Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 06 26 440 441 Fatemeh Afra Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. & Clinical Pharmacist, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Leila Hosseini Department or Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amirmahdi Mojtahedzadeh 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. 2025 05 02 2025 05 14 No Abstract   No Abstract   No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/1280

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 29 442 447 Saeideh Sharafi Department of Nursing, Shahid Beheshti University of Medical Sciences,Tehran. Iran. Ladan Sedighi Department of Internal and Surgical Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran. Iran. Neda Sanaei Department of Internal and Surgical Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran. Iran. Neda Sanaei Department of Internal and Surgical Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran. Iran. Malihe Nasiri Department of Basic Sciences, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran. Iran. 2024 10 21 2024 10 29 Background: Despite advances in pain management, the incidence of postoperative pain remains a concern. In addition, analgesics have many side effects. Therefore, non-pharmacological interventions aimed at reducing the dosage of analgesics seem necessary, whether as a complementary or independent medication. In this regard, the present study was conducted with the aim of investigating the impact of music and acupressure on the pain intensity in the conscious patients hospitalized in intensive care units (ICU). Methods: The present quasi-experimental study was conducted on conscious patients undergoing laparotomy surgery who were hospitalized in the surgical ICU of hospitals affiliated with Shahid Beheshti University in 2023. We randomly assigned 90 patients to one of three groups: nature music, acupressure, or combined. The data collection tools consisted of patients' demographic information form and the visual pain assessment scale, which was measured once before the intervention and over five time points after it. For participants in the nature music group, sounds of rivers, birds, and waterfalls were played using an MP3 player device and headphones for 20 minutes on one occasion. For the participants in the acupressure group, pressure was applied to L14 or Hogo for 10 seconds of pressure, followed by 2 seconds of rest, for a duration of 20 minutes, so that the patient could feel heat, numbness, and heaviness. We simultaneously performed nature music and acupressure for the participants in the combined group. SPSS version 19 was used for data analysis. Results: Three groups of participants were homogeneous, with no statistically significant differences in terms of demographic characteristics (P value < 0.05). There was no statistically significant difference in the pain intensity of the patients among the three groups before the intervention. However, there was a significant difference among the three groups at 30 minutes, 60 minutes, 2 hours, 3 hours, and 4 hours after the intervention, and the combined and concurrent use of music therapy and acupressure proved to be more effective in reducing the pain intensity. Conclusion: The results indicated the effectiveness of both nature music and acupressure when used alone or in combination. Their combined and concurrent implementation is more effective. Therefore, we recommend that nurses adopt combined care programs for pain management in ICU patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1115

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 01 07 567 572 EN Katayoun Haryalchi Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine,Guilan University of Medical Sciences, Rasht, Iran. Sepehr Olangian-Tehrani School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Parisa kasmaei Research Center of Health and Environment, Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran. Sedighe Bab Eghbal Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine,Guilan University of Medical Sciences, Rasht, Iran. Abtin Heidarzadeh Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Fardin Mehrabian Research Center of Health and Environment, Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran. Tohid Karami Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. 2024 10 10 2024 11 04 Background: Nowadays perioperative adjuvants become popular, and they can decrease post-operative opioid consumption gradually, Lidocaine is one of those. It is sodium channel blocker and has a multimodal effect. It is a local anesthetic that has analgesic, antiarrhythmic, anti-hyperalgesic, anti-inflammatory, and anti-neuropathic effect. With these descriptions, can decreases hospital staying period, ameliorate pain scores with post-operative analgesia with opioid-sparing effect, and finally has cost efficiency. It is available, inexpensive, simple, safe, and its’ consumption is easy, making faster bowel habits return and better rehabilitation after the surgeries. This narrative review has been written to evaluate these properties of Lidocaine. Methods: The aim of this narrative review was assess the significance of peri-operative lidocaine as an adjuvant to manage acute postoperative pain. The manuscript has been presented as a comprehensive search that was conducted across several major databases, included: PubMed, Scopus, Web of Science, and Google Scholar. The search focused on studies published between 1990 and 2024 to provide a broad perspective on both historical and current evidence.   Results: This review has reported the results of several articles. It can be obvious perioperative Lidocaine consumption as an adjuvant reduce post-operative pain perception, improve returning bowel habits, and post-surgical better rehabilitation and pain control. Conclusion: Review of these articles illustrated;perioperative systemic lidocaine  as an adjuvant with efficiency of reducing post-operative pain perception, has an opioid-sparing effect,  improving intestinal activity and decreasing post-operative recovery period. Finally bring more comfort for patients and accompanying, less pressure on staff and most importantly is economical for both sides. https://aacc.tums.ac.ir/index.php/aacc/article/view/1104

