Lobectomy with one-lung ventilation presents significant anesthetic challenges, particularly in elderly patients with multiple comorbidities. This case report describes the successful anesthetic management of an elderly patient with adenocarcinoma lung undergoing right lower lobe lobectomy. An elderly male with adenocarcinoma of the right upper lobe presented for lobectomy. His complex medical history included chronic kidney disease requiring regular hemodialysis, post-stroke right-sided hemiparesis, hypertension, hypothyroidism, and diabetes mellitus. The anesthetic management involved careful preoperative optimization, use of a left-sided double-lumen tube for one-lung ventilation, and meticulous hemodynamic monitoring. Challenges encountered included a brief episode of hypoxemia during one-lung ventilation and hypertension, which were successfully managed with ventilator adjustments and dexmedetomidine infusion, respectively. The six-hour surgery was completed successfully with minimal blood loss. The patient was extubated postoperatively and maintained stable oxygenation on supplemental oxygen. Pain management was achieved through multimodal analgesia, including a fentanyl patch. This case illustrates that complex thoracic surgery can be safely conducted in high-risk patients through comprehensive preoperative evaluation, careful intraoperative management, and adherence to enhanced recovery protocols. The successful outcome emphasizes the importance of a multidisciplinary approach in managing such challenging cases.

Trauma to the brain or spinal cord is a type of injury that triggers a cascade of secondary pathophysiological events after the primary mechanical trauma. Neuroinflammation is indeed of foremost importance, acting both as a mediator for tissue repair and an instigator for progressive neurodegeneration. Activated microglia and astrocytes, peripherally derived immune cells infiltrating that site, mediate a complex interaction involving cytokines, oxidative stress, mitochondrial dysfunction, and neurovascular disruption. This early inflammatory signaling helps remove debris and support neuronal regeneration in traumatic brain injury (TBI) and spinal cord injury (SCI). However, when this particular inflammation becomes chronic, it leads to glial damage with aberrant synaptic connections and irreversible harm to neural network circuitry. Mediators, including IL-1β, TNF-α, and the NLRP3 inflammasome, have been identified as promising therapeutic targets; cutting-edge therapies, ranging from small-molecule inhibitors to mitochondrial stabilizers to cell-based interventions, have shown efficacy in preclinical models. Nonetheless, the translation to the clinic has been hindered through shortcomings in classical animal models, failure to integrate biomarker application, and an inability to account for the heterogeneity of human central nervous system (CNS) injury. To bridge this gap, temporally targeted immunomodulation, precision diagnostics, and systems-level approaches will need to align with the molecular pathology involved in disease intervention. Understanding this dual property within post-traumatic inflammation presents an important frontier to develop truly efficacious neuroprotective therapies

Background: Hypertensive disorders of pregnancy, including preeclampsia and eclampsia, represent a significant global maternal health challenge, affecting 2-8% of pregnancies worldwide and contributing to 11-14% of maternal deaths. The complex, multisystemic nature of these conditions, coupled with their unpredictable clinical trajectories, presents substantial challenges for anesthetic management. This narrative review examines the emerging integration of artificial intelligence (AI) technologies in obstetric anesthesia care for hypertensive disorders, exploring current applications, technological foundations, implementation challenges, and future directions. We synthesize evidence demonstrating AI's potential in continuous monitoring, predictive analytics, personalized care delivery, and clinical decision support. While significant barriers to implementation exist-including technological, regulatory, and ethical considerations-the integration of AI into obstetric anesthesia represents a paradigm shift toward precision, predictive, and personalized maternal care. This narrative review synthesizes current evidence to argue that the primary value of AI in this context is not the replacement of clinical judgment, but its augmentation through the synthesis of high-dimensional, time-series data, thereby enhancing anesthesiologist situation awareness and enabling proactive, rather than reactive, management.

The Article Abstract is not available.

