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/1260

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 67 70 Mahsa Sanatkar Department of Biotechnology, Tehran University of Medical Sciences, Tehran, Iran. 2025 12 15 Sepsis is a dynamic and heterogeneous syndrome characterized by a dysregulated host response to infection, leading to concurrent hyperinflammation and profound immunosuppression. Early recognition of pathogen- and damage-associated molecular patterns triggers extensive activation of NF-κB, JAK/STAT, and MAPK pathways, resulting in a cytokine storm, metabolic reprogramming, and endothelial dysfunction. Mitochondrial impairment, glycocalyx degradation, and excessive neutrophil activity further propagate organ injury and microcirculatory collapse. Simultaneously, widespread apoptosis and exhaustion of lymphocytes culminate in immune paralysis and increased susceptibility to secondary infections. Advances in transcriptomics, proteomics, metabolomics, and machine-learning–based classification have uncovered distinct immune endotypes of sepsis, providing the foundation for precision medicine. Emerging immunomodulatory therapies—including IL-7, GM-CSF, and immune checkpoint inhibitors—aim to restore immune function in selected subgroups. Ultimately, sepsis must be viewed as a multifaceted immunometabolic disorder requiring individualized diagnosis, monitoring, and treatment approaches. https://aacc.tums.ac.ir/index.php/aacc/article/view/1526

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 102 107 Alireza Shakeri Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Mohammad Seyed Alshohadaei Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 03 2025 02 08 Spinal anesthesia with bupivacaine is widely used for cesarean sections but can rarely cause angioedema, a rapid swelling of deep tissues that may lead to airway obstruction. This case report presents the occurrence of angioedema in a pregnant woman with postoperative hyper IgE levels following spinal anesthesia. It highlights the intricate interplay between drug sensitivity, immune dysregulation, and the physiological changes associated with pregnancy. We present a case of a 32-year-old woman with post-operative hyper IgE levels who developed angioedema shortly after getting spinal anesthesia with bupivacaine for a cesarean section. It should be noted that the patient had no prior history of allergic reactions, making the case particularly interesting and challenging. This report's goal is to: 1. Report details of the clinical presentation, management, and outcome of this unusual patient; 2. Investigate the potential etiologies of angioedema, with a focus on the relationship between bupivacaine sensitivity, hyper IgE, and other possible factors; and 3. Highlight the challenges in diagnosis and management when facing angioedema in patients with atypical presentations. https://aacc.tums.ac.ir/index.php/aacc/article/view/1195

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 18 25 Maged Elgendy Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Sahar Marzouk Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Enas Samir Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Beshoy Gendy Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Sherif Abbas Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Ahmed Ahmed Department of Anesthesiology, National Cancer Institute, Cairo University, Cairo, Egypt. Norhan Ali Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 04 13 2025 04 25 Background: Propofol and dexmedetomidine have a mitigating effect on postoperative nausea and vomiting (PONV). However, their efficacy in preventing PONV in patients following ureteroscopic operations remains uncertain. This study evaluated the efficacy and safety of infusions of dexmedetomidine versus propofol with respect to the incidence of PONV in patients scheduled for ureteroscopic surgeries under spinal anesthesia. Methods: This randomized controlled trial included 72 adult patients scheduled for ureteroscopic surgery under spinal anesthesia with multiple risk factors for PONV (female, history of PONV, non-smoker). The patients were randomized into three groups (24 patients each). The propofol, dexmedetomidine, and control groups received intravenous infusions of propofol, dexmedetomidine, and normal saline, respectively. The study outcomes were the incidence of PONV (primary outcome) as well as the time and need for antiemetics, Ramsay Sedation Scale, and incidence of intraoperative hemodynamic changes (secondary outcomes). Results: Dexmedetomidine infusion resulted in significantly lower PONV scores and heart rates during and after surgery compared to the propofol and control groups. Both intervention groups had significantly deeper sedation, but dexmedetomidine was more sedating than propofol (p = 0.001) in comparison to the control group. At 40 and 60 minutes intra- and postoperatively, both the propofol and dexmedetomidine groups had a significant reduction in mean blood pressure in comparison to the control group. Mean blood pressure was similar in the two groups. Conclusion: During ureteroscopic procedures under spinal anesthesia, dexmedetomidine effectively and safely reduces the incidence of PONV in highly susceptible patients. It also provides deeper sedation and better hemodynamic control compared to propofol. https://aacc.tums.ac.ir/index.php/aacc/article/view/1262

