Background: Delivery and assuming the parental role, especially for mothers, are often accompanied by anxiety and stress, conditions that are significantly aggravated by the birth of a premature infant. The aim of our study is to "determine the effect of COVID-19 prevention training on the stress levels of mothers with premature infants admitted to the NICU." Methods: This is a quasi-experimental study. The sample consisted of 100 mothers (50 in the experimental group and 50 in the control group) of premature infants hospitalized in the Neonatal Intensive Care Unit (NICU). Participants were randomly assigned to the two groups. The experimental group received an educational program on preventing respiratory infection transmission, with a focus on the coronavirus, delivered through individual face-to-face sessions lasting between 45 to 90 minutes over three sessions. Data for both groups were collected in two phases, before and after the intervention, using a standard Parental Stress Scale questionnaire. Data were analysed using descriptive and analytical statistical tests and SPSS software. Results: According to the findings of our study, the mean age of mothers in the control and intervention groups was 26.88±0.32 and 27.10±0.30 years, respectively (T=-3.482, d=9.98, P=0.527). Also, the mean age of infants in the control group was 34.90±0.30 weeks and in the experimental group was 35.12±0.52 weeks (T=-2.582, d=9.98, P=0.114). The overall stress score in the intervention group after the intervention (93.82±7.15) significantly decreased compared to before the intervention (135.98±0.51) (P<0.001), and this significant decrease was also observed in all stress subscales (P<0.001). Conclusion: Finally, the findings of our study showed that mothers whose infants are hospitalized in the ICU experience high levels of stress. The COVID-19 prevention training leads to a significant reduction in mothers' stress.

Anesthesia in patient care, both in the perioperative period and in the pain clinic, is a challenging field to engage with - this is secondary to the fact that patients are individuals who are influenced by numerous factors, including the bacterial makeup of their microbiome and its parts. With the focus on personalized medicine as the next frontier, this narrative literature review looks at the current trend in individualized medicine, specifically regarding the use of the microbiome and artificial intelligence in the choice of different drugs for the induction and continuation of surgery as well as the management of pain syndromes in patients. This review also includes a summary of the different research directions that can take place based on the most recent data, including microbiome composition testing, therapeutic alterations, and the use of artificial intelligence to select the best drugs for treating the patient

Background: Non-cardiac surgery in patients with cardiovascular risk can lead to postoperative complications. Troponin T, a cardiac biomarker, is proposed as an indicator of cardiac risk in these patients. This study evaluates troponin T levels before and after non-cardiac surgery and their association with postoperative complications. Methods: This prospective cohort study included 46 patients selected through consecutive sampling. Demographic data and troponin T levels were recorded before and 24 hours after surgery. Results: Postoperative complications included cardiac events (15.21%), such as myocardial infarction (4.34%), heart failure (4.34%), and arrhythmia (6.52%), and non-cardiac events (17.39%), such as sepsis (4.34%), bleeding (4.34%), surgical site infection (6.52%), and respiratory insufficiency (2.17%). The average patient age was 50.15 ± 8.81 years, with 60.9% being male. There was a significant relationship between troponin T levels and the incidence of cardiac complications after surgery. Conclusion: Elevated postoperative troponin T levels may serve as a prognostic indicator for cardiac complications in non-cardiac surgery patients. Routine monitoring could aid in early detection and improved postoperative management.

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

Background: The procedure of endoscopic retrograde cholangiopancreatography (ERCP) requires deep sedation for procedural success and patient safety. Propofol is commonly used due to its rapid onset and recovery, but its administration method significantly impacts its effectiveness and safety. This study compares Target Controlled Infusion (TCI) and Manual Controlled Infusion (MCI) of propofol in ERCP patients. Methods: A single-blind randomized controlled trial was conducted with 22 ERCP patients, who were randomly assigned to either the TCI group (n=11) or the MCI group (n=11). In the TCI group, propofol was administered using the Schnider pharmacokinetic model, targeting effect sites, with an initial effect-site concentration set at 2.5 mcg.kg-1. In contrast, the MCI group received an initial propofol bolus of 2 mg.kg-1, followed by 20 mg increments every 10 seconds. The study analyzed propofol induction time, hemodynamic stability, and total propofol consumption, with hemodynamic parameters recorded every five minutes. Results: The TCI group had a significantly longer induction time (10.00 ± 2.05 min vs. 3.45 ± 1.21 min; p < 0.001) but required a lower total dose of propofol (2.30 ± 0.43 mg.kg-1.h-1 vs. 3.69 ± 0.69 mg.kg-1.h-1; p < 0.001). Hemodynamic stability was comparable between both groups. Conclusion: TCI provides similar hemodynamic stability to MCI while reducing total propofol consumption. Despite a longer induction time, TCI may be a more cost-effective and controlled method for propofol administration in ERCP

