Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 84 95 EN Deepa Khurana Department of Anaesthesia and Intensive care, VMMC & Safdarjung Hospital, New Delhi, India. Arin Choudhury Department of Anaesthesia and Intensive care, VMMC & Safdarjung Hospital, New Delhi, India. Manisha Manisha Department of Anaesthesia and Intensive care, VMMC & Safdarjung Hospital, New Delhi, India. Saurav Mitra Mustafi Department of Anaesthesia and Intensive care, VMMC & Safdarjung Hospital, New Delhi, India. Vibha Uppal Department of Biochemistry, VMMC & Safdarjung Hospital, New Delhi, India. Himanshu Khurana Department of Anesthesia and Critical Care, Medanta, Gurgaon, Haryana, India. Harish Sachdeva Department of Anaesthesia and Intensive care, VMMC & Safdarjung Hospital, New Delhi, India. Nitesh Gupta Department of Pulmonary Critical Care and Sleep Medicine, VMMC & Safdarjung Hospital, New Delhi, India. Usha Ganpathy Department of Anaesthesia and Intensive care, VMMC & Safdarjung Hospital, New Delhi, India. 2022 04 14 2022 05 28 Background: Globally critically ill COVID-19 (Coronavirus disease-19) patients have stretched critical care services. This study was undertaken to find factors implicated in mortality amongst COVID positive and negative patients presenting with severe acute respiratory illness (SARI) and factors having the probability of indicating COVID positivity. Methods: The demographic parameters, comorbid illness, clinical parameters and laboratory values of 327 patients were retrospectively analyzed to find the risk factors for mortality in COVID positive and negative patients and factors predicting COVID positivity amongst SARI patients. Results: 58% of SARI patients tested positive by RTPCR. Most common comorbidities were diabetes and hypertension, 35.2% and 33% respectively. Duration of swelling and low haemoglobin were significantly associated with mortality in COVID positive group (p=0.01, 0.005). Acidosis and tachycardia (p=0.003, 0.034) were associated with mortality amongst COVID negative. Creatinine, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) were higher in non-survivors of both groups (p<0.001). Age, history of contact or from containment zone, cough, pain abdomen and P/F ratio were significant predictors of COVID positivity (1.020(1.006–1.035); 3.889(1.316–11.495); 2.908(1.182–7.152); 2.147(1.149–4.012); 0.997(0.994-1.000) respectively) by multivariable regression analysis. Conclusion: A long duration of swelling and low haemoglobin (<12 g%) were responsible for COVID positive mortality while pain abdomen, raised levels of AST, tachycardia and acidosis were associated with mortality in COVID negative. Deranged creatinine, higher SOFA and qSOFA were associated with mortality in both groups. Age, contact history, residence in containment zone, cough, pain abdomen and poor P/F ratio are predictive factors for COVID positivity. https://aacc.tums.ac.ir/index.php/aacc/article/view/522

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 171 177 Mojgan Rahimi Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Noha Shatti School of Allied Medical sciences, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Sheikhshoaei Department of Medical library and information sciences, school of Allied Medical sciences, Tehran University of Medical Sciences, Tehran, Iran. Afzal Shamsi Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2022 05 20 2022 06 25 Background: The term "outpatient surgery" has become a common procedure in most hospitals around the world. On other hand, Spinal aesthesia can mimic the outcome sought by the principle of outpatient surgeries since it takes a short time to recover and limits the need for post-operative pain medication Therefore, the objective of this study is to focus on finding a method to reduce the side effects that commonly accompany the procedure of spinal aesthesia and to avoid the possible hemodynamic changes that may occur. Methods: The method for the study will be a narrative review of various medical journals, conferences papers, and unpublished documents using the dual keywords, outpatient surgeries spinal aesthesia, and ambulatory aesthesia, we include in this research thirty-one original articles, fifty-three reviews articles, two books, three handbooks, and two guidelines searched in the deferent database (google scholar, Research gate, pub med, science direct). Results: Consideration should be given to the quality of patients who participate in outpatient concepts. Finally, in terms of cost, side effects, and patient satisfaction, the spinal aesthetic approach gives a favourable outcome since it covers post-operative time without the need for analgesia and reduces the percentage of postoperative nausea and vomiting, and reduces the time staying in the hospital. Conclusions: In conclusion, the study discovered that a major proportion of surgeries performed over our lifetimes are outpatient procedures. Therefore, Discharge criteria should be posed with one precise criterion. There is no standard protocol to serve these types of surgeries and patients. The only criteria found and practiced served general conditions for outpatients and inpatients. There have been several attempts to create a protocol that can meet the pleasing outcome of outpatient surgeries. Consequently, we need more research to cover this lack and serve the Genuine needs of a protocol to define the criteria and categories that concern the term outpatient and outpatient surgeries and lead to improving the quality of outpatient surgeries with fewer side effects and minimum hemodynamic changes. https://aacc.tums.ac.ir/index.php/aacc/article/view/560

