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 2023 06 25 206 210 Nader Ali Nazemian Yazdi Department of Anesthesiology and Pain, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkar Department of Anesthesiology and Pain, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sadegh Sanie Jahromi Department of Anesthesiology and Pain, Jahrom University of Medical Sciences, Jahrom, Iran. 2023 06 19 Background: Trigeminal neuralgia is a sudden, severe condition characterized by stabbing and recurrent pain. Radiofrequency thermocoagulation (RFT) and pulsed radiofrequency (PRF) are common surgical interventions used to treat trigeminal neuralgia. This study aimed to investigate the therapeutic effects and associated complications of PRF in the treatment of trigeminal neuralgia. Methods: Pulsed radiofrequency was performed on 20 patients with primary trigeminal neuralgia. One months later, pain relief and complication status were evaluated. All patients who referred to the pain clinic of Amir Alam Hospital with a diagnosis of primary TN and after failure of conservative treatment or intolerance to drug side effects were candidates for trigeminal ganglion destruction by PRF method were the study population. Results: In this study, the female to male ratio was 1.5. The mean age of patients was 50.70 years. The highest prevalence was reported in 50-75 years (45%). 7 patients (35%) had pain in the right and 13 patients (65%) had pain in the left. In 18 patients there was involvement in one nerve root and in 2 patients there was involvement in 2 nerve roots. 1 patient (5%) had V1 root involvement, 13 patients (65%) had V2 root involvement and 8 patients (40%) had V3 root involvement. The mean pain score of patients before the procedure was 8.8. The mean pain of patients one hour after surgery was 3.95 and on days 7 and 30 after surgery were 3.3 and 4.25, respectively. One hour after the operation, effective pain relief was observed in 75% of patients. The effective response rate was observed one week after the procedure in 80% of patients and one month later in 60% of patients. There was no significant relationship between patients' gender and the effectiveness or ineffectiveness of the procedure after one month. With age, the effective response to treatment in patients increases. In 2 patients, infection was reported at the procedure site. Four patients reported paresthesia at the procedure site one month after surgery. Conclusion: PRF treatment was an effective, safe and non-destructive method for patients with TN. Primary PRF treatment can be considered as a first-line option before more invasive treatments, such as neurodegenerative procedures and MVD surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/795

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 28 275 276 EN Jyoti Deshpande Department of Anaesthesia, SMCW, Symbiosis International University, Pune, India. Pooja Nimbhore Department of Anaesthesia, SKN, and GH, Pune. University: MUHS Nashik, India. 2022 06 07 2022 06 25 Supraclavicular brachial plexus block is well established regional anaesthesia technique for upper limb surgeries. USG guided supraclavicular brachial plexus block provides many advantages but is also associated with the rare complication of recurrent laryngeal nerve palsy, seen in 1.3% of cases. Recurrent laryngeal nerve palsy is mostly documented in right sided supraclavicular blocks than left sided supraclavicular blocks. Here, we report a case of 28 years old male undergoing right upper arm surgery under supraclavicular block who developed hoarseness of voice due to ipsilateral recurrent laryngeal nerve involvement which was followed up properly and managed successfully. https://aacc.tums.ac.ir/index.php/aacc/article/view/563

