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     No Abstract   No Abstract  No Abstract 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   No Abstract   No Abstract   No Abstract 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

right lateral parietooccipital region, classified as Spetzler Martin Supplementary Grade VI. She underwent craniotomy and AVM resection under OFA. Induction included dexmedetomidine loading at 0.7 mcg/kg for 10 minutes, followed by 0.2–0.5 mcg/kg/h maintenance. Anesthesia was maintained with target-controlled infusion (TCI) propofol in Schnider mode, effect-site concentration 3–5 mcg/mL. Lidocaine 90 mg and rocuronium 30 mg were also administered. Postoperative analgesia consisted of paracetamol 500 mg every 6 hours, ibuprofen, and dexmedetomidine infusion 0.2 mcg/kg/h. Multimodal anesthesia using dexmedetomidine, propofol, rocuronium, and lidocaine effectively replaced opioids, maintaining stable hemodynamics and adequate anesthesia. The combination of propofol and dexmedetomidine provided sedation, hypnosis, and analgesia, facilitating early extubation. The patient experienced rapid recovery without postoperative nausea or vomiting. AVM resection in a 43-year-old woman was successfully performed under OFA, with stable intraoperative conditions and no postoperative complications or neurological deficits. This case demonstrates the feasibility and effectiveness of OFA in complex neurosurgical procedures, supporting its broader application in clinical anesthesia practice. https://aacc.tums.ac.ir/index.php/aacc/article/view/1410

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 02 19 592 594 EN Alireza Shakeri Department of Anesthesia, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 11 10 2026 02 14      No Abstract  No Abstract  No Abstract https://aacc.tums.ac.ir/index.php/aacc/article/view/1480

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2025 12 15 479 483 Behzad Nazemroaya Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Azim Honarmand Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammad Matin Karamati Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammad Mahdi Nafari Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 09 17 2025 09 28 Background: Nasal bleeding is a common event during nasotracheal intubation. The present trial examined whether altering bevel orientation (upward, downward, right, or left) affects the likelihood of epistaxis, ease of intubation, and intraoperative outcomes. Methods: In this triple-blind randomized controlled trial, 200 candidates for elective oral and maxillofacial procedures were randomized into four groups based on bevel orientation. The principal endpoint was the frequency and severity of epistaxis. Secondary endpoints included intubation time, difficulty score, hemodynamic responses, and oxygen saturation. Data were evaluated using chi-square, ANOVA, and Kruskal–Wallis tests (p<0.05). Results: The incidence and grading of epistaxis, intubation time, and difficulty did not significantly differ between the four orientations. Hemodynamic and oxygenation parameters remained stable throughout. Lateral orientations showed a non-significant tendency toward less bleeding and smoother tube passage. Conclusion: Bevel direction did not significantly influence bleeding or difficulty of nasotracheal intubation, although subtle clinical advantages were observed. Larger trials are needed to clarify the potential benefits. https://aacc.tums.ac.ir/index.php/aacc/article/view/1416

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 06 16 559 568 Kimia Khonakdar Department of Anesthesiology, Allied Medical School, Master of Science in Anesthesia Education, Mazandaran University of Medical Sciences, Sari, Iran. Maliheh Shirzad Department of Operating Room, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran Raha Bakhtiari Department of Anesthesiology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. Arian Jahromi Department of Anesthesiology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. Talieh Rostamian Department of Anesthesiology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. 2026 04 16 2026 05 04 Background: Patients undergoing neuraxial anesthesia remain conscious during surgery and may experience perioperative anxiety and psychological distress. Virtual reality (VR) has been proposed as a non-pharmacological strategy to improve patient experience. This scoping review aims to map current evidence on VR effects on psychological and experiential outcomes in adults undergoing neuraxial anesthesia. Methods: This scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and Embase were searched up to November 2025. Studies investigating the use of virtual reality among adult patients receiving neuraxial anesthesia in the operating room were included. Information regarding study design, characteristics of the VR intervention, and reported outcomes was collected and summarized narratively. Results: 13 studies involving 1,127 participants were identified, including 12 randomized controlled trials and one matched retrospective cohort study. Most interventions employed immersive VR during the intraoperative period. Anxiety and stress were the outcomes most frequently assessed, and a large proportion of studies reported significant reductions in anxiety following VR use. Evidence regarding pain reduction was variable and showed limited and inconsistent benefits across studies. Patient satisfaction and comfort were generally improved, whereas findings related to sedative requirements were mixed, with several studies reporting reduced sedative use. Conclusion: VR appears to be a useful adjunct for enhancing perioperative patient experiences, especially with respect to anxiety reduction and patient satisfaction in adults undergoing neuraxial anesthesia. However, evidence concerning pain outcomes and medication use remains inconclusive, emphasizing the importance of conducting well-designed studies with standardized outcome measures. https://aacc.tums.ac.ir/index.php/aacc/article/view/1616

