Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2023 02 08 1 3 Ali Jabbari Ischemic Disorder research Center, Golestan University of Medical Sciences, Gorgan, Iran. & Department of Anesthesiology and Intensive Care, Golestan University of Medical Sciences, Gorgan, Iran. Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Vahid Khori Ischemic Disorder research Center, Golestan University of Medical Sciences, Gorgan, Iran. & Department of Pharmacology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Zahid Hussain Khan Department of Anesthesiology and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2022 03 25 2022 04 24 No Abstract   No Abstract   No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/511

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2022 11 24 4 8 Rameesa Batul Department of anesthesiology and critical care, SKIMS Soura, Srinagar, J&K, India. Uzma Gulzar Department of anesthesiology and critical care, SKIMS Soura, Srinagar, J&K, India. Ouber Qayoom Department of Cardiology, GMC, Jammu, J&K, India. 2022 03 16 2022 04 24 Background: One of the most prevalent regional methods in paediatric anaesthesia is the caudal epidural block. It is a safe, simple procedure that has proven to be quite beneficial in children following infra-umbilical surgery. Ropivacaine causes differential neuraxial blockade, which is associated with less motor block and lower cardiovascular damage. To extend the duration of action of local anaesthetics, several adjuvants are administered. Our goal was to see how fentanyl affected the duration of postoperative analgesia when used in conjunction with ropivacaine in a paediatric population of children aged 3 to 8 years following infraumbilical operations. Methods: On 100 paediatric patients receiving elective infraumbilical operations, a prospective, comparative, and randomised investigation was done. Patients were randomised into two 50-person groups at random. Caudal anaesthesia was administered once the airway was secured. 0.2 percent ropivacaine 0.5ml/kg was given to Group R, while 0.2 percent ropivacaine 0.5ml/kg with fentanyl 0.5mcg/kg was given to Group RF. Face, legs, activity, cry, and consolability pain rating scales were used to measure postoperative pain for 24 hours. The length of the motor blockage and any negative effects were recorded. Hemodynamics, post-operative analgesia duration, and the number of rescue analgesics required were all recorded and statistically evaluated. Results: The mean duration of analgesia in ropivacaine group was 440.60±101.29 minutes (7.25hrs) and in ropivacaine fentanyl group was 891±312.84 (14.76hrs). Statistically, the difference was highly significant. Conclusion: In children having infraumbilical surgery, using fentanyl as an adjuvant to ropivacaine for caudal block enhanced analgesic effectiveness and extended post-operative analgesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/504

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2023 02 08 64 66 Jyoti Deshpande Department of Anaesthesiology and Critical Care, Smt Kashibai Navale Medical College and General Hospital Narhe-Pune, MUHS University, Nashik, India. Merlin Jacob Department of Anaesthesiology and Critical Care, Smt Kashibai Navale Medical College and General Hospital Narhe-Pune, MUHS University, Nashik, India. 2022 04 26 2022 05 28 Situs inversus totalis is a rare congenital positional anomaly with a predicted incidence of 1: 10,000 amongst the general population described by the transposition of the abdominal and thoracic visceral structures. Local infiltration of the breast is a common technique for fibroadenoma of small sizes. However, its efficacy, including duration of action as well as the extent, can be unreliable and surgeon dependent. Unless otherwise contraindicated, the regional technique of thoracic segmental spinal anesthesia has been proven to be a safe and effective method for even major surgeries including laparoscopic cholecystectomy, breast lumpectomy and abdominal surgeries. Multiple regional anesthetic techniques are available and should be used according to the requirement of the surgery as well as the skill and knowledge of the performing anesthetist. We discuss here, a case of fibroadenoma in a patient with isolated situs inversus totalis, operated under thoracic segmental spinal anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/532