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 02 12 596 598 Faranak Behnaz Department of Anesthesiology, School of Medicine, Shohada-e-Tajrish Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran. Narges Bazgir Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ako Faridi Department of Anesthesiology, Erfan Hospital, Tehran, Iran. Sogol Asgari Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 10 20 2024 10 29 During surgical procedures, intraoperative neuromonitoring (IONM) allows for real-time assessment of neural structures like the brain, spinal cord, and peripheral nerves. It enables continuous monitoring and early detection of potential damage during surgery. Adequate neuromonitoring is crucial in anesthesiology to maintain optimal brain function and neurological status during procedures. Muscle twitching during IONM is often associated with electromyography (EMG) or motor-evoked potentials (MEPs) and can indicate nerve activation or irritation. Two cases of patients undergoing posterior spinal fusion procedures experienced complications related to muscle twitching during surgery. In the first case, a 45-year-old male patient experienced damage to his lower lips due to muscle twitching in neuromonitoring. In the second case, a 36-year-old man suffered a tongue injury because a mouth guard shifted during surgery. IONM is a crucial component of modern surgical practices, but the cases presented highlight the potential for muscle twitching to cause patient injuries. Surgical teams must prioritize communication and the implementation of protective measures to safeguard against such occurrences. Future research may provide more comprehensive guidelines to enhance patient safety during IONM. https://aacc.tums.ac.ir/index.php/aacc/article/view/1111

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 02 21 610 612 Ali Jabbari Ischemic Disorder Research Center, Golestan University of Medical Sciences, Gorgan, Iran. & Department of Anesthesiology and Intensive Care, Golestan University of Medical Sciences, Gorgan, Iran. Shabnam Tabasi Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Hassan Mirzaei Ischemic Disorder Research Center, Golestan University of Medical Sciences, Gorgan, Iran. 2024 08 09 2024 08 17   No Abstract   No Abstract   No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/1064

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 02 18 448 454 Amlan Mohanty Department of Anesthesiology, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra, India. Sarita Swami Department of Anesthesiology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India. Kalyani Nilesh Patil Department of Anesthesiology, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India. 2024 11 24 2024 12 04 Background: One of the most prevalent procedures involving general anesthesia (GA) is endotracheal intubation, which can lead to a variety of airway complications. Patients undergoing GA with tracheal intubation may experience a common complication, known as postoperative sore throat (POST). We conducted this study to assess and compare the effectiveness of preoperatively administered nebulized ketamine and dexmedetomidine in alleviating POST. Methods: We randomly divided the patients into two groups, each containing 151 patients. Group-K patients were nebulized with 50 mg (1 ml) with 3 ml normal saline, while Group-D patients were nebulized with dexmedetomidine 50 mcg (0.5 ml) with 3.5 ml normal saline, preoperatively. GA was administered 15 min post-nebulization. POST was graded at 4, 6, 12, and 24 h after extubation on a four-point scale (0-3). The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 17.0. Results: In the present study, the overall incidence of POST was 32.5%. among which 39 patients (25.8%) in the ketamine group and 59 patients (39.1%) in the dexmedetomidine group experienced POST at 4h, following extubation (P value=0.014). A significantly higher incidence of POST in the dexmedetomidine group was noticed as compared to the ketamine group (P value < 0.05). But, at 6h, 12h, and 24h, the difference was not statistically significant between the two groups. A significantly larger percentage of cases in the dexmedetomidine group had more severe POST than in the ketamine group, at 4h following extubation (p-value <0.05). There was no significant rise in systolic and diastolic blood pressure in either group.  However, the ketamine group had a significantly higher mean heart rate after extubation compared to the dexmedetomidine group. Conclusion: Ketamine nebulization significantly decreases the incidence and severity of postoperative sore throat during the early postoperative period with minimum hemodynamic changes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1140

