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     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 2026 02 22 228 229 Srinivasan Parthasarathy Department of anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India. 2025 08 16 2025 10 03     https://aacc.tums.ac.ir/index.php/aacc/article/view/1380

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 132 136 EN Fajrin Syaputra Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. Andi Adil Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia Hisbullah Hisbullah Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia Andi Salahuddin Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia Alamsyah Husain Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia Ari Palinrungi Department of Anesthesiology, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia 2025 04 27 2025 05 11 Background: Cardiac catheterization is an essential procedure in managing pediatric congenital heart disease, providing a less invasive alternative to thoracotomy. However, adverse events remain a concern, especially in high-risk patients. The CRISP (Cardiac Risk in Pediatric) score, developed by the Congenital Cardiac Intervention Study Consortium (CCISC), predicts serious adverse events (SAEs) in pediatric cardiac catheterization. Despite its reliability, CRISP has not been implemented in Indonesia. This study evaluates its predictive ability at Dr. Wahidin Sudirohusodo Hospital, Makassar. Methods: A prospective cross-sectional study was conducted from November 2024 to January 2025. Pediatric patients (<18 years) undergoing elective cardiac catheterization were assigned CRISP scores pre-procedure, and adverse events were recorded. The relationship between CRISP categories and SAE incidence was analyzed. Results: Among 70 patients, the majority of patients were categorized as CRISP I (67.1%), followed by CRISP II (21.4%), CRISP III (5.7%), and CRISP IV (5.7%), with no CRISP V cases. There were 6 cases (8.6%) of serious adverse events identified, consisting of 4 cases (5.71%) of cardiac arrest and 2 cases (2.89%) of bleeding. A significant correlation was found between higher CRISP risk categories and SAE incidence (p < 0.001). SAEs occurred exclusively in CRISP III (50% incidence) and CRISP IV (100% incidence) patients. Conclusion: The CRISP score effectively stratifies risk in pediatric cardiac catheterization. Higher CRISP categories correlate with increased SAE incidence, supporting its predictive validity. Routine CRISP implementation could enhance pre-procedural planning, risk mitigation, and patient safety in Indonesia. Further studies with larger sample sizes are recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/1274

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 187 191 Sogol Asgari Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hasanali Ahmadi Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Hallajnejad Department of Neurosurgery, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faranak Behnaz Department of Anesthesiology, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 06 01 2025 06 30 Background: Postoperative cognitive dysfunction (POCD) is a relatively common and troubling issue, especially in older adults undergoing surgery. Bispectral index (BIS) monitoring enables anesthesiologists to assess anesthetic depth in real time and adjust dosing accordingly. In this article, we summarize the current evidence on BIS-guided anesthesia in reducing the incidence and severity of POCD in adult surgical patients. Methods: A structured search was conducted in PubMed and Scopus databases to identify randomized controlled trials, observational studies, and meta-analyses published between 2000 and 2024. Results: Clinical trials and meta-analyses suggest that BIS monitoring reduces anesthetic exposure, shortens recovery time, and is associated with lower POCD rates. Mechanisms may include optimized drug titration, improved hemodynamic control, and reduced neuroinflammation. Conclusion: BIS monitoring may represent an effective approach to mitigate POCD, especially in high-risk patients. Further large-scale trials are needed to confirm these findings and refine guidelines. https://aacc.tums.ac.ir/index.php/aacc/article/view/1300

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 216 220 Nastaran Mahdavi Department of Anesthesiology, Mofid Children’s Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Javad Ghoroubi Department of Surgery, Mofid Children’s Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Reza Mahdavi Department of Anesthesiology, Mofid Children’s Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shiva Pourakbari Shahid Beheshti University of Medical Sciences, Tehran, Iran. Morteza Mortazavi Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 04 12 2025 04 23 Posterior mediastinal masses pose challenges for anesthesiologists due to their compressive nature. The most frequently used surgical approach is thoracotomy and anesthesia involves awareness of potential complications and airway management strategies. Among different types of foreign bodies (FBs), the esophageal FBs are one of the most common pediatric emergencies among infants and young children and the proximal part is the most common site. Presentation can range from being asymptomatic to symptoms such as vomiting, dysphagia, and drooling, or respiratory issues like coughing, wheezing, choking, or stridor. In this report, we present a case of a posterior mediastinal mass in a child with a history of respiratory disorders and multiple treatment courses. https://aacc.tums.ac.ir/index.php/aacc/article/view/1261