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 178 180 Kasra Karvandian Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Shabnam Beigi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Zahra Ataie-Ashtiani University of Melbourne, Melbourne, Australia. Mohammad Ashouri Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Narjes Mohammadzadeh Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2022 05 14 2022 06 11 Since the first wave of COVID-19, different methods for management of COVID-19 ARDS were proposed. Early intubation and mechanical ventilation was performing more than other methods. after several mounths, limitation of equipment in hospitals, made the specialists think of less aggresive methods. NIV was one of suggestion performed before intubation which improve oxygenation of patients. They don't get any sedation and have regular diet. As a result, the need for ICU and ventilator for respiratory support decreases. In this case study, we report a patient that had permanent tracheostomy and hospitalised for COVID-19 ARDS. At first we connected the tracheostomy to a CPAP devise. https://aacc.tums.ac.ir/index.php/aacc/article/view/550

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 96 101 Alireza Mahdavi Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Shafa Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Sajjad Razavi Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ahmad Eghbali Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tahere Chavoshi Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2022 04 24 2022 06 25 Background: Considering that the gold standard for intubation in children with a difficult airway is the use of fiberoptic bronchoscopy, and few studies have evaluated its application in children, the present study aimed at comparing two bronchoscopic techniques of nasal fiberoptic tracheal intubation (FOI-Nasal) and fiberoptic intubation via laryngeal mask airway (FOI-LMA) in children with a difficult airway. Methods: A single-blind randomized clinical trial was performed on 40 six-month-old to six-year-old children that were divided into two groups each consisting of 20 patients.  The participants were all candidates for elective surgery with clinical criteria for the anticipated difficult intubation. FOI-Nasal and FOI-LMA were performed in the first and second groups, respectively. Mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation levels (SpO2) were assessed and recorded before anesthesia (T1), immediately before bronchoscopy (T2), and immediately after intubation with endotracheal tube (T3). Moreover, ETCO2, the first successful insertion attempt, and the intubation time were recorded, as well. Results: The results of the present study revealed that parameters including MAP, HR, and SpO2 at times T1, T2, and T3 were not significantly different between the two groups after adjusting for potential confounding factors (P> 0.05). However, ETCO2 in FOI-Nasal group with a mean of 38.40 ± 3.57 was significantly higher than that of the FOI-LMA group with a mean of 34.35 ± 3.15 (P = 0.001). In addition, the intubation time in the FOI-LMA group with a mean of 32.40 ± 7.45 was significantly shorter than that of the FOI-Nasal group with a mean of 51.75 ± 9.97 (P <0.001). The success rate in the first attempt in the FOI-Nasal group with the value of 70% was lower than that of the FOI-LMA group with the value of 90%; however, this difference was not statistically significant (P> 0.05). Conclusion: According to the results of the present study, the intubation time in the FOI-LMA group was significantly shorter than that of the FOI-Nasal group. Moreover, the success rate of the first attempt in the FOI-LMA group was higher than that of the FOI-Nasal group. Therefore, it can be stated that FOI-LMA as compared to FOI-Nasal can be regarded as an easier technique, with a shorter intubation time, a higher success rate, and a greater stability of children’s hemodynamic parameters. https://aacc.tums.ac.ir/index.php/aacc/article/view/530

