Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 230 235 Alireza Sharifian Attar Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Afsaneh Attari Jahed Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahdieh Jafari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Moradi Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. & Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 05 24 2025 05 26 Background: Caesarean section is associated with postoperative pain that results in patient dissatisfaction and necessitates the use of various analgesics. In this study, the effect of gabapentin on post-Caesarean-section pain relief was evaluated. Methods: A total of 50 parturients undergoing spinal anesthesia for cesarean section were randomly assigned into intervention and control groups in this randomized clinical trial between 2022 and 2023. Patients in the case group received gabapentin 300 mg capsules one hour before surgery, while the control group received an identical placebo. The postoperative pain intensity and need for analgesics, as well as nausea, vomiting, and drowsiness, were evaluated at 0, 6, 12, and 24 hours after surgery. Results: The mean age of patients in the gabapentin and placebo groups was 26.42±6.15 and 26.5±65.91, respectively (P=0.34). A significant difference was found in postoperative pain intensity and the need for analgesics between the case and control groups at zero (P=0.001 and P=0.003), six (P=0.007 and P=0.002), 12 (P=0.005 and P=0.001), and 24 (P=0.004 and P=0.021) hours after surgery. No significant differences were seen in the rates of nausea, vomiting, and drowsiness between the two groups at the different time points (P>0.05). Conclusion: According to our findings, prescribing gabapentin 300mg before a cesarean section effectively reduces postoperative pain severity and the need for analgesics. This dose is also safe for the neonate. https://aacc.tums.ac.ir/index.php/aacc/article/view/1294

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 02 23 299 309 Mohammad Mehdi Azizi Darbandi Department of Anesthesia & Surgical Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran. Mohammad Gholamzadeh Department of Anesthesiology, School of Allied Medical Sciences, Golestan University of Medical Sciences, Gorgan, Iran. Alireza Mamizadeh Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran. Zahra Ranjbar Department of Anesthesiology and Operating Room, School of allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. Behnam Shiri Zilan Department of Anesthesia & Surgical Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran. 2025 12 27 2026 01 28 Background: Intraoperative handovers, the transfer of patient care between anesthesia providers, are common in the operating room and represent a critical juncture for communication failures. Ineffective handovers are associated with the loss of essential clinical information and an increased risk of adverse postoperative outcomes. This systematic review aimed to synthesize the existing evidence regarding the impact of structured intraoperative handovers on patient safety, communication quality, and continuity of care. Methods: This systematic review was conducted according to the PRISMA guidelines. The study evaluated 17 published research studies (2000–2025) investigating structured intraoperative anesthesia handovers, including the utilization of checklists, SBAR (Situation-Background-Assessment-Recommendation), I-PASS, and cognitive aids. Data extraction focused on patient safety outcomes, communication quality, and the continuity of care. Results: The findings demonstrate that non-standardized handovers commonly result in information loss and variability in clinical practice, thereby potentially compromising patient safety. In contrast, the use of standardized handover tools reliably promotes information transmission, bolsters team collaboration, and minimizes variability in patient-transfer procedures. Moreover, available data suggest that implementing structured intraoperative handovers is associated with reductions in postoperative morbidity, although study findings are heterogeneous. Conclusion: Structured intraoperative handovers are a viable and economical technique to improve communication and patient safety under anesthesia. Standardization and targeted education may further optimize the outcomes. Future research should identify the optimal handover components, evaluate their long-term clinical impact, and guide the development of international implementation strategies. https://aacc.tums.ac.ir/index.php/aacc/article/view/1545

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 310 314 Hadis Daneshvar Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Dariush Abtahi Department of Anesthesiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 06 04 2025 06 15 This case report describes the anesthetic management of a 27-year-old man with hypermobile Ehlers-Danlos syndrome (hEDS) who underwent scleral buckling surgery for retinal detachment. The patient who had joint hypermobility and mild mitral valve prolapse required careful anesthetic management. The surgery, which was performed under general anesthesia with a laryngeal mask airway and EDS-tailored monitoring, was uneventfully accomplished in 85 minutes. The patient was discharged the next day, recovering well, emphasizing the importance of careful preoperative evaluation, correct positioning, and multidisciplinary care for patients with hEDS undergoing complex ophthalmic surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/1302

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 345 346 Anahita Babaei Department of Anesthesiology and Critical Care, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2025 10 10 2025 11 05     https://aacc.tums.ac.ir/index.php/aacc/article/view/1445

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 236 240 Fatemeh Javaherforooshzadeh Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Sara Parhiz Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Behnam Gholizadeh Department of Cardiac Surgery, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2025 05 30 2025 06 07 Background: In perioperative care, patient satisfaction is a key quality indicator; however, very little information exists on anesthetic-specific satisfaction among cardiac surgery ICU patients. Patients admitted to the cardiac surgery intensive care unit (ICU) were evaluated in this study for their level of satisfaction. Methods: Between 2019 and 2020, this cross-sectional analytical research included 186 consecutive adult patients undergoing open-heart surgery at Golestan Hospital, Ahvaz, Iran. The verified Evaluation du Vécu de l'Anesthésie Générale (EVAN-G) scale (score range: 0-100) measured anesthesia satisfaction 48 hours post-extubation. Multivariable linear regression identified predictors of satisfaction. Results: The mean satisfaction score was 73.8 ± 14.2. High satisfaction (≥80) was reported by 52.7% (n=98). Significant predictors included: Preoperative anxiety therapy (β=8.6, p=0.003), Effective pain control (VAS<4) (β=12.1, p<0.001), Clinician communication quality (β=9.3, p<0.001) and, Absence of PONV (β=7.2, p=0.011). The regression model accounted for 63% of satisfaction variation (R²=0.63, p<0.001). Conclusion: Modified variables linked with anesthesia satisfaction in patients in a cardiac ICU are active communication, pain management, and preoperative counseling. https://aacc.tums.ac.ir/index.php/aacc/article/view/1299

