Background: Despite advances in pain management, the incidence of postoperative pain remains a concern. In addition, analgesics have many side effects. Therefore, non-pharmacological interventions aimed at reducing the dosage of analgesics seem necessary, whether as a complementary or independent medication. In this regard, the present study was conducted with the aim of investigating the impact of music and acupressure on the pain intensity in the conscious patients hospitalized in intensive care units (ICU).
Methods: The present quasi-experimental study was conducted on conscious patients undergoing laparotomy surgery who were hospitalized in the surgical ICU of hospitals affiliated with Shahid Beheshti University in 2023. We randomly assigned 90 patients to one of three groups: nature music, acupressure, or combined. The data collection tools consisted of patients' demographic information form and the visual pain assessment scale, which was measured once before the intervention and over five time points after it. For participants in the nature music group, sounds of rivers, birds, and waterfalls were played using an MP3 player device and headphones for 20 minutes on one occasion. For the participants in the acupressure group, pressure was applied to L14 or Hogo for 10 seconds of pressure, followed by 2 seconds of rest, for a duration of 20 minutes, so that the patient could feel heat, numbness, and heaviness. We simultaneously performed nature music and acupressure for the participants in the combined group. SPSS version 19 was used for data analysis.
Results: Three groups of participants were homogeneous, with no statistically significant differences in terms of demographic characteristics (P value < 0.05). There was no statistically significant difference in the pain intensity of the patients among the three groups before the intervention. However, there was a significant difference among the three groups at 30 minutes, 60 minutes, 2 hours, 3 hours, and 4 hours after the intervention, and the combined and concurrent use of music therapy and acupressure proved to be more effective in reducing the pain intensity.
Conclusion: The results indicated the effectiveness of both nature music and acupressure when used alone or in combination. Their combined and concurrent implementation is more effective. Therefore, we recommend that nurses adopt combined care programs for pain management in ICU patients.

Background: One of the most prevalent procedures involving general anesthesia (GA) is endotracheal intubation, which can lead to a variety of airway complications. Patients undergoing GA with tracheal intubation may experience a common complication, known as postoperative sore throat (POST). We conducted this study to assess and compare the effectiveness of preoperatively administered nebulized ketamine and dexmedetomidine in alleviating POST.
Methods: We randomly divided the patients into two groups, each containing 151 patients. Group-K patients were nebulized with 50 mg (1 ml) with 3 ml normal saline, while Group-D patients were nebulized with dexmedetomidine 50 mcg (0.5 ml) with 3.5 ml normal saline, preoperatively. GA was administered 15 min post-nebulization. POST was graded at 4, 6, 12, and 24 h after extubation on a four-point scale (0-3). The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 17.0.
Results: In the present study, the overall incidence of POST was 32.5%. among which 39 patients (25.8%) in the ketamine group and 59 patients (39.1%) in the dexmedetomidine group experienced POST at 4h, following extubation (P value=0.014). A significantly higher incidence of POST in the dexmedetomidine group was noticed as compared to the ketamine group (P value < 0.05). But, at 6h, 12h, and 24h, the difference was not statistically significant between the two groups. A significantly larger percentage of cases in the dexmedetomidine group had more severe POST than in the ketamine group, at 4h following extubation (p-value <0.05). There was no significant rise in systolic and diastolic blood pressure in either group.  However, the ketamine group had a significantly higher mean heart rate after extubation compared to the dexmedetomidine group.
Conclusion: Ketamine nebulization significantly decreases the incidence and severity of postoperative sore throat during the early postoperative period with minimum hemodynamic changes.

Background: Radical cystectomy (RC) remains the standard of care for high-risk bladder cancer despite being associated with elevated perioperative morbidity. The procedure commonly results in substantial intraoperative blood loss, frequently requiring perioperative blood transfusions (PBT), which are associated with adverse events including transfusion-related complications and heightened healthcare expenditures. Pharmacological interventions such as tranexamic acid (TXA) and fibrinogen may decrease transfusion requirements, though TXA's potential thrombogenic effects raise safety concerns. This randomized controlled trial (RCT) aims to investigate the efficacy of combined fibrinogen and TXA delivery protocol in minimizing surgical blood loss and enhancing postoperative recovery in RC patients.
Methods: This randomized controlled trial (RCT) enrolled 140 participants scheduled for elective radical cystectomy (RC) procedures. Eligible individuals were randomly allocated to four study arms: one administered fibrinogen concentrate, a second receiving tranexamic acid (TXA), a third assigned to a lower-dose combination of both agents, and a control group receiving placebo. Primary outcomes evaluated perioperative blood loss (intraoperative and postoperative), while secondary outcomes encompased vital physiological markers and the incidence of postoperative adverse events.
Results: Patients administered fibrinogen, TXA, or a combination of both demonstrated a marked decrease in postoperative hemorrhage (1,437–1,463 mL vs. 2,727 mL in controls). Furthermore, surgical timeframes showed significant contraction in the intervention groups (4.76–4.79 hours) compared to controls (5.58 hours). These treatments were also associated with shorter hospital stays and reduced transfusion volumes of packed red blood cells and fresh frozen plasma (FFP). No statistically significant variations in acidosis or hemoglobin concentrations were observed across groups. Conversely, fibrinogen and TXA delivery protocol substantially elevated fibrinogen levels, though no clinically relevant differences emerged between the intervention patient groups.
Conclusion: The trial demonstrates that adjusting fibrinogen and TXA dosage protocols effectively reduces surgical bleeding during radical cystectomy. While combination therapy showed comparable efficacy to individual agents, these pharmacological strategies decreased transfusion dependency and hospitalization duration without increasing thromboembolic risks.

