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 Wilson’s disease is a rare autosomal recessive condition, that affects the liver and brain mainly. Pregnancy in these patients is of high risk due to involvement of liver and high incidence of abortion, preeclampsia, HELLP syndrome. We report a case of a 24year old G2A1 (35+2 weeks) diagnosed with wilson’s disease 6 years ago, currently on tab zinc. She presented with thrombocytopenia, anemia, extrahepatic portal vein occlusion with splenomegaly and mild ascites. She was taken up for elective section at 35+2 weeks, under general anesthesia. With intramyometrial injection of carboprost, there was sudden desaturation and bronchospasm. However, we managed the case successfully with safe outcome of both the mother and child. There are only very few case reports of Wilson’s disease in pregnancy undergoing C-section under general anesthesia in the presence of hepatic dysfunction. https://aacc.tums.ac.ir/index.php/aacc/article/view/553

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2022 10 15 107 115 Kalpana Balakrishnan Department of Anesthesiology Cancer Institute (WIA), Adyar Chennai, India. Punitha Chockalingam Department of Anesthesiology Cancer Institute (WIA), Adyar Chennai, India. Thendral Ramasamy Department of Anesthesiology Cancer Institute (WIA), Adyar Chennai, India. Meenakshi Venkateswaran Department of Anesthesiology Cancer Institute (WIA), Adyar Chennai, India. Madhupriya Sundaram Department of Surgical Oncology Cancer Institute (WIA), Adyar Chennai, India. Veluswami Sridevi Department of Surgical Oncology Cancer Institute (WIA), Adyar Chennai, India. 2022 05 12 2022 06 11 Background: Recurrence is common after surgery for epithelial ovarian cancer and is multifactorial. Perioperative factors affecting stress and inflammation have an influence on immunity and thus cancer recurrence. The effect of peri-operative epidural anesthesia has been quoted to be beneficial by decreasing stress. A retrospective analysis of perioperative Epidural analgesia use (EA) was compared to general anesthesia (GA) without epidural, with disease free survival (DFS)as the outcome. Methods: We did a retrospective observational study of patients with epithelial ovarian malignancy who had undergone surgery between 2013 and 2017. Cohorts were primarily divided based on receipt of epidural analgesia. Perioperative patient, anesthetic, and tumor related data were collected. The aim was to estimate the association of epidural analgesia with disease free survival (DFS). To prevent bias due to skewed covariate distribution propensity score match was done matching all covariates. Results: We had 312 patients with age ranging from 18 to 77. The median DFS in months was 32.73±25.6 for the entire cohort while it was 54.81±28.69 for the GA group and 27.23±21.84 for EA group. After PSM median DFS was 35.33 for the full cohort and it was 46 and 34 months for the GA and EA groups, respectively. Multivariate Cox regression analysis demonstrated that only patients who were undergoing primary surgery had survival advantage (P<0.013). Perioperative epidural analgesia was not associated with survival benefit (P=0.480). Conclusion: Perioperative use of epidural analgesia did not offer survival benefit in epithelial ovarian cancer as measured by disease free survival. https://aacc.tums.ac.ir/index.php/aacc/article/view/545

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 116 119 Mohammad Taghi Beigmohammadi Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Laya Amoozadeh Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2022 05 01 2022 05 28 Background: COVID-19 patients have various laboratory findings associated with severe conditions and higher mortality rates. We conducted this study to evaluate the laboratory changes and their effect on the mortality of critically ill patients with COVID 19. Methods: This cohort study evaluated the laboratory changes in 192 patients admitted to intensive care units of Imam Khomeini hospital complex, Tehran, Iran. The patients with manifestations of severe COVID-19 of both sexes and older than 16 years were enrolled in the study. The primary outcome was the laboratory changes, and the secondary outcome was the death or survival of the patients. The laboratory data were recorded on the admission day, followed daily by the changes and the neutrophil-lymphocyte ratio (NLR). The laboratory changes of two groups of survived or non-survived patients were compared by chi-square for categorical variables. An independent sample t-test was applied to study the differences between the two groups' continuous variables. Values are shown as mean±SD. Results: Of all the 192 patients, 123 (64.06%) were male, and 69 (35.93%) were female. The survived group was 86 (44.79%), and the non-survived group was 106 (55.20%). Age (62.31±13.77), sex, and BMI (27.34±4.63) were not significantly different in the two groups (P value= .248, .368, and .444, respectively). NLR, lactate dehydrogenase/lymphocyte (LDH/LYM) ratio were significantly different in the two groups (P value= .000, .004, respectively). Conclusion: COVID-19 patients have a variety of laboratory findings. NLR and LDH/LYM ratios have a prognostic value in severe COVID-19 patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/534