Background: The most severe complication of type 1 diabetes mellitus is diabetic ketoacidosis (DKA). Hypokalemia, a common electrolyte disturbance in DKA, can be life-threatening and often worsens during treatment. A significant clinical debate exists regarding the optimal route of potassium administration—central versus peripheral lines. Current guidelines recommend aggressive potassium replacement but lack consensus on the safest administration method. This study investigated the safety and complications of high-concentration peripheral potassium administration in pediatric DKA patients within an intensive care setting. Methods: This observational study, conducted at the PICU of Bahrami Children's Hospital, enrolled 55 pediatric patients with DKA requiring high-concentration potassium supplementation (50, 60, or 70 mEq/L) through peripheral veins. Potassium chloride was administered in normal saline with dosing stratified by serum potassium levels checked every 2 hours. Primary analyses examined associations between infusion-related complications (phlebitis, pain, erythema, burning sensation) and potassium concentration, infusion duration, DKA severity, and patient characteristics. Results: Among 55 patients (mean age: 8.7 ± 4.1 years; 52.7% male), 32 patients (58.2%) received 50 mEq/L, 21 patients (38.2%) received 60 mEq/L, and 2 patients (3.6%) received 70 mEq/L. Of these, 25 patients (45.5%) required infusion duration exceeding 6 hours. Hypokalemia occurred in 30.9% of patients, with higher prevalence in severe DKA (44.4%). A total of eight patients (14.5%) experienced a total of 10 infusion-related complications. These included one case of phlebitis (1.8%), five cases of injection site pain (9.1%), and four cases of burning sensation (7.3%). Infusion duration exceeding 6 hours significantly increased complication risk (OR: 5.7; 95% CI: 2.01-16.56; p=0.042), with combined high concentration and extended duration showing elevated risk (adjusted OR: 3.1; 95% CI: 1.86-5.24; p=0.003). Conclusion: In pediatric DKA patients receiving care in the PICU setting, peripheral potassium infusion at concentrations up to 60 mEq/L demonstrates acceptable safety outcomes when administration duration remains under 6 hours and rigorous monitoring protocols are implemented. However, for infusions exceeding 6 hours, our findings suggest careful consideration of alternative approaches may be warranted, particularly at higher concentrations.

Background: The goal of this study is to compare the effects of the TAP (transversus abdominis plane) block, guided by ultrasound, before the commencement of surgery and after its completion, on reducing postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods: The present study was conducted as a randomized, double-blind clinical trial. The study population included patients scheduled for laparoscopic cholecystectomy at Imam Khomeini Hospital in Sari, Mazandaran, Iran. Patients were randomly assigned to two groups: TAP block before the operation and after the operation. The pain intensity and consciousness level at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery, as well as the time of the first analgesic request, time of first pain expression after surgery, and the amount of morphine consumption within 24 hours for each patient, were documented. Results: 120 patients were included in this study; 60 of them were in the pre-op group and 60 in the post-op group. There was no statistically significant difference in terms of duration of surgery and total morphine consumed between the study groups. The time of the first analgesic request and the time of the first pain expression were significantly longer in the post-op group. Pain intensity was significantly lower in the post-op group. Conclusion: Bilateral ultrasound-guided TAP block after surgery in patients undergoing laparoscopic cholecystectomy leads to a reduction in pain intensity and incidence of vomiting and an increase in the time of analgesic request and pain expression after surgery.

Background: The readmission of a patient to the intensive care unit means a patient's return to the hospital for a certain period of time after discharge for planned or unplanned reasons. Therefore, this study aimed to investigate the risk factors for readmission after appendectomy in hospital. Methods: In this retrospective study, the records of patients who underwent appendicitis in hospitals were reviewed. In order to identify readmissions, a list of patients with a history of readmission was extracted from the hospital's Health Information Technology Unit. Then, the researchers studied the patients' clinical records and extracted data using a researcher-made checklist. To analyze the data, first the data were entered into SPSS version 16 software and then analyzed using descriptive and analytical statistical tests. Results: According to the findings, the mean (SD) age of the patients in the readmitted group was 14.1 (2.8) years, and in the non-readmitted group was 13.9 (2.1) years. In the readmitted patient’s group, 52.4% of the patients were male, 19% of the patients had underlying diabetes, 9.5% had asthma and allergies, and 100% of the surgeries were performed by a specialist. Also, the results showed the reasons for readmission of patients were 4.8% due to intra-abdominal abscess, 42.9% due to wound infection, 14.3% due to abdominal pain, 23.8% due to paralysis/ileus, and 14.3% due to other causes. Conclusion: Given that patient readmission has various complications for the patient, the patient's family, and the healthcare system, it is necessary to take necessary preventive measures regarding the factors affecting it.