Background: Innovative teaching methods can equip undergraduate anesthesia students with the skills to perform advanced cardiac life support (ACLS) confidently and proficiently. Therefore, this study aimed to compare the impact of role-playing and traditional teaching methods on teamwork and self-efficacy in performing ACLS among undergraduate anesthesia students at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Methods: This randomized controlled study was conducted on 47 third- and fourth-year undergraduate anesthesia students selected through a census sampling method. It involved a pre-test and post-test design. Participants were randomly divided into control and intervention groups. The intervention group received role-playing training, where they were divided into groups of six and each was assigned a role based on an ACLS scenario, which they enacted in interaction with other students. The control group, on the other hand, received traditional training, encompassing lectures and the use of mannequins. Teamwork performance was assessed using a scale developed by Sigalet et al., and the Resuscitation Self-efficacy Scale checklist was employed to evaluate students' ACLS skills. Ultimately, covariance analysis was conducted using SPSS version 26 to analyze the data.
Results: The two groups were homogeneous in terms of demographic characteristics (P value< 0.05). A comparison of post-test scores using ANCOVA revealed a significant difference between the groups. Specifically, after receiving role-playing training, the overall score of intervention group students in the post-test demonstrated a significant increase compared to the pre-test across three teamwork subscales and three self-efficacy subscales (P value= 0.001), unlike the control group (P value = 0.001). However, the recognition subscale did not exhibit significant results (P value = 0.347).
Conclusion: When compared to traditional training, role-playing training can significantly enhance self-efficacy and improve teamwork among undergraduate anesthesia students with regard to advanced cardiopulmonary resuscitation. Therefore, it is recommended to integrate role-playing into the anesthesia curriculum.

Background: Stroke is one of the leading causes of annual mortality and disability for many individuals worldwide. Ischemic stroke has a high incidence and mortality rate, which significantly affects the quality of life and places an overwhelming mental and financial burden on the patients' families. Melatonin has a neuroprotective effect on patients with acute ischemic stroke. This study aimed to develop the employment of melatonin on clinical features of acute ischemic stroke.
Methods: This double-blind, placebo-controlled clinical trial was conducted on 70 patients with acute ischemic stroke not eligible for reperfusion therapy who were admitted to Bu-Ali Hospital. The consent form was taken, and all of the patients received routine management. Participants were divided into two groups. The 35 patients received 10 mg of melatonin once daily for five days, and others received 10 mg of placebo. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were recorded for all patients before treatment and after on days 5, 30, and 90.
Results: The 70 patients included in this study were based on inclusion criteria. The severity of stroke and the functional status of patients were compared in both groups. The melatonin group showed a significant reduction in the NIHSS score from day five up to day thirty compared to the placebo group (P = 0.001). There was no difference in the mRS score between the two groups in this study (P > 0.05). The relative frequency of the adverse event of sleepiness in patients receiving melatonin was significantly higher than in patients receiving placebo (P = 0.022).
Conclusion: Patients who receive melatonin early after stroke have better improvement in post-stroke recovery and disabilities. These findings verify the results of other studies.

Background: Considering the epidemiological importance of COVID-19 disease, the high percentage of hospitalization, and the need to prevent morbimortality caused by this disease in children, this study was undertaken to determine the clinical manifestations of COVID disease in critically ill children who need hospitalization in a pediatric intensive care unit (PICU).
Methods: In this retrospective cross-sectional study, the population included critically ill children with COVID-19 who were hospitalized in the PICU of Firozabadi Hospital (Tehran, Iran) between 2020 and 2021. The study patients were examined in terms of clinical manifestations, laboratory results, course of the disease, and duration of hospitalization. From the patients' clinical records, the required information was extracted based on the variables and recorded in a pre-designed form. The obtained data were finally entered into SPSS software version 26 for statistical analysis.
Results: Among 80 patients examined, 44 (55%) were male, and 36 (45%) were female. The average age of the examined patients was 9.9±5.3 years (1-18 years). In terms of COVID-19 symptoms, the fever had the highest frequency in 65 patients (81.3%), followed by gastrointestinal, respiratory, and neurological symptoms in 41 (51.3%), 39 (48.8%), and 29 (36.3%) cases, respectively. Also, 13 (16.2%) patients had an underlying disease, and 17 (21.3%) patients died from COVID-19. Investigating the relationship between the underlying disease and patients’ deaths showed to be statistically significant (P = 0.002); in other words, having an underlying disease was significantly associated with a high mortality percentage (53.8% vs. 14.9%).
Conclusion: This study suggest that children with underlying diseases show higher mortality from COVID-19; therefore, it is necessary to prioritize the provision of medical services to children with underlying diseases in health system policies and patient management.

