Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 118 125 Hendrikus Gede Surya Adhi Putra Department of Anesthesiology and Intensive Care, Giri Emas General Hospital, Singaraja, Indonesia. Made Wiryana Department of Anesthesiology and Intensive Care, Udayana University, Denpasar, Indonesia. Tjokorda Gde Senapathi Department of Anesthesiology and Intensive Care, Udayana University, Denpasar, Indonesia. I Gusti Ngurah Mahaalit Aribawa Department of Anesthesiology and Intensive Care, Udayana University, Denpasar, Indonesia. I Made Gede Widnyana Department of Anesthesiology and Intensive Care, Udayana University, Denpasar, Indonesia. Dewa Ayu Mas Shintya Dewi Department of Anesthesiology and Intensive Care, Udayana University, Denpasar, Indonesia. André A.J. Zundert Department of Anesthesiology, University of Queensland, Brisbane, Australia. Christopher Ryalino Department of Anesthesiology and Intensive Care, Udayana University, Denpasar, Indonesia. & Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands. 2025 05 16 2025 05 30 Background: Postoperative cognitive dysfunction (POCD) is a major concern in anesthesia, leading to increased morbidity and longer hospital stays. Our study aimed to evaluate the efficacy of target-controlled infusion (TCI) dexmedetomidine in reducing the incidence of POCD following laparotomy surgery. Methods: A single-blinded, randomized controlled trial involving 107 patients aged >18 years old undergoing laparotomy surgery was conducted. Patients were randomly assigned to 54 patients in Group D (TCI dexmedetomidine with a target plasma of 1 ng/ml) and 53 patients in Group I (sevoflurane at 0.8% concentration). Results: Our study showed subjects whose anesthesia was maintained by TCI dexmedetomidine had a lower chance of developing POCD (p=0.043) and experienced less pain at 12 hours (p=0.049) and 24 hours (p=0.049) in the postoperative period, compared to the control group. There were no significant differences between both groups in intraoperative MAP (p=0.290) and HR (p=0.453). Conclusion: Maintaining anesthesia using Conox®-guided TCI dexmedetomidine reduces the incidence of POCD and postoperative pain in laparotomy patients who underwent general anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/1288

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 169 180 Mahdi Amirdosara Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammadreza Hajiesmaeili Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sam Hosseininasab Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Masood Zangi Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 06 02 2025 07 01 Trauma to the brain or spinal cord is a type of injury that triggers a cascade of secondary pathophysiological events after the primary mechanical trauma. Neuroinflammation is indeed of foremost importance, acting both as a mediator for tissue repair and an instigator for progressive neurodegeneration. Activated microglia and astrocytes, peripherally derived immune cells infiltrating that site, mediate a complex interaction involving cytokines, oxidative stress, mitochondrial dysfunction, and neurovascular disruption. This early inflammatory signaling helps remove debris and support neuronal regeneration in traumatic brain injury (TBI) and spinal cord injury (SCI). However, when this particular inflammation becomes chronic, it leads to glial damage with aberrant synaptic connections and irreversible harm to neural network circuitry. Mediators, including IL-1β, TNF-α, and the NLRP3 inflammasome, have been identified as promising therapeutic targets; cutting-edge therapies, ranging from small-molecule inhibitors to mitochondrial stabilizers to cell-based interventions, have shown efficacy in preclinical models. Nonetheless, the translation to the clinic has been hindered through shortcomings in classical animal models, failure to integrate biomarker application, and an inability to account for the heterogeneity of human central nervous system (CNS) injury. To bridge this gap, temporally targeted immunomodulation, precision diagnostics, and systems-level approaches will need to align with the molecular pathology involved in disease intervention. Understanding this dual property within post-traumatic inflammation presents an important frontier to develop truly efficacious neuroprotective therapies. https://aacc.tums.ac.ir/index.php/aacc/article/view/1301

