Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2024 01 30 1 2 Zahid Khan Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran. 2024 01 30 No Abstract    No Abstract    No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/938

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 08 3 8 Komal Garg Department of Anaesthesia, SMS Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India. Samridhi Nanda Department of Anaesthesia, SMS Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India. Usha Bafna Department of Anaesthesia, SMS Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India. Chandan Mali Department of Anaesthesia, SMS Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India. Sumaila Naaz Department of Anaesthesia, SMS Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India. Nelwin Sabu Department of Anaesthesia, SMS Medical College and Hospital, Rajasthan University of Health Sciences, Jaipur, India. 2023 03 28 2023 05 29 Background: FESS has its share of complications which can be a challenge for both the surgeon as well the anesthetist and achieving a bloodless surgical field is essential So the principle of controlled hypotension can be used to combat this issue. Methods: A hospital-based randomized comparative interventional study was conducted on 60 patients to compare Clonidine (2mcg/kg in 10 ml of saline over 10 minutes before induction followed by an infusion of 1mcg/kg/hr during maintenance) and Esmolol (1mg/kg in 10 ml of saline over 10 minutes before induction followed by an infusion of 1mg/kg/hr during maintenance) to assess and compare the hypotensive properties of both the drugs. Results: After the induction of anesthesia, there was a significant difference in the mean heart rate, and mean arterial pressure between the two groups throughout the intraoperative period (p-value < 0.05). Both groups achieved a target mean arterial pressure (MAP) of 65-70 mmHg and improved surgical field quality. Conclusion: This study concluded that clonidine and esmolol both provide hemodynamic stability and a better surgical field in functional endoscopic sinus surgery (FESS). Clonidine also helps in achieving postoperative sedation and analgesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/729

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 09 09 91 93 Selvamani Subramanian Department of Anesthesiology, ACS Medical College and Hospital, MGR Educational and Research Institute (Deemed to be university), Chennai, India. Vasanthakumar Murugesan Department of Anesthesiology, ACS Medical College and Hospital, MGR Educational and Research Institute (Deemed to be university), Chennai, India. Gayathri Santhanam Department of Anesthesiology, ACS Medical College and Hospital, MGR Educational and Research Institute (Deemed to be university), Chennai, India. 2022 12 18 2023 02 06 Injury to the Recurrent Laryngeal Nerve is uncommon, but one of the complications of thyroidectomy We report a case of 40 years old female, who underwent total thyroidectomy, following which developed recurrent laryngeal nerve injury and vocal cord palsy, which was diagnosed immediately and managed successfully. https://aacc.tums.ac.ir/index.php/aacc/article/view/691

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 09 26 105 106 Mahtab Poor Zamany Nejat Kermany Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 04 13 2023 06 25    No Abstract    No Abstract   No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/738

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 09 05 9 14 Alireza Rahat Dahmardeh Department of Anesthesiology and Critical Care, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Masoum Khoshfetrat Department of Anesthesiology and Critical Care, Khatam-Al-Anbiya Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Mehdi Heidari Department of Anesthesiology and Critical Care, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. & Clinical Immunology Research Center, Ali IbneAbitaleb 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. 2023 01 16 2023 04 25 Background: Disorders of consciousness, including the vegetative state (VS) and the minimally conscious state (MCS) following brain damage and various complications for the patient, also have economic and social consequences. However, there is still no definitive or effective treatment for this condition. However, there is still no definitive or effective treatment for this condition. Therefore, this study aims to investigate the effectiveness of zolpidem in improving consciousness in patients with acute brain injury. Methods: The present quasi-experimental study was performed from 2020 to 2021 after obtaining the necessary permissions from Zahedan University of Medical Sciences, Iran. Eighty patients with acute brain injury who met the study inclusion criteria were recruited and randomized into zolpidem and placebo groups. In the zolpidem group, 10 mg zolpidem tablets were gavage twice daily. In the placebo group, a placebo tablet with the same appearance as zolpidem was gavage twice daily for 14 days. The consciousness level of patients was measured daily until the outcome (ICU discharge or expiration) was established. Eventually, a comparative data analysis was conducted to determine zolpidem's efficacy in enhancing consciousness, reducing mechanical ventilation duration, and improving patient outcomes. Results: The mean GCS score in the zolpidem group was 6.1±2.4 on admission and 11.6±3.8 at the end of the study, compared to 5.9±1.7 on admission and 11.3±2.8 at the end of the study, for the placebo group (p=0.154 and p=0.211, respectively). The mean duration of mechanical ventilation was 24.41±9.14 days in the zolpidem group and 23.16±10.72 days in the placebo group (P=0.529). Twenty-eight patients in the zolpidem group were discharged from ICU, and 12 expired. For the placebo group, 26 patients were discharged from ICU, while 14 were expired (p=0.87). No statistically significant difference was found in any of the measured variables between the two groups. Conclusion: The results have shown that zolpidem administration had no statistically significant effect on improving the level of consciousness and reducing mechanical ventilation duration and clinical outcomes in acute brain injury patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/700

