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 c 1 2025 04 05 783 785 Alireza Babajani Department of Anesthesiology, School of Allied Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran. Pegah Arman Department of Anesthesiology, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. Parastoo Rahmati Torkashvand Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran. Behrouz Karkhane Department of Anesthesiology, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Kimia Khonakdar Department of Anesthesiology, Allied Medical School, Mazandaran University of Medical Sciences, Sari, Iran. 2024 12 22 2025 01 17 The patient was an 11-year-old girl, weighing 25 kg and measuring 125 cm in height, with a history of congenital cleft palate and previous surgeries (including cleft palate repair and cardiac procedures). She was referred for maxillary alveolar closure surgery. She experienced difficulty swallowing and dyspnea when consuming solids and liquids. During the preoperative evaluation, no significant comorbidities were identified, but anatomical changes in the nasopharynx suggested a defect in the previous repair. To ensure safe airway management and avoid nasopharyngeal injury during surgery, a modified intubation technique was employed. We used a flexible armored endotracheal tube that had been autoclaved at 45°C for 2 min. Anesthesia induction included propofol, fentanyl, and cis-atracurium. Intubation was successfully performed without complications. Postoperatively, the patient recovered well, showing no signs of trauma or airway distress. She was discharged on the first postoperative day with appropriate care recommendations. https://aacc.tums.ac.ir/index.php/aacc/article/view/1161

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 05 05 802 803 Anahita Babaei Department of Anesthesiology and Critical Care, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2025 04 01 2025 04 07 No Abstract    No Abstract  No Abstract    No Abstract  https://aacc.tums.ac.ir/index.php/aacc/article/view/1254

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 05 25 627 634 Arezou Ashari Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Dariush Abtahi Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 21 2025 02 23 Background: Bimalleolar fractures, which often necessitate surgery due to instability, are linked to considerable postoperative pain. Selective cyclooxygenase-2 (COX-2) inhibitors, like celecoxib, have demonstrated potential in alleviating pain and decreasing the need for opioids. However, the optimal dosing regimen remains unclear. This study compares the efficacy of two celecoxib regimens in reducing postoperative pain after ankle fracture surgery. Methods: A double-blind, randomized controlled trial was carried out with 240 patients undergoing bimalleolar fracture surgery under spinal anesthesia. The participants were split into three groups: a placebo group, a group receiving 400 mg of celecoxib (Group 400), and a group receiving 600 mg of celecoxib (Group 600). Pain levels were evaluated using the Visual Analog Scale (VAS) at specific time points (0, 6, 24, and 72 hours after surgery). Additionally, total morphine consumption, the time until first analgesic use, patient satisfaction, and side effects were documented. Results: Patients in Group 600 experienced significantly lower pain scores and delayed morphine use compared to the placebo group (P < 0.05). Both celecoxib groups consumed less morphine overall, with higher patient satisfaction scores reported in Group 600. Adverse events were minimal and comparable across all groups. Conclusion: The preemptive use of celecoxib, particularly at a 600 mg dose, significantly reduces postoperative pain and opioid use while enhancing patient satisfaction with minimal side effects. These results suggest that COX-2 inhibitors are a practical alternative to opioids for managing pain after ankle fracture surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/1214

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 11 767 773 EN Bahare Firouzbakht Department of Anesthesiology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. Bahareh Hakiminia Department of Clinical Pharmacy, School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran. Laleh Dehghanpisheh Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 2024 12 30 2025 01 04 Background: In cardiopulmonary bypass (CPB), there is a need to better maintain appropriate anesthesia due to the physiological and hemodynamic alterations induced by CPB. This review aimed to explore the effects of sevoflurane versus propofol in the management of patients undergoing cardiac surgeries with CPB. Methods: The literature search was conducted in the international databases, including Cochrane, Science-Direct, Scopus, PubMed, and Google Scholar, from January 2012 to July 2024. Results: According to the studies, sevoflurane was associated with a significantly shorter time to extubation, eye-opening, and command compliance with better intraoperative hemodynamic stability. It was superior in reducing oxygen demand and may be associated with less hypoxia in the aortic cross-clamp phase. In addition, sevoflurane produces more prominent myocardial protection, attenuates inflammatory response, and has a lower impact on cognitive function. On the other hand, propofol decreased the incidence and intensity of acute kidney injury and may be preferred over sevoflurane in patients at risk of postoperative nausea. Conclusion: It seems in adults undergoing cardiac surgery with CPB, the class of sevoflurane is superior to propofol with regard to many perioperative and postoperative outcomes. However, more studies with larger sample sizes are needed to clarify this issue. https://aacc.tums.ac.ir/index.php/aacc/article/view/1169

