Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 08 30 277 278 Zahid Khan Department of Anesthesiology and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2023 08 30 No Abstract    No Abstract    No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/852

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 07 05 279 287 EN Charvi Mathur Department of Anesthesiology, ABVIMS and Dr. RML hospital, Guru Gobind Singh Indraprastha University, New Delhi, India. Jasvinder Kohli Department of Cardiac Anesthesiology, ABVIMS and Dr. RML hospital, Guru Gobind Singh Indraprastha University, New Delhi, India. Tina Khurana Department of Anesthesiology, ABVIMS and Dr. RML hospital, Guru Gobind Singh Indraprastha University, New Delhi, India. Mohandeep Kaur Department of Anesthesiology, ABVIMS and Dr. RML hospital, Guru Gobind Singh Indraprastha University, New Delhi, India. Himanshu Bhasin Department of Anesthesiology, ABVIMS and Dr. RML hospital, Guru Gobind Singh Indraprastha University, New Delhi, India. 2022 08 21 2022 09 10 Background: Postoperative nausea and vomiting (PONV), an unpleasant complication following anaesthesia and surgery has various components such as nausea, retching and vomiting. Although PONV is usually self-limiting and non-fatal, it often causes substantial patient distress and dissatisfaction, augmenting healthcare costs by delaying discharge from post anaesthesia care units and causing unexpected hospital re-admissions. Different pharmacological and non-pharmacological approaches have been used for preventing PONV. Nonetheless, the most effective prophylactic regime has not been determined. Methods: We conducted a prospective randomised study for evaluation of effect of preoperative oral carbohydrate fluid (GROUP- C) and placebo drink (clear water) (GROUP-P) on PONV in 90 adult patients undergoing laparoscopic cholecystectomy surgery under general anaesthesia. The number of episodes of nausea, retching and vomiting, total requirement of antiemetic dose in 24 hours, pre and postoperative blood glucose levels, patient satisfaction score, VAS score and haemodynamic parameters were recorded in the two groups and statistical analysis was done. Results: Demographic data was comparable between the two groups with respect to age, gender and BMI. The surgical time and intra-abdominal pressures throughout the surgery were similar in the two groups. In our study the pre-induction blood glucose levels were found to be higher in group C and preoperative thirst was found to be less in group P. Both the groups were comparable in terms of number of episodes of PONV, total requirement of anti-emetic dose in 24 hours, patient satisfaction and well-being. VAS score for pain and requirement of analgesic dose was also similar in the two groups. Conclusion: Pre-operative oral monosaccharide carbohydrate fluid does not prevent PONV, alter requirement of antiemetic, patient satisfaction and well-being, VAS score for pain, requirement of analgesic dose in patients undergoing laparoscopic cholecystectomy under general anaesthesia, as compared to placebo drink.   https://aacc.tums.ac.ir/index.php/aacc/article/view/622

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 08 02 343 356 EN Fatemeh Mohammadyari School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Morteza Biabani Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Behrad Nematollahi Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Soleimani Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran. Morteza Sohbatzadeh School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Sarvin Sadreddini Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. Reyhaneh Shoorizadeh School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Sepideh Shavysi Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. Sepehr Olangian-Tehrani School of Medicine, Iran University of Medical Sciences, Tehran, Iran. & Avicennet, Tehran, Iran. 2023 01 19 2023 03 26 Background: A burn tissue injury is one of the most severe forms of trauma which results in severe life-threatening disturbances. Burn injury has many morbid complications, so it needs a multi-disciplinary care team according to the burn center to reduce its mortality and morbidity. Methods: This article aims to review drawbacks and complications associated with the burning injury including Acute Kidney Injury (AKI), Acute lung injury, Heart Failure, Electrolyte imbalance, intra-abdominal hypertension in children and adult burn patients, and recent challenging treatments. Results: Improved understanding of the pathophysiology of burn-induced complications can contribute to organizing a well-treatment plan, which leads to improved outcomes. Conclusions: Herein, the evidence available on the management of all burn induced-complications is summarized. https://aacc.tums.ac.ir/index.php/aacc/article/view/699

