Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 29 469 473 Shivi . Department of Anesthesiology, SMS Medical College and Hospital, RUHS University, Jaipur, India. Priyasharan Lamba Department of Anesthesiology, SMS Medical College and Hospital, RUHS University, Jaipur, India. Shashank Bhardwaj Department of Anesthesiology, SMS Medical College and Hospital, RUHS University, Jaipur, India. 2022 12 30 2023 03 26 Background: Bedside lung ultrasound (LUS) is increasingly being used in diagnosing various lung pathologies. Acute respiratory distress syndrome (ARDS), one of such lung pathology, is a major underlying cause of mortality in critically ill patients. Early diagnosis of ARDS can improve the outcome in such patients. The primary objective of this study is to explore application of B-lines in LUS for early detection of developing ARDS in susceptible patients. Methods: This is a prospective cohort study. This study enrolled patients admitted in intensive care unit. Daily clinical evaluation, bedside chest x ray and bedside lung ultrasound done to diagnose ARDS. Mean days of diagnosing ARDS by chest x ray and LUS were compared using t-test. Area under the Receiver Operating Curves Characteristics was calculated with a 95% confidence interval to determine the prognostic value of LUS. Results: Out of a total of 100 participants, 28 patients developed ARDS. Lung ultrasound was found to diagnose ARDS significantly earlier then chest x ray (p=0.001). Conclusion: Results in this study showed that B-line score in patients susceptible to develop ARDS can help in early diagnosis of the same. https://aacc.tums.ac.ir/index.php/aacc/article/view/694

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 11 19 541 548 Alireza Jahangirifard Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), 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. Ali Jabbari Department of Anesthesiology and Critical Care Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Leila Saliminejad Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Ghaheri Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran. Zargham Hossein Ahmadi Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 07 15 2023 08 13 Continuous monitoring of the cardiovascular system and control of the changes affecting it is a constant challenge for the surgical team. The need to control the condition of the heart and better understand its condition is raised in the topic of advanced hemodynamic monitoring, which is a set of different techniques for real-time monitoring of the cardiovascular condition and its influencing factors. Cardiac output, as the most important indicator of cardiac function, is an integral part of cardiac monitoring systems. The measurement of this index has witnessed extensive changes in the past few years, which clearly shows its importance. Cardiac surgery is one of the most serious cases that requires accurate assessment of cardiac output and advanced hemodynamic monitoring. Therefore, the present study examines the types of cardiac output in cardiac surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/806

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 21 549 552 Roopali Phulli Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences-Raipur, India. Habib Karim Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences-Raipur, India. Mahesh Kurwe Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences-Raipur, India.Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences-Raipur, India. Manu Kesavankutty Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences-Raipur, India. Klein Dantis Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences-Raipur, India. 2022 08 25 2022 09 10 Surgical resection is frequently the intervention required for post-tuberculous empyema or other sequels. However, pneumonectomy may not be feasible in some situations, and video-assisted thoracoscopic surgery (VATS) plays a role in such a scenario. Whether a patient undergoes open resection of VATS, isolation of infected lung is integral to one-lung ventilation and better access to the surgical field, and a double-lumen tube (DLT) remains the preferred choice. Difficulties in DLT placement after pneumonectomy are reported; however, failure to isolate a lung by appropriately placed DLT is scarce or absent. A 28-year cachectic gentleman with poor preoperative lung function was suffering from endobronchial tuberculosis. He also had one episode of tuberculosis twelve-year back. At presentation, he had a massive pneumothorax and stage-III empyema as a sequel, including a rare finding of plastered mediastinum mimicking vanishing lung syndrome. He underwent uniportal-VATS under general anesthesia using one-lung ventilation. Complete lung destruction from active tuberculosis and its sequel leading to the plastered mediastinum and deformed airway pose a significant lung isolation challenge. U-VATS can be considered for therapeutic purpose where standard thoracotomy and pneumonectomy is contra-indicated. However, lung isolation in such patients is tricky and poses a risk. The present case highlights the challenges faced with lung isolation using a DLT and discusses the probable remedy to these problems. https://aacc.tums.ac.ir/index.php/aacc/article/view/630