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2023 04 15 120 125 Shriram Gautam Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Rajesh Sood Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Rupesh Yadav Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Sandeep Kumar Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2022 05 02 2022 05 28 Background: Perioperative pain in pediatric population is a special concern and Caudal block is easy to perform extensively safe if used in children, resulting in low pain scores and when combined with general anaesthesia, it reduces the requirement for volatile agents, opioids, improved postoperative analgesia, and earlier extubation. Ultrasound guided caudal block has reduced the complication rates such as inadvertent dural or vascular puncture. Aim of the study was to compare the success rate of ultrasound guided with conventional landmark technique caudal block in pediatric patients undergoing lower abdominal surgery under general anaesthesia. Methods: Hundred pediatric patients, ASA class I, age between 6 months to 7 years of either sex, posted for lower abdomen surgery under general anaesthesia were randomly divided in to two groups. In group C- The group with caudal block using conventional landmark technique was used and Group U- The group with caudal block using ultrasound technique was used. Primary objectives of the study to find out the success rate of block in both the groups. Results: The demographic data were comparable in group C and group U. Significant difference was seen in the distribution of successful block between group C and group U. (p value 0.008) block was successful in 96% of patients in group U which was significantly higher as compared to group C (76%). significant difference was seen in the distribution of number of attempts between group C and group U. (p value 0.001). Conclusion: We conclude that Caudal block by ultrasound technique increases the first puncture success rate, decreases the number of multiple needle puncture attempts and overall success rate when compared to the conventional landmark technique in pediatric patients undergoing lower abdomen surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/536

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 2022 11 24 126 131 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 23 2022 04 24 Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The main objective of this study was to identify the outcome of patients with sepsis and septic shock. Methods: A prospective observational study was done in a surgical ICU over a period of one year. We included all adult patients admitted to ICU with features of sepsis and septic shock. Data related to demography, co-existing illnesses, parameters to assess Sequential Organ Failure Assessment (SOFA) scores, other relevant laboratory data, source of infection, organ failures and supportive measures instituted were recorded. Patients were followed till discharge or death from the ICU. Results: 160 patients were included in this study. The mortality rate was significantly higher among females compared with males. The most common co-existing illnesses were hypertension and type II diabetes mellitus. The SOFA scores at admission were high among non-survivors. Older age, presence of anaemia (defined as haemoglobin less than 13 g/dL in males and 12 g/dL in females), renal dysfunction (creatinine level more than 1.3 g/dL), and acute respiratory distress syndrome (ARDS) were associated with higher mortality. Haematocrit, total leucocyte count, serum bilirubin and SOFA scores were significantly higher among non-survivors. Conclusion: Our findings suggest that septic shock occurs frequently in ICU patients and mortality remains high. Several critical scoring systems are useful for the early prediction of mortality. A sepsis mortality based on SOFA scores and haemoglobin has greater predictive power. https://aacc.tums.ac.ir/index.php/aacc/article/view/508

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 2 https://aacc.tums.ac.ir/index.php/aacc/article/view/882