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 07 03 357 359 Krunal Suryavanshi Department of Anaesthesiology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, India. Jyoti Deshpande Department of Anaesthesiology,Symbiosis Medical College for Women, Symbiosis International University, Pune, India. 2022 05 30 2022 06 25 Atrial Septal Defect is most common congenital developmental acyanotic cardiac anomaly. There is left to right shunt of blood in normal compensated state. In decompensated state, the shunt is reversed and flow is from right to left side causing heart failure and thrombo-embolic event. Here, we report a case of Humerus fracture with large ASD, managed under General Anaesthesia with Interscalene block without any deleterious effects like Venous Air Embolism, Spontaneous Reversal of Shunt etc. As patient was in Beach chair position. https://aacc.tums.ac.ir/index.php/aacc/article/view/567

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 06 30 288 293 Kavita Adate Department of Anesthesiology, Smt.Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. Neha Panse Department of Anesthesiology, Smt.Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. Pooja Mhaske Department of Anesthesiology, Smt.Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. Asmita Shinde Department of Anesthesiology, Smt.Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. 2022 07 09 2022 08 13 Background: Levobupivacaine because of its longer duration of action and better safety profile has gained popularity in regional anaesthesia. Intrathecal opioids synergise with Local anaesthetics and potentiate subarachnoid block.  We conducted this study with the primary aim to compare analgesic efficacy of two different doses of buprenorphine as adjuvant to isobaric Levobupivacaine and the secondary aim to compare the onset and duration of sensory and motor blockade, hemodynamic variability and adverse effects if any. Methods: One hundred and twenty patients of American society of anaesthesiologist (ASA) I and II were divided in 3 groups of 40 each. Group A :0.5%levobupivacaine, group B: 0.5%levobupivacaine with 60 mcg buprenorphine Group C:0.5 %levobupivacaine with 90mcg buprenorphine. Duration of analgesia, onset of sensory and motor block, VAS scores, haemodyanamic parameters and adverse effects were noted. Results: The duration of analgesia was significantly prolonged in group C (11±0.41) h than group B (8.5±0.61) hour and Group A (4.8 ±40) hour (p < 0.001). Onset and duration of Sensory and motor blockade was not significantly different. VAS score was significantly lower in group C (p<0.001), hemodynamic parameters were well preserved with higher incidence of PONV in group C (10%). Conclusion: Addition of buprenorphine to intrathecal Isobaric Levobupivacaine prolonged the duration and quality of postoperative analgesia after lower abdominal surgery. Increasing the dose of buprenorphine from 60mcg to 90mcg provided longer duration of analgesia with minimal adverse effects like dizziness and PONV which were not significant to hinder recovery. https://aacc.tums.ac.ir/index.php/aacc/article/view/601

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 07 03 360 365 Richa Chauhan Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India. Abhirup Bose Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India. Lakshmi R Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India. 2022 05 30 2022 06 25 Several formulations of vaccines against novel coronavirus have been launched. Thereby, increasing the plausibility of having one or more successful vaccines. India put in place the world’s largest Covid-19 vaccination drive in January 2021. However, the side effects of these vaccines are slowly unfolding. Each new vaccine has potential adverse events of special interest (AESI) that warrant a focused evaluation. We report a very rare neurological complication Guillain-Barré syndrome, immediately following the first dose of COVID vaccination in a young female. An apparently healthy 35 years old female presented with acute onset lower backache, weakness of bilateral lower limbs 11 days after receiving the first dose of Covishield vaccine, which rapidly ascended to upper limbs over 5 days with symmetric motor weakness, power 1/5 in bilateral lower limbs, 3/5 in bilateral upper limbs, with absent deep tendon reflexes. Mild sensory involvement was seen. Evolving dysphagia and hoarseness of voice. Bladder/bowel function, respiratory pattern, and hemodynamics were unaffected. A provisional diagnosis of Guillain-Barre Syndrome was made on basis of clinical presentation, neurological examination, and nerve conduction studies suggesting axonal polyneuropathy. Gradual improvement of the muscle power over the next 2 weeks following Human Intravenous immunoglobulin was seen. The risk-benefit analysis for an individual should be considered prior to Covid-19 vaccination, including the implementation of a pre-vaccination screening checklist to ensure vaccine safety for every vaccine recipient. The vaccine continues to be far more beneficial than detrimental for the public at large. Nonetheless, increased awareness amongst healthcare professionals and the public regarding the potential adverse effects of the vaccine is warranted. https://aacc.tums.ac.ir/index.php/aacc/article/view/568