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 210 213 Narjes Hamidi Department of Anesthesia, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Atiyeh Sadat Sajadi Department of Anesthesia, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Narges Borhani Department of Anesthesia, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Mohammad Niakan Lahiji Department of Anesthesiology and Critical Care, School of Medicine, Iran Univesity of Medical Sciences, Tehran, Iran. Mahnaz Faramarzi Keneshti Department of Operation Room, Shahriyar Social Security Hospital, Social Security Organization, Tehran, Iran. 2025 02 22 2025 03 06 A 37-year-old male with no significant medical history presented to the hospital following a fall into a pit containing animal feces, resulting in aspiration pneumonia. He was intubated and treated with antibiotics, and after 15 days of hospitalization, he was discharged in stable condition. Four days later, he returned with scrotal pain and swelling, diagnosed as epididymitis, and successfully treated with ceftriaxone. On September 1st, he re-presented with headache, dizziness, and malaise, and imaging revealed a brain abscess. Despite undergoing stereotactic surgery, the patient experienced persistent neurological symptoms, including fluctuating consciousness, nausea, and vomiting. He subsequently developed hydrocephalus, necessitating the placement of an external ventricular drain and transfer to the ICU. The patient was treated with antifungal and antibiotic therapies, but his clinical condition deteriorated. Despite intensive care, he succumbed to his illness after 19 days in the ICU. https://aacc.tums.ac.ir/index.php/aacc/article/view/1215

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 225 227 Shilpa kore Department of Anaesthesiology, D.R.D.Y.Patil Medical College Pune, DR D.Y.Patil Vidyapeeth University, Maharashtra, India. Pragya Pramanik Department of Anaesthesiology, D.R.D.Y.Patil Medical College Pune, DR D.Y.Patil Vidyapeeth University, Maharashtra, India. 2025 06 14 2025 07 06     No Abstract    No Abstract    No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/1314

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 126 131 Masoud Borjian Borujeni Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Azim Honarmand Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Safavi Department of Anesthesiology and Critical Care, 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. 2025 04 22 2025 05 11 Background: Reflex Given the critical role of anatomical airway structures in tracheal intubation, this study aimed to predict the difficulty of mask ventilation and laryngoscopy using ultrasound-based airway evaluation criteria. Methods: This cross-sectional study involved 205 patients undergoing tracheal intubation. During intubation evaluation based on the Cormack-Lehane classification, neck ultrasound was performed. The diagnostic value of neck sonographic parameters was assessed using receiver operating characteristic (ROC) analysis. Results: According to the Cormack-Lehane classification, intubation was easy in 170 patients (82.9%) and difficult in 35 patients (17.1%). Ultrasound findings revealed statistically significant differences in all parameters, including neck circumference, between the easy and difficult intubation groups. All measured values were higher in the difficult intubation group. Conclusion: The findings suggest that ultrasound is a useful, practical tool for predicting difficult intubation. However, due to study limitations such as the small sample size, further research is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/1269

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 181 186 Parisa Moradimajd Department of Anesthesia, Faculty of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Alireza babajani Department of Anesthesiology, School of Allied Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran. Fatemeh Mehdipour Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Mahdi Nazari Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. 2025 07 11 2025 08 21 Background: The presence of a difficult airway (DA) remains a major concern in anesthesia, contributing significantly to patient complications and adverse outcomes. Traditional clinical assessments often fall short in accurately predicting difficult intubation. With the advancement of artificial intelligence, machine learning (ML) has emerged as a promising approach for enhancing airway risk prediction. This systematic review aimed to evaluate current studies that utilize machine learning models for predicting difficult laryngoscopy and intubation and to assess the features, algorithms, and predictive performance of these models. Methods: Following PRISMA guidelines, a comprehensive search was conducted in seven databases (PubMed, Scopus, Web of Science, Science Direct, Wiley, SID, and Google Scholar) to identify relevant original articles published between 2000 and July 2025. Studies using ML models to predict difficult intubation based on clinical, morphological, or acoustic features were included. A total of nine eligible studies were reviewed. Results: Various ML algorithms, including KNN, SVM, Random Forest, XGBoost, and decision trees (J48), were applied across studies. Feature inputs ranged from traditional clinical parameters (e.g., Mallampati score, neck circumference) to advanced modalities such as voice analysis and facial image processing. Reported model performance (AUC) ranged from 0.71 to 0.924, indicating generally high predictive accuracy. Models incorporating non-traditional data (e.g., acoustic or imaging features) tended to perform better. Conclusion: ML-based models show strong potential in improving the prediction of difficult airways and can serve as supportive tools in preoperative assessment. However, standardization of input features, external validation, and enhanced model interpretability are essential for successful clinical implementation. https://aacc.tums.ac.ir/index.php/aacc/article/view/1339