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 09 26 94 96 EN Naeemeh Dini Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Zahra Jahangard- Rafsanjani Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Mamak Tahmasebi Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. 2023 01 17 2023 03 26 Pain is an unpleasant experience and a subjective term that is associated with tissue damage. Cancer patients experience pain for a myriad of reasons, from disease related to treatment causes and unrelated to both of these categories. Opioids are the mainstay in the treatment of moderate to severe cancer pain. Progressive opioid dose increases can cause opioid-induced hyperalgesia (OIH). OIH has no definite management, here we present a 47-year-old cancer patient with OIH and her management. https://aacc.tums.ac.ir/index.php/aacc/article/view/701

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 08 15 23 Vinay Sharmal Department of Anesthesiology, Dr S N Medical College, Jodhpur, India. Pratima Yadav Department of Anesthesiology, SMS Medical College, Jaipur, India. Mathura Tak Department of Anesthesiology, Dr S N Medical College, Jodhpur, India. 2023 01 18 2023 04 18 Background: Although nerve block facilitatory effects of dexmedetomidine when used as a perineural adjunct to local anesthetics in supraclavicular brachial plexus blocks are well recognized in multiple studies, but whether this action is at directly on peripheral nerve fibers or is at central level after systemic absorption is unclear. Aim of this study was to evaluate the effect of adding dexmedetomidine 1 microgram/kg to ropivacaine 0.5% in supraclavicular brachial plexus block in terms of duration of analgesia and 24hour cumulative analgesic requirement and to test the hypothesis whether the effect of dexmedetomidine, is due to direct local action on nerve plexus or is centrally mediated after systemic absorption. Methods: 105 patients of ASA grade I and II of either sex undergoing upper limb orthopedic surgeries were divided in 3 groups of 35 patients in each group. Group Rc (control group) received supraclavicular block with 30ml of 0.5% ropivacaine and intravenous infusion of 30ml of normal saline; group RDexP received supraclavicular block with 30ml solution of 0.5% ropivacaine+ dexmedetomidine 1mcg/kg and intravenous infusion of 30ml of normal saline; and group RDexIV received supraclavicular block with 30ml of 0.5% ropivacaine and intravenous infusion of 30ml of normal saline solution containing dexmedetomidine 1mcg/kg. Primary outcome was duration of analgesia and 24hour cumulative analgesic requirement. Results: The demographic data were comparable in all three groups. Duration of analgesia was longest in group RDexP followed by group RDexIV and least in control group. 24hour cumulative analgesic requirement was least in group RDexP and maximum in group R. 2 patients, one from each group RDexP and group RDexIV reported bradycardia and 6 patients from group RDexIV reported hypotension. Conclusion: We conclude that action of dexmedetomidine is most probably peripheral on brachial plexus nerve fibers directly rather than centrally mediated after systemic absorption. https://aacc.tums.ac.ir/index.php/aacc/article/view/703

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 27 97 100 Manjunatha Munivenkatappa Department of Anesthesiology, Bangalore Medical Colllege and Research Institute, Bengaluru, India. Sudha Kondi Department of Anesthesiology, Bangalore Medical Colllege and Research Institute, Bengaluru, India. Bhaskar Bhaskar Department of Anesthesiology, Bangalore Medical Colllege and Research Institute, Bengaluru, India. Dayanand Parvathamma Department of Anesthesiology, Bangalore Medical Colllege and Research Institute, Bengaluru, India. 2023 01 21 2023 03 26 Huge head and neck tumors are known to cause difficult ventilation and difficult intubation. Edentulous mouth can result in difficult mask ventilation. Head and neck tumor resections can also present hemodynamic challenge, due to their proximity to large vessels. We herein report a clinical case of difficult ventilation due to large parotid tumor in an edentulous patient. https://aacc.tums.ac.ir/index.php/aacc/article/view/705

