Background: Different studies investigated strategies to prevent perioperative bleeding in cardiac surgeries. The use of fibrinogen concentrate is one of these efforts. In this study, we will investigate the efficacy and proper dosage of fibrinogen concentrate as a prophylactic adjuvant for reducing postoperative bleeding in patients with normal blood fibrinogen under coronary artery bypass grafting (CABG) surgery. Methods: Patients with preoperative normal plasma fibrinogen levels were randomly divided into two groups (15 patients in each). At the final stage of cardiac surgery and after reversal of heparin, the first group received 2gr of fibrinogen IV concentrate in 15 minutes, while the other group received the same volume of placebo. In each patient, postoperative haematocrit percentage, intraoperative and postoperative administered blood products, and postoperative drainage amount were collected. Results: Although in the study group, the postoperative amount of plasma fibrinogen increased compared to preoperative and decreased in the control group, but this change was not statistically significant. Also there wasn’t any significant difference in terms of blood drainage and blood product consumption. Conclusion: We did not find evidence of a significant difference in the change of fibrinogen blood level before and after the operation, the amount of drainage, and the consumption of blood products in the fibrinogen and placebo groups.

ABSTRACT Background and Aims The accurate prediction of mortality risk among critically ill children represents a major challenge in Pediatric Intensive Care Units (PICUs). Artificial Intelligence (AI) can find intricate patterns linked to mortality risk by examining large volumes of clinical data. This can help physicians better predict mortality risk and provide more efficient care. A systematic review can summarize the current evidence regarding the role of AI in predicting mortality among critically ill children in the PICU. Methods A comprehensive and systematic search was conducted across three major electronic databases: PubMed, Scopus and Web of Science. The database searches were conducted on December 2, 2024. The screening process was conducted in two stages: title and abstract screening, and full‐text review. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The Prediction model study Risk Of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and concerns regarding the applicability of the included studies. Results Ultimately, the full text of 17 articles was reviewed for study evaluation and data extraction. 76% of the relevant research was conducted in 2020 or later, while 24% of the articles were published before 2020. The most frequently used algorithm in the studies was random forest. Overall, the Area Under the Receiver Operating Characteristic (AUROC) was greater than 0.8 in 88% of the studies and less than 0.8 in 12% of the studies. Conclusion The studies emphasize the crucial role of machine learning and deep learning in improving mortality prediction in PICUs. The variability in AUROC values between different methods shows that while certain models excel in certain contexts, the choice of algorithm and feature selection significantly affect prediction accuracy.

Background:This randomized controlled trial evaluated the efficacy of tranexamic acid in preventing bleeding in patients undergoing transbronchial lung biopsy. Materials and methods:This study was a double-blind, parallel-group, randomized controlled trial. Adult patients referred for flexible bronchoscopy with a planned transbronchial lung biopsy during 2024 were included in the current study. Participants in the intervention group received 10 mg/kg of intravenous tranexamic acid in normal saline, administered 20 minutes prior to the procedure. Those in the placebo group received an equal volume of normal saline. We assessed the need for bleeding control interventions, such as epinephrine or ice saline use, the incidence of tachycardia or hypotension, uncontrolled bleeding, and procedure length. We also measured the hemoglobin levels before and after the procedure. Results:In total, 60 patients - 32 (53.3%) in the tranexamic acid group and 28 (46.7%) in the control group - were enrolled in the study. The percentage of females (53.6% vs. 28.1%) and the mean age of participants (66.5 vs. 42.9 years) were significantly higher in the control group compared to the tranexamic acid group (P < 0.05). After adjusting for age and gender, epinephrine use (18.8% vs. 92.9%) and the procedure length (median of 8 vs. 13 minutes) were lower in the tranexamic acid group compared to the control group (P < 0.05). Additionally, tranexamic acid had a statistically significant effect on post-operative hemoglobin levels (F = 14.08, P < 0.001, partial η2 = 0.207). Conclusions:Tranexamic acid can be effective in preventing bleeding in individuals undergoing transbronchial lung biopsy and in enhancing procedural speed.

