Facilitating the removal of a foreign body in the tongue by intraoperative ultrasound guidance: A case report.

The presence of soft tissue foreign bodies (FBs) presents a substantial concern due to their potential to induce both acute and chronic pain as well as tissue irritation. This case report documents the admission of a 25-year-old female with a history of bur fractures during endodontic treatment, accompanied by signs of infection. The clinical examination and radiographic assessment revealed an embedded foreign body within her tongue. The surgical procedure was informed by repeated ultrasound scans through the incision, facilitating precise targeting. Intraoperative ultrasound enables the accurate detection of submucosal foreign bodies in dynamic tissues like the tongue and facilitates focused and image-guided dissection, thereby decreasing surgical trauma to the delicate soft tissues.

Effect of Music During General Anesthesia on Anesthetic Consumption During Vitrectomy Surgery.

Background: Controversy remains about the positive role of music during general anesthesia and postoperative recovery. We, therefore, tested the hypothesis that intraoperative exposure to classical music reduces the propofol necessary to maintain the bispectral index (BIS) close to 50 during vitrectomy surgery. Materials and Methods: This double-blind clinical study is evaluating 50 patients undergoing vitrectomy surgery under general anesthesia. Patients were randomly assigned to music and white noise groups, and relevant sounds were played to patients after induction of anesthesia. The two groups were compared for the use of propofol as an anesthetic to maintain a BIS near 50 and for postoperative pain, anxiety, nausea, and vomiting. Results: Propofol consumption to maintain the set BIS score was much lower in the music group than in the white noise group (78.72 ± 25.76 microgram/kg/min and 117.91 ± 36.78 microgram/kg/min, respectively, P-value = 0.000). Postoperative pain scores were also much lower in the music group than in the white noise group (P-value = 0.000) and anxiety levels between these two groups did not differ (P-value = 0.870). No patient in the music group had complaints of postoperative nausea and vomiting (PONV) compared to six patients in the white noise group (P-value = 0.011). Conclusions: Listening to music during general anesthesia for vitrectomy surgery can reduce the use of anesthetics, postoperative pain, and PONV. Further, controlled studies are necessary to confirm our results.

Comparison of Optic Nerve Sheath Diameter (ONSD) in Low-Pressure Versus Normal Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Clinical Study.

Background: Low pressure laparoscopic cholecystectomy has been advocated due to reduction in postoperative pain, ventilation problems, hemodynamic complications, and potential for reduction in surgical events. No reported data have been found focusing on the effects of low-pressure laparoscopic cholecystectomy on intracranial pressure (ICP). The aim of this study was to investigate the effect of low-pressure laparoscopic cholecystectomy on intracranial pressure measured by optic nerve sheath diameter (ONSD) in Imam Hossein Medical Center, Tehran, Iran. Methods: The patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were randomly assigned to low-pressure laparoscopy (LPL) group or normal pressure laparoscopy group (NPL). ONSD was measured at 3 different times: (1) before induction of anesthesia; (2) after initiation of gas insufflation; and (3) after the termination of gas insufflation. The collected data were entered into SPSS software (V 24). Data were demonstrated with frequency (percentage) or mean ± standard deviation. We used the Mann-Whitney test to compare the means of continuous variables. The Friedman test was used to compare the mean of variables over time in each of the 2 groups. The significance level in all analyses was considered at ˂0.05. Results: ONSD after the termination of gas insufflation was significantly lower in the LPL group with the mean of 4.97±0.83 mm than the NPL group with the mean of 5.62±1.32 mm (p=0.018). ONSD before induction of anesthesia or immediately after gas insufflation did not differ significantly between LPL and NPL groups. Duration of anesthesia and surgery, mean arterial pressure, the total dose of propofol (p=0.600), and fentanyl (p=0.201) did not show significant differences between the 2 groups. Conclusion: ONSD was lower with low-pressure laparoscopic cholecystectomy after the termination of gas insufflation, which emphasized the neural protective effect of low intraperitoneal pressure. Further studies are needed to evaluate this diagnostic tool in different populations, especially in patients with increased ICP undergoing laparoscopic interventions.

COVID-19 and Acute Kidney Injury: A Systematic Review.

