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 trospective and analytical study from January 1st, 2013, to December 31st, 2021, in the intensive care unit of Cocody University Hospital, Abidjan, Côte d’Ivoire. All patients hospitalized for at least 48 hours in the ICU or in the referring department were included. Results: Among 5330 admissions, 325 patients developed a nosocomial infection (6.1%). Of these, 52% acquired the infection before ICU admission and 48% during their ICU stay. The mean age of the patients was 40 years with a standard deviation of 21 years, and the male-to-female ratio was 1.25. Neurological disorders were the most frequent underlying conditions. Nosocomial pneumonia was the most common infection (49.7%), followed by urinary tract infection (44.2%), bacteremia (37.0%), and other infections (11.1%). Gram-negative bacilli were predominant (79.9%), followed by Gram-positive infections (15.4%) and yeasts (4.7%). The most frequently isolated germs were Pseudomonas aeruginosa, Klebsiella pneumoniae, and E. coli. The overall mortality rate was 77.2%. Poor prognostic factors included mechanical ventilation, deep coma, and ventilator-associated pneumonia (VAP). Conclusion: Nosocomial infections most frequently complicated neurological conditions and were predominantly pulmonary. Pseudomonas aeruginosa was the leading causative pathogen. These infections were responsible of high mortality.   https://aacc.tums.ac.ir/index.php/aacc/article/view/1492

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 28 1469 1469 Maria Teresita Aspi Department of Anesthesiology, College of Medicine, University of the Philippines Manila, Manila, Philippines. & Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Manila, Philippines. & Department of Anesthesiology, Pasig City General Hospital, Pasig, Philippines. Jesse Lance Jariel Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Manila, Philippines. Euner Carlo Murillo Department of Anesthesiology, Pasig City General Hospital, Pasig, Philippines. 2025 11 01 2025 11 11 Neuraxial anesthesia is widely used in obstetric practice due to its well-established benefits for both maternal and fetal outcomes. While spinal anesthesia is more commonly employed, epidural anesthesia remains a valuable alternative, especially when prolonged surgical duration is anticipated. Complications from epidural anesthesia are uncommon, with catheter fracture representing an exceedingly rare occurrence. Because of its rarity, this complication presents unique diagnostic and management challenges. This report details the case of a retained epidural catheter fragment in a parturient undergoing elective repeat cesarean section. During epidural placement, an inadvertent dural puncture occurred, followed by difficulty threading the catheter. Upon withdrawal, the catheter tip was found to be missing, prompting abandonment of the epidural technique and conversion to spinal anesthesia. Postoperatively, serial neurologic examinations revealed no deficits or signs of infection. Magnetic resonance imaging and ultrasound failed to localize the retained fragment, leading to a decision for conservative management. This report emphasizes comprehensive clinical and imaging evaluations in determining the suitable approach to a retained epidural catheter fragment. When a patient is asymptomatic with no radiologic evidence of a neuraxial fragment, observation with close follow-up is acceptable. On the other hand, when a patient develops symptoms or there is evidence of fragment retention within the spinal canal, surgical exploration may be necessary. Due to the risk for complications in the future, full disclosure, thorough documentation, and long-term monitoring are indispensable. https://aacc.tums.ac.ir/index.php/aacc/article/view/1469