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 4 2025 04 07 573 578 Ali Dabbagh Department of Anesthesiology, School of Medicine, Anesthesiology Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Sam Mehdi Hosseininasab Department of Anesthesiology, 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. Sogol Asgari 4. Assistant Professor of Neuroanesthesia, Department of Anesthesiology, School of Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2024 11 05 2024 11 22 Background: Academic medicine depends on mentoring as a way for people to work together to improve their personal and professional lives. However, more clinical, administrative, research, and other educational demands are putting stress on medical faculty mentoring. Therefore, we need to evaluate the evidence supporting the value of mentoring. Methods: In the present systematic review, 74 related studies were retrieved from international and national databases. In addition, the gray literature was searched via Google Scholar. Out of these, 16 studies were selected for the conduction study. We extracted the necessary data for our study from the research and stored it in Excel. 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 manageion> 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 2025 12 29 1395 1395 Mojgan Rahimi Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohamad Sorani Department of Anesthesia, School of Allied Medicine, Tehran University of Medical Sciences, Tehran, Iran. Afzal Shamsi Department of Anesthesia, School of Allied Medicine, Tehran University of Medical Sciences, Tehran, Iran. Myasar Mohamad Department of Anesthesiology and Intensive Care, Al-Shifaa Private Hospital, College of Mediicne, University of Diyala, Diyala, Iraq. Noah Awad Hussain Department of Anesthesiology and Intensive Care, Al-Shifaa Private Hospital, College of Mediicne, University of Diyala, Diyala, Iraq. 2025 09 03 2025 09 14 Background: Spinal anesthesia is a very commonly used procedure in modern-day anesthesia practice. Today most of the lower limb surgeries are performed under spinal anesthesia. Midazolam, dexmedetomidine, and fentanyl are common intravenous adjuvants used during anesthesia to allay anxiety and sedation. The aim of this study was to compare the effects of intravenous dexmedetomidine-midazolam versus fentanyl-midazolam in terms of analgesic characteristics, sedation, and adverse effects. Methods: This is a randomized prospective study that included 35 patients in each group, posted for lower limb orthopedic surgery. Intravenous dexmedetomidine, fentanyl, and midazolam were administered after subarachnoid block. Data for sedation, analgesia, hemodynamic parameters, and adverse effects were recorded. Results: RR for FM group showed significant intra-group variability in RR across perioperative stages (p<0.05), whereas the DM group maintained greater respiratory stability (p=0.243). HR for DM group exhibited significantly lower intraoperative and postoperative HR compared to FM group (p<0.001), with notable within-group changes, unlike the FM group. MAP for both groups remained stable over time (DM: p= 0.283, FM: p= 0.260), although the FM group had slightly higher values in the postoperative recovery phase. Sedation (RSS): DM produced deeper and more sustained sedation intraoperatively and postoperatively (p<0.001), while FM showed quicker sedation decline. Patient satisfaction was significantly higher in the DM group (VAS: 3.0 vs. 4.0, p= 0.001), although surgeon satisfaction did not differ notably. Adverse events were rare and comparable, though hypotension was more frequent in the DM group (22.9% vs. 8.6%). Conclusion: Dexmedetomidine plus midazolam provided superior sedation quality and patient satisfaction, with more stable cardiopulmonary parameters during orthopedic surgery under spinal anesthesia. Despite a slightly higher rate of hypotension, DM appears to offer a more favorable sedative profile compared to fentanyl plus midazolam. https://aacc.tums.ac.ir/index.php/aacc/article/view/1395