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 29 566 568 Ali Jabbari Ischemic Disorders Research Center of Golestan University of Medical Sciences, Gorgan, Iran. & Department of Anesthesiology and Intensive Care Medicine, Golestan University of Medical sciences, Gorgan, Iran. Behrang Nooralishahi Department of Anesthesiology and critical care Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Jahangiri Fard Lung Transplantation Research Center, National Research Institute of Tuberculosis and lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2022 11 25 2023 03 26 No Abstract  No Abstract   No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/684

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 09 23 474 478 Shervin Ramezani Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran. Hesam Aldin Varpaei College of Nursing, Michigan State University, East Lansing, USA. Mostafa Mohammadi Department of Critical Care, Tehran University of Medical Sciences, Tehran, Iran. Hamid Rahmani Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran. Masoud Ramezani Department of Critical Care, Tehran University of Medical Sciences, Tehran, Iran. 2022 11 15 2023 01 09 Background: Ventilator-associated pneumonia (VAP) is a consequence of mechanical ventilation, which can be fatal. Several markers are available to predict outcomes related to VAP. Choosing a predictor that is inexpensive, affordable, and accurate is advantageous. This study aimed to examine red cell distribution width (RDW) as a predictor of mortality in patients with VAP. Methods: This prospective cohort study was conducted among 49 patients in the intensive care unit (ICU) of Valiasr Hospital in Tehran. A researcher-made checklist was used to collect RDW and other marker data, as well as mortality outcomes and length of stay (LOS) in the ICU. The Pearson correlation coefficient in the SPSS software and the regression model in the Eviews software were used to examine the relationship between markers and different outcomes. Results: Of a total of 49 patients (57.1% male; mean age = 54 ± 16), the length of ICU stays ranged from 7 to 14 days. According to the Pearson correlation coefficient, a significant association between RDW and mortality (P =.009) was noted. But no significant relationship between RDW and length of stay in the ICU (P =.81) was noted. Additionally, the regression model showed a positive relationship between RDW and white blood cells (WBC), lactate, and sequential organ failure assessment (SOFA). Conclusion: Our study showed a positive but weak correlation between RDW and ICU mortality in patients with VAP. Due to its availability and low cost of measurement, RDW is an appropriate option for predicting mortality risk in patients who are admitted to the ICU and develop VAP. https://aacc.tums.ac.ir/index.php/aacc/article/view/671

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 29 553 555 Jyoti Deshpande Department of Anaesthesiology, SKNMC & GH, Pune, India. Merlin Jacob Department of Anaesthesiology, SKNMC & GH, Pune, India. 2022 08 29 2022 10 26 Erector spinae plane block is an interfascial plane block that is a novel analgesic technique which is easy to administer. It provides extensive multidermatomal sensory block. It is a simple and safe procedure and is a promise of the future. It has been used to multiple surgeries of the thoracic and abdominal regions like thoracotomy, mastectomy, fibroadenoma, percutaneous nephrolithotomy and so on. Here, we describe the case of a 40year old male patient with ischemic heart disease, posted for percutaneous nephrolithotomy under general anesthesia, supplemented with ultrasound guided erector spinae plane block, with intermittent boluses. The catheter was used for post-operative pain relief for upto 48 hours and later removed. Intraoperative hemodynamics were optimal and post-operative need for multimodal analgesics had reduced. https://aacc.tums.ac.ir/index.php/aacc/article/view/635