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 17 1507 1507 EN Amal Sam Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Department of Liver Anaesthesia and Critical Care, The Institute of Liver Disease & Transplantation, Chennai, India. K Nandakumar Department of Gastro Intestinal and Renal Critical Care, Apollo Hospitals, Greams Road, Chennai, India. Sruthi Shankar Department of Gastro Intestinal and Renal Critical Care, Apollo Hospitals, Greams Road, Chennai, India. Atchya Kumar Department of Gastro Intestinal and Renal Critical Care, Apollo Hospitals, Greams Road, Chennai, India. 2025 12 01 2025 12 06 Background: Stewart's method of acid-base analysis involves analyzing the strong ion difference in the blood. The anion gap (AG), strong ion difference (SID), and strong ion gap (SIG) not only assist in diagnosing underlying acid-base disturbances but also serve as prognostic markers. This study aimed to analyze Stewart's approach in patients with cirrhosis. Methods: Acid-base parameters of forty-eight cirrhosis patients requiring intensive care were prospectively studied. The primary objective of this study was to evaluate the prognostic value of SIG. The secondary objective was to examine the correlation between acid-base parameters, such as lactate, base excess of arterial blood gas analysis (ABG-BE), base excess of unmeasured anions [BE (UA)], AG, SID, and SIG. Results: The median SIG was 4.1 (IQR: 2.5 - 5.6). The median albumin-corrected AG (acAG) level was 15 (IQR, 14–20). The median BE (UA) was -4.2 (IQR: -7.1, 1.7). Apparent SID and BE (UA) demonstrated a strong correlation (r = 0.92; p < 0.001). Effective SID was strongly correlated with ABG-BE (r = 0.83, p < 0.001). SIG and acAG showed a strong correlation with an r value of 0.94 (p < 0.001). An ICU stay of more than 8 days was considered prolonged (75th percentile). ABG-BE, SIG, and acAG on admission day effectively predicted prolonged ICU stay, with AUCs of 0.73, 0.75, and 0.78, respectively. Conclusion: SIG effectively predicts prolonged ICU stay with good predictive ability. However, the anion gap, when corrected for albumin, is better than SIG in terms of predictive accuracy, requiring fewer variables and offering greater ease of use. https://aacc.tums.ac.ir/index.php/aacc/article/view/1507

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 07 13 1654 1654 Fatemeh Afra Department of Clinical Pharmacy, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Khashayar Shahverdi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Leila Sadat Hosseini Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hanieh Jalalian Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Parsa Dokhani Department of Pharmaceutical Biomaterials, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Negin Davoudi Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Ziba Aghsaeifard Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amirmahdi Mojtahedzadeh Center For Undergraduate Students' Study in Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary. Mojtaba Mojtahedzadeh Division of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. & Division of Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2026 06 05 2026 06 22 Background: Post-intensive care syndrome (PICS) is a frequent complication of critical illness characterized by persistent physical, cognitive, psychological, and cardiopulmonary impairments. This narrative review summarizes the biological mechanisms underlying PICS and current approaches to its prevention and management. Methods: A narrative review of contemporary experimental and clinical literature was performed to synthesize evidence on the pathophysiology, prevention, rehabilitation, and long-term management of PICS. Results: PICS is driven by interconnected mechanisms and pathways. These pathways contribute to intensive care unit (ICU)-acquired weakness, cognitive impairment, psychological disorders, and chronic cardiopulmonary dysfunction. Emerging strategies, including biological phenotyping, multi-omics technologies, and precision rehabilitation, may facilitate individualized recovery. The review also highlights the impact of PICS on family members (PICS-F). Conclusion: PICS is a heterogeneous multisystem condition requiring an integrated approach from ICU care through long-term rehabilitation. A better understanding of its biological mechanisms may support personalized interventions and improve long-term outcomes for ICU survivors and their families. https://aacc.tums.ac.ir/index.php/aacc/article/view/1654

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 31 1472 1472 Ishan Garud Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth University, Pimpri, Pune, India. Mounika Yerramshetty Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth University, Pimpri, Pune, India. 2025 11 02 2025 11 11 Airway management in pediatric patients with craniofacial anomalies can be unpredictable, particularly when syndromic features are subtle or masked. We report the case of a 2-year-old boy (20 kg) posted for orchidopexy, whose preoperative airway assessment was limited by irritability, and whose dysmorphic features resembled those of his parents, masking suspicion of an underlying syndrome. Induction was carried out uneventfully, but intubation attempts with 4.5 mm and bougie-guided 4.0 mm endotracheal tubes failed. Placement of an i-gel size 2 initially secured ventilation, though progressive hypercarbia ensued, with end-tidal carbon dioxide (EtCO₂) rising to 75 mmHg. Video laryngoscopy subsequently revealed a markedly anterior larynx, severe supraglottic edema, and a ranula-like swelling. Administration of hydrocortisone and dexamethasone was followed by successful intubation with a bougie-guided 3.5 mm tube, after which ventilation normalized, and the remainder of anesthesia was uneventful. This case highlights the importance of anticipating hidden syndromic airway challenges, recognizing the limitations of supraglottic devices in the setting of edema, and relying on early video laryngoscopy, smaller tube selection, corticosteroids, and advanced adjuncts to ensure safe outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1472