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 214 215 Padideh Ansar Department of Anesthesiology, Shohada-e-Tajrish Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Neda Tadjeddin Department of Anesthesiology, Shohada-e-Tajrish Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamideh Ariannia Department of Anesthesiology, Shohada-e-Tajrish Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faranak Behnaz Department of Anesthesiology, Shohada-e-Tajrish Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyedpouzhia Shojaei Department of Anesthesiology, Shohada-e-Tajrish Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 03 05 2025 03 10 This case report outlines a rare occurrence of accidental intrathecal injection of atracurium during spinal anesthesia for knee arthroscopy in a 22-year-old male patient. The solution intended to be bupivacaine mixed with fentanyl raised concerns after the ampule was discarded before verification. Fortunately, the patient showed no signs of paralysis or analgesia post-injection. The anesthesia team promptly administered high-dose methylprednisolone to reduce potential neurotoxic effects and monitored the patient closely in the Post-Anesthesia Care Unit. After six hours of stability and no neurological deficits, follow-up evaluations confirmed no lasting damage, allowing for safe discharge after 24 hours. This incident underscores the critical need for rigorous drug verification and safety protocols in anesthesia to prevent medication errors. https://aacc.tums.ac.ir/index.php/aacc/article/view/1223

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 https://aacc.tums.ac.ir/index.php/aacc/article/view/1296

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 320 331 EN Asrini Safitri Department of Clinical Nutrition, Faculty of Medicine, Muslim University of Indonesia, Makassar, Indonesia. & Ibnu Sina Hospital, Makassar, Indonesia. Yuliastuti Hayat Arifin Nu’mang Hospital, Sidrap, Indonesia Aryanti Bamahry Department of Clinical Nutrition, Faculty of Medicine, Muslim University of Indonesia, Makassar, Indonesia. & Arifin Nu’mang Hospital, Sidrap, Indonesia. 2025 05 15 2025 06 05 Glucose homeostasis disturbance is a common complication among patients in intensive care units (ICUs), frequently resulting in stress-induced dysglycemia. Individuals with diabetes mellitus (DM) are particularly susceptible to hyperglycemia and face a higher risk of severe hypoglycemia due to overtreatment. Particularly for patients on insulin or glucose-lowering drugs, it is crucial to maintain regular meal patterns in terms of timing, food type, and quantity. The 63-year-old female patient in this case study was referred from the neurology department after experiencing diminished awareness and going two days without eating. She had experienced multiple seizures lasting more than five minutes and presented with a nasogastric tube (NGT) insertion showing 150 mL of greenish gastric residual. The patient reported reduced intake over the past week due to nausea and headaches, occasional vomiting, intermittent fever, and a weight loss of 2.2 kg (4.8%) within one week. Medical nutrition therapy (MNT) was initiated to ensure adequate nutrient intake through enteral and parenteral routes, followed by a gradual transition to oral feeding. This approach aimed to improve the patient’s nutritional and metabolic status through personalized and adequate nutritional care. The patient's clinical condition was managed concurrently, with continuous monitoring of intake, anthropometry, and laboratory parameters to evaluate the intervention’s effectiveness. This case highlights that proper medical nutrition therapy for critically ill patients with metabolic encephalopathy, diabetes mellitus, cerebral infarction, and status epilepticus complicated by severe protein-energy malnutrition can lead to significant improvements in clinical outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1282