Background: Sepsis is a dynamic and heterogeneous syndrome characterized by a dysregulated host response to infection, leading to concurrent hyperinflammation and profound immunosuppression. Early recognition of pathogen- and damage-associated molecular patterns triggers extensive activation of NF-κB, JAK/STAT, and MAPK pathways, resulting in a cytokine storm, metabolic reprogramming, and endothelial dysfunction. Mitochondrial impairment, glycocalyx degradation, and excessive neutrophil activity further propagate organ injury and microcirculatory collapse. Simultaneously, widespread apoptosis and exhaustion of lymphocytes culminate in immune paralysis and increased susceptibility to secondary infections. Advances in transcriptomics, proteomics, metabolomics, and machine-learning–based classification have uncovered distinct immune endotypes of sepsis, providing the foundation for precision medicine. Emerging immunomodulatory therapies—including IL-7, GM-CSF, and immune checkpoint inhibitors—aim to restore immune function in selected subgroups. Ultimately, sepsis must be viewed as a multifaceted immunometabolic disorder requiring individualized diagnosis, monitoring, and treatment approaches.

Background: Lung edema is a life-threatening condition associated with prolonged intensive care unit stay and high mortality. The increased extravascular lung water (EVLW) causes impaired lung compliance and refractory hypoxemia. Although there are promising methods for the detection of EVLW, there is not yet a universally accepted one, and a systematic approach to the problem is missing. The discussion in this article is on the potential of the described assessment methods and techniques and reveals the strong and weak points according to their practical application. Methods: The discussion in this article is on the potential of the described assessment methods and techniques. According to our comparative analysis, the strong and weak points regarding their practical application are presented in a table. Results: This review article summerizes advantages and disadvantages of the most common methods in clinical practice. Conclusion: Although there are promising methods for the detection of EVLW, there is not yet a universally accepted one, and a systematic approach to the problem is yet to be found

Background: The COVID-19 pandemic has been associated with a significant prevalence of thromboembolism. This study aimed to identify the predictive effect of D-dimer and ferritin on thromboembolism occurrences in hospitalized COVID-19 patients. Methods: This retrospective study examined 304 patients with COVID-19, with a mean age of 62.33 ± 17 years, hospitalized at Modares Hospital from March 2020 to March 2021. The case group (PTE) comprised patients who experienced thrombosis complications during hospitalization (152 patients), while the control group (Non-PTE) consisted of patients who did not encounter thrombosis complications during their hospital stay (152 patients). Demographic data, clinical information, and laboratory findings were gathered and documented from patient records. The study examined the impact of D-dimer and ferritin as predictors of thromboembolism in patients. Results: In this study, 100 patients died, with 75 (75%) of these fatalities occurring in the PTE group. The results indicated that PTE patients exhibited higher BMI (28.36 ± 1.87 vs. 27.76 ± 1.31 kg/cm², P<0.001), longer hospital stays (11.2 vs. 8.5 days, P=0.0009), increased ICU admissions (61.8 vs. 26.3%, P<0.001), higher smoking rates (21.9 vs. 4.8%, P<0.001), and greater prevalence of chronic lung disease (13.2 vs. 2.6%, P=0.001) compared to non-PTE patients. Analysis of the laboratory findings indicated a significant increase in lymphocyte count (P=0.034) and C-reactive protein (CRP) 3+ levels (P=0.04) in the PTE group compared to the non-PTE group. The D-dimer concentration in the PTE group was 4178.80 ± 1148.78 ng/ml, while in the non-PTE group it was 606.04 ± 656.86 ng/ml (1.03 OR, 95% CI=1.04-1.02, P<0.001). The ferritin level in the PTE group was recorded at 1639.33 ± 514.38, while in the Non-PTE group, a measurement of 420.48 ± 322.65 ng/ml was recorded (OR: 1.06, CI95%=1.07-1.04, P<0.001). Conclusion: Elevated serum levels of ferritin and D-dimer in COVID-19 patients correlate with an increased risk of thromboembolism. Consequently, elevated concentrations of these parameters in hospitalized patients should serve as a warning to clinicians, necessitating careful attention and prompt treatment interventions.