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 07 786 789 Reza Tahmasabi Department of Anesthesia, Hamadan University of Medical Sciences, Hamedan, Iran. Ibrahim mouhamad Department of Anesthesiology, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. Pegah Arman Department of Anesthesiology, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. Afshin Farhanchi Department of Anesthesia, Hamadan University of Medical Sciences, Hamedan, Iran. 2024 12 24 2025 01 08 A 68-year-old female patient referred for mandibular reconstruction surgery. He was treated for cancer in the mandible last month. Due to the extent of the mass in the lower jaw area, this patient underwent Mandibulectomy 9 months ago. The patient was admitted to Ba'ath Hospital in Hamadan, his vital signs were stable. Before the surgery, according to his underlying diseases, a cardiovascular consultation was done and no complications affecting anesthesia were reported. The challenge of the anesthesia team in this patient was to establish a safe airway for him. According to the physical condition of the patient's neck and mandible, the patient was intubated using a Fireoptic bronchoscope. The patient's surgery lasted 2 hours and 45 minutes. During the entire period of anesthesia, the patient was under strict respiratory monitoring. After the end of the surgery, the patient was transferred to the recovery room without removing the endotracheal tube, and after ensuring that the patient's condition was stable, he was transferred to the intensive care unit. https://aacc.tums.ac.ir/index.php/aacc/article/view/1164

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 23 635 639 Majid Razavi Lung Diseases Research Center, Imam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Hamideh Zarezadeh Lung Diseases Research Center, Imam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Ahmad Bagherimoghaddam Lung Diseases Research Center, Imam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mehryar Taghavi Gilani Lung Diseases Research Center, Imam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 03 01 2025 03 06 Background: Postoperative emergence agitation in children is so common. Isoflurane and propofol are evaluated for agitation, but results were contradictory. This study aimed to compare the effect of isoflurane and propofol for emergence agitation in children under three years old. Methods: This double-blinded, randomized clinical trial was performed on 104 children under three years’ old who were candidates for nasolacrimal probing. The children were anesthetized by sevoflurane and then were divided into isoflurane and propofol groups. After transfer to the recovery room, at first, 4 and 8 minutes, the degree of agitation of the child was measured according to the Watcha sedation criteria. Results: The demographic parameters were not different. The mean duration of anesthesia (from LMA insertion to extubation) in isoflurane was significantly shorter than in propofol (p = 0.001). Also, the recovery time in the isoflurane group was significantly shorter than that of the propofol group (P=0.02). The prevalence of agitation was 7.69% in the propofol and 59.61% in the isoflurane, and the difference was significant (P = 0.001). Agitation scores at first, 4 and 8 minutes in the recovery room, showed less agitation in the propofol group (P=0.001). Conclusion: Our study showed that propofol in children reduces the incidence of emergence agitation compared to isoflurane. But emergence and recovery time in the isoflurane group was less than in the propofol group. https://aacc.tums.ac.ir/index.php/aacc/article/view/1220

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 18 774 779 Zachary Merhavy Ross University School of Medicine, Bridgetown, Barbados, USA. Colton Zeitler Arizona College of Osteopathic Medicine at Midwestern University, Glendale, AZ, USA. Thomas Varkey Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ, USA. Marc Brandon Arizona Anesthesia Consultants, Glendale, AZ, USA. 2025 03 09 2025 03 31 Anesthesia in patient care, both in the perioperative period and in the pain clinic, is a challenging field to engage with - this is secondary to the fact that patients are individuals who are influenced by numerous factors, including the bacterial makeup of their microbiome and its parts. With the focus on personalized medicine as the next frontier, this narrative literature review looks at the current trend in individualized medicine, specifically regarding the use of the microbiome and artificial intelligence in the choice of different drugs for the induction and continuation of surgery as well as the management of pain syndromes in patients. This review also includes a summary of the different research directions that can take place based on the most recent data, including microbiome composition testing, therapeutic alterations, and the use of artificial intelligence to select the best drugs for treating the patient. https://aacc.tums.ac.ir/index.php/aacc/article/view/1229