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 181 184 Poonam Arora Department of Anesthesiology,All India Institute of Medical Sciences, Rishikesh, India. Niyati Arora Department of Anesthesiology,All India Institute of Medical Sciences, Rishikesh, India. 2022 05 16 2022 06 11 Spinal anesthesia is traditionally performed using landmark technique to identify the level and point of needle insertion. However use of ultrasonography (USG) has emerged among anaesthesiologists to guide neuraxial blockade. The views that are of utmost importance are “transverse spinous view”, “transverse interspinous view” and “longitudinal parasagittal oblique view”. For in-plane technique and real time imaging longitudinal parasagittal oblique view is used while transverse views are used for visualizing spinous level, epidural and subarachnoid space, posterior complex (PC), anterior complex (AC) and depth of canal. In patients with deformed spine like kyphoscoliosis or morbid obesity obtaining optimum views is not possible. We discuss a morbidly obese patient with very poor ultrasonographic views of spine. We describe a novel technique to estimate depth of spinal canal using only bony shadows in a single transverse view. https://aacc.tums.ac.ir/index.php/aacc/article/view/552

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 102 106 Amartya Chaudhuri Department of Anaesthesiology, Byramjee Jeejeebhoy Govt. Medical College, Pune, India. Shital Kuttarmare Department of Anaesthesiology, Byramjee Jeejeebhoy Govt. Medical College, Pune, India. Pradnya Bhalerao Department of Anaesthesiology, Byramjee Jeejeebhoy Govt. Medical College, Pune, India. Neha Kamble Department of Anaesthesiology, Byramjee Jeejeebhoy Govt. Medical College, Pune, India. 2022 05 17 2022 06 11 Background: Brachial plexus surgery requires neural repair with the use of intraoperative peripheral nerve stimulation without muscle relaxants. Methods: Twelve cases were conducted under total intravenous anaesthesia, receiving intravenous propofol, fentanyl and dexmedetomidine infusion. Intraoperative hemodynamic conditions and postoperative functional recovery were assessed. Results: 9 out of 12 cases were stable while one was in a lighter plane requiring 20 mg propofol and increased dexmedetomidine, two had bradycardia requiring reduced dexmedetomidine infusion. At three months, five cases showed improvement. Conclusion: Satisfactory conditions were achieved including hemodynamic stability, and muscle-sparing improving prognoses of brachial plexus surgeries. https://aacc.tums.ac.ir/index.php/aacc/article/view/547

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 185 187 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 05 16 2022 07 09 3 2023 11 19 305 306 Masoud Tarbiat Department of Anesthesiology, School of Medicine, Basat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Mohammad Hossein Bakhshaei Department of Anesthesiology, School of Medicine, Basat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Hamid Reza Khorshidi Department of Surgery, School of Medicine, Basat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Sayed Ahmadreza Salimbahrami Department of Anesthesiology, School of Medicine, Basat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. 2023 05 10 2023 06 28 No Abstract No Abstract  No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/762

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 11 19 216 220 Nazli Karami Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran. Alireza Mahoori Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran. Tohid Karami Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran. Alireza Shakeri Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Dariush Abtahi Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 05 16 2023 06 25 Background: Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients. Methods: In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups. Results: The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032). Conclusion: However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility. https://aacc.tums.ac.ir/index.php/aacc/article/view/773

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 12 19 293 295 Shalvi Mahajan Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Kirandeep Kaur Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Priya Thappa Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Aparna Deperu Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. Vinitha Narayan Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India. 2023 05 15 2023 06 28 Acute lymphoblastic leukemia (ALL) is the most common hematological malignancy in the pediatric age group. Anesthesia in such patients necessitates special considerations, in terms of disease progression and its respective treatment as well. We present a case of a 2-year-old child, a known case of ALL posted for drainage of multifocal brain abscess under general anesthesia. Anesthetic management of children with ALL presenting for neurosurgical procedures should focus on disease and its various systemic manifestations, treatment-related side effects, and anesthetic interactions which sometimes may be disastrous. https://aacc.tums.ac.ir/index.php/aacc/article/view/771