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 137 142 Sabran Pulubuhu Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Alamsyah Husain Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Hisbullah Hisbullah Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Andi Salahuddin Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Andi Adil Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Nur Wirawan Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. 2025 05 04 2025 05 11 Background: Non-cardiac surgery in patients with cardiovascular risk can lead to Spine surgery often leads to significant postoperative pain, inflammation, and hemodynamic instability, necessitating opioid use, which increases the risk of side effects. Dexmedetomidine (DEX) and magnesium sulfate (MgSO₄) are anesthetic adjuvants that may enhance recovery and reduce opioid consumption. This study aimed to compare the effects of DEX and MgSO₄ as an anesthetic adjuvant on interleukin-6 (IL-6) levels, hemodynamic stability, postoperative recovery, and opioid consumption in spine surgery. Methods: A randomized controlled trial was performed on 24 patients undergoing spine surgery under general anesthesia. Participants were randomly divided into two groups: Group 1 received DEX (a 1 µg/kg bolus followed by a continuous infusion of 0.3–0.5 µg/kg/h), while Group 2 was given MgSO₄ (a 30–50 mg/kg bolus followed by an infusion of 10–20 mg/kg/h). Hemodynamic parameters, IL-6 levels (pre- and postoperatively), opioid use, and recovery outcomes were analyzed. Results: IL-6 levels decreased significantly in both groups (p=0.001), with a greater reduction in the DEX group (-60.5 pg/dL vs. -24.9 pg/dL), though not statistically significant. Hemodynamic stability was comparable, but DEX provided better pulse rate control. Opioid consumption was lower in the DEX group at 24 and 48 hours postoperatively (p < 0.05). The DEX group also showed higher Aldrete scores (p<0.05) and shorter hospital stays (3.75 vs. 4.83 days, p<0.05). Conclusion: DEX provides superior anti-inflammatory effects, hemodynamic stability, reduced opioid use, and improved recovery compared to MgSO₄ as an anesthetic adjuvant in spine surgery patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1281

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 01 31 192 202 Mohammadreza Hajiesmaeili Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Reza Goharani 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. Mahdi Amirdosara Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Majid Mokhtari Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 06 29 2025 08 10 Background: Transcranial direct current stimulation (tDCS) is an emerging, non-invasive neuromodulation technique with massive potential in neurocritical care settings. This review covers the applications, mechanisms, and outcomes of tDCS in patients with severe neurological disorders. Methods: tDCS uses low-intensity direct current to modulate cortical excitability and induce neuroplasticity, which aids in recovering motor, cognitive, and sensory functions. Its simplicity and noninvasive nature enable bedside use, making it a good alternative to invasive interventions. Results: The evidence suggests that tDCS improves recovery in stroke, TBI, and DOC by affecting synaptic plasticity, releasing neurotrophic factors, and improving cerebral perfusion. However, due to the variability in the methodology and stimulation parameters of the studies, further research is required to determine standardized protocols. Safety appears minimal, with most side effects including mild discomfort. Conclusion: This review underlines the promise of tDCS as an adjunctive therapy in neurocritical care and recommends its integration into traditional rehabilitative strategies to enhance patient outcomes. Future studies should investigate optimizing stimulation parameters, long-term efficacy, and condition-specific applications to exploit tDCS's therapeutic benefits. https://aacc.tums.ac.ir/index.php/aacc/article/view/1326