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 09 28 24 29 Chake Maria Josiane Bekoin-Abhe Multipurpose Intensive Care Unit of Cocody University Hospital, Cocody, Abidjan, Côte d'Ivoire. Goulai Bi You Etienne Bazago Multipurpose Intensive Care Unit of Cocody University Hospital, Cocody, Abidjan, Côte d'Ivoire. Coulibaly Klinna Théodore Multipurpose Intensive Care Unit of Cocody University Hospital, Cocody, Abidjan, Côte d'Ivoire. Mobio Michael Paterne Multipurpose Intensive Care Unit of Cocody University Hospital, Cocody, Abidjan, Côte d'Ivoire. Bedié Yao Vianney Multipurpose Intensive Care Unit of Cocody University Hospital, Cocody, Abidjan, Côte d'Ivoire. 2023 01 21 2023 03 26 Background: Cardiac arrest in the operating room (CAO) is a serious accident of often rare epidemiology. Methods: Retrospective, descriptive and analytical study from 2012 to 2021 in the multipurpose intensive care unit of the Cocody University Hospital in Abidjan, including all patients who presented a recovered CAO. Results: The prevalence was 1.5% (89 out of 5730 admissions). The mean age was 33.5 ± 26 years (13-81). The sex ratio was 0.1. The medical history was mostly hypertension (22.5%). Patients were classified ASA ≥ III (52.8%) for urgent surgery (52.8%) under spinal anesthesia (56.6%). CAO occurred mostly at anesthetic induction (44.3%). The causes were mainly persistent arterial hypotension (54.7%) and hemorrhagic shock (30.2%). Medical CPR was performed in 94.8% of cases in the operating room before transfer to the intensive care unit. The mean duration of LowFlow was 4.5±1.8 minutes (3-12). On admission, the mean Glasgow score was 6.3±4.4 (3-11). Treatment consisted of continued CPR. The mean stay was 3.1±2.9 minutes (1-12). The death rate was 60.4%. ASA class >3, urgent procedure, general anesthesia, presence of NA alone, Gl score ≤ 7, and Low Flow duration> 5 minutes were predictive of mortality (p < 0.05). Conclusion: strengthening of material resources and continuous training in extreme emergency situations for anesthesia personnel could optimize the prognosis of CAO https://aacc.tums.ac.ir/index.php/aacc/article/view/704

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 08 101 104 EN Man Mahajan Department of Anesthesiology, Sawai Man Singh Medical College, Jaipur, India. Mamta sharma Department of Anesthesiology, Sawai Man Singh Medical College, Jaipur, India. Rupali Mahajan Department of Anesthesiology, Civil Hospital, Fazilka, India. 2023 02 02 2023 03 25 Parapharyngeal tumors often distort the airway anatomy leading to obstruction and hinderance for intubation thus posing a challenge for the anesthetist at securing airway with least damage to the nearby structures. We present our experience through a series of 5 such cases in children managed successfully using video laryngoscope. Working in places where availability of advanced airway equipment such as pediatric size fiberoptic is unavailable, a video laryngoscope can help to appropriately assess the airway and prevent disastrous outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/670