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2022 10 15 80 83 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. Behrang Nooralishahi Department of Anesthesiology and critical care Medicine, Tehran University of Medical Sciences, Tehran, Iran. Saeid Amirkhanlou Department of Internal Medicine, School of Medicine, Sayyad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran. Vahid Khori Ischemic Disorders Research Center of Golestan University of Medical Sciences, Gorgan, Iran 2022 04 23 2022 05 28      No Abstract   No Abstract   No Abstract   https://aacc.tums.ac.ir/index.php/aacc/article/view/526

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2023 02 08 9 12 Ravikanth Pula Department of Anesthesiology,ESIC Medical College and Superspeciality Hospital,Sanath Nagar,Hyderabad, India. Swapna Katakam Department of Anesthesiology, ESIC Medical College and Superspeciality Hospital, Sanath Nagar, Hyderabad, India. Sunanda Gooty Department of Anesthesiology, ESIC Medical College and Superspeciality Hospital, Sanath Nagar, Hyderabad, India. Nagarjuna Thakur Department of Anesthesiology, ESIC Medical College and Superspeciality Hospital, Sanath Nagar, Hyderabad, India. 2022 04 23 2022 05 28 Background: The current study is aimed to compare the effect of fixed cuff volume and fixed cuff pressure technique on hemodynamic parameters and on postoperative complications. Methods: The prospective, randomised, controlled study was conducted in a tertiary care hospital with 100 patients aged between 18 to 60 yrs. The patients who are undergoing for elective surgeries under general anaesthesia were enrolled after obtaining ethical committee approval. Patients were randomized based on computer generated random numbers into two groups, fixed volume (7ml) group (group V, n-50) and fixed cuff pressure group (group P, n-50). The ETT cuff was filled with 7 ml of air in the fixed volume technique, and in the fixed cuff pressure group -cuff pressure was maintained at 20 cmH2O, after intubation. Tracheal tube cuff pressures were measured by AMBU cuff pressure gauge manometer. Hemodynamic parameters SBP, DBP, MAP and PR were noted at the time of cuff inflation, after extubation in the both the groups. Post-operative sore throat, hoarseness and cough was assessed at the time of extubation in the both the groups. Results: Mean age in both the groups was 41 years. Statistical significance (P< 0.0001) was observed in Group P in systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, HR whereas no significance was seen in group V. The percentage of post-operative complications like hoarseness, cough, sore throat, and dysphagia were seen to be less in group P when compared to group V. Conclusion: With present data we could conclude that the fixed minimal cuff pressure (20 mm H2O) is an ideal and reliable technique in reducing the post-operative complications along with maintenance of hemodynamic parameters. https://aacc.tums.ac.ir/index.php/aacc/article/view/527

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2023 02 08 67 69 Ahmed Uslu Başkent University, Anesthesiology and Reanimation, Ankara Hospital, Başkent University, Ankara, Turkey. Nedim Çekmen Başkent University, Anesthesiology and Reanimation, Ankara Hospital, Başkent University, Ankara, Turkey. Figen Leblebici Başkent University, Anesthesiology and Reanimation, Ankara Hospital, Başkent University, Ankara, Turkey. 2022 04 07 2022 05 11 The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some complications may occur during the operation, subcutaneous emphysema, pneumomediastinum and pneumothorax are rare complications. In this case, we present a patient who developed subcutaneous emphysema, pneumomediastinum and pneumothorax. A 53-year-old female patient presented with right shoulder pain for 8 months. The patient's body mass index is 20. Additional diseases are rheumatoid arthritis (RA) and vertigo. There was no other systemic disease or comorbidity. She was assigned an American Society of Anesthesiologists (ASA) score of 2. Arthroscopic rotator cuff repair was planned. She was operated under general anesthesia (GA). Subcutaneous emphysema, pneumothorax and pneumomediastinum developed at 6 hours after this surgery. The patient was discharged without any complaints on the 6th day of follow-up. No problem was detected in the follow-up of the patient. After shoulder arthroscopy under GA, subcutaneous emphysema, pneumothorax and pneumomediastinum can occur due to the procedure itself, the pleural and alveolar trauma, the endotracheal intubation or extravasation of irrigation fluid during shoulder arthroscopy. In our case, it was not possible to determine the exact cause. However, it is important to keep in mind that subcutaneous emphysema, pneumothorax and pneumomediastinum can occur after arthroscopic shoulder surgery. Although shoulder arthroscopy is a safe procedure, surgeon familiarity with the risk factors for this complication and close monitoring can aid in its identification and allow for appropriate treatment. https://aacc.tums.ac.ir/index.php/aacc/article/view/517