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 10 24 479 487 Roya Najafi-Vosough Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. Mohammad Hossein Bakhshaei Department of Anaesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Mahnaz Farzian Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran. 2022 11 19 2023 01 09 Background: The objective of the present study was to identify prognostic factors associated with mortality and transfer to intensive care units (ICUs) in hospitalized COVID-19 patients using random forest (RF). Also, its performance was compared with logistic regression (LR). Methods: In this retrospective cohort study, information of 329 COVID-19 patients were analyzed. These patients were hospitalized in Besat hospital in Hamadan province, the west of Iran. The RF and LR models were used for predicting mortality and transfer to ICUs. These models' performance was assessed using area under the receiver operating characteristic curve (AUC) and accuracy. Results: Of the 329 COVID-19 patients, 57 (15.5%) patients died and 106 (32.2%) patients were transferred to ICUs. Based on multiple LR model, there was a significant association between age (OR=1.02; 95% CI=1.00-1.05), cough (OR=0.24; 95% CI=0.10-0.56), and ICUs (OR=7.20; 95% CI=3.30-15.69) with death. Also, a significant association was found between kidney disease (OR=3.90; 95% CI=1.04-14.63), decreased sense of smell (OR=0.28; 95% CI=0.10-0.73), Kaletra (OR=2.53; 95% CI=1.39-4.59), and intubation (OR=8.32; 95% CI=3.80-18.24) with transfer to ICUs. RF showed that the order of variable importance has belonged to age, ICUs, and cough for predicting mortality; and age, intubation, and Kaletra for predicting transfer to ICUs. Conclusion: This study showed that the performance of RF provided better results compared to LR for predicting mortality and ICUs transfer in hospitalized COVID-19 patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/677

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 9 Supp. 2 2023 08 29 556 558 Jyoti Deshpande Department of Anaesthesiology, SKNMC & GH, Pune, India. Merlin Jacob Department of Anaesthesiology, SKNMC & GH, Pune, India. Vishal Jadhav Department of Anaesthesiology, SKNMC & GH, Pune, India. 2022 08 29 2022 10 26 Parotid pleomorphic adenomas are benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. Slowly p patients. Patients were nebulized with dexmedetomidine 1 μg/kg body weight in 5 ml normal saline in group D and only 5 ml normal saline in group C twenty minutes before induction of anesthesia. Anesthesia was induced with an injection of propofol under entropy guidance. Hemodynamic parameters were noted at baseline, after nebulization, immediately after intubation, and up to 10 minutes. The incidence and severity of sore throat were noted in the postoperative period. Results: Demographics were comparable. After laryngoscopy and intubation, the increase in heart rate and blood pressure was much lower in the dexmedetomidine group compared to the saline group. Furthermore, the requirement of propofol to achieve an entropy of 40–50 and the incidence and severity of postoperative sore throats in the dexmedetomidine group were significantly lower than in the normal saline group. Conclusion: Administration of nebulized dexmedetomidine 1 µg/kg preoperatively effectively attenuates the hemodynamic response to laryngoscopy and intubation, with more stable hemodynamics and no side effects. https://aacc.tums.ac.ir/index.php/aacc/article/view/1260

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 67 70 Mahsa Sanatkar Department of Biotechnology, Tehran University of Medical Sciences, Tehran, Iran. 2025 12 15 Sepsis is a dynamic and heterogeneous syndrome characterized by a dysregulated host response to infection, leading to concurrent hyperinflammation and profound immunosuppression. Early recognition of pathogen- and damage-associated molecular patterns triggers extensive activation of NF-κB, JAK/STAT, and MAPK pathways, resulting in a cytokine storm, metabolic reprogramming, and endothelial dysfunction. Mitochondrial impairment, glycocalyx degradation, and excessive neutrophil activity further propagate organ injury and microcirculatory collapse. Simultaneously, widespread apoptosis and exhaustion of lymphocytes culminate in immune paralysis and increased susceptibility to secondary infections. Advances in transcriptomics, proteomics, metabolomics, and machine-learning–based classification have uncovered distinct immune endotypes of sepsis, providing the foundation for precision medicine. Emerging immunomodulatory therapies—including IL-7, GM-CSF, and immune checkpoint inhibitors—aim to restore immune function in selected subgroups. Ultimately, sepsis must be viewed as a multifaceted immunometabolic disorder requiring individualized diagnosis, monitoring, and treatment approaches. https://aacc.tums.ac.ir/index.php/aacc/article/view/1526