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 09 22 30 35 Anjane Sree Surendran 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. Rupesh Yadav Department of Anesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India. 2023 03 31 2023 05 29 Background: Accurate assessment of intravascular volume status is a vital aspect of management of intensive care unit (ICU) patients. Inferior vena cava (IVC) diameter and IVC collapsibility index have surfaced as promising methods to accurately predict hypovolemia. But no such study has evaluated it’s their utility in postoperative patients. Methods: The study aimed to assess the correlation between ultrasound guided IVC collapsibility index (IVC CI) and CVP for volume status in intensive care unit patients. Hundred spontaneously breathing patients receiving postoperative care in our surgical ICU between November 2019 to march 2021were enrolled into the study. Maximum IVC diameter (IVCdmax) at end-expiration, minimum IVC diameter at end-inspiration (IVCdmin) and IVC CI were measured. Simultaneous CVP recordings were obtained. Results: A positive correlation was noted between IVC maximum diameter and CVP (p = <0.001) and between IVC Minimum Diameter and CVP. (p = <0.001) A negative correlation between IVC CI and CVP was seen (p = <0.001). Mean IVC CI was highest in the hypovolemic group. The area under the ROC curve (AUROC) for IVC CI predicting hypovolemia was 0.943 (95% CI: 0.9 - 0.986), thus demonstrating excellent diagnostic performance. At a cut off of ≥58.416%, IVC CI predicts hypovolemia with a sensitivity of 93.8%, and a specificity of 84%. Conclusion: IVC CI can be used to guide fluid therapy due to its excellent diagnostic accuracy in predicting hypovolemia in postoperative patients in ICU. https://aacc.tums.ac.ir/index.php/aacc/article/view/731

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 12 36 42 Priya Nair Department of Anaesthesiology, Shri B.M.Patil Hospital(B.L.D.E.U), Vijayapura, Bharat, India. Sridevi Mulimani Department of Anaesthesiology, Shri B.M.Patil Hospital(B.L.D.E.U), Vijayapura, Bharat, India. Jyoti Mantur Department of Anaesthesiology, Shri B.M.Patil Hospital(B.L.D.E.U), Vijayapura, Bharat, India. Anusha Suntan Department of Anaesthesiology, Shri B.M.Patil Hospital(B.L.D.E.U), Vijayapura, Bharat, India. 2023 01 30 2023 03 25 Background: Unanticipated difficult intubation poses a challenge in routine practice for anaesthesiologists. A preoperative airway evaluation helps in the identification of a difficult airway. Airway assessment with ultrasound is a modality recently being used to predict difficult airway. In this study we evaluate ultrasonography parameters with conventional clinical parameters for predicting difficult airway in adults undergoing elective surgeries. Methods: This cross sectional randomised clinical trial analyses ASA class 1 and 2 adults requiring endotracheal intubation for surgeries under general anaesthesia were enrolled following which Modified Mallampatti score and thyromental distance as well as ultrasound distance to epiglottis (DSE) and distance to hyoid bone (DSHB) were measured and based on Cormack Lehane grading they were categorised into easy and difficult airway groups. Results: DSE had the highest sensitivity of 90.48% whereas Modified Mallampatti grading had least sensitivity of 66.67%. Conclusion: The results of this study showed that ultrasonographic measurements at the thyrohyoid and hyoid level have higher sensitivity and specificity than the clinical parameters for airway assessment. https://aacc.tums.ac.ir/index.php/aacc/article/view/708

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 21 43 48 Pranab Kalita Department of Anaesthesiology and Critical Care, Gauhati medical College and Hospital, Srimanta Sankaradeva University of Health Sciences, Guwahati, India. Prishel Prasad Department of Anaesthesiology and Critical Care, Gauhati medical College and Hospital, Srimanta Sankaradeva University of Health Sciences, Guwahati, India. Biswajit Talukdar Department of Anaesthesiology and Critical Care, Gauhati medical College and Hospital, Srimanta Sankaradeva University of Health Sciences, Guwahati, India. Priyam Saikia Department of Anaesthesiology and Critical Care, Gauhati medical College and Hospital, Srimanta Sankaradeva University of Health Sciences, Guwahati, India. 2023 01 31 2023 04 18 Background: Both ketamine and dexmedetomidine have proven effective in relieving the pain resulting from propofol injection. However, studies comparing them directly are limited. The primary outcome was to compare the incidence of propofol injection pain after dexmedetomidine pretreatment with ketamine pretreatment. Secondary outcome was to study the changes of haemodynamic parameters that arise after the administration of the pretreatment drug till anaesthesia was induced with propofol. Methods: In this randomized, triple blinded, parallel arm single centre study, we compared pre-treatment with dexmedetomidine 0.5mcg/kg (Group A) and ketamine 0.5mg/kg (Group B). Our primary objective was to compare the incidence of propofol injection pain. The McCririck and Hunter scale was used to evaluate the pain. Secondarily, we compared the changes of haemodynamic parameters that arose after the administration of the pre-treatment drug till induction of anaesthesia with propofol. Results: Among 168 patients evaluated for eligibility, 140 were included for final analysis with 70 patients in each group. The incidence of propofol injection pain in Group A was 74.3% (52/70) and that in Group B was 42.9% (30/70) (p value <0.001). No pain was reported by 25.7% (18/70) and 57.1% (40/70) patients in Group A and B respectively. Mild and moderate to severe pain was experienced by 58.6% and 15.7% patients in Group A, where as it was 40% and 2.9% patients in Group B respectively. Conclusion: Ketamine leads to a greater reduction in both the frequency and intensity of pain resulting from propofol injection when compared to dexmedetomidine. https://aacc.tums.ac.ir/index.php/aacc/article/view/709