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 06 30 294 303 Masoum Khoshfetrat Department of Anesthesiology and Critical Care, Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Alireza Rahat Dahmardeh Department of Anesthesiology and Critical Care, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Bibi Mahdie Khodadadi Hosseini Department of Nursing, Alzahra eye Hospital, 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. 2022 08 16 2022 10 26 Background: The intensive care unit is one of the most specialized hospital units that need nurses with a high level of skill and experience. The leave of experienced nurses from this unit reduces the quality of nursing care and imposes heavy costs on the health care system. This study aimed to investigate the reasons for nurses' intention to leave the ICU. Methods: This cross-sectional study was performed on 247 nurses in the ICU affiliated with Zahedan, Tehran, and Mashhad University of Medical Sciences, Iran, from 2018 to 2021. Nurses were included in the study by Census sampling method based on inclusion criteria. They completed a four-part questionnaire including demographic variables, Job Satisfaction Survey (JSS), intention to leave, and reasons for intention to leave the ICU. Data were analyzed with SPSS software using descriptive-analytic statistics, Chi-square, independent t-test, one-way ANOVA, and Pearson correlation. The significance level was considered less than 0.05. Results: Out of 247 nurses studied, 183 (74.1%) were female and 64 (25.9%) were male. The mean age of participants was 32.47± 6.68 years. The mean score of job satisfaction was 115.45±58.20 and the mean score of intention to leave was 15.98±3.76. The mean score of the three areas of reasons for intention to leave had a negative correlation with job satisfaction and a positive correlation with the intention to leave the ICU, which was statistically significant in all cases (p= 0/001). The mismatch between the workload and legal benefits, shortage of nurses, forced overtime, the disproportion of nurse-patient ratio, and lack of welfare facilities had the greatest effect on nurses' intention to leave the ICU. Conclusion: The results of the study showed that the most common reasons for the increase the intention to leave of nurses are related to the mismanagement of nursing managers and authorities of ICU. Therefore, reforming old management styles, observing justice among employees, involving nurses in decisions and the process of patient's treatment are among the things that can increase nurses' self-esteem, job satisfaction and reduce the leave of ICU without providing additional funding for the organization. https://aacc.tums.ac.ir/index.php/aacc/article/view/625

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 4 2023 06 https://aacc.tums.ac.ir/index.php/aacc/article/view/732

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2023 12 27 194 197 Sumedha Mehta Department of Anaesthesiology, SKNMC & GH, Pune, India. Jyoti Despande Department of Anaesthesiology, SMCW-SUHRC, Pune, India. Pooja Nirwan Department of Anaesthesiology, SKNMC & GH, Pune, India. Dhiraj Chopra Department of Anaesthesiology, SKNMC & GH, Pune, India. 2023 03 30 2023 05 29 We report a case of 30-year male who presented with Acquired Tracheoesophageal Fistula with subglottic stenosis and Aspiration Pneumonitis. Patient was managed with Feeding Jejunostomy, Tracheoesophageal Fistula repair and Tracheoplasty, after which patient recovered well. Difficult airway was managed by Awake Fiberoptic Intubation and cross-table ventilation through flexometallic tube intraoperatively during TEF repair. https://aacc.tums.ac.ir/index.php/aacc/article/view/730

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2024 01 16 125 130 Sedighe Shahhosseini Department of Anesthesiology, Anesthesiology and Critical Care Research Centre, Emam hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammad Montasery Department of Anesthesiology, Anesthesiology and Critical Care Research Centre, Emam hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Iman Raeisi Department of Anesthesiology, Anesthesiology and Critical Care Research Centre, Emam hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Amir Shafa Department of Anesthesiology, Anesthesiology and Critical Care Research Centre, Emam hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammad Omid Department of Pediatric Surgery, Surgery Research Center, Emam hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Mehrdad Memarzadeh Department of Pediatric Surgery, Surgery Research Center, Emam hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Yasaman Borghei Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. 2023 05 09 2023 06 20 Background: In the majority of cases, the treatment method for Cleft lip is surgery. Providing adequate pain control during and after surgery for children, is too important. Also, different methods are used for pain relief like analgesic prescription and nerve block and different adjuvants can be added to anesthetics to reduce pain. Aims: This trial was aimed to compare the analgesic effect of Bupivacaine with or without dexmedetomidine or dexamethasone for cleft lip surgery. Methods: This study is a prospective, double-blinded, randomized trial which conducted on 75 pediatrics, aged between 3 to 10 months, who needed unilateral cleft lip surgery. Patients were divided into 3 groups (n=25 in each group). Children in group A, were given a combination of bupivacaine and 0.5 µg/kg of dexmedetomidine, those in group B, 0.1 mg/kg of dexamethasone as an adjuvant to bupivacaine, and in group C, plain 1 cc of bupivacaine 0.5% was injected in the operation site. Outcomes were assessed via FLACC and WATCHA scores. Results: The mean age among children was 4.3 ±1.29 months and mean weight was 6.3± 1.09 kg. Pain score and frequency of analgesic request intra and post-operation in group A was lower than others (p<0.0001). Also, FLACC and WATCHA scores were significantly lower in group A (p<0.0001) and parental and surgeon satisfaction was higher in group A (p<0.05). Conclusion: Our study showed that, dexmedetomidine as an adjuvant to bupivacaine 0.5% is more effective to improve the analgesia, in children who underwent unilateral cleft lip surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/760