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 246 253 Sohrab Salimi Associate Professor, Department of Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shahram Sayadi Associate Professor of Anesthesiology, Anesthesiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran Dariush Abtahi Associate Professor, Department of Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mona Varzandeh Department of Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Arman Jami Emergency Department, MEKPCO (Middle East Kimia Petrochemical Company), Asaluyeh, Iran Sepide Ghesmati Tabrizi Health Division, Local Office, MEKPCO (Middle East Kimia Petrochemical Company), Tehran, Iran 2025 05 27 2025 06 15 Background: Managing intracranial pressure and brain swelling during supratentorial brain tumor surgery often involves hyperosmolar solutions like hypertonic saline and mannitol. However, using these solutions alongside hydroxyethyl starch (HES) could potentially affect blood clotting. This study aimed to compare the impact of hypertonic saline and mannitol, when combined with HES, on blood coagulation in patients undergoing these surgeries. Materials and Methods: This clinical trial compared 20% mannitol and 3% hypertonic saline in patients undergoing brain tumor surgery. Patients were divided into two groups, each receiving one of these osmotic agents along with hydroxyethyl starch. The study focused on assessing any blood clotting abnormalities. Results: The study included 30 patients (15 in each group). Their initial characteristics were similar. The study found no significant differences in blood coagulation tests between the groups. Additionally, osmolality levels and measures of brain tension were comparable in both groups. There were also no significant differences in intraoperative hemodynamic parameters. Conclusion: Both hypertonic saline and mannitol, when used with HES, effectively manage intracranial pressure without significantly affecting blood clotting during supratentorial tumor surgeries. Further research is needed to refine fluid management strategies and minimize potential clotting risks in these procedures. https://aacc.tums.ac.ir/index.php/aacc/article/view/1298

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 332 334 Bhavini Shah Department of Anaesthesiology, DR D Y Patil Medical College Hospital and Research Center, Dr D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Reshma Salim Department of Anaesthesiology, DR D Y Patil Medical College Hospital and Research Center, Dr D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Sachin Wagh Department of Anaesthesiology, DR D Y Patil Medical College Hospital and Research Center, Dr D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. 2025 05 14 2025 05 26 Pan facial trauma, involving multiple fractures of the facial bones, presents significant challenges in anaesthetic management. These injuries often result from high-impact accidents and can lead to airway compromise, making intubation and ventilation difficult. The anaesthesiologist must navigate potential obstacles such as facial distortion, bleeding, and limited mouth opening, all while maintaining cervical spine precautions. The management of these cases requires a thorough preoperative assessment, careful planning, and often necessitates advanced airway techniques. This case report describes the anaesthetic management of a 50-year-old male patient with pan facial trauma scheduled for reconstructive surgery. It highlights the use of CMAC video laryngoscopy intubation as a safe and effective technique in securing the airway in a patient with anticipated difficult intubation. The report also discusses the rationale behind the anaesthetic choices made and the perioperative challenges encountered. By sharing this experience, we aim to contribute to the existing body of knowledge on managing complex airway scenarios in trauma patients and emphasize the importance of individualized anaesthetic planning in such cases. https://aacc.tums.ac.ir/index.php/aacc/article/view/1286

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 254 258 Muhammad Sulaeman Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. Faisal Muchtar Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Department of Anaesthesia, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Hisbullah Hisbullah Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Department of Anaesthesia, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Syafri Kamsul Arif Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Department of Anaesthesia, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Nur Surya Wirawan Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Department of Anaesthesia, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Madonna Damayanthie Datu Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Department of Anaesthesia, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. 2025 06 08 2025 06 15 Background: Ventilator-Associated Pneumonia (VAP) is a common complication in mechanically ventilated ICU patients and is associated with bacterial colonization in the oral cavity. Poor oral hygiene can increase the risk of bacterial aspiration into the lower airway. Various oral hygiene agents such as chlorhexidine, povidone iodine 1%, and fluoride toothpaste are used to prevent this colonization, but their effectiveness is still variable. This study aimed to compare these three agents on tracheal microorganism growth and antibiotic resistance profile in mechanically ventilated patients. Methods: This single-blind randomized clinical trial included 45 ICU patients on mechanical ventilation at Dr. Wahidin Sudirohusodo Hospital, Makassar. Subjects were allocated into three groups to receive oral hygiene using chlorhexidine 0.12%, povidone iodine 1%, or fluoride toothpaste twice daily for five days. Tracheal aspirates were collected at baseline (before intervention), Day 3, and Day 5 to assess microbial colony counts and antibiotic susceptibility profiles. Results: The chlorhexidine group showed the most significant reduction in tracheal microorganism colony counts from 1833.33  566.5 to 1226.7  461.7 CFU/mL on day 5 (p < 0.001), compared to povidone iodine and fluoride. The highest antibiotic resistance was found in Acinetobacter baumannii and Pseudomonas aeruginosa. The chlorhexidine group also had the lowest number of multiresistant isolates. Conclusion: Among the evaluated oral hygiene agents, chlorhexidine 0.12% was the most effective in reducing tracheal microbial colonization and showed a lower tendency for antibiotic resistance development. It is recommended as a superior oral care agent for preventing VAP in mechanically ventilated ICU patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1308