Background: Considering the importance of controlling post-surgical pain in individuals and the limitation in number, in addition to the variations in the results of the clinical research studies focused on pain management outcomes of very low dose naloxone, the present evaluation aims to investigate the role of ultra-low dose naloxone on the severity of pain after the procedure, nausea, vomiting and pruritic.
Methods: In this double-blind controlled randomized clinical trial, 60 patients were selected for laparoscopic cholecystectomy surgery, with class 1 and 2 anesthesia (ASA) by available method, and were allocated to the intervention and control groups using randomization. Every participant underwent general anesthesia with a specific anesthesia protocol. After the operation, PCA was implanted for all patients to control pain. The internal composition of the PCA pump included 20 mg of morphine and naloxone at a specified dosage of 0.25 μg/kg for the intervention group and 20 mg of morphine and placebo for the control arm. Pain intensity, episodes of nausea and emesis and pruritic of patients were evaluated and compared based on VAS criteria within the two groups being analysed, during the immediate postoperative period and then 2, 6, 12 and 24 hours following the surgical procedure.
Results: There was no meaningful variation between therapeutic and standard arms in terms of age, sex, BMI, duration of surgery, duration of anesthesia, and dose of intra-operative fentanyl injection. Also, with respect to the level of pain during the immediate postoperative period and 2, 6, 12, and 24 hours following the surgical procedure, and the intensity of nausea, vomiting, and pruritic during recovery, statistical analysis revealed no remarkable discrepancy between the arms. In both groups, the severity of pain showed a significant decline at each of the examined time points in comparison with the pre-intervention phase (p <0.001, for both groups). Comparing the trend of changes in pain intensity during the postoperative period between the two study groups did not show a statistically meaningful variation (p = 0.569).
Conclusion: The simultaneous prescription of naloxone and morphine in patients undergoing laparoscopic cystectomy does not demonstrate a meaningful influence on achieving relief from post-surgical pain levels, nausea and vomiting and pruritic compared to morphine alone, so the use of naloxone to reduce postoperative pain and complications of opioids is not recommended.

Background: Adherence to drug treatment means taking drugs, following a diet, or implementing changes in lifestyle in accordance with the programs recommended by healthcare workers.
Methods: This cross-sectional descriptive study included 530 cancer patients referred to Tehran medical centers, clinics, and private practices. If the cancer patients could read and write as well as understand the questions in the questionnaire, all the questionnaires were completed by the patients in a self-reported form. Otherwise, the researchers completed the questionnaire by interviewing the patients. The tools used include the Medication Compliance Questionnaire (MCQ) and the Pain and Opioid Analgesic Beliefs Cancer Scale (POABS-CA). We analyzed the data from this study using SPSS version 16 software.
Results: The result indicated that the M(SD) score of the MCQ scale was equal to 30.72 (8.03) and the POABS-CA score was equal to 18.58 (8.40). Furthermore, the score of adherences to drug treatment was higher in people with an age less than 45 years, with male gender, diploma and sub-diploma education, and this difference was statistically significant (p<0.05). Patients who held more positive beliefs demonstrated a higher level of drug treatment compliance.
Conclusion: Considering that the obtained score related to compliance with drug treatment was not at a high level, it is necessary to carry out necessary interventions in this field.

Background: Patients undergoing Coronary Artery Bypass Grafting (CABG) frequently experience fatigue and physical activity tolerance as post-operative complications. The early mobilization technique is one of the beneficial nursing intervention programs that amend patients' outcomes, intercept immobilization, and increase quality of life. This study aimed to assess the effect of the early mobilization (EM) protocol on fatigue and physical activity tolerance in patients who underwent CABG.
Methods: We designed this study as a quasi-experiment with a control group. Participants involved patients who underwent CABG at the Intensive Care Unit (ICU) of Tehran Shahid Modarres Hospital in Iran between April and September 2023. The study included 96 patients, with 48 patients each in the intervention and control groups. Two distinct time points were used to select intervention and control groups (the initial three months and the following three months). Both the control and intervention groups received standard hospital care, but the intervention group also received an EM protocol education. We dedicated three days to intervention education and employment: day 0 (immediately after extubation), day 1 (24 hours later), and day 2 (48 hours later). We collected data were using the Visual Analog Scale-Fatigue (VAS-F) and the Borg scale at two time points (day 0 and day 2). We performed a paired t-test, an independent sample t-test, and an ANCOVA  to analyse data.
Results: 56.3% of participants were men and 43.7% were women. The mean age of participants was 52.7±8.8. In both groups, hypertension (29.2%), hyperlipidemia (27.1%), and diabetes (20.8%) were the most prevalent CVD risk factors. The intervention group's mean fatigue decreased significantly on day 2 (4.40±0.94) compared to day 0 (6.65±1.12) while the mean PA tolerance increased significantly on day 2 (11.82±1.90) compared to day 0 (7.31%±1.20) (P<0.001). The control group did not experience any statistically significant intragroup changes (P>0.05). Significant intergroup changes were observed in the mean fatigue and PA tolerance values on day 2 (P<0.001) while there were no statistically significant intergroup changes in them on day 0 (P>0.05).
Conclusion: This study highlighted that early mobilization was an effective and safe inhibition program to meliorate fatigue and physical activity tolerance in CAD patients.