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 04 18 1531 1531 Nooshin Sarvi-Sarmeydani 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. Bahar Akbari Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Elham Javan Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2025 12 19 2025 12 27    https://aacc.tums.ac.ir/index.php/aacc/article/view/1531

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 17 1392 1392 EN Nethra Nanjundaswamy Bangalore Medical College and Research Institute, Department of Anaesthesiology, Victoria Hospital, Faculty of Anaesthesiology, RGUHS, Bangalore, India Abhishek Ramamurthy Bangalore Medical College and Research Institute, Department of Anaesthesiology, Victoria Hospital, Faculty of Anaesthesiology, RGUHS, Bangalore, India. Anusha Jagadeesh Bangalore Medical College and Research Institute, Department of Anaesthesiology, Victoria Hospital, Faculty of Anaesthesiology, RGUHS, Bangalore, India. Sudheesh Kannan Bangalore Medical College and Research Institute, Department of Anaesthesiology, Victoria Hospital, Faculty of Anaesthesiology, RGUHS, Bangalore, India. 2025 09 01 2025 09 27 Background: Sellick’s maneuver is a well-known technique of cricoid pressure application that is practiced during rapid sequence induction to prevent regurgitation of gastric contents. The effectiveness of the cricoid pressure application has been often questioned with respect to the success of cricoid pressure application in preventing regurgitation and aspiration. The study aims to measure the outer anteroposterior(A-P) diameter of the esophagus visualized on ultrasound during the application of cricoid pressure in real time to assess its effectiveness. Methods: 50 inpatients were enrolled as per inclusion and exclusion criteria. After obtaining informed consent, patients were examined with palpation and USG for identification of the cricoid and marked. As per institutional protocol, general anesthesia was induced. After administration of the induction agent, USG was placed over the cricoid in a slight oblique plane, and an uncompressed image of the esophagus was recorded as T1. An anesthesiologist trained in cricoid pressure application applied 30 N cricoid pressure with thumb and index finger. The anesthesiologist was not shown the image of the USG. The image after the application was recorded as T2. The compression was released after the recordings, and the case proceeded as per protocol. The images were analyzed for the anteroposterior diameter of the oesophagus visualized on cross-section, and values were taken. Results: Appropriate statistical tests were used to obtain mean values of A-P diameter before and after compression. A-P value of 0.05 was considered significant. The oesophagus was visualized in 45/50 (95%) of individuals. In 45 patients, the oesophagus was visualized on the left side of the trachea in the groove behind the thyroid gland and trachea. In 27/45 (60%), there was occlusion of the oesophagus with cricoid pressure application. There was a significant change in the A-P diameter of the oesophageal lumen. In 18/45 (40%), occlusion was not observed. Conclusion: In our study, the oesophagus as located on the lateral side of the trachea towards left. The cricoid pressure was effective in 60% of cases. https://aacc.tums.ac.ir/index.php/aacc/article/view/1392