Introduction: Acute kidney injury (AKI) has been associated with an increased mortality rate among hospitalized patients with Coronavirus disease 2019 (COVID-19). The current review aimed to evaluate the symptoms, complications, and treatments performed to manage AKI in patients with COVID-19. Methods: We searched PubMed/Medline, Web of Science, and Embase for the relevant scientific literature published up to February 1, 2022. The following keywords were used: "COVID-19", "SARS-CoV-2", and "Acute kidney injury". Results: Forty-four studies with a total number of 114 COVID-19 patients with AKI (Mean age: 53.6 years) were included in our systematic review. The most common comorbidities in patients with COVID-19 suffering from AKI were the history of diabetes, hypertension, and hyperlipidemia. Twelve out of the 44 included studies reported a history of chronic kidney disease (CKD) in this group of patients. Focal segmental glomerulosclerosis (FSGS) and acute tubular necrosis (ATN) were the most common pathological evidence. The average length of hospital stay was 19 days, and the average duration of need for mechanical ventilation was 3 days. Conclusions: The current systematic review shows that AKI frequently complicates the course of COVID-19 hospitalizations and is associated with increased severity of illness, prolonged duration of hospitalization, and poor prognosis. Given the extent of the adverse impact of AKI, early detection of comorbidities and renal complications is essential to improve the outcomes of COVID-19 patients.

Prediction of Acute Kidney Injury After Cardiac Surgery Using Interpretable Machine Learning.

Background: Acute kidney injury (AKI) is a complication that occurs for various reasons after surgery, especially cardiac surgery. This complication can lead to a prolonged treatment process, increased costs, and sometimes death. Prediction of postoperative AKI can help anesthesiologists to implement preventive and early treatment strategies to reduce the risk of AKI. Objectives: This study tries to predict postoperative AKI using interpretable machine learning models. Methods: For this study, the information of 1435 patients was collected from multiple centers. The gathered data are in six categories: demographic characteristics and type of surgery, past medical history (PMH), drug history (DH), laboratory information, anesthesia and surgery information, and postoperative variables. Machine learning methods, including support vector machine (SVM), multilayer perceptron (MLP), decision tree (DT), random forest (RF), logistic regression, XGBoost, and AdaBoost, were used to predict postoperative AKI. Local interpretable model-agnostic explanations (LIME) and the Shapley methods were then leveraged to check the interpretability of models. Results: Comparing the area under the curves (AUCs) obtained for different machine learning models show that the RF and XGBoost methods with values of 0.81 and 0.80 best predict postoperative AKI. The interpretations obtained for the machine learning models show that creatinine (Cr), cardiopulmonary bypass time (CPB time), blood sugar (BS), and albumin (Alb) have the most significant impact on predictions. Conclusions: The treatment team can be informed about the possibility of postoperative AKI before cardiac surgery using machine learning models such as RF and XGBoost and adjust the treatment procedure accordingly. Interpretability of predictions for each patient ensures the validity of obtained predictions.

Residency Education Reform Program in Department of Anesthesiology and Critical Care: An Academic Reform Model.

BACKGROUND: Reform in medical education is a basic process in every academic department, especially in residency programs. OBJECTIVES: This study was designed to assess the indices of education and research as part of the Medical Education Reform program (MERP) in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU) for four years. METHODS: MERP in DACC, SBMU was designed and implemented as a modern academic reform model; different outcome measures in education and research were assessed to demonstrate the effects of the reform plan in academic improvements. RESULTS: there were significant improvements regarding education indices (i.e., teaching methods, passing comprehensive exams, mentorship, assessment methods, faculty development, professionalism in medical education, integration in education, and crisis management) and research indices (targeted research activities, innovation in research approaches, increasing the impact of research). CONCLUSIONS: Based on the experiences of DACC, SBMU regarding clinical anesthesiology residency, reform could be achieved using painstaking plans and continuous efforts with tangible documented outcomes. Often, the management period is not durable, and these reforms require meticulous care to sustain.

COVID-19 and Cardiomyopathy: A Systematic Review.