Background: One type of trauma is penetrating abdominal trauma (PAT). For this reason, given the importance of PAT and the management of these patients, this study aimed to determine the clinical characteristics of patients with PAT admitted to the ICU.
Methods: This retrospective study was conducted by reviewing and studying the medical records of patients. Researchers reviewed the records of patients who were hospitalized in the ICU with a diagnosis of PAT and extracted the relevant information. Inclusion criteria included being between the ages of 10 and 60, having a diagnosis of PAT, and being hospitalized in the ICU. Patients whose records were incomplete for any reason were excluded from the study. The research checklist included relevant information. In this study, ethical principles in research were observed in the study of the doctors' clinical records. Additionally, after extracting the data into SPSS version 16 software, data analysis was performed.
Results: Results showed 86.2% of the patients were male and 13.8% were female. Additionally, most of the patients were in the age range between 31-40 years, with 37.9%. The majority had a high school diploma (70.7%) and multiple traumas with 60.3%. The mean (SD) of mortality in the first 24 h was 1.82 (0.38), hospital mortality was 1.74 (0.44), and ICU length of stay (day) was 6.48 (4.2). Additionally, the results showed that most of the radiograph findings included air under the diaphragm at a rate of 6.9%, and the highest rate of complications observed in patients included surgical site infection at a rate of 24.13%.
Conclusion: The results of this study showed that infection is one of the important complications of hospitalization of patients with PAT in the ICU. Therefore, it is essential to carry out the necessary interventions in this area.

Background: The advantages of using saddle block anesthesia have been established in certain surgical procedures; however, its application in patients undergoing dilation and curettage (D&C) has not yet been thoroughly investigated. Given the urgent nature of this procedure, it was necessary to compare the patient’s sitting time. Accordingly, the present study was conducted to compare saddle block anesthesia with three different sitting times in patients undergoing D&C.
Methods: The current randomized, double-blind clinical trial was conducted at Shahid Beheshti Hospital in the city of Isfahan in 2024. Forty-five patients were randomly allocated to three groups. In the first group, patients remained seated for 3 minutes; in the second group, for 4 minutes; and in the third group, for 5 minutes following the injection of Marcaine (bupivacaine). Data were collected using a checklist and analyzed using SPSS version 26.
Results: There were no significant differences among the three groups in terms of age, gestational age, length of hospital stay, and maximum sensory block level (P > 0.05). However, a significant difference was observed between gestational age and pain intensity among the three groups (P < 0.05). Blood pressure (systolic and diastolic) and heart rate showed no significant differences among the three groups (P > 0.05).
Conclusion: Sitting patients undergoing D&C after saddle block anesthesia for 3, 4, or 5 minutes had no significant effect on any of the measured variables, including pain, systolic blood pressure, diastolic blood pressure, and heart rate. Notably, according to the results, if a pregnant woman is beyond 15 weeks of gestation, it is advisable for her to remain seated for 5 minutes after the saddle block to minimize pain intensity, as shorter sitting times will culminate in greater pain intensity.

Background: End-tidal carbon dioxide (EtCO₂) can approximate the arterial pressure of carbon dioxide (PaCO₂) in children without underlying congenital heart defects. However, EtCO₂ may underestimate PaCO₂ in these children, especially during repair procedures. The PaCO₂ to EtCO₂ difference (Δ PaCO₂-EtCO₂) may be significant in children with congenital heart disease (CHD) and can be notably influenced by surgical procedures. Postoperatively, the Δ PaCO₂-EtCO₂ might not remain consistent; thus, arterial blood gas (ABG) analysis may need to be repeated regardless of capnography findings. This hypothesis was tested in our study on children with cyanotic and acyanotic heart defects undergoing corrective surgeries.
Methods: In this cross-sectional study, hospital records of all children under 12 years of age with ASA II-III and cyanotic or acyanotic heart defects who were candidates for elective angiography were reviewed. EtCO₂ was measured by lateral aspiration capnography. Simultaneous measurements of EtCO₂ and PaCO₂ were collected before and after the intervention.
Results: Significant changes were observed in serum HCO₃ concentration and the PaO₂/FiO₂ ratio, both of which significantly decreased after the repair surgery. However, the change in Δ PaCO₂-EtCO₂ remained insignificant postoperatively. In the cyanotic group, in addition to a significant reduction in serum HCO₃ value and an increase in the PaO₂/FiO₂ ratio after the intervention, we found a significant decrease in Δ PaCO₂-EtCO₂.
Conclusion: Arterial blood gas analysis during repair surgery should be repeated in the cyanotic congenital heart defects group due to the intraoperative variability of Δ PaCO₂-EtCO₂, but not in the acyanotic heart defects group due to the stability of this difference. Therefore, EtCO₂ assessed by capnography can estimate PaCO₂ in children with acyanotic heart defects, but not in those with cyanotic heart defects.