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2022 10 24 13 20 Sonal Goyal Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, India. Bhavna Gupta Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, India. 2022 04 06 2022 05 11 Background: The utility of Neuromuscular monitoring (NMT) has not been studied in Indian scenario till date. We did a survey to evaluate the knowledge, attitude, practices of NMT among Indian anesthesiologists. Methods: A questionnaire-based google form was sent to 350 anesthesiologists over 3-months. Demographic data was collected in initial questions, followed by data on their concepts, practices, and knowledge of NMT and postoperative residual nerve block (PRNB). Data were descriptively analysed using frequencies and percentages. Descriptive statistical testing was done using software package IBM SPSS 23. Results: 88.9% of participants reported the use of clinical assessment. Though majority used clinical parameters, they were well-versed about Train-of-Four criteria. 75.9% stated the use of objective NMT in < 25 % of patients. The reasons for not using objective monitoring were scarcity of neuromuscular monitors, non-familiarity, and complexity of monitors. In regards to PRNB, 79.6 % participants considered PRNB to be an important clinical issue. Although in their clinical practice they rarely encountered PRNB, 74% responded that routine NMT can decrease PRNB.  The cross-tabulation table reflected that the use of objective tools (P= 0.014), knowledge about the essentiality of NMT (p=0.003), correctly stating PRNB as an important clinical issue (p=0.006), and their understanding about unreliability of clinical tests (p=0.001) showed significant improvement with increasing anesthesia experience. Conclusion: Participants showed great understanding of clinical and qualitative tests but not of quantitative tests, with low rate of usage of objective NMT. A lacuna in understanding of quantitative parameters must be addressed considering high incidence of PRNB and lack of sensitivity of clinical parameters. https://aacc.tums.ac.ir/index.php/aacc/article/view/515

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 1 2023 02 08 70 73 Deniz Kaya Department of Anesthesiology, Başkent University, Ankara, Turkey. Nedim Çekmen Department of Anesthesiology, Başkent University, Ankara, Turkey. Asude Ayhan Department of Anesthesiology, Başkent University, Ankara, Turkey. 2022 04 04 2022 05 11 The incidence of postpartum hemorrhage (PPH) is increased in multiple pregnancies and is an important cause of maternal death. Controlling bleeding and correct anesthesia management during this period are essential. In our 35-year-old patient with triple pregnancy, hemorrhage due to uterine atony developed during C/S surgery. We aimed to discuss the anesthesia management of PPH in our patient who underwent a total abdominal hysterectomy and bilateral salpingectomy (TAH BS) due to continued bleeding during and after C/S, with literature. We think that morbidity and mortality rates can be reduced in the perioperative period for PPHs with the help of multidisciplinary approach, rapid action, and close follow-up. https://aacc.tums.ac.ir/index.php/aacc/article/view/514

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care https://aacc.tums.ac.ir/index.php/aacc/article/view/636

