Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2025 12 02 349 355 Natalina Manalu Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. Syafruddin Gaus 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. Syamsul Salam 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. Andi Salahuddin Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. Muhammad Rum Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia. Madonna 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 15 2025 07 10 Background: The incidence of postoperative delirium (POD) in geriatric patients is aged 3-61%. The combined effects of inflammatory factors and depth of anesthesia can affect neurotransmitters and receptors in the central nervous system that affect POD. To analyze the relationship between depth of anesthesia and IL-6 with the incidence of POD in geriatric patients undergoing general anesthesia. Methods: A prospective cohort study was conducted in geriatric patients undergoing general anesthesia. Patients were divided into two groups based on the bispectral index (BIS): BIS 40-45 and BIS 51-60. POD was measured using the Confusion Assessment Method (CAM) and Mini-Mental State Exam (MMSE) 24 hours postoperatively. Serum IL-6 measurements were also performed before and 24 hours postoperatively. Results: A total of 22 patients were collected with the results that the MMSE score decreased insignificantly at 24 hours postoperatively, and there was no difference in MMSE scores based on BIS (p > 0.05). The depth of anesthesia was significantly associated with CAM (p < 0.05). Delirium incidence was more frequent in BIS 40-45. IL-6 levels increased significantly at 24 hours postoperatively (p < 0.05). IL-6 levels were not significantly associated with MMSE and CAM scores (p > 0.05). Conclusion: BIS 40-45 has the potential to be a predictor of POD in geriatric patients with general anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/1315

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2026 06 26 427 434 Zahid Hussain Khan Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran. Ramooz Hussain Khan Janan Dental Clinic, Andesheh County, Tehran, Iran. 2026 06 26 The human airway has since long remained a subject of debate and controversies; thus, to arrive at a subtle and acceptable solution, airway assessment tests, innovative techniques, and devices have been introduced to solve the enigma. Although human endeavors have made significant advances since time immemorial, the difficult airway still poses a major challenge even in the best of hands and the best centers. https://aacc.tums.ac.ir/index.php/aacc/article/view/1677

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2025 11 15 440 442 Hossein Karballaei Mirzahosseini Department of Clinical Pharmacy, School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran. Leili Manafi Department of Clinical Pharmacy, Kosar Hospital, Semnan University of Medical Sciences, Semnan, Iran. 2025 08 01 2025 08 10 In certain patients, particularly those receiving mechanical aortic valve replacement, warfarin is the sole permitted anticoagulant. Some individuals exhibit resistance to warfarin for a variety of reasons, necessitating extremely high and occasionally fatal doses of the medication for their survival. This report details a patient who demonstrates warfarin resistance and investigates the fundamental causes of this phenomenon. The case report emphasizes the possible role of genetic polymorphism in elucidating the mechanisms behind warfarin resistance. https://aacc.tums.ac.ir/index.php/aacc/article/view/1361

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2026 01 31 461 463 Paayal Chandrashekar Department of Anaesthesiology, JSS Medical College, JSS Hospital, JSS Academy of Higher Education and Research, Mysuru, India. Meghna Mukund Department of Emergency Medicine, Yenepoya Medical College, Yenepoya Hospital, Yenepoya University, Mangaluru, India. 2025 11 14 2025 12 01    https://aacc.tums.ac.ir/index.php/aacc/article/view/1486

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2026 01 13 458 460 Nasrin Aghazadeh Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran. Parisa Moradimajd Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Vahid Rahmani Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran. & Student Research Committee, Department of Medical Education, School of Medical Education and Learning Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Atiyeh Sadat Sajadi Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. & Student Research Committee, Department of Medical Education, School of Medical Education and Learning Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 11 12 2025 12 01    https://aacc.tums.ac.ir/index.php/aacc/article/view/1484