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2023 12 27 198 200 Malihe Sehat Department of Anesthesiology, Shahid Beheshti Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran. Abbas Ahmadi Department of Anesthesiology, Shahid Beheshti Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran. 2023 04 27 2023 06 25 Complete remaining guide wire in the vascular system after CVC is very rare. For which the maximum symptom-free reporting time in studies was five months, and in our case, the patient was symptom-free for one year. The only finding was one session complaining of ear pain and mastoid tenderness two weeks after catheter placement. A 42-year-old male patient with the diagnosis of necrotizing pancreatitis and a retroperitoneal abscess was a candidate for laparotomy after ERCP. The patient was a candidate for central venous catheter insertion through the internal jugular vein before the surgery in the operating room by a third-year anesthesia resident. After one year, discovered that incidentally remaining guide wire during a follow-up MRI before pancreatitis. Which has been asymptomatic during this period. And despite the risk of rupture of the right heart and blood vessels due to possible fibrosis due to a long stay in the cardiovascular system, it is successfully removed by an endovascular surgeon. The main reasons for the incident were the non-observance of scientific and safety principles at the time of catheter insertion and the failure to perform CXR after that. https://aacc.tums.ac.ir/index.php/aacc/article/view/745

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2024 01 14 131 137 Vijayalaxmi Biradar Department of Anaesthesiology Bharati Vidyapeeth Deemed University medical College, Pune, Maharashtra, India. Mamta Patel Department of Anaesthesiology, Government Medical College, Baroda, Gujarat, India. Kavan Patel Department of Anaesthesiology, Government Medical College, Baroda, Gujarat, India. Mridul Panditrao Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India. 2023 04 10 2023 05 29 Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery. Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software. Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group. Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation. https://aacc.tums.ac.ir/index.php/aacc/article/view/736

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2024 01 30 138 142 Yasmin Nakisa Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sicneces, Tehran, Iran. Ali Movafegh Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sicneces, Tehran, Iran. Mostafa Sadeghi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sicneces, Tehran, Iran. 2023 04 14 2023 05 29 Background: The depth of anesthesia is an important consideration during sleeve surgery, as it can impact patient safety and surgical outcomes. Proper depth of anesthesia can help to ensure patient comfort and reduce the risk of complications such as respiratory depression and hemodynamic instability. This study aimed to determine the association between the depth of anesthesia and the Surgical Rating Score in sleeve surgery. Methods: This study was conducted as a cross-sectional study. Twenty patients who were candidates for sleeve surgery by the laparoscopic method and were referred to Dr. Shariati Hospital from 1394 to 1395 were recruited in this study. Informed consent was obtained before the start of the study. Surgical rating scale (SRS) used to assess surgeon satisfaction. Bispectral Index (BIS) monitoring used to assess the depth of anesthesia. Patients demographics along with hemodynamic, medications, and depth of anesthesia were recorded Results: Twenty patients, including four men (20%) and sixteen women (80%), were examined in two groups of 10 people who underwent laparoscopic sleeve surgery (Mean age 40.20 ±8.87). The depth of anesthesia has a direct relationship with the improvement of the patient's condition and the SRS during the operation. As the observations showed, in the first group, the surgeon's satisfaction decreased as a result of the decrease in the depth of anesthesia, but this decrease was not statistically significant (P = 0.064), but in the second group, with the change of conditions and the increase in the depth of anesthesia from 60–65 to 40–45, the surgeon's satisfaction increased significantly (P = 0.018).There was no significant difference between the two groups in terms of age, sex, drugs (fentanyl, etc.), PEEP, TV, BMI, and fluid intake. Conclusion: In conclusion, the findings of this study suggest that the depth of anesthesia has a significant impact on the improvement of the patient's condition and surgeon's satisfaction (SRS) during surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/740

