Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 11 422 429 Payal Yadav Department of Anesthesiology, Chirayu Private Hospital, Jaipur, India. Dhwani Trambadia Department of Anesthesiology, Pandit Deen Dayal Medical Hospital, Rajkot, India. Bhakti Rajani Department of Anesthesiology, Pandit Deen Dayal Medical Hospital, Rajkot, India. Deepshikha Tripathi Department of Anesthesiology, Byramjee Jeejobhoy Medical Hospital, Ahemdabad, India. Sargunaraj Ayanar Department of Anesthesiology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. Aarti Vaghasia Department of Anesthesiology, Harmony Private Hospital, Ahemdabad, India. 2023 11 23 2023 12 12 Background: A Caudal epidural block is considered as one of the most common regional techniques in pediatric anesthesia. The latest addition to the group of adjuvants for caudal analgesia is α2 agonists namely Clonidine and Dexmedetomidine. This study includes a comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in caudal epidural anesthesia for postoperative pain relief in the pediatric population. Methods: This study was performed on 60 children, aged 1 year to 6 years, of ASA physical status I and II, undergoing elective infra-umbilical surgeries under general anesthesia. The patients were assigned randomly into two groups of 30 patients each, caudal epidural was given in all patients according to their group, after giving general anaesthesia. Group A (n=30) - patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Dexmedetomidine. Group B (n=30)- patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Clonidine. The patients were observed postoperatively for the duration and effect of caudal analgesia, (using the CHEOPS Score - Children’s Hospital of Eastern Ontario Pain Scale), frequency and total dose of supplementary analgesic required, sedative effect (Modified Ramsay Sedation Score), perioperative hemodynamic parameters, and complications. Results: The duration of Caudal analgesia without the need of supplementary analgesic is significantly higher in dexmedetomidine group (743 ± 73.6 min) than clonidine group (181.7 ± 53.60 min) and the total dose of supplementary analgesic (Inj. Paracetamol 15mg/kg i.v) required is significantly higher in clonidine group (491.5 ± 134.55 mg) as compared to dexmedetomidine group (236.5 ± 113.68 mg). Conclusion: Addition of dexmedetomidine (0.5 mcg/kg) to caudal 0.125% bupivacaine (1ml/kg) produces a significantly longer duration of postoperative analgesia, less frequency, and dose of rescue analgesic required for postoperative analgesia in children, aged between 1 to 6 yrs as compared to a similar dose of clonidine used in caudal epidural for infra umbilical surgeries. https://aacc.tums.ac.ir/index.php/aacc/article/view/901

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 05 02 505 514 Alireza Babajani Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran. Atiyeh Sadat Sajadi Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran Zahra Pirdadeh Beiranvand Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran. Shaghayegh Taghizadeh Department of Anesthesia, Faculty of Paramedical Sciences, Guilan University of Medical Sciences, Rasht, Iran. Parisa Moradimajd Department of Anesthesia, Allied Medical School, Iran University of Medical Sciences, Tehran, Iran. 2023 12 19 2024 01 14 The safety of the beating heart is a health service that means the absence of clinical errors during the implementation of health care. The period of anesthesia is identified as one of the most critical phases for patients requiring general anesthesia, carrying the potential for critical clinical errors that may have irreversible consequences. This study's main objective was to conduct a concise assessment of the anesthesia checklists utilized to enhance patient safety during general anesthesia procedures. To accomplish this, a comprehensive search was conducted using relevant keywords spanning from 1990 to 2023 across databases including PubMed, Springer, Google Scholar, Web of Science, Scopus, online libraries, and the Cochrane library. Initially, 188 studies were identified at the outset of the research, and among these, 13 studies that focused on the development of checklists for anesthesia safety were scrutinized. Included articles were reviewed separately and divided into 3 categories; Specific vs. Generalized Scope, Single-Stage vs. Multi-Stage, Single-Factor vs. Multi-Factor. According to the findings from these studies, the systematic and proper utilization of all available checklists can contribute to improved safety. However, due to the specialization of surgical procedures and the increasing emphasis on patient safety over the past decade, there has been a shift in the compilation of anesthesia checklists from being broad and general to becoming specific, transitioning from single-stage to multi-stage, and evolving from single-factor to multi-factor checklists. https://aacc.tums.ac.ir/index.php/aacc/article/view/914