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 211 214 Nalini Bheemanna Department of Anaesthesiology ,Chikkaballapur Institute of Medical Sciences, Chikkaballapur, India. Anusha Nagaraj Department of Anaesthesiology ,Sapthagiri Institute of Medical Sciences,Bangalore, India. Naveen Appajigowda Department of Neurosurgery,Sapthagiri Institute of Medical Sciences,Bangalore, India. 2022 05 27 2022 07 09 Background: Most of the lumbar spine surgeries cause severe post-operative pain. Poorly controlled postoperative pain is associated with increased morbidity and increased health-care costs. Recently, erector spinae plane (ESP) block has been introduced in our clinical practice as a part of the multimodal pain strategy after lumbar spine surgery. This case series is to analyse the efficacy and safety of erector spinae block for lumbar spine surgery. Methods: In this study eight patients, who were posted for lumbar spine surgeries, ultrasound (US) guided bilateral erector spinae block was given post-operatively. Post-operative pain was assessed using Visual analogue scale (VAS), score at 4, 8, 12 and 24 hrs. Rescue analgesia inj tramadol 50gm IV was given when VAS score was more than or equal to 5. Time when the first rescue analgesia was given was noted. Results: Erector spinae block was successfully performed in all the cases. The mean duration of the procedures was 175.6±31.7 mins (Table 1). None of the patients complained of pain in the immediate postoperative period. The mean time of first rescue analgesia was 11.3±2.3 mins. Conclusion: ESP block with dexamethasone offer a good postoperative analgesia in lumbar spine surgeries for acute postoperative pain reducing the opioid consumption. https://aacc.tums.ac.ir/index.php/aacc/article/view/566

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 215 219 Hamed Abdollahi Department of Anaesthesiology, Amir Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Abolghasem Yousefi Department of Anaesthesiology, Amir Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ladan Ghadami Department of Health Care Management ,Amir Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2022 07 30 2022 09 10 Background: Two major difficulties in critical care are muscle weakness and malnutrition. Their prevalence in critically ill patients is about 30-50% during hospital stays, and they can also affect routine patient life after discharge, even leading to recurrent infection and death. Metabolic responses to injury have specific effects on metabolic phases in patients. Methods: This study is a randomized, double-blind, clinical trial on critically ill patients in two groups. Both groups were checked for metabolic markers and demographic characteristics during admission and before discharge. In the nandrolone group, 25mg of nandrolone (IM) was injected weekly for three weeks. In the control group, normal saline was used as a placebo. To assess metabolic responses, albumin, total protein, and testosterone levels were checked, in addition to static measures such as cross-sections of rectus femur and mid-upper arm circumference. Results: There were no significant differences in SOFA and APACHE 2 scores, PSA, ESR, CRP, and PTC levels between the two groups (p<0.05). Results also showed no significant differences between the mean of length of hospital stay, serum albumin, total protein, hemoglobin, testosterone, and HDL between the two groups (p<0.05). LDL and TG had P-values of 0.01 and 0.012, respectively. MUAC and sonographic findings of rectus femoris muscle were better in the case group (P-values 0.008 and 0.012). Conclusion: Nandrolone had no significant effects on metabolic markers in critically ill patients, except for TG and LDL. The changes in muscle characteristics were significant. However, more study is needed to assess muscular power. https://aacc.tums.ac.ir/index.php/aacc/article/view/617

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 220 226 EN Mari Sunohara Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Osaka, Osaka, Japan. Akihiko Maeda Department of Anesthesiology and Intensive Care Medicine, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Osaka, Osaka, Japan. Yukiko Nakanishi Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Osaka, Osaka, Japan. Eizo Amano Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Osaka, Osaka, Japan. Toshiki Okada Department of Anesthesiology and Palliative Care, Nissey Hospital, 2-1-54, Enokojima, Osaka, Osaka, Japan. Hiromi Shibuya Department of Anesthesiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Osaka, Osaka, Japan. 2022 05 22 2022 06 25 Background: The diagnostic efficacy of lung ultrasonography (LUS) has been widely investigated. However, the clinical value of LUS for perioperative monitoring has rarely been reported. The aim of this study was to evaluate the ability of LUS to assess lung aeration status after one-lung ventilation (OLV) using a validated scoring system. Methods: In this prospective observational study, patients undergoing elective video-assisted thoracic surgery (VATS) with OLV underwent a lung ultrasound examination just after induction of anesthesia and at the end of the surgery. After each lung ultrasound examination, a semiquantitative score, the LUS score, was calculated to assess lung aeration on the ventilated dependent side and the non-dependent side separately. The relationship between the LUS scores and various patient-related factors was also investigated. Results: Twenty-five patients were studied. All lung ultrasound examinations were successfully completed. LUS scores after OLV on the dependent side (median [IQR]: 2 [1–4]) increased significantly from baseline (1 [0–1.5], P < 0.001). Further, LUS scores on the non-dependent side (2 [1.5–3.5]) increased significantly from baseline (1 [0–1.5], P < 0.001). None of the factors analyzed was significantly correlated with LUS scores after OLV. Conclusion: LUS examination is possible after VATS with OLV on both sides of the thorax. Ultrasonography-measured lung aeration scores increased from baseline on both sides. https://aacc.tums.ac.ir/index.php/aacc/article/view/557