Background: D-dimer levels in the blood are analyzed to diagnose conditions such as deep vein thrombosis, aortic rupture, certain types of acute headaches resulting from vascular disorders, and pulmonary embolism. D-dimer levels can also be a determining factor in the prognosis of various cancers. This study aimed to compare D-dimer changes in women with gestational diabetes mellitus (GDM) to those in healthy women following elective cesarean section.
Methods: This study, based on the Iran ICU Registry (IICUR), collected data on women hospitalized in the women’s ICU. Data were extracted from the registry using a standardized checklist. The study method involved extracting information on women with GDM and healthy women from the registry checklist and patient clinical records, including laboratory results. All D-dimer measurements were performed using a standardized laboratory kit within the hospital and were documented in the patients’ clinical records.
Results: The findings showed no significant difference in D-dimer levels on the first day after the CS. Additionally, there was a positive correlation between D-dimer levels and both advanced maternal age and higher BMI, with D-dimer levels rising as age and BMI increased among the study participants.
Conclusion: Higher levels of D-dimer were detected in patients with gestational diabetes mellitus (GDM) compared to healthy women after cesarean delivery. These results indicate a potentially elevated risk of deep vein thrombosis (DVT) in women with GDM undergoing elective CS, underscoring the importance of targeted preventive and therapeutic measures.

Background: Gestational diabetes mellitus (GDM) causes various complications for the patient.
Methods: This study included patients admitted to the women’s ICU. These patients were divided into a case and control group. Vitamin D was measured in all patients using the same laboratory kit and the results were categorized as Vit D insufficiency, Vit D deficiency and Vit D severe deficiency. Data This study was conducted using a registry checklist that included questions on Serum vitamin D levels, Anemia, Education, Age and Body mass index (kg/m2) which was completed using information available in the patient's clinical record.
Results: Result showed, in the Case Group, the mean (SD) age was 28.96 (1.54), BMI was 24.6 (0.81), and 48% of the mothers had anemia. Also, in the control group, the mean (SD) age was 29.2 (1.22), BMI was 25.96 (1.69), and 28% of the mothers had anemia. also, the findings showed that in the Case Group, 56% of mothers had Vit D deficiency, 16% had Vit D insufficiency, and 28% had severe Vit D deficiency. Also, in the Control Group, 32% of mothers had Vit D deficiency, 56% had Vit D insufficiency, and 12% had severe Vit D deficiency. Also, different vitamin D percentages were reported in the two groups studied(p<0.05).
Conclusion: Given the relationship between vitamin D and GDM, it is recommended that necessary preventive measures be taken in this regard to prevent pregnant mothers from contracting the disease.

Background: One of the groups at risk for Deep Vein Thrombosis (DVT) is pregnant women. Considering the importance of pregnancy complications, the aim of this study was to determine the risk factors affecting DVT in the ICU.
Methods: In this study, pregnant women admitted to the ICU were included in the study, and instruments used in this study included a registry checklist that included questions. In this study, the clinical records of people with DVT were placed in 2 groups. The sample size included 28 patients with a diagnosis of DVT (case group) and 33 patients without a diagnosis of DVT (control group). Then, the data were analysed with SPSS 16.
Results: Results showed, in the 28 patients studied for whom the diagnosis of DVT was confirmed, the M(SD) of age status was 37.64 (2.57). There was also a significant association between DVT status with a history of thrombocytopenia, chronic diseases, diabetes, and high blood pressure (BP). (P<0.05).
Conclusion: In DVT, variables such as chronic diseases, diabetes, high blood pressure, and thrombocytopenia were effective. For this reason, it is essential to pay due attention to the factors affecting the development of DVT in clinical care for these patients.