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 05 02 515 522 Hojat Rastegari Department of Emergency Medicine, Khatami AL Ambiance 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. 2024 01 12 2024 01 30 Tension pneumothorax (TPT) in trauma patients is an uncommon disorder caused by the progressive accumulation of air in the pleural cavity. In pre-hospital and emergencies, if it is not diagnosed and treated on time, it endangers the lives of patients. In this study, we report a patient who developed tension pneumothorax and extensive subcutaneous emphysema due to mild trauma and not going to the hospital in the early hours, which caused an anaphylactic appearance on the patient's face. https://aacc.tums.ac.ir/index.php/aacc/article/view/930

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 05 653 653 EN Maryam Vosoughian Anesthesiology Research Center, Department of Anesthesiology & Critical Care, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mastaneh Dahi Anesthesiology Research Center, Department of Anesthesiology & Critical Care, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 12 03 2023 12 18 No Abstract    No Abstract    No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/653

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 11 430 439 Seyed Babak Mojaveraghili Department of Anaesthesiology & Intensive care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Fatemeh Talebi Department of Anaesthesiology & Intensive care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Nasser Behnampour Department of Public Health, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran. 2023 12 14 2023 12 28 Background: Control of hemodynamic changes and blood loss is a daily challenge in general anesthesia for patients undergoing septorhinoplasty. This study aimed to evaluate the effects of magnesium sulfate and clonidine on the control of hemodynamic factors and bleeding volume during this procedure. Methods: This double-blind, randomized clinical trial study was conducted on 60 patients undergoing septorhinoplasty at 5th Azar Medical & Educational Centre of Gorgan in 2021-2022. Patients were divided into two intervention groups (50 mg/kg of magnesium sulfate) and control group (5 μg/kg of clonidine) with permutation random block allocation. All patients underwent induced hypotension. Before induction of anesthesia and every 5 minutes afterwards, blood pressure was recorded. Blood loss volume was calculated at the end of the surgery. Results: In the magnesium group, 36 individuals were evaluated, while in the clonidine group, 24 individuals were examined. There were no statistically significant differences in baseline characteristics of patients in the two groups and the duration of surgery. Both drugs were equally effective in inducing hypotension, however blood pressure changes in magnesium group were more trivial than clonidine group. The bleeding volume in the magnesium sulfate and clonidine groups was 139.44 ml and 141.25, respectively and this difference was not statistically significant (p-value=0.634). Conclusion: The results of this study showed that magnesium sulfate can be effectively used as an alternative to clonidine in controlling hemodynamic changes and ultimately reducing blood loss volume during septorhinoplasty surgery. In addition, magnesium is at least as effective as clonidine in stabilizing hemodynamic changes. https://aacc.tums.ac.ir/index.php/aacc/article/view/908

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 05 523 525 Manoj Katewa Department of Anaesthesiology and Critical Care, Pt. B.D.Sharma PGIMS, Rohtak, India. Rashmi Rashmi Department of Anaesthesiology and Critical Care, Pt. B.D.Sharma PGIMS, Rohtak, India. Arvind Kumar Department of Radiodiagnosis, SMS Medical College, Jaipur, India. Manisha Kumari Department of Anaesthesiology and Critical Care, Pt. B.D.Sharma PGIMS, Rohtak, India. 2023 12 17 2024 01 14 Aspiration under general anaesthesia is a dreaded complication which can significantly affects the morbidity and mortility in the postoperative period. Factors such as delayed gastric emptying seen in obesity, pregnancy, paralytic ileus, altered consciousness as under general anaesthesia, head injury can predispose the patient to pulmonary aspiration. The two entities aspiration pneumonia and aspiration pneumonitis although difficult to differentiate in the early course of event but it is of crucial importance to know the pulmonary pathology for effective management of the patient. A morbidly obese patient was posted for fracture humerus surgery under GA who landed in cannot ventilate situation, had pulmonary aspiration which was managed efficiently in ICU. https://aacc.tums.ac.ir/index.php/aacc/article/view/912