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 21 49 54 Jyoti Kale Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. Neha Panse Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. Priyanka Gangathade Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. Aniket Shete Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, India. 2023 02 11 2023 04 25 Background: Intraoperative stress response and ongoing bleeding at surgical site especially in areas like head and neck can cause serious adverse reactions and affect the postoperative outcome. This study compared the effect of intranasally administered dexmedetomidine (dexmed) in combination with local anesthesia (LA) and local anesthetic alone on quality of surgical field, surgical bleeding and haemodyanamic parameters during functional endoscopic sinus surgery (FESS). Methods: Roller gauge strips dipped in dexmedetomidine were used for nasal packing. Sixty patients undergoing FESS were randomly allocated to receive either intranasal Dexmedetomidine with LA (D group) or intranasal LA alone (L group) via nasal packing 15 min before surgery. The primary objective was to study the quality view of surgical field through the endoscope and the blood loss that occurred while raising the nasal mucosal flap. The secondary objective was to study the intraoperative hemodynamic profile and anesthetic and analgesic requirement during surgery. Results: Surgical field quality, Blood loss, hemodynamic profile and satisfaction scores of patients and surgeons were significantly better (P< 0.05) in dexmed group. Conclusion: Patients receiving intranasal dexmed with LA for FESS had better surgical field, surgeon’s satisfaction and minimal hemodynamic fluctuations with lesser blood loss as well as better postoperative comfort and analgesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/713

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 10 06 55 59 Mahima Balakrishnaiah Department of Anaesthesiology, MVJ Medical College & Research Hospital, Hoskote, Karnataka, India. Karthik Sheshadri Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Sudheer Ramegowda Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Rahul Srinivasan Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Raghavendra Ullas Lolakrishna Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Monisha T Sambandam Department of Anaesthesiology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. 2023 02 15 2023 04 18 Background: Ropivacaine is an amino-amide local anesthetic, extensively used for peripheral nerve blocks, numerous adjuvants have been added to Ropivacaine to prolong the duration of analgesia. Aim: To compare the effectiveness of adding Dexamethasone to Ropivacaine versus adding Clonidine to Ropivacaine in ultrasound guided supraclavicular brachial plexus block in terms of analgesic duration, onset & duration of sensory and motor blockade. Methods: A prospective randomized single blinded study carried out in 70 patients of ASA grade I and II, aged 20 to 60 years scheduled for elective upper limb orthopedic surgeries. Patients were randomly allocated into two groups, Group RC - patients received 20ml of 0.75% ropivacaine along with 1mcg/kg of clonidine diluted to 2ml of normal saline, Group RD - patients received 20ml of 0.75% ropivacaine along with 8mg of dexamethasone (2ml). Statistical Analysis: Onset & duration of sensorimotor blockade, duration of analgesia was assessed by Unpaired t-test. If p-value <0.05, results were statistically significant & p-value <0.001 were highly significant. Results: Duration of analgesia is superior and statistically significant in Group RD (1,172.57± 18.37 vs 931.09± 16.3). Onset time for sensory (3.14 ± 1.00 vs 9.71± 1.23) and motor (7.60 ± 1.54 vs 13.66± 1.03) block is rapid in Group RD. Duration of sensory (1,106.57± 20.28 vs 786.26± 31.43) and motor (997.74 ± 24.9 vs 674.57 ± 2.18) block is enhanced in Group RD Conclusion: Dexamethasone as an adjuvant to ropivacaine provided superior post-operative analgesia, faster onset and longer duration of sensory and motor blockade. https://aacc.tums.ac.ir/index.php/aacc/article/view/716