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 71 83 Kavous Shahsavarinia Emergency and Trauma Care Research Center, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Shaghayegh Musazadeh Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Morteza Ghojazadeh Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Nooshin Milanchian Department of Internal Medicine, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran. Maryam Soleimanpour Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Hassan Soleimanpour Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. 2025 05 11 2025 05 26 Background: Coronavirus disease 2019 (COVID-19) is an infectious illness resulting from the SARS-CoV-2 virus. The immune system overactivation triggered by this virus results in multiple organ damage. This infection has the potential to cause acute respiratory distress syndrome and may progress to respiratory failure, both of which can be life-threatening. Vitamin C is proposed as a possible treatment for immune system overactivation due to its antioxidant properties. Methods: This umbrella review seeks to evaluate the effectiveness of vitamin C in the management of COVID-19 infection. To identify pertinent literature, we conducted searches across Embase, PubMed, Scopus, and Web of Science databases. Our analysis incorporated eight systematic reviews and meta-analyses that examined the impact of vitamin C on COVID-19 treatment outcomes. Results: Our findings revealed that the odds ratio (OR) of mortality in the vitamin C group is 0.55 (0.48-0.63). The duration of hospitalization did not differ between the groups and the need for mechanical ventilation in both groups. This umbrella review discusses the use of vitamin C in COVID-19 patients, highlighting its potential to reduce mortality rates. While the duration and dose of treatment vary There was no notable distinction observed between the vitamin C group and the control groups in hospital length, ICU stay, or mechanical ventilation days. Conclusion: The study suggests further research to determine its effectiveness in reducing mortality rates and suggests larger studies with a more specific protocol. https://aacc.tums.ac.ir/index.php/aacc/article/view/1283

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 108 111 EN Alagiri Sneha Department of Anaesthesiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. Rajesh Mane Department of Anaesthesiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. Chaitanya A. Kamat Department of Anaesthesiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. 2025 02 17 2025 02 26 The incidence of paraganglioma has been reported between 2-8 cases per million people yearly. Thoracic functional Paragangliomas accounts for 15-20% of pheochromocytomas derived from chromaffin cells and secretes catecholamines. It has high mortality rate challenging anaesthetic management. Undiagnosed paraganglioma have an extremely high mortality rate up to 60%. The present report is a case of successful management of functional paraganglioma excision at the level of T9-T11 feeding from the descending aorta. A 71-year-old male with lower thoracic functional paraganglioma was posted for excision. Pre-anaesthetic evaluation, revealed history of Ischemic Heart Disease, Hypertension and PTCA 1month prior and intake of regular cardiac medication preoperatively, along with regular medications of Tab Propranolol 10mg and Tab Bisoprolol 2.5mg. PR was 84 bpm and BP was 140/90 mmHg in a supine position and 90/60 mmHg on standing. Echocardiography indicated EF 50% with borderline LV function. Epidural and General Anaesthesia was administered. Continuous roller coaster fluctuations in haemodynamics for intraoperative period of 8hrs, risk challenges calibrated by continuous vasopressor and vasodilation infusions. Extubation and post-operative period were uneventful. Careful perioperative management, including preoperative cardiovascular stabilization and intraoperative hemodynamic monitoring, is crucial in functional paraganglioma cases to prevent mortality and complications. https://aacc.tums.ac.ir/index.php/aacc/article/view/1206

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 26 28 Ebrahim Espahbodi Tehran University of Medical Sciences Mahsa Raji Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Mahsa Raji Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Reza Rahmani Department of cardiology, Tehran University of Medical Sciences, Tehran, Iran Saghar Samimi Department of Anesthesiology, Critical Care and Pain Management, Tehran University of Medical Sciences, Tehran, Iran Mehrzad Rahmanian Department of cardiac surgery, Tehran University of Medical Sciences, Tehran, Iran Ali Karbasforoshan Department of Cardiology, Zanjan University of Medical Sciences, Zanjan, Iran Mehdi Sanatkar Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran 2025 11 25 2025 12 01 Abstract Background: Refractory angina remains a major therapeutic challenge when revascularization options are unavailable. Stellate ganglion block (SGB) may reduce sympathetic tone, improve coronary perfusion, and alleviate ischemic chest pain. This study evaluated the effects of SGB on the severity of chest pain and ST-segment deviation during exercise testing. Methods: This before–and–after interventional study included patients with confirmed coronary artery disease and refractory angina. Baseline treadmill testing assessed angina index and ST-segment deviation. SGB was performed under ultrasound guidance using 0.25% bupivacaine and dexamethasone. Treadmill testing was repeated 24–48 hours after the block. Results: Sixteen patients participated (56% male; mean age 60.7±9.7 years). The angina index significantly improved (1.90±0.34 to 0.50±0.32; P < 0.001). ST-segment deviation decreased modestly but significantly (1.0±0.4 to 0.9±0.3 mm; P=0.041). No major complications occurred. Conclusion: SGB significantly reduced chest pain severity and improved ischemic ST-segment abnormalities in patients with refractory angina. It may serve as a safe and effective adjunct therapy. https://aacc.tums.ac.ir/index.php/aacc/article/view/1502