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 221 224 Shilpa Kore Dr D Y Patil Medical College Hospital and Research Centre, Vidyapeeth, Pimpri, Pune, India. Anushka Sharma Dr D Y Patil Medical College Hospital and Research Centre, Vidyapeeth, Pimpri, Pune, India. 2025 04 13 2025 05 02 Lobectomy with one-lung ventilation presents significant anesthetic challenges, particularly in elderly patients with multiple comorbidities. This case report describes the successful anesthetic management of an elderly patient with adenocarcinoma lung undergoing right lower lobe lobectomy. An elderly male with adenocarcinoma of the right upper lobe presented for lobectomy. His complex medical history included chronic kidney disease requiring regular hemodialysis, post-stroke right-sided hemiparesis, hypertension, hypothyroidism, and diabetes mellitus. The anesthetic management involved careful preoperative optimization, use of a left-sided double-lumen tube for one-lung ventilation, and meticulous hemodynamic monitoring. Challenges encountered included a brief episode of hypoxemia during one-lung ventilation and hypertension, which were successfully managed with ventilator adjustments and dexmedetomidine infusion, respectively. The six-hour surgery was completed successfully with minimal blood loss. The patient was extubated postoperatively and maintained stable oxygenation on supplemental oxygen. Pain management was achieved through multimodal analgesia, including a fentanyl patch. This case illustrates that complex thoracic surgery can be safely conducted in high-risk patients through comprehensive preoperative evaluation, careful intraoperative management, and adherence to enhanced recovery protocols. The successful outcome emphasizes the importance of a multidisciplinary approach in managing such challenging cases. https://aacc.tums.ac.ir/index.php/aacc/article/view/1263

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 143 148 Amirali Barkhordarioon School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Effat Hosseinali Beigi Department of Pediatric Intensive Care, Bahrami Children’s Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Mahtab Ramezani School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Paniz Pourpashang Department of Pediatric Nephrology, Bahrami Children’s Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Maryam Ghodsi Department of Pediatric Intensive Care, Bahrami Children’s Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran 2025 04 30 2025 05 14 Background: The most severe complication of type 1 diabetes mellitus is diabetic ketoacidosis (DKA). Hypokalemia, a common electrolyte disturbance in DKA, can be life-threatening and often worsens during treatment. A significant clinical debate exists regarding the optimal route of potassium administration—central versus peripheral lines. Current guidelines recommend aggressive potassium replacement but lack consensus on the safest administration method. This study investigated the safety and complications of high-concentration peripheral potassium administration in pediatric DKA patients within an intensive care setting. Methods: This observational study, conducted at the PICU of Bahrami Children's Hospital, enrolled 55 pediatric patients with DKA requiring high-concentration potassium supplementation (50, 60, or 70 mEq/L) through peripheral veins. Potassium chloride was administered in normal saline with dosing stratified by serum potassium levels checked every 2 hours. Primary analyses examined associations between infusion-related complications (phlebitis, pain, erythema, burning sensation) and potassium concentration, infusion duration, DKA severity, and patient characteristics. Results: Among 55 patients (mean age: 8.7 ± 4.1 years; 52.7% male), 32 patients (58.2%) received 50 mEq/L, 21 patients (38.2%) received 60 mEq/L, and 2 patients (3.6%) received 70 mEq/L. Of these, 25 patients (45.5%) required infusion duration exceeding 6 hours. Hypokalemia occurred in 30.9% of patients, with higher prevalence in severe DKA (44.4%). A total of eight patients (14.5%) experienced a total of 10 infusion-related complications. These included one case of phlebitis (1.8%), five cases of injection site pain (9.1%), and four cases of burning sensation (7.3%). Infusion duration exceeding 6 hours significantly increased complication risk (OR: 5.7; 95% CI: 2.01-16.56; p=0.042), with combined high concentration and extended duration showing elevated risk (adjusted OR: 3.1; 95% CI: 1.86-5.24; p=0.003). Conclusion: In pediatric DKA patients receiving care in the PICU setting, peripheral potassium infusion at concentrations up to 60 mEq/L demonstrates acceptable safety outcomes when administration duration remains under 6 hours and rigorous monitoring protocols are implemented. However, for infusions exceeding 6 hours, our findings suggest careful consideration of alternative approaches may be warranted, particularly at higher concentrations. https://aacc.tums.ac.ir/index.php/aacc/article/view/1278