Background: Epistaxis can result from surgery, trauma, hypertension, hereditary hemorrhagic telangiectasia, or unknown reasons and can be treated in various ways. This study examined the pain severity related to epistaxis management in the emergency department of a tertiary otolaryngology facility.
Methods: This study was a descriptive and analytical cross-sectional analysis involving 129 patients. These patients were chosen from those referred to the emergency otolaryngology department for treatment of epistaxis. The treatment method was selected based on the severity of the epistaxis and whether a bleeding vessel was visible. Patients were categorized into nose pinching, anterior nasal packing, and bipolar electrocautery groups. For reducing pain from electrocautery and nasal packing, a mesh instilled with lidocaine and epinephrine is used before procedures. We assessed pain levels using a visual analog scale ranging from 0 to 10. We also studied the impact of xylocaine-prilocaine cream on reducing discomfort from anterior nasal packing in 42 patients who came to the emergency department with nosebleeds.
Results: The mean age of patients was 53.67 ± 19.96 years; 76 (57.6%) were male. Anterior nasal packing was the most common procedure for controlling epistaxis, with a mean pain severity of 6.61 (± 2.3). The pain score in the nostril-pinching group was significantly lower than in the other groups (P<0.001). In the second part of the study, the mean pain score in the xylocaine-prilocaine cream group was 4.52 ± 2.3, significantly lower than in the group without the cream (P<0.001).
Conclusion: According to the results, nasal packing was the most prevalent procedure for controlling epistaxis, which causes severe pain for patients. Application of xylocaine-prilocaine cream can reduce the severity of pain in comparison with lidocaine solution alone.

Background: Spinal anesthesia is widely used for cesarean deliveries due to its effectiveness and safety. However, it often causes post-anesthesia hypotension, which poses risks to both the mother and baby. Fluid preloading is a common method to prevent hypotension, yet the ideal type and volume of fluid remain uncertain. This research investigates how crystalloid and colloid preloading influence sensory block levels and hemodynamic stability during spinal anesthesia for cesarean sections.
Methods: Conducted as a randomized, double-blind, controlled trial at Imam Hossein Hospital in Tehran, Iran, from January to June 2022, this study involved 141 women undergoing elective cesarean sections under spinal anesthesia. Participants were randomly divided into three groups: normal saline, Ringer's lactate, or 6% hydroxyethyl starch (130/0.4). Sensory block levels were assessed every 5 minutes for the first 30 minutes and then at 60 and 90 minutes post-anesthesia. Continuous monitoring of hemodynamic parameters, such as systolic blood pressure and heart rate, was performed throughout the procedure.
Results: The findings revealed that normal saline achieved the highest maximum sensory block level. Hydroxyethyl starch (HES) showed a slightly longer duration of the block and a reduced incidence of hypotension. Despite these trends, the observed differences among the groups were not statistically significant.
Conclusion: This study demonstrates that the choice of preload fluid influences sensory block characteristics and hemodynamic stability during spinal anesthesia for cesarean sections. Additional research with larger sample sizes is necessary to refine fluid management strategies in this context.

Background: Nursing interventions in neonatal intensive care units of hospitals can occasionally turn into futile and costly measures, bringing about ethical conundrums. The aim of the present study was to investigate the relationship between futile care and moral sensitivity among nurses working at the neonatal intensive care units (NICU) of teaching medical centers in Gorgan city, North of Iran.
Methods: This 2024 descriptive-analytical study was conducted on 100 NICU nurses enrolled by quota sampling. Data collection tools included a demographic information questionnaire, the Lutzen moral sensitivity questionnaire, and a futile care questionnaire developed based on the Corley moral distress scale. The data gathered were entered into SPSS version 21 software and analyzed using descriptive (tables, mean, and standard deviation) and inferential (Pearson correlation coefficient) statistics.
Results: According to the results, the participants acquired the mean score of 62.12 ± 4.08 for moral sensitivity and 44.16 ± 5.81 for futile care. The Pearson correlation coefficient showed no significant association between moral sensitivity and futile care (r = - 0.12, P = 0.2).
Conclusion: Regarding the impact of nurses’ moral sensitivity and perception of futile care on the quality of health service provision, authorities are advised to consider plans and solutions (such as professional ethics training courses) to improve nurses’ awareness of ethical dilemmas, moral sensitivity, and attitudes towards futile care.

Background: Coronary artery bypass graft (CABG) is a common surgery aimed at treating coronary artery disease. A vital aspect of CABG is managing hemodynamics during the cardiopulmonary bypass (CPB) phase, especially in terms of maintaining appropriate mean arterial pressure (MAP). Studies indicate that MAP levels during CPB can affect postoperative recovery, particularly regarding respiratory outcomes; however, the optimal MAP for enhanced recovery remains uncertain. This research examines the impact of two MAP targets (60 mmHg and 80 mmHg) on respiratory recovery after CABG surgery.
Methods: Eighty-six patients selected for elective on-pump CABG were grouped based on intraoperative MAP: 43 with a MAP of 60 mmHg and 43 with a MAP of 80 mmHg. We compared perioperative and postoperative metrics, such as mechanical ventilation duration, ICU stay, and re-intubation requirements. Statistical analysis used SPSS version 23, with a significance threshold of p < 0.05.
Results: Patients with a mean arterial pressure (MAP) of 80 mmHg experienced a significantly reduced duration of mechanical ventilation, averaging 8.23 ± 1.54 hours, in contrast to the 60 mmHg group, which averaged 10.02 ± 2.14 hours (p = 0.001). Additionally, the ICU stays were significantly shorter for the high MAP group, with a markedly lower re-intubation rate at 4.7%, compared to 27.9% in the lower MAP group (p = 0.007).
Conclusion: Sustaining a MAP of 80 mmHg during CPB enhances respiratory recovery after CABG. This is demonstrated by shorter mechanical ventilation durations and reduced ICU stays. These results indicate that effectively managing MAP during surgery could facilitate recovery by improving tissue perfusion and reducing ischemic injury, which in turn may lead to improved pulmonary outcomes