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 01 28 579 584 EN Mohammad Kurniawan Departement of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. & Faculty of Medicine, IPB University, Bogor, Indonesia. & Departement of Anesthesiology and Intensive Care, Bakti Pajajaran Regional General Hospital, Bogor, Indonesia. Riyadh Firdaus Departement of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Sidharta Manggala Departement of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. 2025 09 19 2025 10 03 Snakebite envenomation is a medical emergency with potentially fatal systemic complications. We report a case of a 32-year-old male patient who presented to the Emergency Department with a complaint of a snakebite on his right ear. On arrival, he didn’t have signs of bleeding, fever, or swelling. Two hours after admission, the patient developed cardiac arrest and required mechanical ventilation. Although resuscitation was successful, the patient’s condition deteriorated, with progressive neurological and motor deficits, despite unremarkable findings on head CT scans and chest X-rays. Given progressive neurological and motoric deficits, hemoperfusion was initiated six hours post-envenomation as an adjunctive therapy. The procedure lasted six hours using a standard hemoperfusion cartridge. The patient demonstrated significant neurological recovery within 22 hours post-procedure, and he was successfully extubated on day 4. This case highlights the potential role of hemoperfusion as an adjuvant treatment in managing venomous snakebite envenomation, especially in places with limited species-specific antivenom availability. Early recognition of systemic complications and timely initiation of hemoperfusion may improve neurological outcomes in critically envenomed patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1417

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 01 01 484 489 Mamta Sharma Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India. Kirandeep Kaur Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India. & Department of Anaesthesiology, Fortis Hospital, Kangra, Himachal Pradesh, India. Ajay Ajay Department of Anaesthesia and Pain Medicine, AIIMS Gorakhpur, Uttar Pradesh, India. 2025 08 03 2025 09 13 Background: Postoperative pain following lumbosacral spine surgery is often intense and may hinder early recovery and ambulation. Caudal epidural analgesia using local anesthetics, particularly when combined with adjuvants, has shown potential in enhancing pain control. Dexmedetomidine which has a high affinity for α2-adrenergic receptors, may augment the analgesic effects of ropivacaine and extend its duration. To evaluate the effectiveness and safety of caudal epidural administration of ropivacaine alone versus ropivacaine combined with dexmedetomidine in patients undergoing lumbosacral spine surgery under general anesthesia. Methods: A total of 60 adult patients (ASA I–II) scheduled for elective lumbosacral spine procedures were enrolled in this prospective, randomised, double-blind trial. Participants were assigned to two groups. One group received 20 mL of 0.2% ropivacaine, and another group received 18 mL of 0.2% ropivacaine with 2 mL of dexmedetomidine (1 µg/kg). Pain scores, time to first rescue analgesia, sedation levels, hemodynamic parameters, and adverse events were monitored. Statistical evaluation was carried out with SPSS version 21, with significance set at p < 0.05. Results: Patients who received dexmedetomidine showed lower pain scores at 4, 8, and 12 hours after surgery. Their average duration of postoperative analgesia was also longer (23.00 ± 4.33 hours) when compared with the control group (15.13 ± 1.74 hours). Sedation profiles and intraoperative hemodynamics were largely similar in both groups. No clinically important adverse effects, such as hypotension, bradycardia, or respiratory compromise, were observed. Conclusion: Incorporating dexmedetomidine into a caudal epidural block with ropivacaine provides more effective postoperative pain relief without significant side effects. https://aacc.tums.ac.ir/index.php/aacc/article/view/1363