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2025 11 15 356 361 Hanie Dahmardeh Department of Medical-Surgical Nursing, Community Nursing Research Center, Faculty of Nursing, Zahedan University of Medical Sciences, Zahedan, Iran. Manizhe Nasirizade Department of Medical Surgical Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran. Taybeh Lashkari Community Nursing Research Center, Department of Emergency Nursing, Faculty of Nursing, Zahedan University of Medical Sciences, Zahedan, Iran Habibollah Gheysaranpour Khatam Al Anbia Hospital, Department of Pediatric Nursing, Zahedan University of Medical Sciences, Zahedan, Iran. 2025 06 26 2025 07 10 Background: Breast cancer can lead to pain and reduced comfort in individuals and affect their lives. Therefore, planning to maintain or improve the level of comfort and pain management in these patients with training focused on virtual reality seems necessary. Therefore, the present study aimed to investigate the effect of using virtual reality on pain and comfort in breast cancer patients undergoing chemotherapy in Zahedan. Methods: This randomized clinical trial was conducted on 90 patients undergoing chemotherapy at Khatam Al-Anbiya Hospital in Zahedan. Participants were randomly assigned to two intervention groups (n=45) and control groups (n=45). The intervention group used Samsung Gear VR in the first 15 minutes of chemotherapy, while the control group did not receive any intervention. Data collection included the McGill Pain Questionnaire (MPQ) and the Hospital Comfort Questionnaire (HCQ), which were administered before and after chemotherapy. Data were analyzed using SPSS 21 software with paired and independent t-tests. Results: The mean pain score in the intervention group decreased significantly after using VR (pre: 42.00 ± 12.99, post: 30.77 ± 11.6, p=0.0001), while no significant change was observed in the control group (p>0.05). Similarly, the comfort level in the VR group improved significantly compared to the control group (p<0.05). Conclusion: The use of virtual reality significantly reduced pain and increased comfort in chemotherapy patients. Implementing VR as a non-pharmacological method in pain management protocols can improve the quality of life and treatment experience of cancer patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1320

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2026 05 23 435 439 Masoud Kashefizadeh Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Yousef Asadoola Jamshidi Department of Adult Nursing, College of Nursing, University of Kut, Wasit, Iraq. Maryam Kazempour Department of Paediatric Dentistry, School of Dentistry, Ilam University of Medical Sciences, Ilam, Iran. 2025 11 22 2025 12 01 Background: Before dental procedures, children often require mild to moderate sedation. This study was conducted to determine the effect of rectal midazolam on pediatric dental pain using a systematic review method. Methods: In this systematic review study, articles published from 2000 up to the beginning of 2025 that focused on the effect of rectal midazolam on the clinical condition of pediatric patients undergoing dental services were included. The search was conducted by both authors of the article: one holding a specialization degree in pediatric dentistry and the other being a pharmacist. The search keywords included "pediatrics," "tooth," "dentistry," "dental services," "midazolam," "rectal midazolam," "children," and "clinical indicators." The search was performed across all international databases, including PubMed, Scopus, Web of Science, Embase, EBSCO, and the Google Scholar search engine. After searching for the articles, the relevant data were extracted using a checklist designed by the researchers, and the findings were reported in table format using a descriptive method. Results: The result showed the initial search yielded 189 articles. After reviewing and evaluating the articles based on research objectives, methodology, the type of drug prescribed to patients, the method of drug administration, the manner of reporting findings, the language of publication, and the availability of the full article files, 5 articles proceeded to the systematic review stage. Also, in all extracted studies, the administration of rectal midazolam resulted in a positive effect on the clinical conditions of the patients, and the administration of this drug caused no side effects in the patients. Conclusion: The administration of midazolam rectally has proven effective in achieving the study objectives, including maintaining stable clinical conditions for the patients and resulting in no significant clinical side effects. Therefore, the rectal administration of this drug is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/1499

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 4 2025 11 06 443 446 Fatemeh Eftekharian Department of Internal Medicine, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. Navid Kalani Department of Anesthesiology, Faculty of Medicine, Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran. Arnoosh Ghodsian Student Research Committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. Reza Sahraei Department of Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. 2025 08 03 2025 08 11 Bilateral adrenalectomy, in the event of elective surgery, poses problems for an anesthetic manager due to hemodynamic instability, glucocorticoid replacement dependency, adrenal insufficiency, or a whole series of their associated endocrine disorders, one of which is hypothyroidism. This case report deals primarily with the perioperative considerations and management of the patient with Cushing's syndrome, who was planned for elective rhinoplasty following bilateral adrenalectomy. A 33-year-old woman who underwent bilateral adrenalectomy in childhood due to Cushing's syndrome came for elective rhinoplasty to correct post-traumatic nasal septal deviation. The preoperative workup revealed severe hair loss, dry skin, symptoms of orthostatic hypotension, and a systolic blood pressure reading consistently below 80 mmHg. Laboratory investigations gave evidence of elevated TSH (18.9 mIU/L), suggestive of hypothyroidism. Therefore, she was referred to an endocrinologist, and treatment with levothyroxine and fludrocortisone was initiated. An improvement in thyroid function was established a month later (TSH: 1.9 mIU/L), and hypotension was controlled. Surgery was scheduled after getting approval from the anesthesiology team and a detailed risk discussion with an informed patient consenting to proceed. During surgery, constant monitoring of the patient's vitals was carried out. Everything went on very well, and the patient was discharged, stable. Among challenging patients such as those with adrenal insufficiency, careful preoperative evaluation, hormone imbalance correction, and proper steroid supplementation play a vital role in avoiding adrenal crisis states during or after surgery. Effective teamwork is achieved between anesthesiologists, endocrinologists, and surgeons in endeavoring to make a surgical outcome safe and successful. https://aacc.tums.ac.ir/index.php/aacc/article/view/1364