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 11 13 221 226 Mohammadreza Safavi Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Azim Honarmand Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Behzad Nazemroaya Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Negar Maleky Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2023 05 27 2023 06 28 Background: Nausea and vomiting after operation has high prevalence and cause adverse effect. The aim of this study was to compare the effect of dexmedetomidine with ondansetron in prevention of post-operative nausea and vomiting (PONV) after middle ear surgery under general anesthesia.and saliva gas in traumatic patients under mechanical ventilation. Methods: This in this double-blinded clinical trial study, one hundred and sixty-two patients undergoing middle ear surgery under general anesthesia were randomly divided into three groups of 55 each: ondansetron (O), dexmedetomidine (D) and control (C). Group O received 0.1 mg/kg of ondansetron, Group D received 1 μg/kg/min of dexmedetomidine and Group C received 10 cc of normal saline 15 to 20 minutes before surgical incision. After that, the patients were examined in post-anesthesia care unit (PACU) and up to 24 hours after the operation in terms of PONV and other study variables. Results: The severity of nausea after operation based on VAS (visual analog scale) was significantly different between Group O (2.2±0.7) and Group D (3.9± 0.7) and Group C (5.15±1.3) (P= 0.04). The incidence of vomiting in the first 24h postoperatively was 14.8% in Group O, 46.3% in Group D and 88.8% in Group C (P= 0.003). Conclusion: Our study showed that ondansetron was better than dexmedetomidine for prevention of PONV after middle ear surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/778

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 11 11 296 302 Mahmoud Ganjifard Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Department of Anesthesiology and Pain Medicine,Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Espahbodi Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Department of Anesthesiology and Pain Medicine,Tehran University of Medical Sciences, Tehran, Iran. Abbas Tafakhori Department of Neurology, School of Medicine, Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital Complx, Tehran University of Medical Sciences, Tehran, Iran 2023 04 29 2023 06 25 Spontaneous intracranial hypotension (SIH) is an orthostatic headache syndrome with variable symptoms and complications which is often misdiagnosed at initial manifestations. SIH results from spontaneous CSF leakage leading to brain sag. The typical findings on cranial MR imaging consist of subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain. Subdural hematoma may occur as a result of tearing of bridging veins and usually develop into chronic subdural hematoma. The majority of patients with SDH due to SIH have chronic DSH and, therefore, rarely present with neurological deficits. Evacuation of SDH may be performed for large SDH with ME (mass effects), or when dilated or asymmetric pupil is present. However in most cases, evacuation of the hematoma is not necessary and may result in worsened outcomes. The epidural blood patch (EBP) is a treatment of choice. Fortunately, most of these subdural hematomas can be handled with treatment directed at the underlying spinal CSF leak without the need for surgery. We report the case of 42-year-old man with the chief complaint of orthostatic headache. He was admitted to neurology ward and after imaging studies, it was found that he has bilateral subdural hematoma. Due to the lack of history of trauma, underlying disease, and coagulation disorder, and considering the imaging findings, the patient was referred to the pain department to perform an epidural blood patch. After performing the epidural blood patch, the patient's pain was relieved immediately, and during a three-month follow-up period, the epidural hematoma was completely absorbed. Spontaneous intracranial hypotension (SIH) is a highly misdiagnosed and underdiagnosed disorder and requires a high index of suspicion for diagnosis. During the last decades, a much larger number of spontaneous cases are identified. Literature is a bit confusing, with some authors recommending evacuation of subdural fluid in cases of deteriorating consciousness and few others recommending EBP first even in patients with comatose state but epidural patch is often an important part of treatment. https://aacc.tums.ac.ir/index.php/aacc/article/view/752

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 10 16 227 231 EN Faranak Behnaz Department of Anesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Atiyeh Tizghadam Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gholamreza Mohseni Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Leila Nazari Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 06 22 2023 07 25 Background: One of the most important treatments used in women with infertility is IVF, and improving its results can affect the success of assisted reproductive techniques. It was previously shown that anesthetics can enter the follicular fluid (FF), so there is concern about the accumulation of anesthetics in the FF and their negative effects on fertilization and fetal growth under general anesthesia. The use of drugs that have both analgesic and sedative effects but do not have hemodynamic side effects is of particular importance and dexmedetomidine is one of the drugs introduced in this field. On the other hand, the use of sedatives such as midazolam and propofol may cause hemodynamic disturbances and severe hypotension in these patients, which limits the use of such drugs. Accordingly, and considering the importance of the issue, in this study, we decided to evaluate and compare the effect of propofol and dexmedetomidine on fertility in IVF candidates. Methods: In this clinical trial study, 78 infertile patients who underwent IVF were randomly examined. After dividing the patients into two groups receiving dexmedetomidine and propofol or standard recording doses, the fertility rate of the patients in the two groups was evaluated using chi-square and Fisher tests at a significance level of 0.05. Results: The use of dexmedetomidine for (P = 0.0348) Pressure_After_Dia, HR_Before (P = 0.0204), Injection_Time (P =0.000) and Recovery Time (P =0.000) indices caused a significant increase compared to the propofol group. Conclusion: The results of the present study did not show a significant difference in the use of these two drugs on fertility. https://aacc.tums.ac.ir/index.php/aacc/article/view/796