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 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 01 01 1363 1363 Mamta Sharma Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India. Kirandeep Kaur Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India. & Department of Anaesthesiology, Fortis Hospital, Kangra, Himachal Pradesh, India. Ajay Ajay Department of Anaesthesia and Pain Medicine, AIIMS Gorakhpur, Uttar Pradesh, India. 2025 08 03 2025 09 13 Background: Postoperative pain following lumbosacral spine surgery is often intense and may hinder early recovery and ambulation. Caudal epidural analgesia using local anesthetics, particularly when combined with adjuvants, has shown potential in enhancing pain control. Dexmedetomidine which has a high affinity for α2-adrenergic receptors, may augment the analgesic effects of ropivacaine and extend its duration. To evaluate the effectiveness and safety of caudal epidural administration of ropivacaine alone versus ropivacaine combined with dexmedetomidine in patients undergoing lumbosacral spine surgery under general anesthesia. Methods: A total of 60 adult patients (ASA I–II) scheduled for elective lumbosacral spine procedures were enrolled in this prospective, randomised, double-blind trial. Participants were assigned to two groups. One group received 20 mL of 0.2% ropivacaine, and another group received 18 mL of 0.2% ropivacaine with 2 mL of dexmedetomidine (1 µg/kg). Pain scores, time to first rescue analgesia, sedation levels, hemodynamic parameters, and adverse events were monitored. Statistical evaluation was carried out with SPSS version 21, with significance set at p < 0.05. Results: Patients who received dexmedetomidine showed lower pain scores at 4, 8, and 12 hours after surgery. Their average duration of postoperative analgesia was also longer (23.00 ± 4.33 hours) when compared with the control group (15.13 ± 1.74 hours). Sedation profiles and intraoperative hemodynamics were largely similar in both groups. No clinically important adverse effects, such as hypotension, bradycardia, or respiratory compromise, were observed. Conclusion: Incorporating dexmedetomidine into a caudal epidural block with ropivacaine provides more effective postoperative pain relief without significant side effects. https://aacc.tums.ac.ir/index.php/aacc/article/view/1363

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 28 1417 1417 EN Mohammad Kurniawan Departement of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. & Faculty of Medicine, IPB University, Bogor, Indonesia. & Departement of Anesthesiology and Intensive Care, Bakti Pajajaran Regional General Hospital, Bogor, Indonesia. Riyadh Firdaus Departement of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Sidharta Manggala Departement of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. 2025 09 19 2025 10 03 Snakebite envenomation is a medical emergency with potentially fatal systemic complications. We report a case of a 32-year-old male patient who presented to the Emergency Department with a complaint of a snakebite on his right ear. On arrival, he didn’t have signs of bleeding, fever, or swelling. Two hours after admission, the patient developed cardiac arrest and required mechanical ventilation. Although resuscitation was successful, the patient’s condition deteriorated, with progressive neurological and motor deficits, despite unremarkable findings on head CT scans and chest X-rays. Given progressive neurological and motoric deficits, hemoperfusion was initiated six hours post-envenomation as an adjunctive therapy. The procedure lasted six hours using a standard hemoperfusion cartridge. The patient demonstrated significant neurological recovery within 22 hours post-procedure, and he was successfully extubated on day 4. This case highlights the potential role of hemoperfusion as an adjuvant treatment in managing venomous snakebite envenomation, especially in places with limited species-specific antivenom availability. Early recognition of systemic complications and timely initiation of hemoperfusion may improve neurological outcomes in critically envenomed patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1417

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 08 1542 1542 Shweta Khatri Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Aishwarya Hunashikatti Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 12 26 2026 02 04    https://aacc.tums.ac.ir/index.php/aacc/article/view/1542