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2023 12 27 143 147 Kaushal Kenchey Department of Anaesthesia, Bharati Vidyapeeth (Deemed to be) University Medical College, Pune, India. Sarita Swami Department of Anaesthesia, Bharati Vidyapeeth (Deemed to be) University Medical College, Pune, India. Kalyani Patil Department of Anaesthesia, Bharati Vidyapeeth (Deemed to be) University Medical College, Pune, India. 2023 04 21 2023 05 29 Background: Diabetic patients are known to have gastroparesis and consequent delayed gastric emptying which predisposes them to an increased risk of aspiration as compared to the general population. This study compares the gastric volumes in diabetic and non-diabetic patients using point-of-care ultrasound and correlates it with the HbA1c levels in diabetic patients. Methods: This cross-sectional study included 180 patients, 90 diabetic (>5 years) and 90 nondiabetic, aged >40 years, American Society of Anaesthesiologists' physical status I–II kept fasting for 8 hours. Before induction, gastric ultrasound was performed to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume (GV) in right lateral decubitus (RLD) position using curved array probe. In diabetic patients, the gastric volumes were correlated with HbA1c values. Results: In the RLD, the mean CC and AP diameters were higher in diabetic Group. The calculated CSA in RLD in diabetics (8.014 ± 2.412 cm2) were significantly higher than non-diabetic (6.314± 2.894 cm2) (p < 0.0001). The calculated GV of 71.501 ± 35.937 ml in the diabetic group was significantly higher than 48.0022± 41.587 ml in the non-diabetic group (p < 0.0001). In diabetics, the gastric volumes showed significant correlation with HbA1c. Conclusion: Diabetic patients show higher residual gastric volume as compared to non-diabetic patients indicating gastroparesis. The gastric volumes are further increased in those with poorly controlled disease with high HbA1C levels. Ultrasound is an effective tool in assessing the risk of aspiration and altering anaesthetic management accordingly. https://aacc.tums.ac.ir/index.php/aacc/article/view/743

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2023 12 27 148 153 Shubhra K Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Mohandeep Kaur Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Sandeep Kumar Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Amlendu Yadav Department of Critical Care Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Rupesh Yadav Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2023 04 25 2023 05 29 Background: The combined spinal-epidural (CSE) anesthesia technique gives a reliable subarachnoid block as well as the flexible epidural block. One of the modified technique of CSE is epidural volume expansion (EVE) in which normal saline or local anesthetic (LA) is instilled though epidural catheter leading to increase in level of sensory blockade. Aim of the study was to compare two different volumes of normal saline for enhancing the effects of spinal anaesthesia in adult patients undergoing elective lower limb surgeries. Methods: 90 patients were randomly divided into two group. Group A - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 10ml of 0.9% normal saline for EVE using CSE technique. Group B - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 15ml of 0.9% normal saline for EVE using CSE technique. Results: The demographic data were comparable in both groups. Significant difference was seen in total duration of sensory blockade between group A (192.11±9.80) and group B (Mean ± SD 215.33±17.57minutes) (p<0.0001). Total duration of motor blockade was longer in group B (Mean± SD: 181.91± 16.42) as compared to group A (Mean ± SD: 162.48 ± 9.35 minutes) (p<0.0001). Conclusion: We conclude that epidural volume expansion (EVE) with 15 ml epidural normal saline was associated with faster onset, higher level and early achieve maximum level of sensory blockade, longer two segment regression time, early onset and longer duration of motor blockade as compared to EVE with 10 ml epidural normal saline. https://aacc.tums.ac.ir/index.php/aacc/article/view/744