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 07 01 463 467 Nima Mohamadi Afrakoti Department of Anesthesiology and Critical Care, Shariati Hospital ,Tehran University of Medical Science,Tehran,Iran. Aylin Hefzollesan Medical School, Tehran University of Medical Science, Tehran, Iran. Mohammadsadegh Talebi Kahdouei Medical School, Tehran University of Medical Science, Tehran, Iran. Seyyed Mojtaba Marashi Department of Anesthesiology and Critical Care, Shariati Hospital ,Tehran University of Medical Science,Tehran,Iran. Arash Heroabadi Department of Anesthesiology and Critical Care, Shariati Hospital ,Tehran University of Medical Science,Tehran,Iran. Samaneh Hajy Mola Rabi Department of Neurology, Alborz University of Medical Science, Alborz, Iran. Fatemeh Aghaei Medical School, Tehran University of Medical Science, Tehran, Iran. 2023 11 13 2023 12 08 Background: The emergence of COVID-19 in late 2019 swiftly led to a global pandemic, prompting urgent investigation into its multifaceted impacts. While prior studies have highlighted compromised sleep quality in hospitalized COVID-19 patients, this research delves into the enduring effects on sleep patterns for those with severe pulmonary involvement post-intensive care. This study addresses a critical gap in understanding the long-term consequences of the virus, emphasizing the importance of post-recovery care. Methods: Conducted as a cross-sectional study, we consecutively enrolled COVID-19 patients with over 20% pulmonary involvement admitted to the ICU at Shariati Hospital, Tehran, between June 2021 and January 2022. Demographic and clinical data were extracted from hospital records. After ethics committee approval, participants were contacted six months post-discharge to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Exclusions comprised obstructive sleep apnea patients and those with incomplete records. Results: Of the 60 eligible post-COVID-19 patients, 56 participated. Three individuals were unresponsive to calls, while one declined. Participants, primarily female (64.3%), had a mean age of 51.7 years. Notably, 80.4% exhibited sleep disorders six months post-discharge. Gender differences were observed, with females reporting higher scores in specific sleep quality components. Intriguingly, single individuals demonstrated a higher preference for sleep medication. These findings underscore the imperative for targeted interventions to improve post-ICU sleep quality in severe COVID-19 cases. Conclusion: The high prevalence of sleep disorders six months post-discharge underscores the enduring impact of COVID-19 on sleep quality. These findings call for targeted interventions and comprehensive post-ICU care protocols that prioritize sleep health. https://aacc.tums.ac.ir/index.php/aacc/article/view/892

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 05 468 473 Seyed Morteza Heidari Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mohammadreza Habibzadeh 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. Sayed Abolfazl Mousavi School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2023 12 25 2024 01 14 Background: Sedation plays a crucial role in the care of intensive care unit (ICU) patients, addressing the challenges presented by factors such as agitation, anxiety, and delirium, particularly during mechanical ventilation (MV). Dexmedetomidine and propofol are commonly used sedatives, each with its unique characteristics and side effects. Combining these agents has been proposed to optimize effectiveness and minimize adverse effects. This study aims to compare the efficacy of the dexmedetomidine-propofol combination with dexmedetomidine alone and propofol alone for sedation during mechanical ventilation in ICU patients. Methods: A triple-blinded clinical trial was conducted in Isfahan, Iran, involving patients eligible for spinal fusion surgery and mechanical ventilation. Patients were randomized into three groups: dexmedetomidine alone (DO), propofol alone (PO), and a combination of both drugs (DP) dexmedetomidine-propofol (ProDex). Various dosages and infusion protocols were carefully administered, and patients were assessed for demographic and clinical variables. Hemodynamic parameters and sedation levels were monitored, and statistical analysis was performed. Results: The study involved 87 patients, with the ProDex group demonstrating the shortest mechanical ventilation duration. Hemodynamic stability was observed in the ProDex group, with significantly lower systolic blood pressure and heart rate compared to other groups. Sedation scores did not differ significantly among groups, suggesting similar sedative effects. The ProDex group exhibited favorable outcomes despite differences in hemodynamic variables. Conclusion: The dexmedetomidine-propofol combination appears effective in minimizing side effects associated with monotherapy sedation, leading to favorable clinical outcomes. This study contributes valuable insights into optimizing sedation strategies for mechanically ventilated ICU patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/920

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 05 474 481 Gholamreza Khalili Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Marzieh Soheilipoor School of Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2023 11 13 2023 12 08 Background: Nausea While elderly patients are at an increased risk of perioperative morbidity and mortality; old age alone is not a contraindication for surgery. General factors that should be considered in preoperative risk assessments include age, functional status, cognition, nutritional status, and comorbidities, such as cardiac, pulmonary, renal, and endocrine disorders. Induction of anesthesia is a critical step in surgery, particularly for elderly patients and those with a high physical status. Commonly used drugs for this purpose include etomidate and propofol. Therefore, this study aimed to compare the impact of Ketofol versus etomidate alone on the hemodynamic status of patients who fall under the ASA class II or higher. Methods: The study was a prospective randomized double-blind clinical trial, with a study population of age of ≥65 years, ASA physical status class II or higher, that were randomized into two groups. Ketofol (n=45) and, Etomidate (n=45) groups. Patients followed for clinical outcomes including their hemodynamic status during the induction period. Results: The present study showed that, the examination of hemodynamic parameters up to 10 minute after laryngoscopy showed that none of these parameters were significantly different between the two groups, while immediately after anesthesia induction, heart rate and blood pressure were found to be significantly different. However, there was no significant difference in terms of SPO2 among the two groups in any given interval. Conclusion: The results of the present study revealed that Ketofol resulted in better regulation and stability of blood pressure and heart rate in patients undergoing endotracheal intubation, compared to etomidate alone. https://aacc.tums.ac.ir/index.php/aacc/article/view/896