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 84 89 Masoomeh Tabari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Soheila Milani Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Malihe Aghasizadeh Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 05 22 2025 06 02 Background: The gut microbiome has emerged as a notable factor in the field of anesthesiology. It affects different dimensions of anesthesia outcomes, pain control, and recovery following the surgery. A comprehensive understanding of the interplay between gut microbiota and anesthetic methods is imperative for improving patient care. Methods: This narrative review synthesizes existing scholarly literature on the interactions between gut microbiota and anesthetic agents, examining their implications for drug metabolism, inflammatory responses, and the gut-brain axis. Results: It highlights clinical trials that explore the effectiveness of probiotics and prebiotics in reinstating microbial equilibrium and augmenting surgical outcomes. A study indicates that alterations in the composition of the gut microbiome can notably influence the pharmacokinetics and therapeutic efficacy of anesthetic agents. So, there are effects on dosage regimens and strategies for controlling postoperative pain. An equilibrated microbiome has been demonstrated to enhance anti-inflammatory mechanisms and bolster immune function; thus, it promotes an optimal recovery trajectory. Also, the gut-brain axis suggests that microbiome profiles may serve as predictors for postoperative cognitive dysfunction and pain perception. Conclusion: This review emphasizes the relevance of the gut microbiome within anesthesiology and advocates for the adoption of personalized anesthetic approaches that consider individual microbiome characteristics. Prospective research in this field holds significant potential for the development of innovative perioperative care strategies. It may enhance recovery and mitigate complications associated with surgical procedures. https://aacc.tums.ac.ir/index.php/aacc/article/view/1293

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 112 114 Parisa Sezari Department of Anesthesiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Firozeh Madadi Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sogol Asgari Department of Anesthesiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 01 2025 02 11 Intravenous cannulation can be a challenging issue in hospitalized patients, especially during the perioperative period. Objectives: In this study we will present our experience about an emergency popliteal vein cannulation during surgery. We successfully cannulated the popliteal vein in a prone position with an ultrasound guide in an emergency situation. Conclusion: The popliteal vein can be a safe intravenous access during surgeries in a prone position without significant adverse events. https://aacc.tums.ac.ir/index.php/aacc/article/view/1192

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 29 37 Vahid Saidkhani Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Kianoosh Bagheri 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. Azita Zaheri Department of Anesthesiology, Faculty of Paramedical, Shahrekord University of Medical Sciences, Shahrekord, Iran. 2025 04 22 2025 04 24 Background: Concept mapping and debriefing are educational strategies used to create motivation and meaningful learning. This study compared the effect of teaching incorporating these two techniques on learning and achievement motivation in anesthesia management of neurosurgery among anesthesia students. Methods: This was a quasi-experimental study involving two experimental groups (concept mapping and debriefing) and one control group. The statistical population included all 5th- and 7th-semester undergraduate students of anesthesia at Ahvaz Jundishapur University of Medical Sciences. Census sampling yielded 51 participants, who were then randomly assigned to three groups: 17 in the concept mapping group, 17 in the debriefing group, and 17 in the control group. The experimental groups were exposed to group concept mapping and debriefing, while the control group received traditional instruction. Data were collected using the Hermans Achievement Motivation Questionnaire and a standard learning questionnaire. Data were analyzed using analysis of covariance (ANCOVA) and t-tests. Results: Covariance analysis demonstrated that teaching interventions, using both group concept mapping and debriefing, significantly increased achievement motivation and learning outcomes in anesthesia students (p < 0.05). Furthermore, concept mapping yielded a statistically significant increase in achievement motivation as well as meaningful and deep learning compared to debriefing. Regarding learning levels, after two months of intervention, students taught using concept mapping exhibited significantly higher scores (30.41 ± 0.732) than both the debriefing group (29.17 ± 0.772) and the control group (28.78 ± 0.771, p < 0.05). Conclusion: This research suggests that educational stakeholders should integrate concept mapping into anesthesia curricula, focusing on its motivational components, to significantly boost student achievement and learning outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1270