Background: Cardiomyopathies (CMPs) due to myocytes involvement are among the leading causes of sudden adolescent death and heart failure. During the COVID-19 pandemic, there are limited data available on cardiac complications in patients with COVID-19, leading to severe outcomes. Methods: We conducted a systematic search in Pubmed/Medline, Web of Science, and Embase databases up to August 2020, for all relevant studies about COVID-19 and CMPs. Results: A total of 29 articles with a total number of 1460 patients were included. Hypertension, diabetes, obesity, hyperlipidemia, and ischemic heart disease were the most reported comorbidities among patients with COVID-19 and cardiomyopathy. In the laboratory findings, 21.47% of patients had increased levels of troponin. Raised D-dimer levels were also reported in all of the patients. Echocardiographic results revealed mild, moderate, and severe Left Ventricular (LV) dysfunction present in 17.13, 11.87, and 10% of patients, respectively. Conclusions: Cardiac injury and CMPs were common conditions in patients with COVID-19. Therefore, it is suggested that cardiac damage be considered in managing patients with COVID-19.

Attitudes of Anesthesiology Residents Toward a Small Group Blended Learning Class.

BACKGROUND: Accreditation Council for Graduate Medical Education (ACGME) has been used to evaluate the residents' competency; however, the thriving of residents needs especial training methods and techniques. Small group learning has been used for this propose. OBJECTIVES: This study assessed the attitudes of CA-1 to CA-3 anesthesiology residents toward level-specific small-group blended learning. METHODS: Anesthesiology residents from Department of Anesthesiology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran participated in this cross-sectional attitude assessment descriptive-analytical study throughout the 2nd academic semester (May-October 2019). They took part in a level-specific small-group blended learning program and filled out an attitude assessment questionnaire. The questionnaire included eight closed questions and was filled out anonymously. RESULTS: The residents believed that this program made important contributions to their theory training and clinical skills of anesthesia; while created a greater sense of solidarity. In addition, nearly the majority of the respondents did not believe that participating in the classes made interference in their clinical duties or was a difficult task. Instead, the majority of residents believed that these classes were in favor of reducing their burnout. The reliability of the questionnaire based on Cronbach's Alpha was 0.885. CONCLUSIONS: Anesthesiology residents are in favor of small-group learning, especially when considering their clinical setting and the degree of burnout they tolerate.

Maternal sciatic nerve administered bupivacaine induces hippocampal cell apoptosis in offspring.

BACKGROUND: Bupivacaine, an amid-type local anesthetic, is widely used for clinical patients especially in pregnant women. In addition to neurotoxicity effect of bupivacaine, it can cross the placenta, accumulates in this tissue and retained in fetal tissues. Nevertheless, whether bupivacaine can cause neurotoxicity in fetus remains unclear. Hence, this study was design to investigate the effects of maternal bupivacaine use on fetus hippocampal cell apoptosis and the possible related mechanism. METHODS: On day 15 of pregnancy, sciatic nerve of pregnant wistar rat (180-200 g) were exposed by lateral incision of the right thigh and 0.2 ml of bupivacaine was injected. After their delivery, we randomly selected one male offspring of every mother. On day 30 after of their birth, the rat's hippocampi were isolated for molecular studies. Western blotting was used to examine the expression of cleaved caspase-3, caspase-8 and p-Akt in fetal hippocampus. RESULTS: Our results showed that maternal bupivacaine use caused a significant increment of cleaved caspase-3 and caspase-8 expression in fetal hippocampus compared with the sham group. In addition, maternally administered bupivacaine could significantly decrease hippocampal P.Akt/T.Akt ratio which was concurrent with an increment of cleaved caspase-3 and caspase-8 expression. CONCLUSION: Our data suggest that maternal bupivacaine use increases fetal hippocampal cell apoptosis markers such as caspase 8 and cleaved caspase 3, at least in part, via inhibiting the Akt activation.

Attitudes of the Third-Year Clinical Anesthesiology Residents Toward an Independent Clinical Practice Rotation in COVID-19 Pandemic in Iran.

BACKGROUND: COVID-19 was a worldwide pandemic with international health emergencies and great challenges; health care personnel shortage and physician burnout is a potential major challenge that should be planned and managed; especially in those countries with a high COVID-19 occurrence. OBJECTIVES: This study was designed to assess the attitudes of 3rd-year anesthesiology residents toward an independent one month-length clinical care course for patients with COVID-19. METHODS: A closed self-administered questionnaire was developed to assess the attitudes of 3rd-year clinical anesthesiology residents. A self-administered closed questionnaire was developed. Cronbach's alpha was calculated to measure the reliability of the questionnaire; added with a factor analysis process. RESULTS: All 19 clinical anesthesiology residents took part in the study, with a 100% response rate. Cronbach's alpha for the reliability of the questionnaire was 0.678. The eigenvalue for 8 factors was equal to 1; however, further assessment led us to 7 factors. CONCLUSIONS: This one-month period could improve the competencies of the 3rd year clinical anesthesiology residents based on their viewpoints. Since the COVID-19 pandemic is ongoing health and social problem worldwide, 3rd-year anesthesiology residents could help the health system to recover health care delivery faults regarding manpower; a promising point for crisis preparedness in the COVID-19 pandemic. Besides, there were many constructive results for the clinical anesthesiology residents regarding their training and clinical service delivery.