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 11 440 445 Faranak Behnaz Department of Anesthesiology, Anesthesiology Research Center, Shohada -e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Rahmatollah Mohammadzadeh Namaghi Department of Anesthesiology, Anesthesiology Research Center, Shohada -e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gholmreza Mohseni Department of Anesthesiology, Anesthesiology Research Center, Shohada -e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Meisam Jafari Kafiabadi Department of Orthopedic Surgery, Clinical Research Center Development Unit of Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 09 23 2023 10 09 Background: The purpose of this study is to investigate the rate of allogeneic transfusion after the administration of intravenous iron in patients who are candidates for intertrochanteric fracture surgery. Methods: Patients who were candidates for intertrochanteric surgery referred to the orthopedic surgery and trauma department of Shahada Tajrish Hospital were included in the study after providing full explanations and obtaining written consent. The 80 patients were randomly divided into control group (No: 40) and intervention (No: 40). Patients in the intervention group were prescribed 600 mg of Venofer drug by ViforCo. This is while patients in the control group were not injected with Venofer before surgery. The results were evaluated using t-test and SPSS21 software. Results: Based on the results, the 1 hour after surgery, three indicators of systolic blood pressure, pulse rate, breathing rate, RBC showed a significant decrease in patients undergoing intervention (P<0.05). However, the oxygenation index showed a significant increase in the patients of this group (P>0.05). Meanwhile, in the period of 1 week after the surgery, we also see a significant decrease in the two indices of average hemoglobin and PTT time in the mentioned patients compared to the control subjects (P=0.030, P=0.037). The amount of blood consumed significantly lower in the patients of the intervention group than in the control group. Conclusion: The administration of injectable iron in patients with intertrochanteric fracture surgery candidates can improve some of the patients' clinical indicators in addition to a significant reduction in allogeneic blood transfusion. https://aacc.tums.ac.ir/index.php/aacc/article/view/869

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 Supp. 1 2024 03 05 526 529 Bhavani Vaidiyanathan Department of Anaesthesiology, Indiragandhi Medical College & Research Institute, Kathirkamam, India. Saravanakumar Sundaresan We obtained the variance of the research using the binomial distribution. In addition, heterogeneity of research was done by the I2 index. We evaluated the information using a random effects model. Results: The results indicated that the mentoring program included three stages: “Targeting and Familiarization with the Implementation of the Mentoring Program,” “Mentoring Program Implementation,” and “Evaluation of the Mentoring Program.” The Traditional One-to-One Mentoring Program, the Peer Mentoring Program, and the Distance Education Mentoring Program were some of the ways that the plan was put into action. Conclusion: Mentoring is perceived as an important part of academic medicine, but the evidence to support this perception is not strong. https://aacc.tums.ac.ir/index.php/aacc/article/view/1122

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 02 18 599 602 Nahid Manoucherian Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran. Pegah Arman Department of Anesthesiology, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. Parastoo Rahmati Torkashvand Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran. Younes Barazesh Department of Anesthesiology, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2024 11 04 2024 11 30 A 45-year-old male patient was diagnosed with papillary thyroid cancer and was scheduled for total thyroidectomy. Three months before, he had undergone laryngeal surgery for squamous cell carcinoma of the larynx. Before the operation, an internal consultation was performed and no respiratory or cardiac complications were reported. Upon visiting Besat Hospital, the patient's vital signs were stable. Establishing a safe airway due to tracheostomy breathing was a challenge. But after consultation with the anesthesia team, the endotracheal tube was successfully inserted. This surgery lasted for 5.5 hours smoothly and without complications. The patient was transferred to the intensive care unit after the operation and was discharged in a stable condition after recovery. https://aacc.tums.ac.ir/index.php/aacc/article/view/1121