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 01 1373 1373 Seyedbabak Mojaveraghili Department of Anesthesiology & Intensive Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Mohammadali Izadfar Department of Neurological Surgery, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Naser Behnampour Health Management and Social Development Research Centre, Department of Biostatistics and Epidemiology, Golestan University of Medical Sciences, Gorgan, Iran. 2025 08 07 2025 08 13 Background: Spinal fusion surgery, as one of the treatment options for back pain, often results in significant postoperative pain due to complexity and multiple incisions. Glutamate receptors such as NMDA are among the main receptors involved in this process, causing central hyperalgesia and sensitization and ultimately accelerating pain processing in the CNS. Therefore, NMDA receptor antagonists such as ketamine and magnesium sulfate can be considered as suitable options for treating pain caused by these surgeries. A prospective study was conducted to compare the effects of ketamine and magnesium sulfate on pain control in these patients. This double-blind clinical trial was performed on 72 patients undergoing fusion surgery, referred to the 5th Azar Medical & Educational Center of Gorgan in 2020-2022. Methods: In group A, 50mg/kg of magnesium sulfate along with CVE=5 ml/kg was infused over 20 minutes, and then 500 mg/h of magnesium sulfate was given during and up to 48 hours after surgery. In group B, 0.5 mg/kg of ketamine was given as a bolus after patient positioning and 2 minutes before surgical incision, followed by 2.5 mcg/kg/h of ketamine during and up to 48 hours after surgery. Pain was evaluated using the NRS scale from admission to recovery up to 48 hours after surgery, and the amount of opioid consumption was recorded. Results: Both ketamine and magnesium sulfate led to a significant reduction in pain during the first 48 hours after surgery (P value <0.0001). The speed of pain reduction in the first 6 hours was higher in women in the ketamine group and in men in the magnesium group, although the results were reversed in the second 6 hours. Pain assessment in opium addicts indicated the superiority of magnesium in the speed of pain reduction in patients during the first 12 hours. The amount of analgesic used during recovery was statistically similar in both groups (p=0.645), but during the 24 hours after surgery, the amount of opioid consumption used in the magnesium group was significantly lower (p=0.025). After 24 hours, none of the two groups needed analgesics. No severe side effects were observed in any of the patients in the two groups. Conclusion: Magnesium sulfate not only works well with ketamine in controlling postoperative pain but can also perform better than ketamine in women and opioid addicts, leading to a reduction in the use of opioids and avoidance of ketamine's side effects. In addition to reducing pain and analgesic use, considering the benefits of magnesium in stabilizing hemodynamics and reducing anesthetic use, this drug can be a very suitable alternative to ketamine for a wider range of patients undergoing spinal surgery, including those with heart and mental illnesses. https://aacc.tums.ac.ir/index.php/aacc/article/view/1373

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 06 16 1602 1602 EN Sonal Khatavkar Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Amruta Chaudhari Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2026 03 12 2026 03 28    https://aacc.tums.ac.ir/index.php/aacc/article/view/1602

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 11 1374 1374 Azim Honarmand Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mehdi Mahmoodkhani Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Behzad Nazemroaya Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Alireza Ahmadian Department of Anesthesiology and Critical Care,School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 08 10 2025 09 13 Background: This randomized controlled trial evaluated the analgesic effect of adding subcutaneous ketamine to bupivacaine in lumbar fusion surgery. Methods: 46 adult patients were randomized to receive subcutaneous bupivacaine with or without ketamine before incision. Pain scores (VAS), time to first rescue analgesia, opioid use, extubation time, and patient satisfaction were assessed. Results: The ketamine group had higher early postoperative pain (30 and 60 min; P < 0.05) but showed prolonged time to rescue analgesia (P = 0.037) and reduced opioid use (not statistically significant). Extubation time was significantly longer. Satisfaction scores were similar. Conclusion: Subcutaneous ketamine delayed opioid use but increased early pain and extubation time. It may be considered in selected patients, pending further research. https://aacc.tums.ac.ir/index.php/aacc/article/view/1374

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 20 1529 1529 Sabyasachi Mohapatra Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Sandip Baheti Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Siddharth Baheti Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 12 19 2026 01 01    https://aacc.tums.ac.ir/index.php/aacc/article/view/1529

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 11 1378 1378 EN Arie Swardhani Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Haizah Nurdin Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Ari Palinrungi Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Syamsul Salam Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Faisal Muchtar Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Charles Tan Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. 2025 08 15 2025 08 29 Background: Ventilator-associated pneumonia (VAP) is a major source of morbidity and mortality in mechanically ventilated patients, with heterogeneous rates reported across Indonesian ICUs. Although evidence-based prevention bundles reduce VAP, real-world adherence is inconsistent. This study evaluated the association between VAP bundle compliance and VAP incidence among ICU patients at Wahidin Sudirohusodo Hospital in 2024. Methods: We conducted a retrospective analytical study (January–December 2024) including adults ventilated ≥48 h with complete bundle documentation; patients with pre-existing pneumonia or incomplete records were excluded. VAP was defined by CDC criteria. Compliance with the five-element bundle (head-of-bed elevation, daily sedation interruption/readiness to extubate, stress-ulcer prophylaxis, DVT prophylaxis, and oral chlorhexidine) was recorded daily, calculated as a percentage, and categorized as 60% (3/5 elements), 80% (4/5), or 100% (5/5). Associations with VAP were analyzed statistically. Results: Of the 385 patients who were on ventilators, 92 (23.9%) developed VAP. Of those, 52 (56.5%) died. The highest adherence was for head-of-bed elevation (91.5%), while the lowest was for DVT prevention (3.1%). In the VAP group (n=92), 65 subject manifested at 60% adherence (70.7%), 24 at 80% (26.1%), and 3 at 100% (3.3%). A higher level of adherence was significantly associated with a lower incidence of VAP (p = 0.001). Conclusion: Higher adherence to the VAP preventive bundle is associated with a lower VAP rate. To increase bundle adherence and patient outcomes in ICU, targeted interventions are needed. These should include more staff training and regular audits, with an emphasis on DVT prevention and daily weaning.   https://aacc.tums.ac.ir/index.php/aacc/article/view/1378