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 1 2023 11 03 60 65 Mohsen Mousavi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Atef Yekta Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arash Heroabadi Department of Anesthesiology, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2023 02 28 2023 04 18 Background: Propofol is one of the most widely used medications in anesthesia and intensive care. Propofol Intravenous injection is painful for patients at the injection site. The aim of this study was to determine the effect 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 Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reihaneh Hosseini Department of Obstetrics and Gynecology, Arash women’s hospital, Tehran University of Medical Sciences, Tehran, Iran 2023 04 29 2023 06 25 Background: Although epidural analgesia (EA) is a popular and effective method for pain relief during labor, significant controversy exists in terms of the impact of EA on labor outcomes and the best time for initiation of EA. Here, we aim to explore the effects of early initiation EA on the labor process in nulliparous at-term pregnant women. Methods: A total of 240 nulliparous women enrolled in this study. The early epidural (EE) group (n=120) consisted of women in the latent phase of labor and the late epidural (LE) group (n=120) were in the active phase of labor. Each group received 16 ml of 0.125% preservative-free isobaric bupivacaine with 50 µg fentanyl (total: 17 ml) as a primary bolus dose in the epidural space for labor analgesia and an intermittent bolus of 5-10 ml of the primary solution was administered via a catheter. The length of labor, rate of cesarean section (CS), neonatal well-being, and infant Apgar scores were recorded. Results: There were no statistically significant differences between the two groups regarding the duration of the first (p=.43) and second (p=.54) phases of labor. No statistically significant differences were observed between the two groups in terms of the rate of CS (p=.21), causes for CS (p=.24), and neonatal Apgar scores (p=0.84). Conclusion: Initiation of EA during early labor did not result in increased CS or instrumental vaginal deliveries, and did not prolong labor duration. https://aacc.tums.ac.ir/index.php/aacc/article/view/753

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 2 2024 01 29 164 169 Mangal Ahlawat Department of Anesthesiology, Pt. B D Sharma PGIMS, Rohtak, Pt BDS University of Health Sciences, Rohtak (Haryana), India. Geeta Ahlawat Department of Cardiac Anesthesia, Pt. B D Sharma PGIMS, Rohtak, Pt BDS University of Health Sciences, Rohtak (Haryana), India. Aakanksha Saharan Department of Anesthesiology, Pt. B D Sharma PGIMS, Rohtak, Pt BDS University of Health Sciences, Rohtak (Haryana), India. Manju Bala Department of Anesthesiology, Pt. B D Sharma PGIMS, Rohtak, Pt BDS University of Health Sciences, Rohtak (Haryana,) India. Kirti Kshetrapal Department of Anesthesiology, Pt. B D Sharma PGIMS, Rohtak, Pt BDS University of Health Sciences, Rohtak (Haryana), India. Renu Bala Department of Anesthesiology, Pt. B D Sharma PGIMS, Rohtak, Pt BDS University of Health Sciences, Rohtak (Haryana), India. 2023 05 01 2023 07 03 Background: Radial arterial cannulation is a commonly done procedure in ICU. Multiple cannulation attempts can lead to radial artery spasm resulting in low pulse volume, decreased pulse palpability and cannulation failure. This study evaluates the effects of periarterial nitroglycerine infiltration with lignocaine vs lignocaine alone in USG guided radial artery cannulation in ICU patients. Methods: A total of 60 ICU patients in age group 18-65 years who required radial artery cannulation for ABG analysis and invasive blood pressure monitoring were enrolled. They were randomly allocated to Group LN (periarterial infiltration with 0.2ml nitroglycerine+0.8 ml lignocaine 2%) and Group L (periarterial infiltration with 1ml of lignocaine 2%) of 30 patient each. Both groups were compared with respect to radial artery dimensions before and after infiltration of drug, pulse palpability score, no of attempts, time of cannulation and failure rates. Results: There was significantly greater increase in radial artery dimensions in group LN as compared to group L after intervention. Pulse palpability score was also better in group LN. Mean time required for cannulation, number of attempts and insertion failure were significantly lesser in group LN as compared to another group. No hemodynamic adverse effect was reported in either group. Co