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 102 107 Alireza Shakeri Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Mohammad Seyed Alshohadaei Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 03 2025 02 08 Spinal anesthesia with bupivacaine is widely used for cesarean sections but can rarely cause angioedema, a rapid swelling of deep tissues that may lead to airway obstruction. This case report presents the occurrence of angioedema in a pregnant woman with postoperative hyper IgE levels following spinal anesthesia. It highlights the intricate interplay between drug sensitivity, immune dysregulation, and the physiological changes associated with pregnancy. We present a case of a 32-year-old woman with post-operative hyper IgE levels who developed angioedema shortly after getting spinal anesthesia with bupivacaine for a cesarean section. It should be noted that the patient had no prior history of allergic reactions, making the case particularly interesting and challenging. This report's goal is to: 1. Report details of the clinical presentation, management, and outcome of this unusual patient; 2. Investigate the potential etiologies of angioedema, with a focus on the relationship between bupivacaine sensitivity, hyper IgE, and other possible factors; and 3. Highlight the challenges in diagnosis and management when facing angioedema in patients with atypical presentations. https://aacc.tums.ac.ir/index.php/aacc/article/view/1195

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 18 25 Maged Elgendy Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Sahar Marzouk Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Enas Samir Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Beshoy Gendy Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Sherif Abbas Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Ahmed Ahmed Department of Anesthesiology, National Cancer Institute, Cairo University, Cairo, Egypt. Norhan Ali Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 04 13 2025 04 25 Background: Propofol and dexmedetomidine have a mitigating effect on postoperative nausea and vomiting (PONV). However, their efficacy in preventing PONV in patients following ureteroscopic operations remains uncertain. This study evaluated the efficacy and safety of infusions of dexmedetomidine versus propofol with respect to the incidence of PONV in patients scheduled for ureteroscopic surgeries under spinal anesthesia. Methods: This randomized controlled trial included 72 adult patients scheduled for ureteroscopic surgery under spinal anesthesia with multiple risk factors for PONV (female, history of PONV, non-smoker). The patients were randomized into three groups (24 patients each). The propofol, dexmedetomidine, and control groups received intravenous infusions of propofol, dexmedetomidine, and normal saline, respectively. The study outcomes were the incidence of PONV (primary outcome) as well as the time and need for antiemetics, Ramsay Sedation Scale, and incidence of intraoperative hemodynamic changes (secondary outcomes). Results: Dexmedetomidine infusion resulted in significantly lower PONV scores and heart rates during and after surgery compared to the propofol and control groups. Both intervention groups had significantly deeper sedation, but dexmedetomidine was more sedating than propofol (p = 0.001) in comparison to the control group. At 40 and 60 minutes intra- and postoperatively, both the propofol and dexmedetomidine groups had a significant reduction in mean blood pressure in comparison to the control group. Mean blood pressure was similar in the two groups. Conclusion: During ureteroscopic procedures under spinal anesthesia, dexmedetomidine effectively and safely reduces the incidence of PONV in highly susceptible patients. It also provides deeper sedation and better hemodynamic control compared to propofol. https://aacc.tums.ac.ir/index.php/aacc/article/view/1262