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 06 790 794 Ibnu Samdani Department of Anesthesiology and Intensive Care, Padjadjaran University, Bandung, Indonesia. Iwan Fuadi Department of Anesthesiology and Intensive Care, Padjadjaran University, Bandung, Indonesia. Iwan Rachman Department of Anesthesiology and Intensive Care, Padjadjaran University, Bandung, Indonesia. 2025 01 05 2025 02 03 Intraoperative Neurophysiological Monitoring (IONM) refers to the use of various electrophysiological methods to monitor the function of the brain, spinal cord, and related nerves during surgical procedures. IONM involves the use of neurophysiological recordings to detect changes in nervous system function during surgery, allowing doctors to identify potential nerve damage before it occurs. Reported is a 65-year-old male patient with a diagnosis of unruptured aneurysm of the Posterior Communicating Artery (PcomA) and left ophthalmic segment of C5 whose aneurysm was planned to be clipped. The patient was planned to have the aneurysm clipped under general anesthesia. The challenge in the anesthesia process for aneurysm cases is maintaining the pressure in the aneurysm and cerebral perfusion pressure (CPP), protecting the brain during periods of ischemia, and providing as wide an operating field as possible. Post-operatively, the patient showed stable neurological function with no new deficits, highlighting the importance of intraoperative neurophysiological monitoring in achieving a favorable outcome. https://aacc.tums.ac.ir/index.php/aacc/article/view/1173

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 23 640 647 EN Behzad Nazemroaya Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Zahra Rahimi Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mojtaba Rahimi Varposhti Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Movahed Dehghani Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 03 01 2025 03 10 Background: This study was conducted with the aim of comparing the sedation rate of Propofol and Lidocaine -Propofol combination in patients undergoing bronchoscopy. Methods: In this clinical trial study, 60 patients undergoing bronchoscopy were divided into two groups of 30 people, in the first group 1 mg/kg of Propofol and in the second group 1 mg/kg of Propofol together with 1.5 mg/kg of Lidocaine were injected. And the hemodynamic parameters, depth of sedation, consumption of Propofol and midazolam, and pain intensity after the operation were evaluated and compared between two groups. Results: Patients in the propofol-Lidocaine group had better hemodynamic stability and the trend of sedation score changes was significantly different between the two groups (P=0.042). In terms of pain intensity during recovery, propofol-Lidocaine recipients had less pain intensity (P<0.001). Patients receiving propofol-Lidocaine received less Propofol (P=0.028) and midazolam (P=0.01). Conclusion: The results of the present study show that the use of injectable Lidocaine with Propofol is associated with more favorable hemodynamic stability, reduction of Propofol consumption, better sedation, and less postoperative pain, so it seems that the use of Lidocaine with Propofol is beneficial. It is preferable to Propofol alone. https://aacc.tums.ac.ir/index.php/aacc/article/view/1221

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 03 31 795 798 EN Hossein Karballaei Mirzahosseini School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran. Leili Manafi School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran. 2025 01 14 2025 01 19 Baclofen functions as a GABA-B receptor agonist and is utilized as a muscle relaxant. Acute baclofen poisoning can lead to significant central nervous system depression, which may occasionally be challenging to distinguish from brain death. Because of the complexities associated with the diagnosis and treatment of baclofen poisoning, we decided to document this case. We present the case of an 18-year-old female who experienced acute poisoning due to an intentional overdose of baclofen. He was intubated and in a deep coma with no brainstem reflexes. Initial evaluations indicated brain death due to the lack of neurological responses. The patient received intensive supportive care and continuous monitoring. Over the following days, she showed gradual neurological improvement, eventually regaining consciousness and autonomic stability. After an extended hospital stay and a careful reduction of ventilation support, she achieved a full neurological recovery. Baclofen toxicity may show severe symptoms of brain death, but with the support of the intensive care unit, the symptom may be completely reversible. https://aacc.tums.ac.ir/index.php/aacc/article/view/1178