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 10 14 232 238 Faranak Behnaz Department of Anesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Sadeghzadeh Sadat Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gholamreza Mohseni Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mahshid Ghasemi Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 06 25 2023 07 25 Background: Today, the COVID19 pandemic is one of the most important health system challenges in the world, which doesn’t have specific treatment yet. It includes a wide range of respiratory and non-respiratory signs and symptoms, that lead to hospitalization and intensive care units. Methods: In this study, 78 patients in two groups of 39 patients were included. The case group included 39 COVID19 patients who had specified sign in CT scans and factors of viral infection, high serum ferritin, increased inflammatory factor in the blood. There were two intervention groups (receiving deferoxamine and vitamin C) and the control group (receiving only official protocol drugs of the country). All patients were admitted to the ICU of Shohada-e-Tajrish Hospital and underwent complete cardiorespiratory monitoring. All changes in Spo2, hemodynamics, serum ferritin and CRP were recorded before the study. Results: This study presented that improved patient had lower ferritin levels than those who were still ill. In addition, prescribing deferoxamine as an adjunct to vitamin C can prevent cytokine storms that was effective for improving the patients with COVID19. Conclusion: In conclusion. According to the role of deferoxamine and vitamin C in significantly reducing inflammatory factors of ferritin and CRP, they can be used as an adjunctive therapy in patients with COVID19. https://aacc.tums.ac.ir/index.php/aacc/article/view/798

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 11 19 239 246 EN Moloud Zolfaqari Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mehrdad Mokaram Dori Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed Hossein Khademi Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mehryar Taghavi Gilani Lung Diseases Research Center. Mashhad University of Medical Sciences, Mashhad, Iran. Maliheh Ziaee Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. Tayyebe Ghanei Mashhad University of Medical Science, Mashhad, Iran. 2023 06 19 2023 07 25 Background: Perioperative pain management can improve surgery results and patient outcomes. Moreover, multimodal methods for pain control have been advised so this study was conducted to assess the beneficial impact of preoperative ultrasound-guided femoral nerve blocks in hip replacement surgery. Methods: This study is a double-blinded clinical trial including 60 individuals who were candidates for joint replacement surgery. The intervention group (n = 30) received a femoral nerve block prior to general anesthesia. Results: After surgery, patients received morphine, Apotel, and morphine + Apotel, all of which were administered at lower doses in the intervention group (femoral nerve block) than in the control group. Pain intensity in first hour (P= 0.01), 4 hours (P= 0.003), 8 hours (P= 0.01), 12 hours (P= 0.001), and 24 hours (P= 0.01) after surgery and average pain 4 hours (P= 0.01), 8 hours (P = 0.01), 12 hours (P = 0.02), and 24 hours (P= 0.01) after surgery was significantly less in the intervention group (femoral nerve block) than in the control group. Conclusion: The findings of our investigation demonstrated the efficacy of ultrasound-guided femoral nerve blocks in the improvement of pain control following hip replacement surgery.   https://aacc.tums.ac.ir/index.php/aacc/article/view/793

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 10 21 247 251 Mohammad Reza Khajavi Anesthesia, Critical Care, and Pain Management Research Center,Tehran University of Medical Sciences, Tehran, Iran. Mohammad Maroofian Anesthesia, Critical Care, and Pain Management Research Center,Tehran University of Medical Sciences, Tehran, Iran. Hamed Akhavizadegan Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2023 06 30 2023 08 24 Background: We intend to evaluate the effect of intraoperative diphenhydramine administration on incidence and severity of catheter related bladder discomfort (CRBD) and pain after percutaneous nephrolithotomy. Methods: In a double blind randomized clinical trial, adult male patients undergoing percutaneous nephrolithotomy were enrolled. They were randomized into two groups by a computerized digital random allocation method. Before anesthesia induction, group D (Diphenhydramine group) (n = 48) received 5 ml normal saline containing 0.5 mg/kg of diphenhydramine intravenously. In group C (Control group) (n = 48), 5 ml of normal saline was injected in the same manner. Induction and maintenance of anesthesia were identical in both groups. The incidence and severity of CRBD and postoperative pain were assessed at recovery room. Results: The incidence of CRBD was significantly lower in group D than in group C (14% vs. 63%, P=0.001). The severity of CRBD was milder in group D in comparison to group C (P<0.05). Postoperative pain score was significantly lower in group D (P<0.05). Conclusion: Intraoperative administration of diphenhydramine is an effective practice for the prevention of CRBD after percutaneous nephrolithotomy in male patients and can reduce postoperative pain as well. https://aacc.tums.ac.ir/index.php/aacc/article/view/801