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 31 482 486 Alireza Jahangirifard Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mandana Hossein Zadeh Masih Deveshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Mirtajani Lung transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamid Jamali Taraei Bank Melli Hospital, Tehran, Iran Farzad Salari Bank Melli Hospital, Tehran, Iran Mohammad Hossein Mandegar Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2023 11 18 2023 12 08 Background: Bleeding management during and after urgent heart surgery is always challenging in patients who are taken anticoagulants especially antiplatelet ones. The present study was conducted with the aim of investigating the role of intraoperative hemoperfusion in the active removal of Plavix in patients undergoing on-pump CABG surgery. Methods: The present study recruited patients on Plavix who underwent urgent CABG surgery. All patients have discontinued consuming Plavix less than 36 hours before surgery. During cardiopulmonary bypass, hemoperfusion set was added to the circuit and the surgery was done according to the standard open heart surgery protocols. The patients were transferred to the intensive care unit at the end of surgery and amount of bleeding was recorded in the ICU sheet hourly and calculated after 24 hours. Results: In our study, the average age of participating patients was 73,625 years. 5 patients out of 8 (62.5%) were male and 3 (37.5%) were female. Hypertension and blood type O were the most prevalent among the patients. The average amount of bleeding was 425 in the first day after surgery and the average units of transfused blood for patients was 0.125, which is acceptable and less than the values reported in other studies that do not use the hemoperfusion. Conclusion: The use of hemoperfusion during urgent CABG surgery, can reduce the postoperative bleeding and blood products consumption in patients on preoperative Plavix. https://aacc.tums.ac.ir/index.php/aacc/article/view/898

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 02 05 487 492 Ali Pouresmaeil Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Saeed Sohrabpour Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Behnaz Aghaei Department of Nutritional Sciences, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran. Reza Erfanian Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Leyla Noury Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Amirmohsen Asadi Kiapey Medicine School, Tehran University of Medical Sciences, Tehran, Iran. Anahita Shoormeij Medicine School, Tehran University of Medical Sciences, Tehran, Iran. Mina Abdolahi Department of Clinical Nutrition, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran. Abolghasem Yousefi Department of Anesthesiology, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran. 2023 09 05 2023 09 13 Background: The University of Washington quality of life questionnaire (UW-QOL) is widely used to evaluate the quality of life for head and neck cancer patients. The purpose of this study is translation of the UW-QOL questionnaire's into Persian. Methods: After translation and cultural adaptation of the UW-QOL, the questionnaire was distributed among 100 head and neck cancer patients. Internal reliability of the translated UW-QOL was determined using Cronbach's alpha coefficient. The validity was determined by Spearman correlation coefficient between UW-QOL and 12-Item Short Form Survey (SF-12). The test – retest reliability was measured by Intraclass Correlation Coefficient (ICC) after one week. Results: Cronbach's alpha coefficient was more than 0.75 and ICC coefficient was more than 0.80 in all variables. The UW-QOL questionnaire composite score had a positive significant association with SF-12 questionnaire total score (Spearman's Correlation Coefficient= 0.70, P< 0.0001). Conclusion: In conclusion Persian translation of the UW-QOL questionnaire has acceptable reliability and validity and is as valid as the original English version in evaluating the quality of life for patients with head and neck cancer. https://aacc.tums.ac.ir/index.php/aacc/article/view/858

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 06 09 493 498 Majid Razavi Cardiac Anesthesia Research Center, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran. Mohammad Alipour Cardiac Anesthesia Research Center, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran. Leila Mashhadi Cardiac Anesthesia Research Center, Imam-Reza Hospital, School