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 01 1680 1680 Khashayar Shahverdi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Afra Department of Clinical Pharmacy, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Leila Sadat Hosseini Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amirmahdi Mojtahedzadeh Faculty of Medicine, Semmelweis University, Budapest, Hungary. Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh Division of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. & Division of Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2026 07 02 2026 07 03 Background: Sepsis is a life-threatening condition that frequently leads to intensive care unit (ICU) admission and is characterized by organ dysfunction, high morbidity, and mortality. Severe cases may progress to septic shock, further increasing the risk of death. Vitamin D, especially in its active form, plays a critical role in modulating the immune response. Vitamin D deficiency is common in patients with sepsis and has been associated with worse outcomes. Despite emerging evidence suggesting that supplementation may improve clinical outcomes, results are inconsistent due to variability in study design, patient populations, dosing regimens, and outcome measures. Methods: This protocol outlines a systematic review with potential meta-analysis if sufficient data are available. Randomized-controlled trials (RCTs) evaluating vitamin D supplementation in adult patients with sepsis or septic shock will be included. Primary outcomes will focus on all-cause mortality, while secondary outcomes will include ICU and hospital length of stay, duration of mechanical ventilation, change in sequential organ failure assessment (SOFA) score, and vasopressor requirements. A comprehensive literature search will be conducted in PubMed, Scopus, Embase, and Web of Science, with supplementary searches in grey literature and reference lists. Screening, data extraction, and quality assessment will be conducted independently by multiple researchers using predefined forms and the Cochrane Risk of Bias 2 (RoB2) tool. Data synthesis will include narrative summaries and meta-analysis when appropriate, using standardized statistical methods. Results: This review will systematically synthesize the available evidence regarding the effectiveness of vitamin D supplementation in critically ill patients with sepsis and septic shock. If sufficient homogeneous data are available, a meta-analysis will be performed to generate pooled estimates for mortality and other clinically relevant outcomes. Conclusion: This systematic review and meta-analysis will provide a comprehensive and up-to-date synthesis of evidence regarding vitamin D supplementation in sepsis and septic shock. The findings are expected to clarify the current evidence, identify knowledge gaps, and inform future clinical research and evidence-based practice. https://aacc.tums.ac.ir/index.php/aacc/article/view/1680

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 31 1444 1444 Aram Moradi Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. & Department of Anesthesia, School of Allied Medical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran. Raheleh Charmchi Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Parisa MoradiMajd Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Mohammadreza Jamshidi Department of Anesthesia, School of Allied Medical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran. 2025 10 09 2025 10 27 Unintentional extubation during prone-position surgery is a rare but critical airway emergency in anesthetic practice. We report a case of a 41-year-old obese female with predictors of a difficult airway undergoing elective lumbar laminectomy. Intraoperative dislodgement of the endotracheal tube, likely due to inadequate fixation, was promptly identified. Prone mask ventilation with an oropharyngeal airway maintained oxygenation until safe repositioning and reintubation were achieved. This case highlights the importance of rapid recognition, effective prone ventilation, and coordinated team response in managing airway emergencies in non-supine positions to optimize patient outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1444

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 08 1504 1504 Alla Reddy Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Sandip Baheti Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Siddharth Baheti Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Jyothi Nair Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 11 29 2025 12 08    https://aacc.tums.ac.ir/index.php/aacc/article/view/1504

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 17 1422 1422 EN Hussein Hussein Department of Anesthesia, College of Health and Medical Technologies, Alayen Iraqi University, Thi-Qar, Iraq. Myasar Mohammed Department of General Surgery, College of Medicine, Diyala University, Diyala, Iraq. Qusay Yaqoob Department of Surgery, College of Medicine, University of Kufa, Al-Kufa Street, Najaf, Iraq. Mohammed Sasaa Department of Anesthesia, College of Health and Medical Techniques, Al-Mustaqabal University, Hillah, Iraq. Majid Alhamaidah Department of Anesthesia, College of Health and Medical Technologies, Alayen Iraqi University, Thi-Qar, Iraq. Hussein Alkhfaji Department of Anesthesia, College of Health and Medical Technologies, Alayen Iraqi University, Thi-Qar, Iraq. Ammar Mahdi Department of Anesthesia, College of Health and Medical Techniques, University of Bilad Alrafidain, Diyala, Iraq. Abbass Haydar Department of Anesthesia, College of Health and Medical Technologies, Alayen Iraqi University, Thi-Qar, Iraq. 2025 09 26 2025 10 29 Background: Cardiopulmonary bypass (CPB) and aortic cross-clamping are essential components of many cardiac surgical procedures. However, prolonged durations have been linked to adverse outcomes, including delayed recovery and increased intensive care unit (ICU) resource utilization. Understanding their impact is critical for improving perioperative management and optimizing patient outcomes. We aimed to assess how cardiopulmonary bypass time (CPBT) and aortic cross-clamp time (ACCT) affect the length of ICU stay in patients undergoing elective cardiac surgery. Methods: Our study was retrospective clinical study which conducted at Nasiriya Heart Center, Iraq, between September 2023 and September 2024. A total of 100 patients (aged 18–65 years) who underwent elective cardiac surgery were included. Demographic data, type of surgery, admission and discharge dates, and intraoperative variables (CPBT and ACCT) were collected. Associations between CPBT, ACCT, and ICU stay were analysed by using suitable statistical approaches. Results: Of the 100 patients, 47% were male and 53% female, with a mean age of 44 years. The mean CPBT was 112.6 ± 44.2 minutes, and the mean ACCT was 69.0 ± 34.5 minutes. Gender showed no significant effect on ICU stay. In contrast, both prolonged CPBT and ACCT were significantly associated with longer ICU stays (P = 0.047 and P = 0.005, respectively). Conclusion: Extended CPBT and ACCT are significant predictors of prolonged ICU stay after cardiac surgery. Strategies to minimize intraoperative times may help reduce postoperative ICU occupancy and improve overall resource allocation in cardiac surgical care. https://aacc.tums.ac.ir/index.php/aacc/article/view/1422