Background: With the increasing prevalence of knee osteoarthritis, providing treatment solutions was on the agenda of research teams. Therefore, the present study was conducted to compare the efficacy and safety of intra-articular injection of Dexmedetomidine and Triamcinolone in improving knee pain and function in patients with primary knee osteoarthritis.
Methods: To carry out the current clinical trial study, all patients with knee osteoarthritis referred to Imam Hossein Hospital in Tehran were included within one year. Eligible patients were randomly divided into two groups: (D) Dexmedetomidine and (T) Triamcinolone. After registering the patients' demographic information, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to evaluate the treatment process of the patients in two groups. VAS was used to measure the patient's pain level in three periods before the injection, one month and three months after the last injection. Data were recorded in a pre-designed questionnaire and analyzed using the SPSS 20.0 statistical program.
Results: The pain, symptoms, sports-recreational performance, and knee-related quality of life three months after the procedure showed a statistically significant difference between the dexmedetomidine and the triamcinolone groups (P value <0.05).
Conclusion: The overall results show that patients with primary knee osteoarthritis who received dexmedetomidine had reduced pain and required fewer analgesics than those who received triamcinolone.

Background: Nowadays perioperative adjuvants become popular, and they can decrease post-operative opioid consumption gradually, Lidocaine is one of those. It is sodium channel blocker and has a multimodal effect. It is a local anesthetic that has analgesic, antiarrhythmic, anti-hyperalgesic, anti-inflammatory, and anti-neuropathic effect. With these descriptions, can decreases hospital staying period, ameliorate pain scores with post-operative analgesia with opioid-sparing effect, and finally has cost efficiency. It is available, inexpensive, simple, safe, and its’ consumption is easy, making faster bowel habits return and better rehabilitation after the surgeries. This narrative review has been written to evaluate these properties of Lidocaine.
Methods: The aim of this narrative review was assess the significance of peri-operative lidocaine as an adjuvant to manage acute postoperative pain. The manuscript has been presented as a comprehensive search that was conducted across several major databases, included: PubMed, Scopus, Web of Science, and Google Scholar. The search focused on studies published between 1990 and 2024 to provide a broad perspective on both historical and current evidence.  
Results: This review has reported the results of several articles. It can be obvious perioperative Lidocaine consumption as an adjuvant reduce post-operative pain perception, improve returning bowel habits, and post-surgical better rehabilitation and pain control.
Conclusion: Review of these articles illustrated;perioperative systemic lidocaine  as an adjuvant with efficiency of reducing post-operative pain perception, has an opioid-sparing effect,  improving intestinal activity and decreasing post-operative recovery period. Finally bring more comfort for patients and accompanying, less pressure on staff and most importantly is economical for both sides.

Background: Academic medicine depends on mentoring as a way for people to work together to improve their personal and professional lives. However, more clinical, administrative, research, and other educational demands are putting stress on medical faculty mentoring. Therefore, we need to evaluate the evidence supporting the value of mentoring.
Methods: In the present systematic review, 74 related studies were retrieved from international and national databases. In addition, the gray literature was searched via Google Scholar. Out of these, 16 studies were selected for the conduction study. We extracted the necessary data for our study from the research and stored it in Excel. We obtained the variance of the research using the binomial distribution. In addition, heterogeneity of research was done by the I2 index. We evaluated the information using a random effects model.
Results: The results indicated that the mentoring program included three stages: “Targeting and Familiarization with the Implementation of the Mentoring Program,” “Mentoring Program Implementation,” and “Evaluation of the Mentoring Program.” The Traditional One-to-One Mentoring Program, the Peer Mentoring Program, and the Distance Education Mentoring Program were some of the ways that the plan was put into action.
Conclusion: Mentoring is perceived as an important part of academic medicine, but the evidence to support this perception is not strong.

Background: Scorpion stings have been reported to induce inadequate block or block failure in local anesthesia. The present study has reviewed the resistance to local anesthetics in patients with a history of scorpion stings.
Methods: Articles from domestic and foreign journals in databases such as SID, IranMedex, Magiran, Uptodate, Google Scholar, Cochrane, Scopus, and Web of Science from 2010-2024 were searched, and ultimately 13 related high-quality articles based on STROBE were included in this review.
Results: According to the results of the included studies, which have dealt with scorpion sting cases and resistance to local anesthetics, patients with a history of scorpion stings experience significantly prolonged times of onsets for both sensory and motor blocks and the peak of sensory and motor blocks. Some of these patients have failed/inadequate sensory and motor block.
Conclusion: According to the mentioned materials, the prevalence of resistance to local anesthetics is higher in patients with a history of scorpion stings.