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 227 231 Jyoti Deshpande Department of Anaesthesia, Smt. Kashibai Navale Hospital, Narhe, Pune, India. Pooja Jadhao Department of Anaesthesia, Smt. Kashibai Navale Hospital, Narhe, Pune, India. 2022 05 31 2022 07 11 Background: We assessed postoperative analgesic effect of ultrasound guided ilioinguinal and iliohypogastric nerve block, duration of action of the said block as well as the overall analgesic consumption in the first 24 hours of postoperative period after addition of dexamethasone. Methods: After approval from the institutional ethics committee, hospital based randomized prospective study was carried out in patients of age group 40-60 years by dividing them into two groups A and B, posted for unilateral inguinal hernioplasty, comparing ilioinguinal and iliohypogastric block with ropivacaine 0.375% and ropivacaine 0.375% with dexamethasone 4mg respectively. The aim of the study was to assess the postoperative analgesia with visual analogue scale (VAS) and satisfactory score and total analgesic consumption and time till rescue analgesia. Statistical Analysis: We used Chi-square test and paired t test and P<0.05 was considered statistically significant. Results: Mean of duration of analgesia was significantly prolonged in group B (14.13±3.461 h) as compared to group A (5.77±2.161 h). Patients in group B had significantly lower VAS score and less number of rescue analgesic requirements in first 24 hours (h) postoperatively. No adverse effects recorded in any group. Conclusion: Dexamethasone as an adjuvant with ropivacaine in ultrasound guided ilioinguinal and iliohypogastric block provided profound prolongation of duration of postoperative analgesia and reduces analgesic consumption of patients undergoing subarachnoid block for unilateral inguinal hernioplasty. https://aacc.tums.ac.ir/index.php/aacc/article/view/570

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 232 237 Monika Garg Department of Anaesthesia,Sawai Man Singh Hospital, Rajasthan University of Health Sciences, Jaipur, India. Reema Meena Department of Anaesthesia,Sawai Man Singh Hospital, Rajasthan University of Health Sciences, Jaipur, India. Adhokshaj Joshi Department of Anaesthesia,Sawai Man Singh Hospital, Rajasthan University of Health Sciences, Jaipur, India. Anjum Saiyed Department of Anaesthesia,Sawai Man Singh Hospital, Rajasthan University of Health Sciences, Jaipur, India. Arun Garg Department of Anaesthesia,Sawai Man Singh Hospital, Rajasthan University of Health Sciences, Jaipur, India. 2022 07 08 2022 07 23 Background: Central venous catheters are inserted in internal jugular vein during cardiac surgeries in all patients. However, the length of the catheter should be correctly estimated and the tip of the CVC should be correctly placed to avoid various complications.  The primary objective of this study is to compare anatomical landmark technique versus using ECG-guided technique for the correct insertion length of the Central Venous Catheter. Methods: Prospective, randomized, interventional study was conducted on 72 patients of <12 years age. Patients were randomly allotted to two groups of 36 patients each (landmark and ECG). After induction, CVC cannulation was performed using either of the techniques in right IJV in all patients. Correct position of CVC was checked by obtaining post operative chest X rays in all patients. CVC tip position within 0.5cm above/below or at carina was considered as correct position. Using student t-tests and Chi square-tests analyses were performed. Results: In landmark group, CVC was positioned correctly in 22(61.11%) out of 36 patients as compared to 33 (91.67%) in the ECG group, (P = 0.006). The mean depth of CVC insertion was 9.05±1.66 and 8.26±1.41 in the landmark and ECG group respectively (P= 0.032). The landmark group had 12 (33.33%) patients with complications during the procedure, as compared to 3(8.33%) in the ECG-guided group, (P = 0.020). Conclusion: ECG-guided CVC insertion, a simple bedside technique was found more accurate with lesser complications for CVC tip placement than the landmark technique. ECG-guided CVC placement is therefore relatively more accurate, efficient, and safe. https://aacc.tums.ac.ir/index.php/aacc/article/view/599