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 29 648 654 Mehdi Dehghani Firoozabadi Department of Anesthesiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Afzal Shamsi Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Hosseini Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2025 03 03 2025 03 06 Background: Delivery and assuming the parental role, especially for mothers, are often accompanied by anxiety and stress, conditions that are significantly aggravated by the birth of a premature infant. The aim of our study is to "determine the effect of COVID-19 prevention training on the stress levels of mothers with premature infants admitted to the NICU." Methods: This is a quasi-experimental study. The sample consisted of 100 mothers (50 in the experimental group and 50 in the control group) of premature infants hospitalized in the Neonatal Intensive Care Unit (NICU). Participants were randomly assigned to the two groups. The experimental group received an educational program on preventing respiratory infection transmission, with a focus on the coronavirus, delivered through individual face-to-face sessions lasting between 45 to 90 minutes over three sessions. Data for both groups were collected in two phases, before and after the intervention, using a standard Parental Stress Scale questionnaire. Data were analysed using descriptive and analytical statistical tests and SPSS software. Results: According to the findings of our study, the mean age of mothers in the control and intervention groups was 26.88±0.32 and 27.10±0.30 years, respectively (T=-3.482, d=9.98, P=0.527). Also, the mean age of infants in the control group was 34.90±0.30 weeks and in the experimental group was 35.12±0.52 weeks (T=-2.582, d=9.98, P=0.114). The overall stress score in the intervention group after the intervention (93.82±7.15) significantly decreased compared to before the intervention (135.98±0.51) (P<0.001), and this significant decrease was also observed in all stress subscales (P<0.001). Conclusion: Finally, the findings of our study showed that mothers whose infants are hospitalized in the ICU experience high levels of stress. The COVID-19 prevention training leads to a significant reduction in mothers' stress. https://aacc.tums.ac.ir/index.php/aacc/article/view/1222

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 05 05 655 665 Ebrahim Espahbodi Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkar Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Reza Yekta Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Alireza Khajenasiri Pain Research Center, Neuroscience Institute, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Fahimeh Karimi Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Nima Amiresmaili Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2025 03 05 2025 03 16 Background: Lumbosacral radiculopathy due to disc herniation is a leading cause of chronic pain and disability worldwide. While fluoroscopic-guided epidural steroid injections (ESIs) are widely used for symptom relief, their efficacy is variable, and the long-term benefits remain controversial. Ozone therapy has emerged as a promising adjunct to steroid injections due to its anti-inflammatory, analgesic, and oxygenating effects. This study aimed to compare the efficacy and safety of fluoroscopic-guided caudal epidural steroid injections with and without ozone therapy in patients with lumbosacral radiculopathy. Methods: A randomized, single-blind clinical trial was carried out with 40 adults diagnosed with radicular pain from lumbar disc protrusion at L4-L5 or L5-S1. They were randomly placed into two equal-sized groups. The first group (n=20) received a caudal injection containing dexamethasone (8 mg), lidocaine (5 mL, 1%), and saline (3 mL). The second group (n=20) received the same injection along with 5 mL of ozone (10 µg/cc). Fluoroscopy was used to guide all procedures. Pain and physical function were tracked using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), both before treatment and again after one, three, and six months. Results: Improvements were seen in both groups over time. Still, the ozone group reported stronger pain relief and better functional scores at every follow-up. At one month, VAS and ODI scores were significantly lower in the ozone group (VAS: 1.85 ± 0.75 vs. 2.40 ± 0.90, p = 0.029; ODI: 22.3 ± 4.5 vs. 26.7 ± 5.1, p = 0.025). The difference held steady at three months (VAS: p = 0.022; ODI: p = 0.021) and at six months (VAS: p = 0.017; ODI: p = 0.015). No major side effects occurred, and mild ones cleared up on their own. Conclusion: The addition of ozone therapy to fluoroscopic-guided caudal epidural steroid injections significantly enhances pain relief and functional recovery in patients with lumbosacral radiculopathy compared to steroid injections alone. This combination therapy represents a safe, minimally invasive, and effective treatment option for individuals with refractory radicular pain. Further large-scale, multicenter trials with long-term follow-up are warranted to validate these findings and optimize treatment protocols. https://aacc.tums.ac.ir/index.php/aacc/article/view/1225