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 27 455 461 Alireza Shakeri Anesthesiology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Fathi Critical Care Quality Improvement Research Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Parisa Sezari Anesthesiology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. & Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Marzie Shahrabi Department of Anesthesiology and Critical Care, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Maede Karimian Department of Anesthesiology and Critical Care, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zahra Bahramzadehharsini Students Research Committee, School of Medicine, Xi’an Jiaotong University, Xi’an, China. Amin Magsudy Department of Medical Science, Islamic Azad University Tabriz Branch, Iran. Mohsen Ariannik Department of Anesthesiology, Taleghani General Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Maryam Baniani Department of Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gandom Sedehi Anesthesiology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 12 03 2025 01 29 Background: Radical cystectomy (RC) remains the standard of care for high-risk bladder cancer despite being associated with elevated perioperative morbidity. The procedure commonly results in substantial intraoperative blood loss, frequently requiring perioperative blood transfusions (PBT), which are associated with adverse events including transfusion-related complications and heightened healthcare expenditures. Pharmacological interventions such as tranexamic acid (TXA) and fibrinogen may decrease transfusion requirements, though TXA's potential thrombogenic effects raise safety concerns. This randomized controlled trial (RCT) aims to investigate the efficacy of combined fibrinogen and TXA delivery protocol in minimizing surgical blood loss and enhancing postoperative recovery in RC patients. Methods: This randomized controlled trial (RCT) enrolled 140 participants scheduled for elective radical cystectomy (RC) procedures. Eligible individuals were randomly allocated to four study arms: one administered fibrinogen concentrate, a second receiving tranexamic acid (TXA), a third assigned to a lower-dose combination of both agents, and a control group receiving placebo. Primary outcomes evaluated perioperative blood loss (intraoperative and postoperative), while secondary outcomes encompased vital physiological markers and the incidence of postoperative adverse events. Results: Patients administered fibrinogen, TXA, or a combination of both demonstrated a marked decrease in postoperative hemorrhage (1,437–1,463 mL vs. 2,727 mL in controls). Furthermore, surgical timeframes showed significant contraction in the intervention groups (4.76–4.79 hours) compared to controls (5.58 hours). These treatments were also associated with shorter hospital stays and reduced transfusion volumes of packed red blood cells and fresh frozen plasma (FFP). No statistically significant variations in acidosis or hemoglobin concentrations were observed across groups. Conversely, fibrinogen and TXA delivery protocol substantially elevated fibrinogen levels, though no clinically relevant differences emerged between the intervention patient groups. Conclusion: The trial demonstrates that adjusting fibrinogen and TXA dosage protocols effectively reduces surgical bleeding during radical cystectomy. While combination therapy showed comparable efficacy to individual agents, these pharmacological strategies decreased transfusion dependency and hospitalization duration without increasing thromboembolic risks. https://aacc.tums.ac.ir/index.php/aacc/article/view/1151

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 11 579 584 Alireza Sharifian Attar Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Pouria Namaee Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Shima Sheybani Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Masoumeh Tabari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmoudreza Moharreri Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Moradi Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. & Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2024 11 17 2024 11 20 Background: Scorpion stings have been reported to induce inadequate block or block failure in local anesthesia. The present study has reviewed the resistance to local anesthetics in patients with a history of scorpion stings. Methods: Articles from domestic and foreign journals in databases such as SID, IranMedex, Magiran, Uptodate, Google Scholar, Cochrane, Scopus, and Web of Science from 2010-2024 were searched, and ultimately 13 related high-quality articles based on STROBE were included in this review. Results: According to the results of the included studies, which have dealt with scorpion sting cases and resistance to local anesthetics, patients with a history of scorpion stings experience significantly prolonged times of onsets for both sensory and motor blocks and the peak of sensory and motor blocks. Some of these patients have failed/inadequate sensory and motor block. Conclusion: According to the mentioned materials, the prevalence of resistance to local anesthetics is higher in patients with a history of scorpion stings. https://aacc.tums.ac.ir/index.php/aacc/article/view/1131