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 71 83 Kavous Shahsavarinia Emergency and Trauma Care Research Center, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Shaghayegh Musazadeh Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Morteza Ghojazadeh Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Nooshin Milanchian Department of Internal Medicine, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran. Maryam Soleimanpour Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Hassan Soleimanpour Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. 2025 05 11 2025 05 26 Background: Coronavirus disease 2019 (COVID-19) is an infectious illness resulting from the SARS-CoV-2 virus. The immune system overactivation triggered by this virus results in multiple organ damage. This infection has the potential to cause acute respiratory distress syndrome and may progress to respiratory failure, both of which can be life-threatening. Vitamin C is proposed as a possible treatment for immune system overactivation due to its antioxidant properties. Methods: This umbrella review seeks to evaluate the effectiveness of vitamin C in the management of COVID-19 infection. To identify pertinent literature, we conducted searches across Embase, PubMed, Scopus, and Web of Science databases. Our analysis incorporated eight systematic reviews and meta-analyses that examined the impact of vitamin C on COVID-19 treatment outcomes. Results: Our findings revealed that the odds ratio (OR) of mortality in the vitamin C group is 0.55 (0.48-0.63). The duration of hospitalization did not differ between the groups and the need for mechanical ventilation in both groups. This umbrella review discusses the use of vitamin C in COVID-19 patients, highlighting its potential to reduce mortality rates. While the duration and dose of treatment vary There was no notable distinction observed between the vitamin C group and the control groups in hospital length, ICU stay, or mechanical ventilation days. Conclusion: The study suggests further research to determine its effectiveness in reducing mortality rates and suggests larger studies with a more specific protocol. https://aacc.tums.ac.ir/index.php/aacc/article/view/1283

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 108 111 EN Alagiri Sneha Department of Anaesthesiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. Rajesh Mane Department of Anaesthesiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. Chaitanya A. Kamat Department of Anaesthesiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. 2025 02 17 2025 02 26 The incidence of paraganglioma has been reported between 2-8 cases per million people yearly. Thoracic functional Paragangliomas accounts for 15-20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has high mortality rate challenging anaesthetic management. Undiagnosed paraganglioma have an extremely high mortality rate up to 60%. The present report is a case of successful management of functional paraganglioma excision at the level of T9-T11 feeding from the descending aorta. A 71-year-old male with lower thoracic functional paraganglioma was posted for excision. Pre-anaesthetic evaluation, revealed history of Ischemic Heart Disease, Hypertension and PTCA 1month prior and intake of regular cardiac medication preoperatively, along with regular medications of Tab Propranolol 10mg and Tab Bisoprolol 2.5mg. PR was 84 bpm and BP was 140/90 mmHg in a supine position and 90/60 mmHg on standing. Echocardiography indicated EF 50% with borderline LV function. Epidural and General Anaesthesia was administered. Continuous roller coaster fluctuations in haemodynamics for intraoperative period of 8hrs, risk challenges calibrated by continuous vasopressor and vasodilation infusions. Extubation and post-operative period were uneventful. Careful perioperative management, including preoperative cardiovascular stabilization and intraoperative hemodynamic monitoring, is crucial in functional paraganglioma cases to prevent mortality and complications. https://aacc.tums.ac.ir/index.php/aacc/article/view/1206

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 26 28 Ebrahim Espahbodi Tehran University of Medical Sciences Mahsa Raji Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Reza Rahmani Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Saghar Samimi Department of Anesthesiology, Critical Care and Pain Management, Tehran University of Medical Sciences, Tehran, Iran Mehrzad Rahmanian Department of cardiac surgery, Tehran University of Medical Sciences, Tehran, Iran Ali Karbasforoshan Department of Cardiology, Zanjan University of Medical Sciences, Zanjan, Iran Mehdi Sanatkar Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran 2025 11 25 2025 12 01 Abstract Background: Refractory angina remains a major therapeutic challenge when revascularization options are unavailable. Stellate ganglion block (SGB) may reduce sympathetic tone, improve coronary perfusion, and alleviate ischemic chest pain. This study evaluated the effects of SGB on the severity of chest pain and ST-segment deviation during exercise testing. Methods: This before–and–after interventional study included patients with confirmed coronary artery disease and refractory angina. Baseline treadmill testing assessed angina index and ST-segment deviation. SGB was performed under ultrasound guidance using 0.25% bupivacaine and dexamethasone. Treadmill testing was repeated 24–48 hours after the block. Results: Sixteen patients participated (56% male; mean age 60.7±9.7 years). The angina index significantly improved (1.90±0.34 to 0.50±0.32; P < 0.001). ST-segment deviation decreased modestly but significantly (1.0±0.4 to 0.9±0.3 mm; P=0.041). No major complications occurred. Conclusion: SGB significantly reduced chest pain severity and improved ischemic ST-segment abnormalities in patients with refractory angina. It may serve as a safe and effective adjunct therapy. https://aacc.tums.ac.ir/index.php/aacc/article/view/1502