Background: Cesarean section operation with spinal anesthesia is one of the most frequently performed surgical operations worldwide. Perioperative shivering is a problem that often happens during surgery with spinal anesthesia, with an incidence that can be up to 50%. Nevertheless, this shivering condition still receives less attention in the literature and daily clinical practice. Paracetamol lowers hypothalamic temperature set points to reduce postoperative shivering by centrally inhibiting prostaglandins. By lowering thermoregulatory set points and IL-6 levels, paracetamol has also been demonstrated to lessen postoperative stress. Methods: This study was designed as a double-blind, randomized, controlled trial involving 34 participants randomly distributed between two groups. Group 1 (n=17) will receive paracetamol 15 mg/kg body weight, and group 2 (n=17) will receive 100 mL of 0.9% sodium chloride solution. Shivering is assessed using the Bedside Shivering Assessment Score at 0, 15, 30, 45, 60, and 120 minutes after injecting the drug into the subarachnoid space. Interleukin-6 (IL-6) levels will be taken by taking peripheral blood samples 3 times (1 hour before surgery, 1 hour after surgery, and 6 hours after surgery) and then examined using the Enzyme-Linked Immunosorbent Assay (ELISA) method in pg/dL. Results: The statistical analysis showed no significant difference (P>0.05) in the IL-6 comparison between the paracetamol and control groups. However, compared with the control group, the paracetamol group's average IL-6 levels were lower. Statistical analysis revealed a significant difference (P = 0.038) in the incidence between those receiving paracetamol and those in control groups. The paracetamol group demonstrated a lower incidence of shivering (35.3%) than the control group (76.5%). Significant variations (P = 0.038) were also observed in the onset of shivering between the paracetamol and the control group. The paracetamol group experienced shivering at a later time (between minutes 45 and 120) than the control group (between minutes 30 and 60). Conclusion: Administration of 15 mg/kg BW paracetamol significantly reduced shivering incidents, shivering onset, and the need for rescue pethidine compared to the control group that received 100 ml of 0.9% sodium chloride after a cesarean section with spinal anesthesia but did not significantly reduce IL-6 levels.

Background: Postoperative emergence agitation in children is so common. Isoflurane and propofol are evaluated for agitation, but results were contradictory. This study aimed to compare the effect of isoflurane and propofol for emergence agitation in children under three years old. Methods: This double-blinded, randomized clinical trial was performed on 104 children under three years’ old who were candidates for nasolacrimal probing. The children were anesthetized by sevoflurane and then were divided into isoflurane and propofol groups. After transfer to the recovery room, at first, 4 and 8 minutes, the degree of agitation of the child was measured according to the Watcha sedation criteria. Results: The demographic parameters were not different. The mean duration of anesthesia (from LMA insertion to extubation) in isoflurane was significantly shorter than in propofol (p = 0.001). Also, the recovery time in the isoflurane group was significantly shorter than that of the propofol group (P=0.02). The prevalence of agitation was 7.69% in the propofol and 59.61% in the isoflurane, and the difference was significant (P = 0.001). Agitation scores at first, 4 and 8 minutes in the recovery room, showed less agitation in the propofol group (P=0.001). Conclusion: Our study showed that propofol in children reduces the incidence of emergence agitation compared to isoflurane. But emergence and recovery time in the isoflurane group was less than in the propofol group.

Background: Cardiovascular diseases are the leading cause of mortality worldwide. Numerous risk factors contribute to cardiovascular diseases. Identifying individuals at high risk and ensuring they receive appropriate treatment can prevent premature deaths. This study aimed to "determine cardiovascular risk factors and some clinical parameters in patients admitted to the cardiac surgery intensive care unit." Methods: This study employed a cross-sectional design and was conducted on 109 patients admitted to the cardiac ICU of a central Tehran hospital. Samples were selected using convenience sampling based on inclusion criteria. Data were collected using a researcher-developed questionnaire and analyzed using SPSS version 25 with statistical tests. Results: The average age of the participants was 61.05±8.5 years. The majority of the sample was male (73.3%). The prevalence of diabetes and hypertension in the patients was 66.1% and 45.9%, respectively. The average BMI of the patients (25.9±3.6) was above the normal range. The mean blood glucose (153.26±36.65), cholesterol (151.7±36.2), triglycerides (135.85±51.9), kidney enzymes, and arterial blood gases were within acceptable ranges. Conclusion: Risk factors for cardiovascular diseases (particularly high weight and obesity, diabetes, and hypertension) are prevalent in patients undergoing cardiac surgery. Accordingly, planning and education are recommended to control and reduce cardiovascular disease risk factors in these patients.

Intraoperative Neurophysiological Monitoring (IONM) refers to the use of various electrophysiological methods to monitor the function of the brain, spinal cord, and related nerves during surgical procedures. IONM involves the use of neurophysiological recordings to detect changes in nervous system function during surgery, allowing doctors to identify potential nerve damage before it occurs. Reported is a 65-year-old male patient with a diagnosis of unruptured aneurysm of the Posterior Communicating Artery (PcomA) and left ophthalmic segment of C5 whose aneurysm was planned to be clipped. The patient was planned to have the aneurysm clipped under general anesthesia. The challenge in the anesthesia process for aneurysm cases is maintaining the pressure in the aneurysm and cerebral perfusion pressure (CPP), protecting the brain during periods of ischemia, and providing as wide an operating field as possible. Post-operatively, the patient showed stable neurological function with no new deficits, highlighting the importance of intraoperative neurophysiological monitoring in achieving a favorable outcome.

Background: In cardiopulmonary bypass (CPB), there is a need to better maintain appropriate anesthesia due to the physiological and hemodynamic alterations induced by CPB. This review aimed to explore the effects of sevoflurane versus propofol in the management of patients undergoing cardiac surgeries with CPB. Methods: The literature search was conducted in the international databases, including Cochrane, Science-Direct, Scopus, PubMed, and Google Scholar, from January 2012 to July 2024. Results: According to the studies, sevoflurane was associated with a significantly shorter time to extubation, eye-opening, and command compliance with better intraoperative hemodynamic stability. It was superior in reducing oxygen demand and may be associated with less hypoxia in the aortic cross-clamp phase. In addition, sevoflurane produces more prominent myocardial protection, attenuates inflammatory response, and has a lower impact on cognitive function. On the other hand, propofol decreased the incidence and intensity of acute kidney injury and may be preferred over sevoflurane in patients at risk of postoperative nausea. Conclusion: It seems in adults undergoing cardiac surgery with CPB, the class of sevoflurane is superior to propofol with regard to many perioperative and postoperative outcomes. However, more studies with larger sample sizes are needed to clarify this issue.