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 05 603 605 Sogol Asgari Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Parisa Sezari Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Morteza Mortazavi Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faranak Behnaz Department of Anesthesiology, School of Medicine Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 12 02 2024 12 23 Neuromuscular disorders are a wide range of conditions that weaken muscles. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an uncommon acquired immune-mediated prejunctional disorder that is not caused by an injury. This case report presents the anesthetic management of a 48-year-old male patient diagnosed with CIDP who required an emergency umbilical herniorrhaphy. The patient, weighing 95 kg and with a height of 172 cm, presented with acute abdominal pain, nausea, and vomiting, and had a notable history of intravenous immunoglobulin (IVIg) treatment and oral opium addiction. Anesthesia was induced using rapid sequence induction techniques, and general anesthesia was maintained with total intravenous anesthesia (TIVA). The operation was completed without complications, despite the patient experiencing transient symptoms of Raynaud's phenomenon during the procedure. Postoperatively, the patient had an uneventful recovery without respiratory complications or exacerbation of CIDP symptoms. This case highlights the complexities of anesthetic management in patients with CIDP due to potential risks associated with neuromuscular weakness, muscle relaxants, and the effects of immunosuppressive therapies. Further research is warranted to standardize anesthetic protocols for this patient population. https://aacc.tums.ac.ir/index.php/aacc/article/view/1149

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 05 07 462 470 EN Masoumeh Albooghobeish Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Vahid Salmani 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. Nooshin Sarvi-Sarmeydani Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2024 11 24 2024 12 04 Background: Innovative teaching methods can equip undergraduate anesthesia students with the skills to perform advanced cardiac life support (ACLS) confidently and proficiently. Therefore, this study aimed to compare the impact of role-playing and traditional teaching methods on teamwork and self-efficacy in performing ACLS among undergraduate anesthesia students at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Methods: This randomized controlled study was conducted on 47 third- and fourth-year undergraduate anesthesia students selected through a census sampling method. It involved a pre-test and post-test design. Participants were randomly divided into control and intervention groups. The intervention group received role-playing training, where they were divided into groups of six and each was assigned a role based on an ACLS scenario, which they enacted in interaction with other students. The control group, on the other hand, received traditional training, encompassing lectures and the use of mannequins. Teamwork performance was assessed using a scale developed by Sigalet et al., and the Resuscitation Self-efficacy Scale checklist was employed to evaluate students' ACLS skills. Ultimately, covariance analysis was conducted using SPSS version 26 to analyze the data. Results: The two groups were homogeneous in terms of demographic characteristics (P value< 0.05). A comparison of post-test scores using ANCOVA revealed a significant difference between the groups. Specifically, after receiving role-playing training, the overall score of intervention group students in the post-test demonstrated a significant increase compared to the pre-test across three teamwork subscales and three self-efficacy subscales (P value= 0.001), unlike the control group (P value = 0.001). However, the recognition subscale did not exhibit significant results (P value = 0.347). Conclusion: When compared to traditional training, role-playing training can significantly enhance self-efficacy and improve teamwork among undergraduate anesthesia students with regard to advanced cardiopulmonary resuscitation. Therefore, it is recommended to integrate role-playing into the anesthesia curriculum.   https://aacc.tums.ac.ir/index.php/aacc/article/view/1137

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 22 585 595 EN Yaser Saeed Nursing Care Research Center, Clinical Sciences Institute and Nursing Faculty of Baqiyatallah University of Medical Sciences, Tehran, Iran. Neda Sanaie Medical and Surgical Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shima Shirozhan Department of Nursing, Health in Emergency and Disaster Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Sorour Khari School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ladan Sedighie Medical and Surgical Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 12 03 2024 12 27 Background: Considering the vital role of the mechanical ventilator in providing respiratory support to patients, it is important and necessary to pay attention to and identify the common alarms of this device and to sensitize the medical team to these warnings. Methods: This integrative review study was conducted in order to evaluate both printed and non-printed studies. Searching was done from 20/09/2010 to 20/09/2023 based on Prisma 2009 guidelines in Scopus, PubMed, Embase, and ProQuest databases. The keywords included "pulmonary ventilator," "mechanical ventilators," "ventilator," "respirators," "alarm," "clinical alarms," and "alarm fatigue," and the articles were selected based on the entry criteria Results: Out of a total of 264 retrieved articles, 13 articles were included in the study. The obtained results indicated that the most frequent alarms were High PIP, High RR, and High/Low MV, which are not only important alarms, but also have high prevalence in the intensive care unit. Therefore, great attention should be paid while setting the alarm range and reacting to auditory and visual alarms. Conclusion: Failure to pay attention to alarms and setting them improperly has a significant effect on the medical team’s fatigue, which leads to a decrease in the quality of care. Therefore, using a correct management strategy in order to increase the medical team’s knowledge and reduce unnecessary alarms can play an effective role in improving the quality of the services provided to the patients hospitalized in special care units. Identifying the important alarms of mechanical ventilators and using the appropriate strategy to set the alarms correctly can increase the quality of the care provided for the patients under mechanical ventilation. https://aacc.tums.ac.ir/index.php/aacc/article/view/1150