Tehran University of Medical Sciences Archive(P<0.001). Conclusion: Acupressure can reduce preoperative anxiety in children; however, this effect is less than the effect of oral midazolam. https://aacc.tums.ac.ir/index.php/aacc/article/view/831

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 01 29 415 417 EN Ehsan Yousefi-Mazhin Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Hossein Karballaei-Mirzahosseini Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Sharifnia Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farhad Najmeddin Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Tofighi-Mohammadi Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Rezvan Hassanpour Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2023 09 14 2023 11 03 Familial hypokalemic periodic paralysis is a rare disorder that manifests manifests with the sudden onset of flaccid paralysis that is triggered by low levels of blood potassium, which can be caused by various factors such as, rest after intense exercise, or high-carbohydrate foods. This report presents cases of hypokalemic periodic paralysis attack triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 29-year-old male patient was admitted with quadriparesis, fever, shortness of breath, and sever hypokalemia. The patient had a history of three episodes of Familial hypokalemic periodic paralysis (HPP). Diagnostic tests, such as chest computed tomography scan and polymerase chain reaction test, confirmed SARS-CoV-2 infection. The patient was treated with potassium chloride infusion, spironolactone, and remdesivir, and was eventually discharged from the hospital.in conclusion, SARS-CoV-2 infection can potentially exacerbate HPP and should be considered a risk factor for its occurrence. https://aacc.tums.ac.ir/index.php/aacc/article/view/866

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2023 09 28 323 326 Nima Nazari Department of Anesthesiology and Critical Care,Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Goudarzi Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Ashkan Taghizadeh Department of Anesthesiology and Critical Care,Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Hojatollah Raji Department of Pediatric Surgery, Tehran Unversity of Medical Sciences, Tehran, Iran. Bita Malekianzadeh Department of Anesthesiology and Critical Care, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2023 08 13 2023 08 29 Background: Herniorrhaphy is the most common inguinal surgery in children. Several methods such as caudal block, ilioinguinal iliohypogastric block, and wound infiltration have been studied for postoperative pain management in these patients. Caudal block is common in pediatrics. However, ilioinguinal iliohypogastric block is effective and less invasive. Previous studies have shown different comparative results regarding these blocks. This study compares the analgesic effect of caudal and bilateral ilioinguinal iliohypogastric block with ropivacaine in children. Methods: This study is a randomized double-blind clinical trial. A total number of 66 patients aged between 1-7 years that volunteered for bilateral inguinal hernia repair were randomly assigned to two groups. After general anesthesia, caudal block with 1cc/kg ropivacaine 0.2% was performed for 33 patients and sonography-guided ilioinguinal iliohypogastric block with 0.1 cc/kg ropivacaine for each side was considered for another group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) during anesthesia, pain score (CHEOPS), delirium score (PAED), nurses’ satisfaction score (RN), need for additional narcotic, recovery time, and complications were compared in these two groups. Results: There was no statistically significant difference between the two groups in terms of hemodynamic parameters during the anesthesia process. Furthermore, the two groups had no statistically significant difference in CHEOPS score (6.27 in ilioinguinal block and 5.70 in caudal block, P=0.061), PAED score (5.64 vs 5.30, P=0.144), and RN satisfaction score. However, the need for narcotics, mean recovery time, and block complications were comparable in two groups. Conclusion: Caudal block and ilioinguinal block are equally effective for post herniorrhaphy pain and emergence agitation management in pediatrics. Additionally, no differences were observed in complications. It is recommended that the study be performed with a larger sample size. https://aacc.tums.ac.ir/index.php/aacc/article/view/839