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 0 0 2026 06 22 1592 1592 EN Bhagyashree Soor Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Kruthi Tellakula Department of Obstetrics and Gynecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2026 02 26 2026 04 04    https://aacc.tums.ac.ir/index.php/aacc/article/view/1592

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 28 1379 1379 Ali Zaidan Department of Intensive Care Unit, University Hospital of Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia. Imed Chouchene Department of Intensive Care Unit, University Hospital of Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia. 2025 08 16 2025 09 13 Background: Spinal anesthetic has improved perioperative care for lower-limb procedures. However, sympathetic blocking can induce considerable hemodynamic instability. While fluid preloading and vasopressors are established preventive interventions, dexamethasone and ondansetron, employed as antiemetics, have lately been studied for their cardiovascular-stabilizing effects. This study compares the effects of preoperative intravenous dexamethasone (8 mg) and ondansetron (8 mg) on hemodynamic stability and postoperative nausea and vomiting during spinal anesthesia. Methods: 192 ASA I-II patients undergoing elective lower-limb orthopedic surgery under spinal anesthesia at Alkafeel Hospital in Karbala from 2nd September, 2022, to 3rd November, 2024, were assigned to four groups: dexamethasone (Group D), ondansetron (Group O), combination (Group B), and control (Group C). MAP, HR, and SpO₂ incidences of nausea and vomiting were measured at 5, 10, 15, 30, and 60 minutes after spinal block. Results: MAP and HR did not differ significantly between groups (p = 0.326 and 0.458, respectively). At 5 minutes, Group B had greater MAP (p = 0.001) and HR (p = 0.030) than Group C. No significant differences in SpO₂ levels were seen (p > 0.05). The incidence of nausea was lowest in Group B (2.1%), compared to Group C (14.6%) (p = 0.009). Vomiting occurred in all groups, with zero incidences in Group B. Conclusion: Combining dexamethasone and ondansetron before lower-limb surgery under spinal anesthesia improved cardiovascular stability and reduced nausea. https://aacc.tums.ac.ir/index.php/aacc/article/view/1379

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 19 1553 1553 Shilpa Deshmukh Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Ashish Erry Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2026 01 04 2026 02 02 Kearns-Sayre Syndrome (KSS) is a rare mitochondrial cytopathy caused by large deletions in mitochondrial DNA, leading to impaired energy production in cells. It has an estimated incidence of 1 to 3 cases per 100,000 population. KSS has no racial or sex predilection. The significant concerns for an anesthesiologist associated with this syndrome are multi-system involvement, including cardiac conduction defects, endocrinopathies, sensorineural deafness, and neurological dysfunction. These manifestations make it challenging for the anesthesiologist. These concerns significantly influence the choice of anesthesia given to the patient, particularly regarding the selection of neuromuscular blockers and their effects on patients with this syndrome compared to those in the general population. Anesthetic management of Kearns-Sayre syndrome patients requires careful preoperative assessment of cardiac, neurological, and metabolic status due to risks of heart block, malignant hyperthermia, respiratory muscle weakness, and lactic acidosis. Also, intraoperative and postoperative vigilance is necessary to prevent any adverse events. We report a 48-year-old female, a known case of Kearns-Sayre Syndrome, scheduled for hysteroscopic polypectomy. This case highlights the importance of detailed preoperative evaluation and tailoring the anesthetic technique to minimize mitochondrial stress. https://aacc.tums.ac.ir/index.php/aacc/article/view/1553