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 315 319 Parviz Amri Department of Anesthesiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. Ebrahim Hejazian Department of Surgery, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. Fatemeh Amri Department of Pediatrics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 2025 06 17 2025 07 06 Cerebral salt wasting syndrome (CSWS) is a cause of hyponatremia in patients with brain injury, but it often improves in a short time. In this article, a patient with prolonged CSWS after craniotomy for subdural hematoma (SDH) and intracranial hemorrhage (ICH) is presented. A 73-year-old woman was transferred to the ICU due to a decreased level of consciousness (GCS= 9) with a diagnosis of SDH and ICH. The patient had a history of atrial fibrillation. The pupils were mid-sized and reactive. BP= 130/90 mm/Hg, HR=80/min, T=37.3, and initial tests were HB=12.7 gr/dl, Bun=12, Cr=0.7, Na=138 Meq/lit, K=4meq/lit, Ptt=25 Sec, INR=1.1, ESR=10. The patient was intubated 48 hours later due to a decreased level of consciousness and underwent craniotomy and hematoma drainage. From the 4th day after the operation, the patient developed hyponatremia and polyuria, but despite the administration of hypertonic sodium and normal saline, the hyponatremia persisted. On the 8th day after the operation, fludrocortisone was started, one tablet twice a day, and the patient showed a partial response to the treatment after one week, but the hyponatremia was corrected after 2 weeks. CSWS is more common and prolonged in severe and multiple brain injuries, and in these cases, the administration of fludrocortisone in addition to normal sodium and hypertonic sodium is helpful. https://aacc.tums.ac.ir/index.php/aacc/article/view/1316

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 347 348 Mounika Yerramshetty Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. Ishan Garud Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. 2025 11 02 2025 11 11     https://aacc.tums.ac.ir/index.php/aacc/article/view/1471

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 241 245 EN Rafly Wahid Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Muh. Ramli Ahmad Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. & Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Haizah Nurdin Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. & Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. & Hasanuddin University Hospital, Makassar, Indonesia. A. Husni Tanra Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Andi Musba Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. & Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. & Hasanuddin University Hospital, Makassar, Indonesia. Charles Tan Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. & Siloam Hospital, Makassar, Indonesia. 2025 05 27 2025 06 15 Background: Hysterectomy often triggers a systemic inflammatory response, increasing biomarkers like C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR), which can delay recovery and raise complication risks. Ketamine, a common anesthetic, possesses anti-inflammatory properties that may modulate this postoperative response. This study aimed to further examine the effects of ketamine on CRP and NLR levels in patients undergoing hysterectomy. Methods: This double-blind randomized clinical trial included 28 adult female patients (ASA I–II) undergoing elective abdominal hysterectomy under epidural anesthesia. Patients were randomized to receive either 0.5 mg/kg intravenous ketamine (intervention group) or no ketamine (control group). Serum CRP and NLR were measured preoperatively and at 8 and 24 hours postoperatively. The visual analog scale was used to evaluate pain level, data were processed with the appropriate statistical test, and a p-value < 0.05 is considered significant. Results: Our study discovers that intravenous ketamine reduced postoperative inflammatory markers significantly. Postoperative measurements at 8 and 24 ours proved that the ketamine group had lower CRP and NLR levels significantly (p<0.05). Patients receiving ketamine showed a non-significant reduction in VAS pain scores compared with controls. No participant in either group needed additional opioids for pain control. Conclusion: Intravenous ketamine decreased postoperative inflammatory response significantly in hysterectomy patients receiving epidural anesthesia, as proved by lower CRP and NLR.  Ketamine seemed to improve patient comfort by lowering pain intensity. Combining epidural anesthesia with ketamine may be a viable strategy to suppress inflammation and enhance recovery after hysterectomy. 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 Background: This study aimed to compare the combination of intravenous ibuprofen and intravenous paracetamol versus combined diclofenac suppository and intravenous paracetamol for pain control after tonsillectomy or adenotonsillectomy in children. Methods: This is a randomized controlled study involving 90 children aged between 1 and 7 years, classified as ASA I or II, scheduled to undergo tonsillectomy or adenotonsillectomy between February 2023 and February 2024 at Cairo University Hospitals. Results: There was a statistically significant difference regarding FLACC score between the two groups (p=0.006) at 10 min after arrival to PACU, while it was not significantly different between the two groups on arrival or discharge from PACU (p=0.054 and 0.208, respectively). There was no statistically significant difference in PPPM between the two groups at 4, 12, and 24 hours postoperative (p=0.718, 0.470, and 0.738, respectively). Regarding the number of patients who received rescue analgesia (pethidine), they were fewer in group A (p=0.031), and the mean dose of pethidine received/kg as rescue analgesia was also significantly lower in group A (p=0.0316). The incidence of postoperative adverse events, i.e., nausea, vomiting, hypotension (low SBP = <70 + 2 (age in years)), bradycardia (less than 60 beats/min), drug allergic reaction, and postoperative bleeding requiring return to the operative room, was zero in the two groups. Conclusion: The combination of intravenous ibuprofen and intravenous paracetamol was a more effective analgesic regimen than the combined rectal diclofenac and intravenous paracetamol in pediatric patients undergoing tonsillectomy or adenotonsillectomy without increased complications. https://aacc.tums.ac.ir/index.php/aacc/article/view/1328