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2025 12 15 585 589 EN Mahnaz Arian Department of Infectious Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Masoumeh Gharib Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Saeid Amel Jamehdar Antimicrobial Resistant Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Hesamoddin Hosseinjani Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. Reza Pourahmadazar Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Farshad Abedi Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 09 21 2025 10 07 Although varicella-zoster virus (VZV) infection is typically self-limiting in immunocompetent individuals, this case underscores its rare but fatal potential when complicated by appendicitis, hepatitis, and pneumonia. The rapid progression to septic shock in a healthy young adult makes this report novel and clinically significant. An 18-year-old previously healthy Iranian woman underwent an appendectomy, after which she developed diffuse varicella-like skin lesions. Polymerase chain reaction of peripheral blood confirmed VZV viremia. During hospitalization, she developed pneumonia, hepatitis, and septic shock requiring intensive care. Despite aggressive treatment, including intravenous acyclovir, broad-spectrum antibiotics, and hemodynamic support, she died from multiorgan failure seven days after admission. This case demonstrates that even common, typically benign infections (e.g., chickenpox) and routine surgical conditions (e.g., appendicitis) can culminate in fatal systemic complications in immunocompetent patients. Clinicians should maintain a high index of suspicion for atypical VZV presentations in adults, as early antiviral therapy may improve outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1419

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 01 11 490 496 Azim Honarmand Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mehdi Mahmoodkhani Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Behzad Nazemroaya Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Alireza Ahmadian Department of Anesthesiology and Critical Care,School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 08 10 2025 09 13 Background: This randomized controlled trial evaluated the analgesic effect of adding subcutaneous ketamine to bupivacaine in lumbar fusion surgery. Methods: 46 adult patients were randomized to receive subcutaneous bupivacaine with or without ketamine before incision. Pain scores (VAS), time to first rescue analgesia, opioid use, extubation time, and patient satisfaction were assessed. Results: The ketamine group had higher early postoperative pain (30 and 60 min; P < 0.05) but showed prolonged time to rescue analgesia (P = 0.037) and reduced opioid use (not statistically significant). Extubation time was significantly longer. Satisfaction scores were similar. Conclusion: Subcutaneous ketamine delayed opioid use but increased early pain and extubation time. It may be considered in selected patients, pending further research. https://aacc.tums.ac.ir/index.php/aacc/article/view/1374

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 01 11 497 503 EN Arie Swardhani Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Haizah Nurdin Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Ari Palinrungi Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Syamsul Salam Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Faisal Muchtar Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Charles Tan Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. 2025 08 15 2025 08 29 Background: Ventilator-associated pneumonia (VAP) is a major source of morbidity and mortality in mechanically ventilated patients, with heterogeneous rates reported across Indonesian ICUs. Although evidence-based prevention bundles reduce VAP, real-world adherence is inconsistent. This study evaluated the association between VAP bundle compliance and VAP incidence among ICU patients at Wahidin Sudirohusodo Hospital in 2024. Methods: We conducted a retrospective analytical study (January–December 2024) including adults ventilated ≥48 h with complete bundle documentation; patients with pre-existing pneumonia or incomplete records were excluded. VAP was defined by CDC criteria. Compliance with the five-element bundle (head-of-bed elevation, daily sedation interruption/readiness to extubate, stress-ulcer prophylaxis, DVT prophylaxis, and oral chlorhexidine) was recorded daily, calculated as a percentage, and categorized as 60% (3/5 elements), 80% (4/5), or 100% (5/5). Associations with VAP were analyzed statistically. Results: Of the 385 patients who were on ventilators, 92 (23.9%) developed VAP. Of those, 52 (56.5%) died. The highest adherence was for head-of-bed elevation (91.5%), while the lowest was for DVT prevention (3.1%). In the VAP group (n=92), 65 subject manifested at 60% adherence (70.7%), 24 at 80% (26.1%), and 3 at 100% (3.3%). A higher level of adherence was significantly associated with a lower incidence of VAP (p = 0.001). Conclusion: Higher adherence to the VAP preventive bundle is associated with a lower VAP rate. To increase bundle adherence and patient outcomes in ICU, targeted interventions are needed. These should include more staff training and regular audits, with an emphasis on DVT prevention and daily weaning.   https://aacc.tums.ac.ir/index.php/aacc/article/view/1378