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 05 606 609 Sogol Asgari Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Sam Mehdi Hosseininasab Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faranak Behnaz Department of Anesthesiology, School of Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 12 05 2024 12 23 There is a rare genetic disorder called Jervell-Lange Nielsen syndrome that leaves people congenitally deaf and with a long QT interval. This can lead to deadly heart rhythm problems and sudden death. For the treatment of hearing loss, cochlear implants, and for the treatment of heart difficulties, beta-blockers, and in certain circumstances, implantable cardioverter defibrillators, arrhythmias, syncope attacks, and sudden death are recommended. We discuss the case of an 8-year-old child who was referred for cochlear implantation after being diagnosed with Jervell-Lange Nielsen syndrome. In this study, we want to deal with patient management preoperatively and during surgery and describe the side effect of this syndrome. https://aacc.tums.ac.ir/index.php/aacc/article/view/1152

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 23 471 480 Mahsa Rabiee Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Science Branch, Tehran, Iran. Hesam abdolhoseinpour Department of Neurosurgery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. Amirmahdi Mojtahedzadeh Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary. Mojtaba Mojtahedzadeh Department of clinical pharmacy Faculty of Pharmacy and Pharmaceutical Science Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Shiemorteza Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Science Branch, Tehran, Iran. Fatemeh Ghanbarzamani Department of immunology Faculty of Veterinary Medicine, Karaj Islamic Azad University, Karaj, Iran. Amirhossein Ghanbarzamani Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Science Branch, Tehran, Iran. & Department of immunology Faculty of Veterinary Medicine, Karaj Islamic Azad University, Karaj, Iran. 2024 12 22 2025 01 07 Background: Stroke is one of the leading causes of annual mortality and disability for many individuals worldwide. Ischemic stroke has a high incidence and mortality rate, which significantly affects the quality of life and places an overwhelming mental and financial burden on the patients' families. Melatonin has a neuroprotective effect on patients with acute ischemic stroke. This study aimed to develop the employment of melatonin on clinical features of acute ischemic stroke. Methods: This double-blind, placebo-controlled clinical trial was conducted on 70 patients with acute ischemic stroke not eligible for reperfusion therapy who were admitted to Bu-Ali Hospital. The consent form was taken, and all of the patients received routine management. Participants were divided into two groups. The 35 patients received 10 mg of melatonin once daily for five days, and others received 10 mg of placebo. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were recorded for all patients before treatment and after on days 5, 30, and 90. Results: The 70 patients included in this study were based on inclusion criteria. The severity of stroke and the functional status of patients were compared in both groups. The melatonin group showed a significant reduction in the NIHSS score from day five up to day thirty compared to the placebo group (P = 0.001). There was no difference in the mRS score between the two groups in this study (P > 0.05). The relative frequency of the adverse event of sleepiness in patients receiving melatonin was significantly higher than in patients receiving placebo (P = 0.022). Conclusion: Patients who receive melatonin early after stroke have better improvement in post-stroke recovery and disabilities. These findings verify the results of other studies. https://aacc.tums.ac.ir/index.php/aacc/article/view/1163

