbstractNo AbstractNo AbstractNo AbstractNo Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/478