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 01 28 504 511 Ali Zaidan Department of Intensive Care Unit, University Hospital of Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia. Imed Chouchene Department of Intensive Care Unit, University Hospital of Farhat Hached, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia. 2025 08 16 2025 09 13 Background: Spinal anesthetic has improved perioperative care for lower-limb procedures. However, sympathetic blocking can induce considerable hemodynamic instability. While fluid preloading and vasopressors are established preventive interventions, dexamethasone and ondansetron, employed as antiemetics, have lately been studied for their cardiovascular-stabilizing effects. This study compares the effects of preoperative intravenous dexamethasone (8 mg) and ondansetron (8 mg) on hemodynamic stability and postoperative nausea and vomiting during spinal anesthesia. Methods: 192 ASA I-II patients undergoing elective lower-limb orthopedic surgery under spinal anesthesia at Alkafeel Hospital in Karbala from 2nd September, 2022, to 3rd November, 2024, were assigned to four groups: dexamethasone (Group D), ondansetron (Group O), combination (Group B), and control (Group C). MAP, HR, and SpO₂ incidences of nausea and vomiting were measured at 5, 10, 15, 30, and 60 minutes after spinal block. Results: MAP and HR did not differ significantly between groups (p = 0.326 and 0.458, respectively). At 5 minutes, Group B had greater MAP (p = 0.001) and HR (p = 0.030) than Group C. No significant differences in SpO₂ levels were seen (p > 0.05). The incidence of nausea was lowest in Group B (2.1%), compared to Group C (14.6%) (p = 0.009). Vomiting occurred in all groups, with zero incidences in Group B. Conclusion: Combining dexamethasone and ondansetron before lower-limb surgery under spinal anesthesia improved cardiovascular stability and reduced nausea. https://aacc.tums.ac.ir/index.php/aacc/article/view/1379

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2026 02 17 512 517 Fitri Azis Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Faisal Muchtar Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Ari Palinrungi Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Syamsu Salam Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Haizah Nurdin Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Andi Adil Department of Anesthesiolgy, Intensive Care and Pain Management, Dr. Wahidin Sudirohusodo Hospital, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. 2025 08 18 2025 08 29 Background: Acute Respiratory Distress Syndrome (ARDS) is associated with an increased risk of stress-related mucosal disease (SRMD) due to hypoxemia, systemic inflammation, and prolonged mechanical ventilation. Stress ulcer prophylaxis is routinely administered in the intensive care unit (ICU), most commonly using proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs). Although PPIs provide more potent gastric acid suppression, their use has been associated with a higher risk of infection, and evidence regarding their superiority over H2RAs remains inconclusive. This study aimed to compare the efficacy of PPIs and H2RAs in maintaining gastric pH and preventing stress ulcers in mechanically ventilated patients with ARDS. Methods: This single-blind randomized controlled trial included 40 adult patients diagnosed with ARDS who required mechanical ventilation. Participants were randomly assigned to receive either intravenous omeprazole 40 mg once daily (PPI group) or intravenous ranitidine 50 mg every 12 hours (H2RA group) for three days. Gastric pH was measured at baseline (day 1) and on day 4 using nasogastric aspirates. Results: The PPI group demonstrated a statistically significant increase in gastric pH from day 1 to day 4 (p = 0.012), whereas no significant change was observed in the H2RA group (p = 0.528). The between-group comparison showed a significant difference in pH changes over time (p = 0.024), with the PPI group exhibiting a mean increase of 0.65 ± 0.99, while the H2RA group showed a mean decrease of 0.18 ± 1.21. However, there were no significant differences between groups in absolute gastric pH values on day 1 (p = 0.265) or day 4 (p = 0.117), nor in the incidence of stress ulcers (p = 1.000). ARDS severity did not differ significantly between groups on day 1 or day 4 (p = 0.058 and p = 0.655, respectively), and the proportion of patients with worsening ARDS severity was also comparable (30% vs. 15%, p = 0.451). Conclusion: Both PPIs and H2RAs were effective for stress ulcer prophylaxis in mechanically ventilated ARDS patients, with similarly low rates of stress ulcer bleeding. Although PPIs resulted in a greater increase in gastric pH, this did not translate into superior clinical outcomes. Therefore, the choice between PPIs and H2RAs should consider not only their acid-suppressive effects but also potential adverse events, including infection risk. https://aacc.tums.ac.ir/index.php/aacc/article/view/1385