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 03 05 418 421 Yasaman Esfahanian Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Mohammadi Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran. Parsa Mohammadi Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran. 2023 06 10 2023 08 15 Anemia, a common symptom in pregnancy, can lead to life-threatening cardiomyopathy. A 30-years old gravida 2 para 1 woman was admitted at 34 weeks of gestational age with asymptomatic pancytopenia and vitamin B12 deficiency in the laboratory tests. She also had a diet-controlled gestational diabetes, megaloblastic changes in Bone marrow aspiration and cardiomyopathy shown by echocardiography. The patient recovered from pancytopenia and cardiomyopathy after one week treatment with vitamin B12 and folate. In this case, cardiomyopathy worsened with anemia. By treating vitamin B12 deficiency, cardiomyopathy can be prevented or controlled during pregnancy. Careful consideration is needed when assessing anemia in pregnant women on vegetarian diet and at higher risk. https://aacc.tums.ac.ir/index.php/aacc/article/view/783

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 02 08 327 333 Asghar Hajipour Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Razieh Erfani Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Maziar Maghsoudloo Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Amir Keshvari Departments of Surgery, Tehran University of Medical Sciences, Tehran, Iran. Mojgan Rahimi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2023 09 04 2023 09 09 Background: Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach. Methods: 72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12. Results: There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P>0.05), although DBP fluctuation>20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively). Conclusion: The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach. https://aacc.tums.ac.ir/index.php/aacc/article/view/857

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 03 05 334 342 Ali Reza Montaseri Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Abdul Jammoul School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Seyed Mohammad Mireskandari Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Nima Nazari Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Babak Eslami Department of Anesthesiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ali Jammoul School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. 2023 09 07 2023 09 11 Background: Whether in a hospital setting or in the community, medical students are exposed to cardiac arrests. Fast response and effective resuscitation are main determinants for decreasing mortality and morbidity due to cardiac arrests. We assessed the effectiveness of anesthesiology rotation in acquiring cardiopulmonary and cerebral resuscitation for medical students. Methods: A pre-test/post-test quasi experimental design was undertaken, comprising A fortuitious sample of medical students who were undergoing anesthesiology rotation at Tehran University of Medical Sciences hospital complexes during the academic year 2021-2022 using a self-administered questionnaire to evaluate their theoretical comprehension, knowledge, skills and before and after the rotation. Results: The study revealed an increase in theoretical scores (mean dif +2.6/20), increased in self-assessment knowledge scores (mean dif + 0.84/5), as well as an increased in self-assessment skill scores (mean dif +0.96/5). The highest scored were witness in students with previous cardiopulmonary resuscitation (CPR) experience. Conclusion: It is of extreme importance for medical students to participate in anesthesiology rotations. It is essential for possessing the appropriate knowledge and skills to provide effective resuscitation care and gain confidence to perform CPR. https://aacc.tums.ac.ir/index.php/aacc/article/view/860

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 01 16 343 352 Maryam Sadat Mirenayat Pulmonary Rehabilitation Research Center (PRRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Narjes Jalali Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Somayeh Sadeghi Infectious Disease and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Acquired Immunodeficiency Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Reyhaneh Zahiri Pulmonary Rehabilitation Research Center (PRRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mitra Lotfalipour Pulmonary Rehabilitation Research Center (PRRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zahra Amraei Pulmonary Rehabilitation Research Center (PRRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faculty of Sport Sciences and Health, University of Shahid Beheshti, Tehran, Iran. Atefeh Fakharian Pulmonary Rehabilitation Research Center (PRRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 08 23 2023 09 13 Background: The effect of using high flow oxygen delivery through the nasal cannula (HFNC) in COVID-19 patients has been associated with different results. This study aimed to evaluate the effect of different HFNC temperatures in COVID-19 patients. Methods: Patients were randomly divided into three groups under high current oxygenation with temperatures of 31, 34, and 37. Except for the temperature, other device settings were set equally. After 24 hours, clinical conditions were on the agenda and compared with the conditions before the intervention. Results: Fever, sore throat, malaise, diarrhea in patients of 31 degree group and indicators of nausea, cough, body pain, headache have changed the most in 37 degree group. Abdominal pain has shown the greatest change in the 34 degree group. PR, DBP, and SpO2 indices changed the most at 31 degrees and RR and SBP at 37 degrees. PR, RR, SBP and SPO2 indices showed significant values in intra-group comparison, and in inter-group comparison, only PR, RR indices had significant differences. In intra-group analysis, PaCO2, WBC, CRP, ESR and ferritin had significant changes, and in inter-group comparison, none of the indicators had significant differences. Conclusion: Based on the results of the present study, reducing the temperature in the use of HFNC can improve the clinical conditions of patients with COVID-19. https://aacc.tums.ac.ir/index.php/aacc/article/view/845