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 84 89 Masoomeh Tabari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Soheila Milani Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Malihe Aghasizadeh Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 05 22 2025 06 02 Background: The gut microbiome has emerged as a notable factor in the field of anesthesiology. It affects different dimensions of anesthesia outcomes, pain control, and recovery following the surgery. A comprehensive understanding of the interplay between gut microbiota and anesthetic methods is imperative for improving patient care. Methods: This narrative review synthesizes existing scholarly literature on the interactions between gut microbiota and anesthetic agents, examining their implications for drug metabolism, inflammatory responses, and the gut-brain axis. Results: It highlights clinical trials that explore the effectiveness of probiotics and prebiotics in reinstating microbial equilibrium and augmenting surgical outcomes. A study indicates that alterations in the composition of the gut microbiome can notably influence the pharmacokinetics and therapeutic efficacy of anesthetic agents. So, there are effects on dosage regimens and strategies for controlling postoperative pain. An equilibrated microbiome has been demonstrated to enhance anti-inflammatory mechanisms and bolster immune function; thus, it promotes an optimal recovery trajectory. Also, the gut-brain axis suggests that microbiome profiles may serve as predictors for postoperative cognitive dysfunction and pain perception. Conclusion: This review emphasizes the relevance of the gut microbiome within anesthesiology and advocates for the adoption of personalized anesthetic approaches that consider individual microbiome characteristics. Prospective research in this field holds significant potential for the development of innovative perioperative care strategies. It may enhance recovery and mitigate complications associated with surgical procedures. https://aacc.tums.ac.ir/index.php/aacc/article/view/1293

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 112 114 Parisa Sezari Department of Anesthesiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Firozeh Madadi Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sogol Asgari Department of Anesthesiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 01 2025 02 11 Intravenous cannulation can be a challenging issue in hospitalized patients, especially during the perioperative period. Objectives: In this study we will present our experience about an emergency popliteal vein cannulation during surgery. We successfully cannulated the popliteal vein in a prone position with an ultrasound guide in an emergency situation. Conclusion: The popliteal vein can be a safe intravenous access during surgeries in a prone position without significant adverse events. https://aacc.tums.ac.ir/index.php/aacc/article/view/1192