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 335 340 EN Mahmoud Mohammed ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Eriks Sliders ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Ashraf Alakkad Internal Medicine Department, Madinat Zayed Hospital, SEHA, United Arab Emirates. Osama Ahmed SEHA Kidney Care, Abu Dhabi, United Arab Emirates. Mostafa Saleh CU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. & Critical Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October, Egypt. 2025 06 30 2025 07 07 Diabetic ketoacidosis (DKA) may become life-threatening when accompanied by acute pancreatitis, sepsis, and acute respiratory distress syndrome (ARDS), resulting in a cascade of inflammation and multi-organ dysfunction. We describe a 70-year-old male with severe DKA complicated by septic shock, ARDS, and multi-organ failure, who required individualized, precision-based fluid therapy. Aggressive but closely titrated resuscitation, guided by dynamic clinical markers, together with early initiation of Continuous Renal Replacement Therapy (CRRT), achieved stabilization. This case highlights the value of adaptive fluid management and timely CRRT in critically ill patients with complex DKA. https://aacc.tums.ac.ir/index.php/aacc/article/view/1329

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 259 266 Aparna Bagle Department of Anaesthesiology, D.Y. Patil Medical College, Hospital & Research Centre, Pune, India. Yashwant Nankar Department of Anaesthesiology, D.Y. Patil Medical College, Hospital & Research Centre, Pune, India. Kshitija Bora Department of Anaesthesiology, D.Y. Patil Medical College, Hospital & Research Centre, Pune, India. 2025 06 23 2025 07 06 Background: Effective management of postoperative pain in breast cancer surgery is crucial to enhance recovery and quality of life. Regional anesthesia techniques such as Pecs II and Serratus Anterior Plane Block (SAPB) have emerged as alternatives to systemic opioids. To compare the efficacy of single-shot Pecs II block and SAPB in terms of acute and long-term (up-to 2 months) postoperative analgesia following modified radical mastectomy. Methods: A single-blind, randomized controlled trial was conducted on 46 ASA I-II female patients undergoing MRM, assigned to either Pecs II block (Group P) or SAPB (Group S), each with 30 mL of 0.25% bupivacaine. Numerical Rating Scale (NRS) scores at rest and during movement were recorded perioperatively and during 60-day follow-up. Secondary outcomes included time to first rescue analgesia, number of rescue analgesics in 48 hours, and adverse effects. Results: Both blocks provided comparable acute pain relief in the first 48 hours (p>0.05). Group P showed significantly lower NRS scores at 15, 30, and 60 days at rest and on movement (p<0.05), indicating better long-term analgesia. There was no significant difference in rescue analgesic requirements or adverse effects. Conclusion: Both Pecs II and SAPB offer effective acute postoperative pain control following MRM, while Pecs II provides superior long-term analgesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/1318

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 341 344 Mahmoud Mohammed ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Eriks Sliders ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Shanavaskhan Shamsudeenkutty Cardiology Department, Al Dhafra Zayed Hospital, United Arab Emirates. Ashraf Alakkad Internal Medicine Department, Madinat Zayed Hospital, SEHA, United Arab Emirates. Mostafa Saleh ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. & Critical Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October, Egypt. Mohamed Abd Elrahman Internal Medicine Department, CMO Sila Hospital, Abu Dhabi, United Arab Emirates. 2025 07 01 2025 07 09 Acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiac arrest presents a major clinical challenge, especially in resource-limited settings without immediate access to percutaneous coronary intervention (PCI). We report a 37-year-old man with anterior STEMI who suffered prolonged ventricular fibrillation cardiac arrest. After 20 minutes of high-quality CPR and failed thrombolysis at a rural hospital, he was urgently transferred 250 km to a PCI-capable center. Emergent coronary angiography revealed complete proximal left anterior descending artery occlusion, treated successfully with thrombus aspiration and stenting. Comprehensive intensive care, including early antibiotics for aspiration pneumonia, meticulous hemodynamic management, and multidisciplinary rehabilitation, resulted in full neurological recovery. The patient was discharged hemodynamically stable with improving left ventricular function and remained asymptomatic at two-week follow-up. This case underscores the importance of organized regional care networks, adherence to advanced cardiac life support protocols, timely recognition of thrombolysis failure, and prompt transfer for PCI in achieving favorable outcomes in STEMI patients with cardiac arrest. Systems enabling rapid interhospital coordination can significantly improve survival and neurological outcomes, even in geographically isolated settings. https://aacc.tums.ac.ir/index.php/aacc/article/view/1332