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 04 1386 1386 Masoomeh Nataj Majd Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Sajjad Al Nasery Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Afzal Shamsi Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. 2025 08 19 2025 08 21 Background: Nausea and vomiting are distressing symptoms that are commonly experienced during cesarean section and can also occur in the period following the procedure. Shivering is also common with spinal anesthesia. This study aimed to compare the effectiveness of ketamine and tramadol in preventing post-spinal shivering, nausea, and vomiting during cesarean section surgery. Methods: This clinical trial study was conducted in 2025 on 108 pregnant mothers who were candidates for cesarean section under spinal anesthesia. The samples were selected at Arash Hospital using a convenience method and were randomly assigned to two groups: ketamine (53 people) and tramadol (52 people). The dose of ketamine was 0.25 mg/kg, and tramadol was 0.5 mg/kg. We measured the patient's vital signs (such as body temperature, blood pressure, and heart rate), vomiting status, nausea and shivering, and any other changes that may indicate the occurrence of nausea/vomiting or shivering. Results: The mean age of the total cohort was 29.84 years, with no significant difference between the tramadol and ketamine groups. Weight, BMI, and NPO time were comparable between the two groups, confirming that they were well-balanced at baseline. Post-intervention outcomes showed significant differences between the two groups. The heart rate was significantly lower in the ketamine group compared to the tramadol group, and systolic blood pressure was higher in the ketamine group. Fever was slightly higher in the ketamine group. The rates of shivering in the tramadol and ketamine groups were 26.92% and 18.87%, respectively, which were not statistically significant. The rates of vomiting or nausea in the tramadol and ketamine groups were also reported to be 73.1% and 11.32%, respectively, which were significant (P<0.001). The use of rescue medications (pethidine/ephedrine and plasil/ondansetron) mirrored these findings, with significant differences between groups. Conclusion: In conclusion, ketamine demonstrated favorable effects on hemodynamic stability, nausea/vomiting, and temperature regulation compared to tramadol, with significant differences observed in nausea/vomiting incidence. https://aacc.tums.ac.ir/index.php/aacc/article/view/1386

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 23 1489 1489 Sonal Khatavkar Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Ishan Garud Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Mounika Yerramshetty Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. 2025 11 15 2025 12 07 Double aortic arch (DAA) is a rare congenital vascular anomaly that forms a complete vascular ring encircling the trachea and esophagus, potentially leading to respiratory and feeding difficulties. We present a case of a 15-month-old male with an incomplete cleft palate who had an incidental finding of codominant double arch of aorta on preoperative imaging. The child underwent successful cleft palate surgery under general anesthesia with appropriate airway precautions and multidisciplinary planning. This report highlights the anesthetic implications of vascular rings and the need for thorough preoperative assessment in children presenting with non-specific symptoms like recurrent upper respiratory tract infections (URTI) and feeding intolerance. https://aacc.tums.ac.ir/index.php/aacc/article/view/1489

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 17 1382 1382 Nima Mohamadi Afrakoti Department of Anesthesiology and Critical Care, Dr Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Danial Meibodi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Samaneh Hajy Molla Rabi Department of Neurology, Dr, Rajaee Hospital, Alborz University, Karaj, Iran. Sara Mehri School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2025 08 17 2025 09 28 Background: Sepsis and septic shock are life-threatening conditions. They occur when the body has an uncontrolled response to infection, often leading to problems in multiple organs and significant health issues. Even with improvements in critical care, survivors often deal with ongoing physical challenges, lower quality of life, and long-term disabilities. One widely used biomarker for systemic inflammation is C-reactive protein (CRP). It rises quickly after infection and tissue damage. While CRP is known to predict short-term mortality in sepsis, its impact on long-term recovery is still not well understood. This study aimed to find out if CRP levels at admission relate to physical activity in sepsis survivors one month after leaving the hospital. This is a crucial time when survivors are at high risk for readmission and functional decline. Methods: In this cross-sectional study, we included 98 adult patients (ages 22 to 80) with sepsis or septic shock (SOFA score ≥3) admitted to Shariati Hospital ICU in Tehran, Iran, from February 2023 to March 2024. We excluded those with major health issues (like cancer) or pre-existing disabilities or who died during their hospital stay. We recorded admission CRP levels, SOFA scores, length of stay (LOS), and days on a ventilator. We ass