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 09 03 488 494 Ritesh Patel Department of Anaesthesiology, GMERS Medical College, Himmatnagar, Gujarat, India. Gunjan Vadhadiya Department of Anaesthesiology, GMERS Medical College, Morbi, Gujarat, India. Hina Gadani Department of Anaesthesiology, GMERS Medical College, Gandhinagar, Gujarat, India. Shobhana Gupta Department of Anaesthesiology, GMERS Medical College, Gandhinagar, Gujarat, India. 2022 11 19 2023 01 30 Background: Intravenous (IV) sedation is often used to relieve anxiety or stress during surgery under regional anesthesia. Subarachnoid block is a widely followed regional anaesthesia technique, especially in lower abdominal and lower limb surgeries. Intense sensory and motor block, continuous supine position and the inability to move the body also brings a feeling of discomfort and phobia in many patients. Sedation has been shown to increase patient satisfaction during regional anaesthesia. Dexmedetomidine is well suited for conscious sedation as patient can be quickly aroused and oriented on demand. Aim of this study was to compare infusion doses of 0.3μg/kg/hr and 0.5μg/kg/hr, after loading dose of 1μg/kg of injection (inj).dexmedetomidine in order to obtain a better regimen for patients undergoing procedures under spinal anaesthesia in terms of sedation and hemodynamic stability. Objective: To compare efficacy of dexmedetomidine for intraoperative sedation and hemodynamic stability at doses of 0.3μg/kg/hr and 0.5μg/kg/hr after loading dose of 1 μg/kg in patients operated under spinal anaesthesia. Methods: Adult 80 Patients were randomly divided into two groups, (Group D-0.3) and (Group D-0.5). They were given spinal anaesthesia with 0.5% hyperbaric bupivacaine and initial dose of inj.dexmedetomidine 1 μg/kg was infused over 10 minutes. Group D-0.3 received maintenance dose of inj.dexmedetomidine of 0.3μg/kg/hr and Group D-0.5 received maintenance dose of 0.5μg/kg/hr.  Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), spO2 and sedation using observer’s assessment of alertness/sedation (OASS) were recorded at baseline, after loading dose, before spinal anesthesia, after spinal anesthesia at every 5 minutes upto 30 minutes, followed by every 15 minutes till the end of surgery and every 5 minutes upto 15 minutes after surgery. Data were compared using chi-square and unpaired t test.   Results: The mean age for Group D-0.3 is 43.9+11 and for Group D-0.5 is 35.3+20. There is no statistically significant difference in demographic profile between two groups. It was also observed that there is no statistically significant difference in HR, SBP, DBP, MAP, RR and SpO2 in all point of time (p>0.05). According to sedation score in group D-0.3 72% patients were sleeping comfortably but easily arousable and 8% patients were in deep sleep, while in group D-0.5 70% were sleeping comfortably but easily arousable and 15% in deep sleep. Conclusion: After a loading dose of 1 μg/kg intravenously, an iv infusion of dexmedetomidine at a lower rate, i.e. 0.3μg/kg/hr is equally effective in providing sedation for patients undergoing surgeries under spinal anesthesia as 0.5μg/kg/hr.   https://aacc.tums.ac.ir/index.php/aacc/article/view/678

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 09 18 559 561 Hannah Mounika Nunna Department of Anesthesia, Sree Balaji Medical College and Hospital, Bharath University, Chennai, India. Vinod Krishna Gopal Department of Anesthesia, Sree Balaji Medical College and Hospital, Bharath University, Chennai, India. Purushotham G Department of Anesthesia, Sree Balaji Medical College and Hospital, Bharath University, Chennai, India. 2022 09 15 2022 12 10 Hot water Epilepsy (HWE) is a type of epilepsy which occurs when hot water is poured over the body. Patient undergoing implant exit removal of tibia was intra operatively managed who has the history of corrected VSD and hot water epilepsy. https://aacc.tums.ac.ir/index.php/aacc/article/view/641