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 267 272 Achmad Toba Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. Syafruddin Gaus Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Andi Musba Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Muhammad Ahmad Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Alamsyah Husain Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Intensive Care and Pain Management, Dadi General Hospital, Makassar, South Celebes, Indonesia. Madonna Datu Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. & Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. 2025 06 30 2025 07 10 Background: Acute postoperative pain following modified radical mastectomy (MRM) remains a significant clinical problem, affecting patients’ quality of life. Opioid-based anesthesia (OBA), while effective for analgesia, is associated with adverse effects, including increased interleukin-6 (IL-6) levels, and the higher the IL-6 levels, the higher the likelihood of breast cancer recurrence. Opioid-free anesthesia (OFA) has emerged as a potential alternative to mitigate these effects. This study aimed to compare the impact of OBA and OFA on intraoperative hemodynamic stability, IL-6 levels, postoperative pain degree, and total postoperative opioid requirements. Methods: This was a single-blind randomized clinical trial involving 30 patients undergoing MRM, allocated into two groups: Group I received OBA, and Group II received OFA. Parameters assessed included intraoperative hemodynamic changes, serum IL-6 levels, postoperative pain degree, and total postoperative opioid requirements. Results: The OFA group had significantly lower IL-6 levels at 24 hours post-surgery. The OFA group also demonstrated more stable intraoperative hemodynamics, significantly lower postoperative pain degree, and reduced postoperative opioid (fentanyl) requirements compared to the OBA group. Conclusion: OFA is better than OBA in modified radical mastectomy surgery. OFA significantly reduced IL-6 levels as a marker of inflammation, resulted in lower recurrence of breast cancer, reduced the degree of postoperative pain, maintained hemodynamic stability during the procedure, and reduced postoperative opioid requirements. These findings suggest that OFA is a more effective and safe anesthetic option in controlling pain and surgical stress response. https://aacc.tums.ac.ir/index.php/aacc/article/view/1331

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 273 280 Ahmed Abdelmoniem Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. Mennatullah Abdel-Maksoud Critical Care and Intensive Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October, Egypt. Amr Elhadidi Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. Ahmed Battah Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. Doaa Moubarez Critical Care Medicine Department, Faculty of Medicine, Kaser Elani, Cairo University, Cairo, Egypt. 2025 07 28 2025 08 11 Background: Accurate assessment of volume status in cases with acutely decompensated heart failure (ADHF) is crucial for prognostication and management. While brain natriuretic peptide (pro-BNP) and echocardiographic inferior vena cava (IVC) diameter are commonly used surrogate markers, their combined prognostic value has not been thoroughly established. Methods: This prospective cohort study included 100 adults with ADHF and reduced ejection fraction (EF <40%). Pro-BNP levels and IVC diameter were assessed on admission and after 72 hours. The primary outcome was in-hospital mortality; secondary outcomes included complications and 30-day cardiovascular mortality. Repeated measures ANOVA, ROC analysis, and correlation testing were performed to evaluate predictive value. Results: In-hospital mortality occurred in 21% of cases. Pro-BNP levels were significantly higher in non-survivors both on admission (median: 11,542 pg/mL vs. 6,350 pg/mL, p<0.001) and after 72 hours (3,695 pg/mL vs. 3,029 pg/mL, p<0.001). Similarly, IVC diameter was significantly greater in the mortality group at both time points (2.85 cm vs. 2.2 cm on admission, p<0.001; 2.15 cm vs. 1.9 cm after 72 hours, p=0.004). ROC analysis revealed strong predictive power for in-hospital mortality with admission Pro-BNP >8,856 pg/mL (AUC=0.89) and IVC diameter >2.55 cm (AUC=0.81). A combined model incorporating both parameters at admission yielded the highest diagnostic accuracy (AUC=0.89; NPV=95.4%). Conclusion: Pro-BNP and IVC diameter are independent yet complementary predictors of in-hospital mortality in ADHF. Combined early assessment significantly enhances risk stratification and may guide intensive monitoring and therapeutic strategies. https://aacc.tums.ac.ir/index.php/aacc/article/view/1359