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 01 31 203 209 Dariush Abtahi Department of Anesthesiology, Clinical Research and Development Unit of Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ebtehaj Heshmatkhah Department of Obstetrics and Gynecology, Valiasr Private Hospital, Qom, Iran. 2025 10 24 2025 11 08 Hypertensive disorders of pregnancy, including preeclampsia and eclampsia, represent a significant global maternal health challenge, affecting 2-8% of pregnancies worldwide and contributing to 11-14% of maternal deaths. The complex, multisystemic nature of these conditions, coupled with their unpredictable clinical trajectories, presents substantial challenges for anesthetic management. This narrative review examines the emerging integration of artificial intelligence (AI) technologies in obstetric anesthesia care for hypertensive disorders, exploring current applications, technological foundations, implementation challenges, and future directions. We synthesize evidence demonstrating AI's potential in continuous monitoring, predictive analytics, personalized care delivery, and clinical decision support. While significant barriers to implementation exist-including technological, regulatory, and ethical considerations-the integration of AI into obstetric anesthesia represents a paradigm shift toward precision, predictive, and personalized maternal care. This narrative review synthesizes current evidence to argue that the primary value of AI in this context is not the replacement of clinical judgment, but its augmentation through the synthesis of high-dimensional, time-series data, thereby enhancing anesthesiologist situation awareness and enabling proactive, rather than reactive, management. https://aacc.tums.ac.ir/index.php/aacc/article/view/1462

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 149 153 Ananda Asadul Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Ari Palinrungi Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Haizah Nurdin Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. A. Husni Tanra Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Nur Surya Wirawan Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Rusmin B.Syukur Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Hasanuddin University/Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. 2025 04 28 2025 05 15 Background: Vitamin D plays a vital role in bone metabolism, immune function, and overall health. Healthcare professionals, particularly those working indoors, may be at increased risk for deficiency due to limited sunlight exposure. This study aimed to evaluate serum vitamin D levels and explore associated factors among anesthesiology residents. Methods: A retrospective cross-sectional study was conducted among 50 anesthesiology residents at Dr. Wahidin Sudirohusodo General Hospital in Makassar from January to February 2025. Data were collected through self-administered questionnaires and medical records. Serum 25-hydroxyvitamin D [25(OH)D] levels were used to determine vitamin D status. Statistical analysis was performed using SPSS version 26, with P values < 0.05 considered significant. Results: Among the 50 participants, 76% were found to be vitamin D deficient. No significant associations were found between vitamin D levels and sex, age, or BMI. However, vitamin D deficiency was more common among residents with obesity and younger age groups. Vitamin D supplementation (p = 0.022) and duration of sunlight exposure (p = 0.029) showed significant associations with serum vitamin D levels. Dietary intake and comorbidities were not significantly related to vitamin D status. Conclusion: A high prevalence of vitamin D deficiency was observed among anesthesiology residents, likely due to occupational limitations on sun exposure. Supplementation and regular sun exposure appear to be protective factors. Targeted strategies, including routine screening and preventive interventions, are recommended for at-risk healthcare workers. https://aacc.tums.ac.ir/index.php/aacc/article/view/1276

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 154 157 Mehdi Sarafi Mofid Children's Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Behzad Azimi Department of General Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Aminollah Vasigh School of Medicine, Ilam University of Medical Sciences, Ilam, Iran. Gholamreza Ebrahimisaraj Mofid Children's Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 05 01 2025 05 25 Background: A hernia is defined as the protrusion of an organ, tissue, or part of an organ through a structure that normally contains it. Inguinal hernias are a type of hernia that causes pain. Methods: In this study, 62 individuals aged 4 to 18 years who met the inclusion criteria were enrolled. The tools used included a demographic characteristics form, a patient clinical characteristics form, and the Widder Scale questionnaire. After completing the questionnaires, data related to CPIP (likely an abbreviation for a pain assessment measure, but further information is needed for confirmation) and its influencing factors were entered into SPSS version 18 software and analyzed. Results: According to the findings, out of 62 patients studied, 3 (4.8%) patients had CPIP, with the prevalence of CPIP being higher in men than in women. Also, none of the postoperative complications, including readmission, hydrocele, infection, and recurrence status, were observed in the patients. Also, regarding the duration of pain, it was shown that the pain of 36 patients was within the time range of up to one week, and the pain of 19 patients was within the time range of one week to one month. Conclusion: It is essential to follow up on factors affecting CPIP in children undergoing hernia surgery on an ongoing basis or even one year after surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/1279