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 21 495 499 EN Vibhuti Sharma Department of Anaesthesia & Intensive Care, VMMC & Safdarjung Hospital, India. Mahesh Chandra Department of Anaesthesia & Intensive Care, VMMC & Safdarjung Hospital, India. Santvana Kohli Department of Anaesthesia & Intensive Care, VMMC & Safdarjung Hospital, India. Surabhi Sandill Department of Anaesthesia & Intensive Care, VMMC & Safdarjung Hospital, India. Ankita Yadav Department Of AnaeaDepartment of Anaesthesia & Intensive Care, VMMC & Safdarjung Hospital, India.sthesia & Intensive care, VMMC & Safdarjung Hospital Harish Sachdeva Department of Anaesthesia & Intensive Care, VMMC & Safdarjung Hospital, India. 2022 11 20 2023 01 09 Background: Covid-19 has been associated with more than 330 million cases and 5.5 million deaths since December 2019 with many countries witnessing two or three waves of covid -19 cases. In our study we retrospectively analysed data of patients admitted to Intensive Care Unit of a tertiary care hospital in India with moderate to severe disease for association of mortality with comorbidities, gender and age of patients. Methods: Data of patients admitted to Intensive care unit of our hospital from march 2021 to august 2021 with moderate to severe covid infection was retrospectively collected, patients with incomplete data in records were excluded and data of total of 415 patients was analysed for association of comorbidities (Diabetes, CKD, CAD, Hypertension, Chronic respiratory illness), gender and age for any association with mortality by multivariate binary logistic analysis and chi square test. Results: There was significant association of increased mortality with age more than 50 yrs having an odds ratio of 1.5 and age more than 70 yrs having odds ratio of 2.46(p= 0.027). There was also significant association between CKD and mortality with odds ratio of 3.117. (p =0.050). No association between Diabetes, CAD, Hypertension, Chronic respiratory illness and gender was found in our study. Conclusion: The novel coronavirus infection (COVID-19) has significantly increased mortality in patients of age more than 50 yrs, the risk increases further if age is more than 70 yrs. We also found increased mortality in patients with chronic kidney disease. https://aacc.tums.ac.ir/index.php/aacc/article/view/682

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 09 23 562 565 EN Azadeh Ferdosnia Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Masoud Ramezani Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Mirahmadi Eraghi Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. & Student Research Committee, School of Medicine, Islamic Azad University, Qeshm International Branch, Qeshm, Iran. & School of Medicine, Qeshm International Branch, Islamic Azad University, Qeshm, Iran. Shabnam Seifipour Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Seyed Amir Hossein Javadi Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. & Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2022 11 11 2023 01 09 Propofol is a commonly used medication for sedation during surgery; however, it must be used with precaution in neurologic patients because of the subsequent adverse effects of cardiovascular and neurologic. An 83-year-old male patient with acute subdural hemorrhage was referred with a two-year history of falling and a recent occurrence of imbalance; the patient underwent urgent surgery under general anesthesia, using 100 µg fentanyl for premedication, 50 mg Propofol for induction, and Isoflurane gas and fentanyl drip for maintenance. During transmission of the patient for postsurgical computed tomography, two ccs Propofol 1% were mistakenly injected into the patient's radial artery and managed appropriately by the master. Following this management, the patient represented no alteration in his vital signs and was discharged in a favorable condition. Here, we report how this case could be managed successfully. Robust data regarding the complications of accidental administration of Propofol through an artery are lacking, and the presented results remain controversial. The authors have herby drawn attention to the unique management of an accidental intra-arterial injection of Propofol. Further studies are warranted to establish definite conclusions. https://aacc.tums.ac.ir/index.php/aacc/article/view/665

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 24 500 507 Nethra Nanjundaswamy Bangalore Medical College and Research Institute, Departmentof Anaesthesiology,Victoria Hospital, Bangalore,India. Sudheesh Kannan Bangalore Medical College and Research Institute, Departmentof Anaesthesiology,Victoria Hospital, Bangalore,India. Vijaykumar Narayanappa Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India. Saraswathi Nagappa Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India. Sandya Kalappa Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India. 2022 11 24 2023 01 09 Background: Pnuemoperitonium in laparoscopy is associated with cardiorespiratory changes. Combination of epidural with General anaesthesia (GA) will offer benefit of hemodynamic control and perioperative analgesia. We aimed to study the efficacy of Combined Epidural- General Anaesthesia (CEGA) with pre-emptive activation over general anaesthesia in laparoscopic cholecystectomies. Methods: In this prospective double blind –randomised study, 90 surgical inpatients were studied in two study groups. Group GE-(n=45) received Lumbar Epidural analgesia with ropivacaine 0.2% along with GA and Group G (n=45) received only GA. Heart rate (HR), Mean arterial Pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), Capnogram (ETCO2), saturation (spo2), VAS score, Ramsay sedation score, requirement of propofol, muscle relaxants and analgesics were studied. Results: Statistical analysis was carried out with SPSS version 20. Statistical value of p<0.05 was considered significant. We noted significant difference in MAP, SBP, DBP, muscle relaxants, Propofol, Fentanyl and lesser pain scores in Group GE than Group G i.e (p<0.001). Conclusion: Combination of epidural and general anaesthesia technique with pre emptive activation has the benefit of better control of hemodynamics .It reduced requirements of analgesics and anaesthetic drugs and had faster recovery with less post operative pain in laparoscopic cholecystectomies. https://aacc.tums.ac.ir/index.php/aacc/article/view/685