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 29 37 Vahid Saidkhani Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Kianoosh Bagheri Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Ali Khalafi Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Azita Zaheri Department of Anesthesiology, Faculty of Paramedical, Shahrekord University of Medical Sciences, Shahrekord, Iran. 2025 04 22 2025 04 24 Background: Concept mapping and debriefing are educational strategies used to create motivation and meaningful learning. This study compared the effect of teaching incorporating these two techniques on learning and achievement motivation in anesthesia management of neurosurgery among anesthesia students. Methods: This was a quasi-experimental study involving two experimental groups (concept mapping and debriefing) and one control group. The statistical population included all 5th- and 7th-semester undergraduate students of anesthesia at Ahvaz Jundishapur University of Medical Sciences. Census sampling yielded 51 participants, who were then randomly assigned to three groups: 17 in the concept mapping group, 17 in the debriefing group, and 17 in the control group. The experimental groups were exposed to group concept mapping and debriefing, while the control group received traditional instruction. Data were collected using the Hermans Achievement Motivation Questionnaire and a standard learning questionnaire. Data were analyzed using analysis of covariance (ANCOVA) and t-tests. Results: Covariance analysis demonstrated that teaching interventions, using both group concept mapping and debriefing, significantly increased achievement motivation and learning outcomes in anesthesia students (p < 0.05). Furthermore, concept mapping yielded a statistically significant increase in achievement motivation as well as meaningful and deep learning compared to debriefing. Regarding learning levels, after two months of intervention, students taught using concept mapping exhibited significantlyrnalTitle>Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 273 280 Ahmed Abdelmoniem Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. Mennatullah Abdel-Maksoud Critical Care and Intensive Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October, Egypt. Amr Elhadidi Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. Ahmed Battah Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. Doaa Moubarez Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. 2025 07 28 2025 08 11 Background: Accurate assessment of volume status in cases with acutely decompensated heart failure (ADHF) is crucial for prognostication and management. While brain natriuretic peptide (pro-BNP) and echocardiographic inferior vena cava (IVC) diameter are commonly used surrogate markers, their combined prognostic value has not been thoroughly established. Methods: This prospective cohort study included 100 adults with ADHF and reduced ejection fraction (EF <40%). Pro-BNP levels and IVC diameter were assessed on admission and after 72 hours. The primary outcome was in-hospital mortality; secondary outcomes included complications and 30-day cardiovascular mortality. Repeated measures ANOVA, ROC analysis, and correlation testing were performed to evaluate predictive value. Results: In-hospital mortality occurred in 21% of cases. Pro-BNP levels were significantly higher in non-survivors both on admission (median: 11,542 pg/mL vs. 6,350 pg/mL, p<0.001) and after 72 hours (3,695 pg/mL vs. 3,029 pg/mL, p<0.001). Similarly, IVC diameter was significantly greater in the mortality group at both time points (2.85 cm vs. 2.2 cm on admission, p<0.001; 2.15 cm vs. 1.9 cm after 72 hours, p=0.004). ROC analysis revealed strong predictive power for in-hospital mortality with admission Pro-BNP >8,856 pg/mL (AUC=0.89) and IVC diameter >2.55 cm (AUC=0.81). A combined model incorporating both parameters at admission yielded the highest diagnostic accuracy (AUC=0.89; NPV=95.4%). Conclusion: Pro-BNP and IVC diameter are independent yet complementary predictors of in-hospital mortality in ADHF. Combined early assessment significantly enhances risk stratification and may guide intensive monitoring and therapeutic strategies. https://aacc.tums.ac.ir/index.php/aacc/article/view/1359

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 02 02 281 287 EN Mohamed Abdalla Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Helen Rizk Critical Care and Intensive Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October City, Egypt. Hossam Mowafi Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Kamel Mohammed Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Mohamed Elansary Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 08 02 2025 08 11 Background: Intradialytic hypotension (IDH) is a common and serious complication of intermittent hemodialysis (IHD) in critically ill patients with acute kidney injury (AKI). Accurate pre-dialysis risk stratification remains a challenge, particularly in the ICU. This study aims to determine whether ultrasound-based cardiopulmonary profiles could predict IDH in this high-risk population. Methods: This prospective cohort study included 100 critically ill adults undergoing IHD for AKI. All patients underwent pre-dialysis echocardiography and lung/inferior vena cava (IVC) ultrasound to assess stroke volume, cardiac output, B-lines, and IVC collapsibility index (IVC-CI). Patients were divided into two groups based on the presence or absence of IDH. Results: IDH occurred in 35% of patients. Significant predictors of IDH included lower systolic blood pressure (124.86 ±16.02 vs. 139.92 ±22.8 mmHg, P < 0.001), higher IVC-CI [51% (13–58) vs. 27.38% (13–60), P < 0.001], sepsis (88.6% vs. 70.8%, P = 0.044), and elevated potassium (5.17 ±1.34 vs. 4.62 ±0.87 mmol/L, P = 0.015). Multivariate analysis identified IVC-CI (OR = 1.097, P < 0.001) and SBP (OR = 0.942, P = 0.001) as independent predictors. IVC-CI >49.5% predicted IDH with 68.6% sensitivity and 87.7% specificity (AUC = 0.757, 95% CI: 0.652–0.862). Conclusion: Ultrasound-derived IVC-CI is a valuable, noninvasive tool for predicting IDH in critically ill patients receiving IHD. Incorporating sonographic profiles into routine pre-dialysis evalua