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 02 02 281 287 EN Mohamed Abdalla Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Helen Rizk Critical Care and Intensive Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October City, Egypt. Hossam Mowafi Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Kamel Mohammed Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Mohamed Elansary Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 08 02 2025 08 11 Background: Intradialytic hypotension (IDH) is a common and serious complication of intermittent hemodialysis (IHD) in critically ill patients with acute kidney injury (AKI). Accurate pre-dialysis risk stratification remains a challenge, particularly in the ICU. This study aims to determine whether ultrasound-based cardiopulmonary profiles could predict IDH in this high-risk population. Methods: This prospective cohort study included 100 critically ill adults undergoing IHD for AKI. All patients underwent pre-dialysis echocardiography and lung/inferior vena cava (IVC) ultrasound to assess stroke volume, cardiac output, B-lines, and IVC collapsibility index (IVC-CI). Patients were divided into two groups based on the presence or absence of IDH. Results: IDH occurred in 35% of patients. Significant predictors of IDH included lower systolic blood pressure (124.86 ±16.02 vs. 139.92 ±22.8 mmHg, P < 0.001), higher IVC-CI [51% (13–58) vs. 27.38% (13–60), P < 0.001], sepsis (88.6% vs. 70.8%, P = 0.044), and elevated potassium (5.17 ±1.34 vs. 4.62 ±0.87 mmol/L, P = 0.015). Multivariate analysis identified IVC-CI (OR = 1.097, P < 0.001) and SBP (OR = 0.942, P = 0.001) as independent predictors. IVC-CI >49.5% predicted IDH with 68.6% sensitivity and 87.7% specificity (AUC = 0.757, 95% CI: 0.652–0.862). Conclusion: Ultrasound-derived IVC-CI is a valuable, noninvasive tool for predicting IDH in critically ill patients receiving IHD. Incorporating sonographic profiles into routine pre-dialysis evaluation may enhance risk stratification and improve dialysis safety. https://aacc.tums.ac.ir/index.php/aacc/article/view/1362

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 288 292 EN Khadijeh Ghavibonyeh Department of Anesthesiology and Critical Care, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Dabbagh Department of Anesthesiology and Critical Care, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Alireza Jahangiri Fard Department of Anesthesiology and Critical Care, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ramin Baghaei Department of Cardiac Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Kamal Fani Department of Anesthesiology and Critical Care, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Marzieh Shahrabi Department of Anesthesiology and Critical Care, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mina Fani School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 07 29 2025 08 18 Background: Different studies investigated strategies to prevent perioperative bleeding in cardiac surgeries. The use of fibrinogen concentrate is one of these efforts. In this study, we will investigate the efficacy and proper dosage of fibrinogen concentrate as a prophylactic adjuvant for reducing postoperative bleeding in patients with normal blood fibrinogen under coronary artery bypass grafting (CABG) surgery. Methods: Patients with preoperative normal plasma fibrinogen levels were randomly divided into two groups (15 patients in each). At the final stage of cardiac surgery and after reversal of heparin, the first group received 2gr of fibrinogen IV concentrate in 15 minutes, while the other group received the same volume of placebo. In each patient, postoperative haematocrit percentage, intraoperative and postoperative administered blood products, and postoperative drainage amount were collected. Results: Although in the study group, the postoperative amount of plasma fibrinogen increased compared to preoperative and decreased in the control group, but this change was not statistically significant. Also there wasn’t any significant difference in terms of blood drainage and blood product consumption. Conclusion: We did not find evidence of a significant difference in the change of fibrinogen blood level before and after the operation, the amount of drainage, and the consumption of blood products in the fibrinogen and placebo groups. https://aacc.tums.ac.ir/index.php/aacc/article/view/1295

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 02 09 293 298 Kareem Abbass Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Reham Saleh Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Ahmed Lotfy Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Ghada Omar Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Heba Bakr Department of Anaesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 06 29 2025 07 20