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 90 96 Afsaneh Hashemidoust Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmoudreza Moharreri Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Pouria Namaei Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Alireza Shariafian Attar Department of Anesthesiology, 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. 2025 03 26 2025 04 06 Background: Dexmedetomidine, a selective α2-adrenergic receptor agonist, is widely used for sedation and analgesia in critically ill pediatric patients. Its dose-dependent modulation of pre- and postsynaptic receptors induces sympatholysis and vascular effects. While systemic hemodynamic impacts are well-documented, its influence on pulmonary artery pressure (PAP) remains underexplored. This systematic review evaluates dexmedetomidine’s effects on PAP. Methods: This systematic review analyzes studies from databases including SID, IranMedex, Magiran, Google Scholar, Cochrane, Scopus, and Web of Science (2005–2024). Keywords such as “dexmedetomidine,” “pulmonary artery pressure,” and “pulmonary effects” identified cross-sectional studies assessing PAP changes. Fifteen high-quality articles met inclusion criteria. Results: Dexmedetomidine’s effects on PAP seem inconsistent. Animal studies have reported both increased PAP with intravenous administration and no significant changes. Paradoxically, some models demonstrated PAP reduction in hypertensive states via suppressed vascular contraction. Human studies have observed transient PAP elevation after bolus dosing, though loading doses have shown no sustained pulmonary vascular effects. Preoperative administration reduced pulmonary vascular resistance and mean arterial pressure. Secondary pulmonary outcomes included improved oxygenation and lung mechanics in restrictive lung disease, though benefits were not universal. Conclusion: Dexmedetomidine exhibits variable PAP modulation, with evidence suggesting transient pressure spikes after bolus doses but neutral or beneficial effects in controlled administrations. Animal-human discrepancies highlight physiological differences, necessitating further clinical research. Beyond hemodynamics, dexmedetomidine may enhance oxygenation and ventilation-perfusion matching while mitigating pulmonary inflammation, though inconsistent oxygenation outcomes underscore context-dependent variability. These findings emphasize cautious dosing in pulmonary hypertension and identify gaps for future human trials to clarify its role in cardiopulmonary management.   https://aacc.tums.ac.ir/index.php/aacc/article/view/1244

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 38 41 Mehdi Sarafi Mofid Children's Hospital, Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Behzad Azimi Department of Operating Room, Emam Khomeini Hospital, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran. Milad Borji Department of Anesthesiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran. Gholamreza Ebrahimisaraj Mofid Children's Hospital, Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 27 2025 04 11 Background: The readmission of a patient to the intensive care unit means a patient's return to the hospital for a certain period of time after discharge for planned or unplanned reasons. Therefore, this study aimed to investigate the risk factors for readmission after appendectomy in hospital. Methods: In this retrospective study, the records of patients who underwent appendicitis in hospitals were reviewed. In order to identify readmissions, a list of patients with a history of readmission was extracted from the hospital's Health Information Technology Unit. Then, the researchers studied the patients' clinical records and extracted data using a researcher-made checklist. To analyze the data, first the data were entered into SPSS version 16 software and then analyzed using descriptive and analytical statistical tests. Results: According to the findings, the mean (SD) age of the patients in the readmitted group was 14.1 (2.8) years, and in the non-readmitted group was 13.9 (2.1) years. In the readmitted patient’s group, 52.4% of the patients were male, 19% of the patients had underlying diabetes, 9.5% had asthma and allergies, and 100% of the surgeries were performed by a specialist. Also, the results showed the reasons for readmission of patients were 4.8% due to intra-abdominal abscess, 42.9% due to wound infection, 14.3% due to abdominal pain, 23.8% due to paralysis/ileus, and 14.3% due to other causes. Conclusion: Given that patient readmission has various complications for the patient, the patient's family, and the healthcare system, it is necessary to take necessary preventive measures regarding the factors affecting it. https://aacc.tums.ac.ir/index.php/aacc/article/view/1217

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 42 48 Moein Daneshmand Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Alireza Jahangirifard Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Nazembokaee Anesthesiology and Critical Care Department University, Critical Care Quality Improvement Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Marzie Shahrabi Department of Anesthesiology and Critical Care, Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Lida Fadaizadeh Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Alireza Salimi Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Kobra Rafiei Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 03 19 2025 04 13 Background: Airway management is a routine part of any type of anesthesia; therefore, the present study was designed to compare the effect of transtracheal dexmedetomidine and transtracheal lidocaine in patients undergoing bronchoalveolar lavage and other adverse events. Methods: Individuals aged 18 to 65 years that were candidates for bronchoalveolar lavage in three groups were included in the study. All three groups of patients underwent a standard treatment with the same anesthesia method with the same treatment group. Patients were administered lidocaine (4 cc 2% lidocaine), dexmedetomidine (0.5 g/kgµ dexmedetomidine), and lidocaine + dexmedetomidine (4 cc 2% lidocaine + 0.5 g/kgµ dexmedetomidine) groups. Results: A total 150 patients with a mean age of 57.2±16.32 were evaluated in three equal groups. The clinical status of the patients showed that the patients in the combined use of dexmedetomidine and lidocaine group underwent sedation significantly more than the other two groups. The incidence of cough in dexmedetomidine and lidocaine group of patients was significantly lower than in the other groups. Conclusion: The simultaneous use of transtracheal lidocaine and dexmedetomidine significantly reduces the incidence of cough in patients undergoing bronchoalveolar lavage. https://aacc.tums.ac.ir/index.php/aacc/article/view/1241

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 49 53 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 Department of Anesthes