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 22 481 485 Maryam Vafapour Firoozabadi Clinical Research Development Unit (FACRDU), Department of Pediatric, Iran University of Medical Sciences, Tehran, Iran. Fatemeh Naderipour Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyede Hamideh Hashemiyazdi Department of Anesthesiology, Shahid Madani Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran. Ramin Zare Mahmoudabadi Pediatric Intensive Care Unit, Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences, Tehran, Iran. Kimia Jazi Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran. Javad Hoseinzade Iran University of Medical Science, Tehran, Iran. Soheila Mahdavynia Department of Pediatric Nephrology, Firouzabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran. Masoud Zangi Anesthesiology Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 12 25 2025 01 30 Background: Considering the epidemiological importance of COVID-19 disease, the high percentage of hospitalization, and the need to prevent morbimortality caused by this disease in children, this study was undertaken to determine the clinical manifestations of COVID disease in critically ill children who need hospitalization in a pediatric intensive care unit (PICU). Methods: In this retrospective cross-sectional study, the population included critically ill children with COVID-19 who were hospitalized in the PICU of Firozabadi Hospital (Tehran, Iran) between 2020 and 2021. The study patients were examined in terms of clinical manifestations, laboratory results, course of the disease, and duration of hospitalization. From the patients' clinical records, the required information was extracted based on the variables and recorded in a pre-designed form. The obtained data were finally entered into SPSS software version 26 for statistical analysis. Results: Among 80 patients examined, 44 (55%) were male, and 36 (45%) were female. The average age of the examined patients was 9.9±5.3 years (1-18 years). In terms of COVID-19 symptoms, the fever had the highest frequency in 65 patients (81.3%), followed by gastrointestinal, respiratory, and neurological symptoms in 41 (51.3%), 39 (48.8%), and 29 (36.3%) cases, respectively. Also, 13 (16.2%) patients had an underlying disease, and 17 (21.3%) patients died from COVID-19. Investigating the relationship between the underlying disease and patients’ deaths showed to be statistically significant (P = 0.002); in other words, having an underlying disease was significantly associated with a high mortality percentage (53.8% vs. 14.9%). Conclusion: This study suggest that children with underlying diseases show higher mortality from COVID-19; therefore, it is necessary to prioritize the provision of medical services to children with underlying diseases in health system policies and patient management. https://aacc.tums.ac.ir/index.php/aacc/article/view/1167

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 05 05 486 495 EN Mahmood Reza Mohaghegh Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Masoud Ghorbanlo Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Nasrin Nouri Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Salume Sehat Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Ali Habibi Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2024 12 27 2025 01 08 Background: Considering the importance of controlling post-surgical pain in individuals and the limitation in number, in addition to the variations in the results of the clinical research studies focused on pain management outcomes of very low dose naloxone, the present evaluation aims to investigate the role of ultra-low dose naloxone on the severity of pain after the procedure, nausea, vomiting and pruritic. Methods: In this double-blind controlled randomized clinical trial, 60 patients were selected for laparoscopic cholecystectomy surgery, with class 1 and 2 anesthesia (ASA) by available method, and were allocated to the intervention and control groups using randomization. Every participant underwent general anesthesia with a specific anesthesia protocol. After the operation, PCA was implanted for all patients to control pain. The internal composition of the PCA pump included 20 mg of morphine and naloxone at a specified dosage of 0.25 μg/kg for the intervention group and 20 mg of morphine and placebo for the control arm. Pain intensity, episodes of nausea and emesis and pruritic of patients were evaluated and compared based on VAS criteria within the two groups being analysed, during the immediate postoperative period and then 2, 6, 12 and 24 hours following the surgical procedure. Results: There was no meaningful variation between therapeutic and standard arms in terms of age, sex, BMI, duration of surgery, duration of anesthesia, and dose of intra-operative fentanyl injection. Also, with respect to the level of pain during the immediate postoperative period and 2, 6, 12, and 24 hours following the surgical procedure, and the intensity of nausea, vomiting, and pruritic during recovery, statistical analysis revealed no remarkable discrepancy between the arms. In both groups, the severity of pain showed a significant decline at each of the examined time points in comparison with the pre-intervention phase (p <0.001, for both groups). Comparing the trend of changes in pain intensity during the postoperative period between the two study groups did not show a statistically meaningful variation (p = 0.569). Conclusion: The simultaneous prescription of naloxone and morphine in patients undergoing laparoscopic cystectomy does not demonstrate a meaningful influence on achieving relief from post-surgical pain levels, nausea and vomiting and pruritic compared to morphine alone, so the use of naloxone to reduce postoperative pain and complications of opioids is not recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/1168

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 07 496 500 Seyed Amir Sheikholeslami Department of Adult Hematology & Oncology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Soheila Sadeghi Department of Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Behnam Kharazmi Department of Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Parisa Delkash Department of Adu