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 02 17 353 356 Alireza Montasseri Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Omid Nabavian Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Babak Eslami Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Enab Zehra Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2023 08 29 2023 09 12 Background: Anesthesia techniques significantly impact the long-term and short-term outcomes after cancer surgery such as cancer recurrence, post-discharge hospitalizations, and duration of hospitalization, probably by decreasing the neuroendocrine stress response during surgery, reducing opioid requirement, reducing post-operation nausea vomiting, and pain, and interacting with the immune system. Research in recent years has provided ample evidence that epidural anesthesia produces better post-operation outcomes compared to general anesthesia. The purpose of this study was to evaluate the effects of epidural anesthesia on cancer recurrence after surgery in gastrointestinal cancer patients. Methods: To perform this study medical records from the archive of gastrointestinal cancer patients who have undergone surgery at Imam Khomeini Hospital Complex (IKHC) from the years 1390 to 1400 were used. The variables required for the study were obtained from the records. The data obtained were analyzed by the SPSS software and the significance value of < 0.05 was considered. Results: Our study included 8987 patients out of which 1673 patients received epidural anesthesia. Cancer recurrence was reported after 90 days and 180 days and for the type of surgery (using or not using epidural anesthesia) B value for 90 days and 180 days was 0.079 and 0.018 respectively. Thus causality was not established for the type of surgery with recurrence of cancer. Conclusion: The findings of our study indicate that the rate of gastrointestinal cancer recurrence after surgery is not influenced by having or not having epidural anesthesia.   https://aacc.tums.ac.ir/index.php/aacc/article/view/850

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2023 08 29 357 360 Shreedevi Yenni Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India. Namburi Naveena Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India. Rajesh Mane Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India. Guruprasad Shetty Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India. 2023 07 25 2023 08 21 Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients. Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted. In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA. Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B. Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA. https://aacc.tums.ac.ir/index.php/aacc/article/view/822

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 05 10 361 366 Alireza Montaseri Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences,Tehran, Iran. Hamidreza Amiri Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences,Tehran, Iran. Babek Eslami Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences,Tehran, Iran. Maryam Parnian Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences,Tehran, Iran. Ridda Ridda Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences,Tehran, Iran. 2023 08 30 2023 09 11 Background: To evaluate the decision-making proficiency among medical residents at Tehran University of Medical Sciences in the year 2022-2023. Methods: A structured online web-survey via national approved services Author’s designed questionnaire was used to collect the relative data based on variables of the study and was developed by the authors of the study by reviewing the previously conducted studies. The forms were sent to the medical residents at Tehran University of Medical Sciences as a link via electronic mail and social media; assistance was offered via direct or indirect contact upon request. Results: In this study, 88 medical residents of Tehran University of Medical Sciences were evaluated. Out of 88 participants, the frequency of females was 52(59.09%) and frequency of males was found out to be 36(40.91%). The frequency of the first- year residents was 28(37.50), second year residents was 33(21.59), third year residents was 19(9.09) and the fourth- year residents was found out to be 8(31.82). The frequency of different specialties were: Pathology 1(1.14%), Infectious diseases 1(1.14%), Cardio vascular diseases 1(1.14%), Emergency medicine 1(1.14%), Orthopedics2(2.27%), Psychiatry 3(3.41%), ENT 12(13.64%), Internal Medicine 13(14.77%), Pediatrics13(14.77%), OB&GYN 19(21.59%), Anesthesiology19(21.59%), Dermatology 2(2.27%), General Surgery 1(1.14%). Conclusion: There is a significant relationship based on linear regression between not having self - reported availability bias and surgical residency specialties. The surgical specialty is less prone to the availability bias. A difference of communication exists between the surgical and nonsurgical speciality and the nonsurgical specialties need to confirm their decision using other methods to prevent the patient harm.   https://aacc.tums.ac.ir/index.php/aacc/article/view/853