Background: Considering the vital role of the mechanical ventilator in providing respiratory support to patients, it is important and necessary to pay attention to and identify the common alarms of this device and to sensitize the medical team to these warnings.
Methods: This integrative review study was conducted in order to evaluate both printed and non-printed studies. Searching was done from 20/09/2010 to 20/09/2023 based on Prisma 2009 guidelines in Scopus, PubMed, Embase, and ProQuest databases. The keywords included "pulmonary ventilator," "mechanical ventilators," "ventilator," "respirators," "alarm," "clinical alarms," and "alarm fatigue," and the articles were selected based on the entry criteria
Results: Out of a total of 264 retrieved articles, 13 articles were included in the study. The obtained results indicated that the most frequent alarms were High PIP, High RR, and High/Low MV, which are not only important alarms, but also have high prevalence in the intensive care unit. Therefore, great attention should be paid while setting the alarm range and reacting to auditory and visual alarms.
Conclusion: Failure to pay attention to alarms and setting them improperly has a significant effect on the medical team’s fatigue, which leads to a decrease in the quality of care. Therefore, using a correct management strategy in order to increase the medical team’s knowledge and reduce unnecessary alarms can play an effective role in improving the quality of the services provided to the patients hospitalized in special care units. Identifying the important alarms of mechanical ventilators and using the appropriate strategy to set the alarms correctly can increase the quality of the care provided for the patients under mechanical ventilation.

During surgical procedures, intraoperative neuromonitoring (IONM) allows for real-time assessment of neural structures like the brain, spinal cord, and peripheral nerves. It enables continuous monitoring and early detection of potential damage during surgery. Adequate neuromonitoring is crucial in anesthesiology to maintain optimal brain function and neurological status during procedures. Muscle twitching during IONM is often associated with electromyography (EMG) or motor-evoked potentials (MEPs) and can indicate nerve activation or irritation. Two cases of patients undergoing posterior spinal fusion procedures experienced complications related to muscle twitching during surgery. In the first case, a 45-year-old male patient experienced damage to his lower lips due to muscle twitching in neuromonitoring. In the second case, a 36-year-old man suffered a tongue injury because a mouth guard shifted during surgery. IONM is a crucial component of modern surgical practices, but the cases presented highlight the potential for muscle twitching to cause patient injuries. Surgical teams must prioritize communication and the implementation of protective measures to safeguard against such occurrences. Future research may provide more comprehensive guidelines to enhance patient safety during IONM.

A 45-year-old male patient was diagnosed with papillary thyroid cancer and was scheduled for total thyroidectomy. Three months before, he had undergone laryngeal surgery for squamous cell carcinoma of the larynx. Before the operation, an internal consultation was performed and no respiratory or cardiac complications were reported. Upon visiting Besat Hospital, the patient's vital signs were stable. Establishing a safe airway due to tracheostomy breathing was a challenge. But after consultation with the anesthesia team, the endotracheal tube was successfully inserted. This surgery lasted for 5.5 hours smoothly and without complications. The patient was transferred to the intensive care unit after the operation and was discharged in a stable condition after recovery.

Neuromuscular disorders are a wide range of conditions that weaken muscles. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an uncommon acquired immune-mediated prejunctional disorder that is not caused by an injury. This case report presents the anesthetic management of a 48-year-old male patient diagnosed with CIDP who required an emergency umbilical herniorrhaphy. The patient, weighing 95 kg and with a height of 172 cm, presented with acute abdominal pain, nausea, and vomiting, and had a notable history of intravenous immunoglobulin (IVIg) treatment and oral opium addiction. Anesthesia was induced using rapid sequence induction techniques, and general anesthesia was maintained with total intravenous anesthesia (TIVA). The operation was completed without complications, despite the patient experiencing transient symptoms of Raynaud's phenomenon during the procedure. Postoperatively, the patient had an uneventful recovery without respiratory complications or exacerbation of CIDP symptoms. This case highlights the complexities of anesthetic management in patients with CIDP due to potential risks associated with neuromuscular weakness, muscle relaxants, and the effects of immunosuppressive therapies. Further research is warranted to standardize anesthetic protocols for this patient population.

There is a rare genetic disorder called Jervell-Lange Nielsen syndrome that leaves people congenitally deaf and with a long QT interval. This can lead to deadly heart rhythm problems and sudden death. For the treatment of hearing loss, cochlear implants, and for the treatment of heart difficulties, beta-blockers, and in certain circumstances, implantable cardioverter defibrillators, arrhythmias, syncope attacks, and sudden death are recommended. We discuss the case of an 8-year-old child who was referred for cochlear implantation after being diagnosed with Jervell-Lange Nielsen syndrome. In this study, we want to deal with patient management preoperatively and during surgery and describe the side effect of this syndrome.