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2024 06 09 252 259 Omid Nabavian Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Shahram Samadi Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran. Anesthesia, Critical Care and Pain Research Center, Tehran University of Medical Sciences, Tehran, Iran. Shabnam Beigi Department of Anesthesiology and Intensive Care, Tehran University of Medical Sciences, Tehran, Iran. Leyla Sahebi Maternal, Fetal, and Neonatal Research Center & Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Babak Eslami Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alireza Montaseri Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyedeh Azadeh Hosseini Department of Anesthesiology and Intensive Care, Tehran University of Medical Sciences, Tehran, Iran. 2023 12 20 2024 01 14 Background: The Covid-19 disease was the most significant pandemic of the century. Health care providers showed great sacrifices in managing this disease and saving humanity, and they suffered many injuries. So, this study aimed to investigate the effect of Covid-19 on the resident’s quality of life and comparison with medical students. Methods: This cross-sectional study was performed on 223 Residents and 225 medical students. Using a random sampling method, WHOQOL-BREF 26 questionnaire was distributed among the participants. The collected data were analyzed with SPSS 21 software using T-test and ANCOVA. Results: The results showed that covid-19 had caused a decrease in the quality of life of residents compared to medical students (P value<0.001). In addition, more advanced statistical analyzes showed that high work and study hours, irregular sleep, work history in COVID-19 wards, and the experience of CPR and intubation conditions of covid-19 patients have independent effects on the quality of life. Conclusion: Covid-19 hurt all aspects of the quality of life of residents. Considering the essential role of residents in educational and treatment hospitals, it is necessary to make plans to improve the quality of life and psychological support of these people to prevent the decline in the quality of healthcare services. https://aacc.tums.ac.ir/index.php/aacc/article/view/916

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 3 2023 11 30 260 265 Dorna Kheirabadi Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA. Amir Shafa Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Rasouli Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA. Azim Honarmand Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Safavi Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran. 2023 06 18 2023 08 07 Background: Anaesthesiologists face difficult intubation (DI) more frequently in obese patients. Thus, we aimed to test if central obesity indices including hip circumference (HC), neck circumference (NC) or waist circumference (WC) can effectively predict DI and difficult mask ventilation (DMV) in them. Methods: HC, NC, WC, mask ventilation grade, intubation difficulty scale (IDS), history of snoring and obstructive sleep apnoea (OSA) were measured in 300 patients with BMI ≥ 30 kg/m2. Receiver operating characteristic curve (ROC) and multivariate, logistic regression were employed to identify predictors of DI (IDS ≥5) and DMV define as mask ventilation grade of 3 or 4. Results: DI and DMV were, respectively, detected in 14.7% and 12.7% of subjects. According to Multiple logistic regression analysis BMI (Odds ratio (OR):1.17, 95% confidence interval (CI): 1.08-1.28, p<0.001), NC (OR: 1.26, 95% CI: 1.04-1.52, p=0.01), HC (OR:1.06, 95% CI: 1.03-1.10) and HC/NC ratio (OR: 4.9, 95% CI: 1.64-14.92, p= 0.004) considered as independent predictors of DI. The same analysis recognized BMI (OR:1.13, 95% CI: 1.03-1.24, p=0.006), WC (OR: 1.06, 95% CI:1.01-1.11, p=0.01), and HC/BMI ratio (OR=0.18, 95% CI:0.06-0.53, p=0.002) as DMV predictors. Sensitivity of BMI >35.8 kg/m2, NC >39.9 centimetres (c