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2025 12 28 518 524 Ango Privat Désiré Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. Mobio N'kan Michael Paterne Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. Kouamé Koffi Isidore Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. Coulibaly KT Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. Kouassi Konan Jean Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. Bédié Yao Vianney Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. Kouamé Antoine Centre for Medicine and Specialities, Department of Anaesthesia and Intensive Care, Medical Sciences Training and Research Unit of Abidjan, Félix Houphouet Boigny University, Abidjan, Ivory Coast. 2025 08 18 2025 10 28 Background: The aim of this study was to identify the poor prognostic factors associated with acute dyspnea in medical emergencies. Methods: A retrospective descriptive and analytical study conducted over a 12-month period (January 2022 to December 2022) in the medical emergency department of the Centre Hospitalier Universitaire de Treichville. All patients admitted to the medical emergency department for dyspnea during the study period were included. Results: Prevalence was 7%. The mean age was 49 years, with a standard deviation of 16 years. The sex ratio was 1.08. Comorbidities were dominated by arterial hypertension (30.5%) and diabetes (14.7%). The majority of patients had NYHA stage 4 dyspnea (40%). Vital signs revealed arterial hypotension (45.5%), tachycardia (43.75%), tachypnea (66.9%), desaturation (52.2%), and disturbed consciousness (28.3%). The etiological diagnosis was dominated by bacterial pneumonia (35%), covid-19 pneumonia (22.4%), heart failure (21.7%), and pulmonary tuberculosis (13%). The mean time to therapeutic management was 3 hours and 23 minutes. Oxygen therapy was used in all patients. The average length of stay in the medical emergency department was 4 days ± 2 days. Mortality was 29% and was statistically associated with the existence of comorbidities (heart disease, arterial hypertension, tuberculosis, and diabetes), tachycardia (HR greater than 120 bpm), arterial hypotension (MAP less than 60 mmhg), tachypnea (respiratory rate greater than 30 cycles per minute), saturation less than 80%, and impaired consciousness (Glasgow score less than 14). Conclusion: Dyspnea is responsible for a significant mortality rate. Several poor prognostic factors have been identified. Management of these factors could reduce mortality. https://aacc.tums.ac.ir/index.php/aacc/article/view/1384

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2025 12 29 525 530 Rana Mohammad Yousef Department of Anesthesiology and Critical Care, School of Medicine, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran. Aqeel Jawad Abdulsahib Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Razieh Ramezani Department of Anesthesiology and Critical Care, School of Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran. Afzal Shamsi Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Elham Shahidi Delshad Department of Anesthesia, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran 2025 08 19 2025 09 01 Background: Circumcision is one of the most frequently performed pediatric surgeries. Effective perioperative analgesia is essential to minimize pain, reduce stress responses, and facilitate early recovery. This study aimed to compare the analgesic efficacy, hemodynamic effects, and recovery outcomes of ropivacaine versus bupivacaine in penile nerve block among children undergoing circumcision. Methods: In this quasi-randomized clinical trial conducted at Bahrami Children’s Hospital (Tehran, Iran) from November 2024 to January 2025, 66 male children aged 3 months to 3 years (ASA I–II) scheduled for elective circumcision were consecutively enrolled. Based on sequential allocation, participants received either 0.2% ropivacaine (Group R) or 0.25% bupivacaine (Group B) at 0.2 mL/kg for dorsal penile block. Hemodynamic parameters were recorded at key perioperative time points. Pain was assessed using the FLACC scale, and recovery time and fentanyl consumption were documented. Results: Group R demonstrated significantly lower heart rates and higher systolic blood pressure at post-induction, post-incision, and end-of-surgery time points (p < 0.05). The need for intraoperative fentanyl was lower in group B (24.2% vs. 66.7%, p < 0.001), while postoperative FLACC scores were lower in Group R (p = 0.024). Recovery time was significantly shorter in the ropivacaine group (p < 0.001). No adverse events occurred. Conclusion: Both drugs (ropivacaine and bupivacaine) were safe and effective. Ropivacaine provided better analgesia and faster postoperative recovery, while bupivacaine reduced intraoperative opioid use. These findings suggest that drugs should be selected based on individual clinical preferences. https://aacc.tums.ac.ir/index.php/aacc/article/view/1387

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 5 2025 12 29 531 538 Mojgan Rahimi Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohamad Sorani