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 05 09 666 673 EN Sanaz Omidi Department of Clinical Pharmacy, TeMS.C., Islamic Azad University, Tehran, Iran. Maryam ShiehMorteza Department of Clinical Pharmacy, TeMS.C., Islamic Azad University, Tehran, Iran. Amirhossein Ghanbarzamani Faculty of Pharmacy and Pharmaceutical Science Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2025 03 07 2025 03 13 Background: Patients admitted to the intensive care unit (ICU) are at high risk of gastrointestinal (GI) mucosal injury and stress ulcers, which may lead to gastrointestinal bleeding, due to their critical condition and use of mechanical ventilation. Stress ulcer prophylaxis drug regimens, including proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs), are commonly used to prevent these complications. However, there are concerns about the side effects of these drugs, including an increased risk of ventilator-associated pneumonia (VAP). This study aimed to compare the effects of pantoprazole and famotidine on clinical outcomes and the risk of VAP in patients admitted to the ICU. Methods: This study was designed as a single-center randomized clinical trial conducted in the Intensive Care Unit (ICU). The study population included 138 patients admitted to the ICU who required mechanical ventilation. The treatment regimens studied included two groups: group 1 received intravenous pantoprazole (40 mg daily), and group 2 received intravenous famotidine (20 mg twice daily). The study's primary outcome measure was the incidence of VAP, which was assessed according to ATS/IDSA and CDC guidelines. Other clinical variables included ICU length of stay, APACHE score, and incidence of adverse events. Results: The results showed that in the famotidine group, ICU length of stay and APACHE II score were significantly shorter than in the pantoprazole group. However, no statistically significant differences were observed in variables such as age, weight, drug administration duration, and intubation duration. In addition, the frequency of death and pneumonia incidence in the famotidine group was lower than in the pantoprazole group, although this difference was not statistically significant. Conclusion: This study showed that both famotidine and pantoprazole are effective in the prophylaxis of stress ulcers in critically ill ICU patients, but famotidine may be associated with more favorable clinical outcomes, including reduced length of stay and severity of illness. Also, the use of gastric acid suppressant drugs is associated with an increased risk of VAP, which requires more attention to drug selection and patient management. The findings of this study can help in better decision-making regarding the use of SUP drugs in ICU patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1226

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 28 674 678 Mehdi Dehghani Firoozabadi Department of Anesthesiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Afzal Shamsi Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. 2025 03 07 2025 03 10 Background: Cardiovascular diseases are the leading cause of mortality worldwide. Numerous risk factors contribute to cardiovascular diseases. Identifying individuals at high risk and ensuring they receive appropriate treatment can prevent premature deaths. This study aimed to "determine cardiovascular risk factors and some clinical parameters in patients admitted to the cardiac surgery intensive care unit." Methods: This study employed a cross-sectional design and was conducted on 109 patients admitted to the cardiac ICU of a central Tehran hospital. Samples were selected using convenience sampling based on inclusion criteria. Data were collected using a researcher-developed questionnaire and analyzed using SPSS version 25 with statistical tests. Results: The average age of the participants was 61.05±8.5 years. The majority of the sample was male (73.3%). The prevalence of diabetes and hypertension in the patients was 66.1% and 45.9%, respectively. The average BMI of the patients (25.9±3.6) was above the normal range. The mean blood glucose (153.26±36.65), cholesterol (151.7±36.2), triglycerides (135.85±51.9), kidney enzymes, and arterial blood gases were within acceptable ranges. Conclusion: Risk factors for cardiovascular diseases (particularly high weight and obesity, diabetes, and hypertension) are prevalent in patients undergoing cardiac surgery. Accordingly, planning and education are recommended to control and reduce cardiovascular disease risk factors in these patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1228

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 Supp. 1 2025 04 20 679 685 Sohrab Salimi Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sara Salarian Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Noor Mohammad Arefian Department of Anesthesiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamidreza Khayat Kashani Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Niloofar Abdous Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Dariush Abtahi Department of Anesthesiology, Clinical Research and Development Unit, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 03 09 2025 03 18 Background: The optimal dosing regimen of tranex