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2023 12 27 154 159 Shivam Jaisawal Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Amlendu Yadav Department of Critical Care Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Sandeep Kumar Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Rupesh Yadav Atal Bihari Bajpeyi Institute of Medical Sciences & Dr RML Hospital, New Delhi, India Vijay Nagpal Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2023 04 27 2023 06 25 Background: Laryngoscopy, endotracheal intubation, pneumoperitoneum creation and extubation is stressful event marked by hemodynamic changes during laparoscopic procedures. This increases secretion of many biochemical stress markers for example, cortisol levels, TNF-alpha levels, CRP levels, blood Sugar levels. Aim of the study was to compare magnesium sulphate and dexmedetomidine for attenuation of stress response in patients undergoing laparoscopic cholecystectomy under general anaesthesia by measuring biochemical markers of stress response. Methods: 60 patients, age between 18 to 60 years of either sex, who were undergoing Laparoscopic cholecystectomy randomized into two groups of 30 patients each by computer generated random number. Group M- received magnesium sulphate 50 mg/kg and group D -  received dexmedetomidine 1 µg/kg. Results: The demographic data were comparable in both groups. Cortisol levels rise in both the groups but significantly more in group M than group D at 30 minute (p-value < 0.001) and 4 hours (p-value < 0.001). CRP levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.013) and 4 hours (p-value 0.020). Blood sugar levels rise in both the groups but significantly more in group M than group D at 30 min, 4 hours and 24 hours (p-value <0.001). TNF-alpha levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.005) and 4 hours (p-value 0.007). Conclusion: We conclude that biochemical stress marker levels (Cortisol levels, TNF-alpha, levels, CRP levels, Blood Sugar levels) were more increased in the magnesium sulphate group compared with the dexmedetomidine group. Heart rate and Mean arterial pressure   were higher in the Magnesium sulphate group than the Dexmedetomidine group. Dexmedetomidine is better than magnesium sulphate in attenuating the stress of surgery in patients undergoing laparoscopic cholecystectomy. https://aacc.tums.ac.ir/index.php/aacc/article/view/748

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2024 02 12 160 163 Masoomeh Nataj-Majd Department of Anesthesiology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Majid Akrami Department of Anesthesiology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amene Abiri Department of Obstetricsand Gynn 4mg intravenous dexamethasone in 5ml normal saline along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Group DE - 25 patients were given 8mg intravenous dexamethasone in 5ml normal saline along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Results: The demographic data were comparable in all groups. The VAS score was significantly lower in Group DF and DE compared to Group S at 3,4,6,8,10,12 and 24 hours, with p values < 0.0001 at 3,4,5,6,8,10 and 12 hours and p value 0.0002 at 24 hours. The VAS scores between the groups DF and DE were comparable at 3,4,5,6,8,10,12 and 24 hours without any significant difference. The time for first rescue analgesia was significantly in Group DF and DE compared to Group S (p value <0.0001). There was no significant difference between the groups DF and DE in the time for first rescue analgesia (p value 0.75). Conclusion: We conclude that dexamethasone used intravenously even in lower doses as 4mg along with supraclavicular brachial plexus block effectively increases the duration of analgesia and motor blockade, shortens the onset of sensory and motor blockade, reduces the total analgesic requirement in the first 24 hours after surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/577

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 253 258 Radhika Dhanpal Department of Anaesthesiology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka,India. Shwetha Mudalagirigowda Department of Anaesthesiology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka,India. Deepika Chandrashekar Department of Anaesthesiology, Vydehi Institute of Medical Sciences, Bangalore, Karnataka,India. 2022 06 30 2022 07 28 Background: Laparoscopic cholecystectomy is usually performed as a day care procedure for diseases involving the gall bladder. Pain in the immediate post-operative period is due to multiple factors and hence different modalities of pain relief are used. The present study was conducted to study the effectiveness of Peri-operative Multi-Modal Analgesia with Ultrasound guided Bilateral Subcostal TAP block for Post-operative analgesia in 60 patients undergoing elective laparoscopic cholecystectomy. Methods: In this hospital based, randomized prospective interventional study patients were randomly allocated into 4 groups of 15 in each group, Group B received Bilateral Ultrasound guided Subcostal TAP Block with 20 ml of 0.25% Bupivacaine, Group P received Tab Pregabalin tablet 150 mg, Group D received Inj Dexamethasone 8 mg IV and Group C was the control group. The hemodynamic changes like heart rate, blood pressure, saturation was monitored both intra and post operatively. The post-operative VAS scoring, duration of analgesia, time for fi