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 158 162 Behzad Azimi Department of General Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Rabea Mohsen Ali Department of Maternal and Neonatal Nursing, College of Nursing, University of Kut, Wasit, 52001, Iraq. Shideh Ariana Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 05 19 2025 05 26 Background: Intrauterine adhesion (IUA) typically occurs as a result of intrauterine trauma associated with a surgical procedure. This study aimed to assess the prevalence and risk factors of postoperative adhesions following repeated cesarean sections. Methods: In this registry-based study, data collection tools included a standardized registry checklist and the American Fertility Society (AFS) classification system for assessing IUA. The diagnosis of IUA was confirmed by an obstetrician-gynecologist, and the AFS scoring was performed by trained researchers responsible for completing the registry data. This study specifically focused on patients who were admitted to the Intensive Care Unit (ICU) of Ayatollah Taleghani Hospital in Ilam following their second cesarean delivery (CD). Within a defined timeframe, the incidence of IUA among these ICU-admitted patients was evaluated. The collected data were subsequently analyzed using SPSS statistical software. Results: According to the findings, out of 121 hospitalized patients, 35 (28.92%) patients were diagnosed with IUA. Out of 35 patients, 15 (42.9%) patients were in Stage I (mild), 13 (37.1%) patients were in Stage II (moderate), and 7 (20%) patients were in Stage III (severe). also, there was no difference between any of the variables in Table 1 and the stage of adhesions (P>0.05). Conclusion: Given that the rate of IUA has been significant, it is recommended that necessary preventive and therapeutic interventions be implemented to reduce its incidence, contributing factors, and related complications. https://aacc.tums.ac.ir/index.php/aacc/article/view/1291

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 01 01 163 168 Masoud Hatefi Department of Neurosurgery, Ilam University of Medical Sciences, Ilam, Iran. Ahmed Hasan Ajeel Alhachami Department of Adult Nursing, College of Nursing, University of Kut, Wasit, 52001, Iraq. Mustafa Saleem Department of Optics, College of Health and Medical Techniques Al Dour, Northern Technical University, Al Dour 34002, Iraq. Seyed Hossein Aghamiri Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amir Sherafat Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Aminollah Vasigh Department of Anesthesiology, Ilam University of Medical Sciences, Ilam, Iran. Shahram Kargar Department of Cardiology, Ilam University of Medical Sciences, Ilam, Iran. Mahdieh Razi Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 03 28 2026 01 01 Background: Pain is a recognized complication of COVID-19, and identifying the factors influencing it is crucial for diagnosis. Given the significance of pain assessment in viral patients, this study aimed to determine the relationship between different pain types and inflammatory markers in COVID-19 patients. Methods: This registered registry study included 2,780 COVID-19 patients hospitalized in Ilam City. Data collection involved using a patient demographic form and a researcher’s checklist to assess pain status. Data was primarily gathered by reviewing patient files at referral hospitals admitting COVID-19 cases. If necessary, information was missing from the file, researchers collected supplementary data through clinical examinations and patient interviews. All collected data was then entered into SPSS software, version 16. Results: The prevalence of pain types was high: back pain in 2,067 patients (77.2%), neck pain in 2,060 (77%), headache in 2,219 (82.9%), and myalgia in 2,419 (90.4%). Results indicated that the ESR level was statistically significantly higher (P<0.05) in patients experiencing pain in areas such as the neck, back, and head compared to other patients. Furthermore, a significant relationship was found between CRP status and the status of all types of pain (P<0.05). Conclusion: The findings demonstrate a significant association between the pain condition and the inflammatory factors (ESR and CRP) in COVID-19 patients. Due to COVID-19 being an emerging disease, further research in this area is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/1250