Evaluation of One-Day Multiple-Choice Question Workshop for Anesthesiology Faculty Members.

BACKGROUND: Multiple-choice questions (MCQs) are used commonly to evaluate medical health students. Most novice educators tend to create poor quality, flawed, and low-cognitive-level questions. Therefore, there is a need for educating the assessors to maximize the quality of MCQs and evaluations. OBJECTIVES: The current study aimed to evaluate the effect of a one-day MCQ workshop on anesthesiology faculty members. METHODS: Faculty members were invited to participate in a four-hour, one-day MCQ workshop. At the beginning of the workshop, the participants were questioned about their knowledge about MCQ quality indexes and also were asked about MCQ general principles (pre-test). Participants were again asked about the questions which they had in the pre-test as their post-test and were questioned about their expectations and the influence of this workshop. RESULTS: The participants declared that their expectations were fulfilled (9.4 ± 0.6 out of 10), and the course was applicable (9.7 ± 0.7 out of 10). Before the workshop, only 12.5% of the participants know MCQ indicators. This rate increased to 41% after the workshop (P < 0.05). Also, they were questioned about Millman's checklist for the MCQ examination. Participants' correct answers were increased from 2.75 to 3.05 out of four (P < 0.05). CONCLUSIONS: Although previous participation in MCQ training courses did not demonstrate an increase in knowledge and attitude, it could be theorized that short-term repetition would yield better results.

Improving the Training Process of Anesthesiology Residents Through the Mentorship-Based Approach.

BACKGROUND: Although mentoring has been accepted as an effective and nourishing component in medical learning, known mentoring programs for the residents are lacking in most countries. OBJECTIVES: To evaluate the mentoring program for anesthesiology residents at Shahid Beheshti University, an examination was designed to explore the styles of mentoring programs, as well as the aims and outcome followed by such programs. METHODS: In October 2016, Anesthesiology Department of Shahid Beheshti University of Medical Sciences enrolled all the nine educational wards in "mentorship program". Twelve members of the faculty were chosen to be mentor. This program contained: (a) Creating online groups for reporting, feedbacks, and problem-solving, (b) integrating each chapter of textbooks for studying program each month, (c) establishing formative and summative assessments (i.e., PMP, OSCE, multiple choice exams), (d) role-playing for stress management of level 4 residents. Our main objective was to provide the residents with the provision of mentors. The goals of our programs were: Arrange a safe environment to encourage and foster reflection, promote self-care and wellness, guide special development, provide a resource for residents pursuing control, enrich team constructing and problem-solving skills, and promotion in career counseling of anesthesia residents at Shahid Beheshti University of Medical Sciences enrolled in this program from 2014 to 2017. We retrospectively compared 2 periods before (2014 - 2015) and after (2016 - 2017) of monthly examination and educational conference. RESULTS: In the academic stage from 2014 - 2015, the overall first-time license rate for the IBA written QE was 7 of 14 (50%) and in the period of 2016 - 2017, the general rate was 11 of 14 (78%) and in the period of 2017 - 2018, it was 12 of 14 (85%). For each extra year experiencing the program, the odds ratio for passing IBA written QE was 1.7 (P < 0.05). The median Iranian Board of Anesthesiology In-Training Examination (IBAITE) percentile was considerably greater in period 2 than period 1 (P < 0.05). Also, there was a significant correlation between IBAITE score and first-time passing rates for the IBA written QE (0.55, P < 0.05). CONCLUSIONS: The results of this study demonstrated the clinical mentorship program as an effective method in improving theoretical, clinical, and professional achievement of anesthesiology residents. Programmed mentorship could significantly improve the educational goal achievements for anesthesiology residents. Mentoring programs are needed to be more used; however, need to be assessed and evaluated, especially regarding the professional aspects of education. Medical schools could subsequently be assessed regarding the number and quality of their running mentorship programs as a quality improvement tool.