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 24 508 515 EN Trupti Patel Department of Anaesthesiology, Smt.Shardaben General Hospital,Ahmedabad, India. Urvi Shah Department of Anaesthesiology, GMERS Medical College Gandhinagar, Gujarat, India. Bharti Rajani Department of Anaesthesiology, GMERS Medical College Gandhinagar, Gujarat, India. Shobhana Gupta Department of Anaesthesiology, GMERS Medical College Gandhinagar, Gujarat, India. 2022 12 01 2023 01 11 Background: Spinal anaesthesia is the most common technique used for lower abdominal surgeries. Spinal anaesthesia using plain hyperbaric bupivacaine has disadvantages like delayed onset, shorter duration etc. Adding adjuvants like fentanyl, dexmedetomidine has overcome these disadvantages and improve post operative analgesia and stable hemodynamic condition with minimal side effects. Aim of the study was to determine the time of onset and duration of sensory and motor block, sedation score and postoperative analgesic efficacy of Fentanyl and Dexmedetomidine as adjuvant to bupivacaine in lower abdominal surgeries. Methods: This prospective, double blind, randomized study included total 100 patient-divided equally in 2 groups (group F-fentanyl and group D-dexmedetomidine) after matching the inclusion and exclusion criteria. Group F received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 25 mcg Fentanyl and Group D received 3ml of 0.5 % injection Hyperbaric Bupivacaine + 5mcg Dexmedetomidine intrathecally. The onset and duration of sensory and motor block, sedation score, duration of postoperative analgesia and need of rescue analgesia along with haemodynamic parameters were recorded. Results: The mean time for onset of sensory block in group D was (3.5 ± 0.88 mins) significantly lower than group F (4.4 ± 1.2 mins) (p=0.001). And the mean time of onset of motor block in group D (3.23 ± 1.0mins) was significantly lower than in group F (4.3 ± 1.1 mins). Duration of sensory and motor block was significantly higher in group D as compared to group F. The mean analgesic dose in group D was 1.4 ± 0.78 and in group F was 3.6 ± 0.73(p<0.005). Conclusion: From our study we concluded that Dexmedetomidine is a better adjuvant than Fentanyl as it provides rapid onset and prolonged sensory and motor block, hemodynamic stability with excellent post operative analgesia.   https://aacc.tums.ac.ir/index.php/aacc/article/view/688