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 03 05 367 371 EN Babak Jahangirifard Department of Anesthesia and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran. Hamidreza Karbalaei-Musa Student Research Committee, AJA University of Medical Sciences, Tehran, Iran. Mohammad Hossein Hajali Student Research Committee, AJA University of Medical Sciences, Tehran, Iran. Parisa Kianpour Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Afsahi Department of Anesthesia and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran. 2023 12 09 2023 12 30 Background: Major surgeries cause metabolic stress and insulin resistance, leading to postoperative hyperglycemia and increased morbidity and mortality in diabetic patients. Therefore, this study aimed to assess blood sugar level changes in diabetic patients undergoing elective surgery and its confounding factors. Methods: A cross-sectional study compared blood sugar levels (BS) in 100 diabetic patients undergoing elective surgeries. Demographic data, medical history, surgery type, and anesthetic technique were documented. Laboratory assessments included fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1C). Statistical analysis used SPSS software and nonparametric tests. Results: Postoperative blood sugar levels significantly increased compared to preoperative levels (mean change 11.40 ± 14.356 mg/dL). Age over 60 and general anesthesia were significant factors associated with elevated blood sugar. Conclusion: This study reveals a significant postoperative increase in blood glucose levels in diabetic patients, particularly those aged over 60 and under general anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/902

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 01 29 372 376 Alireza Rahat Dahmardeh Department of Anesthesiology and Critical Care, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Aliakbar Keykha Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Department of Medical-Surgical Nursing, School of Nursing and Midwifery Zahedan University of Medical Sciences, Zahedan, Iran. 2023 08 18 2023 09 04 Background: Electrolyte imbalance is one of the influential causes in determining the outcome of traumatic patients. One of the electrolytes that get less attention from healthcare providers is magnesium. Therefore, this study investigated the frequency of hypomagnesemia in trauma patients hospitalized in the intensive care unit. Methods: The descriptive-cross-sectional study was conducted after approval at Zahedan University of Medical Sciences on 118 patients with multiple traumas from 2021 to 2022. Patients were selected by convenience sampling method according to the inclusion criteria. Age, sex, weight, body mass index, level of consciousness, and level of blood serum electrolytes were measured and recorded on the first and fifth days after hospitalization. The data were analyzed and compared using descriptive statistics, chi-square, and independent t-test. Results: Of 118 patients studied, 81 (68.6%) were male, and 38 (31.4%) were female. On the fifth day after hospitalization, the mean serum magnesium level of the patients was 1.4 ± 0.81 mg/dL. 87 patients (73.7%) had normal magnesium serum levels, 27 patients (29.9%) had hypomagnesemia, and 4 patients (3.4%) had severe hypomagnesemia. No statistically significant relationship existed between hypomagnesemia and gender, age group, and comorbidity diseases. The level of other blood serum electrolytes on the fifth day after hospitalization, age, weight, body mass index, and status of consciousness was not statistically significant between the two groups of patients with hypomagnesemia and without hypomagnesemia. Conclusion: Trauma and the subsequent treatment measures lead to decreased magnesium serum levels in intensive care patients. Therefore, the normal serum level of other electrolytes should not be considered a diagnostic indicator for the normality of magnesium serum level. Magnesium should be measured along with other electrolytes to make a timely decision to replace magnesium supplements in a patient with hypomagnesemia. https://aacc.tums.ac.ir/index.php/aacc/article/view/842

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 10 4 2024 01 29 377 384 Nader Ali Nazemian Department of Anesthesia and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Alireza Khajehnasiri Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkar Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Samavatian Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Nikoo Physical Medicine and Rehabilitation Reseaech Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2023 09 18 2023 09 27 Background: The effect of ozone therapy in reducing inflammation and radicular pain with lumbar transforaminal epidural steroid has not been sufficiently investigated. This study compares the effectiveness of transforaminal steroid injection with or without ozone therapy on radicular (leg) pain. Methods: In a double-blind clinical trial, 40 patients with chronic radicular pain whose pain did not respond to conservative treatments were selected and randomly assigned to two treatment groups of A and B. Group A underwent transforaminal epidural steroid injection with ozone and group B underwent transforaminal epidural steroid injection without ozone. The intensity of pain with the Numerical Rating scale (NRS) scale and the degree of disability with the Oswestry Disability Index (ODI) questionnaire were compared in both groups of patients before treatment, 24 hours after treatment, 1 and 3 months after treatment. Results: Both groups of A and B were similar in terms of age, gender, pain duration, pain intensity and disability before treatment (P>0.05). In treatment groups of A and B the mean of pain score 24 hours after treatment was 6.95±2.50 and 6.15±3.50 (P=0.495), one month after treatment it was 4.10±2.59 and 3.25±2.32 (P=0.355) and the third month of treatment was 3.85±3.01 and 3.55±3.25 (P=0.429). respectively. The mean of ODI 24 hour