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 01 1627 1627 Dariush Abtahi Clinical Research and Development Unit, Department of Anesthesiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2026 04 29 2026 05 24 Background: The integration of artificial intelligence (AI) and machine learning (ML) technologies in anesthesiology has emerged as a transformative force in perioperative medicine. This narrative review synthesizes current evidence on AI applications across the perioperative continuum. The objective is to provide a comprehensive overview of AI applications in anesthesiology, examining current implementations, clinical outcomes, and future directions across preoperative assessment, intraoperative monitoring, drug delivery, postoperative care, and clinical documentation. Methods: A systematic literature search was performed across several databases for peer-reviewed publications on AI applications in anesthesiology from 2015 to June, 2025. If the papers were peer reviewed and come from quality journals. Sixty-six papers from reputable peer-reviewed medical journals of high quality were selected for analysis. Results: The use of AI-based applications for anesthesiology can be summarized into 5 specific domains: predictive modeling to predict surgical risk assessment, real-time monitoring systems that measure anesthesia depth, automated drug delivery systems (and devices), postoperative complication prediction after surgery, and natural language processing (NLP) to assess clinical documentation. Recent advances show better patient outcomes, clinical decision-making and operational efficiency. Conclusion: AI technology holds substantial potential to enhance anesthesiology practice along the entire perioperative continuum. Although some challenges need to be addressed in respect of clinical integration and validation, we believe that there is sufficient evidence to justify undertaking further development work with a view towards implementation of AI-assisted anesthesia care. https://aacc.tums.ac.ir/index.php/aacc/article/view/1627

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 11 1424 1424 EN Taufiq Gemawan Departement of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. & Dr.Soetomo General Academic Hospital, Surabaya, Indonesia. Fajar Perdana Departement of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. & Dr.Soetomo General Academic Hospital, Surabaya, Indonesia. 2025 09 26 2025 10 27 Tetralogy of Fallot (TOF) is becoming the most common cyanotic congenital heart disease, so there are many considerations for anesthesia and perioperative management, and also comorbidities such as laryngomalacia and microcephaly make its management quite challenging. This case report describes the perioperative and intensive care management of a patient undergoing total correction of TOF with a large ASD, complicated by postoperative atelectasis, pneumonia, and ventricular tachyarrhythmia. A 1-year-11-month-old boy with a weight of 10.2 kg was diagnosed with TOF + large secundum ASD, with a history of cyanotic spells, malnutrition, and laryngomalacia. Baseline SpO₂ was 85% on room air, and echocardiography shows severe infundibular pulmonary stenosis (PG 94 mmHg). The patient underwent total correction, including pulmonary valve-sparing infundibulectomy, patch closure of VSD and ASD, and tricuspid commissuroplasty, with intraoperative TEE monitoring. He developed ventricular tachycardia after cross-clamp removal, successfully treated with DC shock and amiodarone infusion. Postoperatively, he required prolonged mechanical ventilation and reintubation due to atelectasis and nosocomial pneumonia. This case highlights the importance of meticulous hemodynamic and airway management in TOF with comorbidities. Multidisciplinary care, intraoperative TEE guidance, and early recognition of postoperative complications contributed to a favorable outcome. https://aacc.tums.ac.ir/index.php/aacc/article/view/1424

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849</