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 24 516 521 Alireza Rahat Dahmardeh Department of Anesthesiology and Critical Care, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Aliakbar Keykha Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. & Department of Medical-Surgical Nursing, School of Nursing and Midwifery Zahedan University of Medical Sciences, Zahedan, Iran. Mehdi Rezvani Amin Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. & Department of Medical-Surgical Nursing, School of Nursing and Midwifery Zahedan University of Medical Sciences, Zahedan, Iran. Masoum Khoshfetrat Department of Anesthesiology and Critical Care, Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. 2022 12 11 2023 02 06 Background: The improved consciousness level reflects the patient’s recovery following acute brain injury. The medications that can regulate neurotransmitter levels, neural synaptic plasticity, and functional connectivity of consciousness networks might play a crucial role in improving the consciousness status of the patients. Thus, this study aims to evaluate the effectiveness of amantadine in improving consciousness in acute brain injury patients. Methods: The present quasi-experimental study was performed from 2021 to 2022 after obtaining the necessary permissions from Zahedan University of Medical Sciences, Iran. Eighty patients with acute brain injury who met the study inclusion criteria were recruited and randomized into amantadine and placebo groups. The amantadine group was given a daily dose of 100 mg amantadine tablets, while the placebo group received a gavage of amantadine-like placebo tablets twice daily for 14 days. The consciousness level of patients was measured daily until the outcome (ICU discharge or expiration) was established. Eventually, a comparative data analysis was conducted to determine amantadine's efficacy in enhancing consciousness, reducing mechanical ventilation time, and improving patient outcomes. Results: The mean GCS score in the amantadine group was 5.5±1.4 on admission and 11.9±3.7 at the end of the study, compared to 6.6±1.5 on admission and 11.8±3 at the end of the study, for the placebo group (p=0.154 and p=0.211, respectively). The mean duration of mechanical was 28.87±11.34 days in the amantadine group and 24.13±14.93 days in the placebo group (P=0.329). Twenty-four patients in the amantadine group were discharged from ICU, and 16 were expired. For the placebo group, 21 patients were discharged from ICU, while 16 were expired (p=0.221). No statistically significant difference was found in any of the measured variables between the two groups. Conclusion: The results demonstrate that amantadine administration had no statistically significant impact on improving consciousness status and clinical outcomes and reducing mechanical ventilation time in acute brain injury patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/690

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 12 20 522 529 Sushma Sannaboraiah Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnatka, India. Swarooprani Rajegowda Department of Anesthesiology, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India. 2022 12 19 2023 03 26 Background: Spinal Anesthesia Induced Hypotension(SAIH) continues to be the troublesome complication for obstetric patients undergoing cesarean section under subarachnoid block. Vasopressors are emerging as the cornerstone of treating SAIH in cesarean section patients with the evolving evidence of arterial vasodilatation as the primary cause of hypotension. This study was hypothesized to compare the efficacy of norepinephrine and ephedrine boluses to maintain hemodynamics in cesarean section. Methods: After approval from institutional ethics committee and registration in Clinical Trials Registry India(CTRI ) and informed consent, study was conducted in 110 healthy parturients aged 18-40 years, belonging to ASA  physical status I and II, posted for elective cesarean section under spinal anesthesia, were randomly allocated into group N(n=55) and group E(n=55),who received intravenous boluses of norepinephrine  6 g and ephedrine 10mg respectively as prophylaxis(one dose soon after induction) and in treatment of SAIH. The number of vasopressor boluses were recorded as primary objective and hemodynamics, APGAR scores, adverse events were noted. Results: The number of boluses of vasopressor used was 1.9±1.2 for Ephedrine and 4.72±2.9 for Norepinephrine. At 30,40,50 and 60 minutes after anesthesia, there was significant fall in mean arterial pressure in the norepinephrine group compared to ephedrine group. The incidence of tachycardia was more in ephedrine group and incidence of bradycardia was more in norepinephrine group. Conclusion: Both the study drugs, ephedrine and norepinephrine are  comparably effective in preventing SAIH after prophylactic bolus and effective in maintaining blood pressure intraoperatively, more number of boluses of norepinephrine was required compared to ephedrine. https://aacc.tums.ac.ir/index.php/aacc/article/view/692

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 09 03 530 535 Jyoti Deshpande Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, India. Priyanka Kulkarni Department of Anaesthesiology, SMCW, SUHRC Symbiosis International university,Pune, India. Sanjana Nashine Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, India. 2022 12 22 2023 03 26 Background: In patients undergoing lower limb orthopaedic surgery, unrelieved post-operative pain not only results in discomfort to the patients but also predispose to the development of chronic pain syndromes. The dawn of ultrasonographic-guided techniques has led to increased interest in femoro-sciatic nerve block (FSNB) for lower