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 238 245 Atabak Najafi Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arezoo Ahmadi Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahed-Zadeh Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Nasim Zarrin Clinical Research Development Unit, Shahid Rajaee Hospital, Qazvin University of Medical Sciences, Qazvin, Iran. Reza Shariat Moharrari Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Khajavi Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farhad Etezadi Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Pejman Pourfakhr Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Neishaboury Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2023 02 08 2023 04 25 Background: Cytokine storm in severe Covid-19 disease is one of the leading causes of death in these patients. Hemoperfusion is a method used to purify the blood from toxins and inflammatory factors. The aim of this study was to evaluate the effect of hemoperfusion on mortality and morbidity in patients with severe Covid - 19 disease. Methods: This was a retrospective study which performed by reviewing the files of 30 patients with severe Covid-19 disease referred to Sina Hospital affiliated to Tehran University of Medical Sciences in 2020. Thirty patients with severe covid-19 disease and positive PCR participated in the study. All patients received routine treatment protocol for covid-19. Hemoperfusion was used for 15 patients in addition to receiving routine care. The remaining 15 patients were included in the control group. Patients in the hemoperfusion group underwent four sessions of hemoperfusion using continuous renal replacement therapy with continuous venovenous hemofiltration. Results: the ICU length of stay in the control and hemoperfusion groups was 3.40 ± 11.40 and 9.65 ± 16.33 days, respectively (P= 0.075). 8 patients died and 7 patients were discharged in the control group, but 11 patients died and 4 patients were discharged in the hemoperfusion group (P= 0.256). The respiratory rate of patients in the control and hemoperfusion groups decreased from 7.43 ± 29.40 to 4.03 ± 24.60 and from 6.11 ± 31.60 to 5.04 ± 24.46, respectively (P < 0.001). The percentage of arterial blood oxygen saturation in the control and hemoperfusion groups increased from 90.86 ± 5.61 to 93.06 30 4.30 and from 92.33 26 3.26 to 92.06 31 5.31, respectively (P= 0.456). Conclusion: Hemoperfusion could not prevent the mortality of patients and finally out of 15 patients, 11 patients died and 4 patients were discharged. Also, no significant difference was observed between the two groups in terms of arterial blood oxygen saturation. https://aacc.tums.ac.ir/index.php/aacc/article/view/711

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 3 2023 06 25 246 252 Praveen Sarguru Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Ranvinder Kaur Department of Critical Care Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. Usha Yadav Department of Obstetrics & Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India. Rupesh Yadav Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2022 06 13 2022 07 09 Background: Pain is associated with increased sympathetic activity leads to tachycardia, elevated blood pressure and myocardial insults so pain control is necessary during the surgery and in the postoperative period. Aim of the study was to study the effect of intravenous dexamethasone on the duration of analgesia provided by supraclavicular block (SCB) for upper limb surgery. Methods: 75 patients, age between 18 to 70 years of either sex, ASA class I and II, who were undergoing upper limb surgery randomized into three groups of 25 patients each by computer generated random number. Group S - 25 patients were given 5ml of normal saline intravenously along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Group DF - 25 patients were given 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