Background: Competency-based medical education (CBME) emphasizes longitudinal development of professional competence and has driven a shift away from isolated high-stakes examinations toward programmatic assessment (PA). Programmatic assessment integrates multiple low-stakes assessments, continuous feedback, and portfolio-based decision-making to support learning and ensure defensible judgments of competence. Evidence regarding the implementation of PA in anesthesiology residency remains limited. Objectives: The main objective of this study was to assess the efficiency of PA in anesthesiology residency in Iran for improving the quality of anesthesiology training. Methods: This mixed-methods descriptive-analytic study evaluated the implementation of a PA system in an anesthesiology residency program at a university-affiliated teaching hospital in Iran (2020 - 2025). The assessment framework incorporated entrustable professional activities (EPAs), workplace-based assessments [mini-clinical evaluation exercise (mini-CEX) and direct observation of procedural skills (DOPS)], bi-monthly multiple-choice question (MCQ) examinations with individualized feedback, multisource feedback, global faculty assessments, and an electronic portfolio. Longitudinal resident performance data were analyzed using descriptive statistics and linear mixed-effects models. Faculty mentors’ attitudes were assessed using a validated questionnaire. Results: Sixty-one residents contributed 134 resident-year observations across four years of training. Mean scores for direct observational performance assessments, EPAs, and global faculty assessments increased progressively with advancing training year. Mixed-effects analyses demonstrated a significant effect of training year on all outcomes (P < 0.001). Faculty mentors reported positive attitudes toward the PA system, high satisfaction, and strong willingness to continue participation, indicating acceptability and perceived educational value. Conclusions: Programmatic assessment was feasible to implement in anesthesiology residency and was associated with longitudinal improvement in resident performance across competency domains. Faculty acceptance further supports the educational value of PA as an effective strategy for operationalizing CBME and supporting evidence-informed, learner-centered educational decision-making.

Background: Telemedicine technology can not only improve service quality, reduce costs, and broaden access to specialized and subspecialty healthcare services, but also be utilized to provide certain anesthesia services.Objective: The objective of this study was to translate and assess the validity and reliability of the Telehealth Readiness Assessment (TRA) tool, used to evaluate the readiness of healthcare providers, for anesthesia services to implement telemedicine for delivering anesthesia services to patients.Material and Methods: In this cross-sectional study, the initial step involved translating the questionnaire followed by an assessment of its validity and reliability. The questionnaire was then distributed to the staff members in the Anesthesiology Research Center. The readiness assessment encompassed various aspects, including Core Readiness, Financial Considerations, Operations, Staff Engagement, and Patient Readiness.Results: The Content Validity Index (CVI) and Content Validity Ratio (CVR) were 93% and 72%, respectively. The internal consistency of each item and the overall TRA score demonstrated excellent reliability, with all values exceeding 0.90. The internal consistency coefficients ranged from 0.92 to 1.00, indicating high reliability and consistency in the measurements of the TRA questionnaire. Cronbach’s alpha was 99%. The TRA subscales mean scores were 71.77±14.76, 63.25±16.14, 67.36±20.46, 68.81±18.50, and 72.52±14.39, respectively. The TRA total mean score was 68.61±17.33. Conclusion: The Persian version of the TRA questionnaire exhibits acceptable levels of validity and reliability. The readiness level related to the implementation of telemedicine for anesthesiologists was obtained as moderate. To ensure the success of telemedicine projects, it is of the utmost importance to pay close attention to the relevant indicators, with particular focus on financial considerations, as this area received the lowest score.

Background:Oxidative stress is a major contributor to postoperative complications in patients undergoing open-heart surgery. Probiotics have been suggested to enhance antioxidant defenses by modulating gut microbiota and reducing systemic inflammation. This study aimed to evaluate the impact of probiotic supplementation on oxidative stress biomarkers in patients undergoing open‑heart surgery. Methods:A total of 37 patients with cardiovascular disease scheduled for open‑heart surgery were initially recruited, with 18 allocated to the intervention group and 19 to the control group. The intervention, consisting of probiotic supplementation, began 1 day before surgery and continued for 2 weeks, while the control group received a placebo for the same duration. Plasma levels of malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured at baseline and at the end of the intervention using ELISA and colorimetric methods, respectively. Results:The intervention group had a significant increase in TAC levels from 221.52 ± 24.68 to 356.23 ± 34.57, whereas the control group experienced a decrease from 220.73 ± 14.12 to 209.68 ± 14.83 (F = 15.794; P < 0.001). No significant change was found regarding the effect of probiotic supplementation on the level of MDA. Conclusion:Probiotic supplementation may improve the postoperative antioxidant status in patients undergoing open-heart surgery. Probiotics may serve as an adjunctive therapy to enhance antioxidant defenses and mitigate postoperative oxidative stress. Further large-scale studies are warranted.

ABSTRACT Background and Aims Recent advancements in gene expression studies have shed light on the role of non‐coding RNAs in negatively regulating mRNA and inhibiting mRNA translation. Given the significant impact of miRNAs on cardiovascular function, our review aims to comprehensively explore their contribution to mitigating heart injury and their protective effects during cardioplegic‐induced cardiac arrest. Methods A systematic search conducted in December 2023 across PubMed, Web of Science, Scopus, and Google Scholar yielded valuable insights. Results Our findings indicate that cardioplegia leads to the upregulation of several miRNAs, including miR‐208b, miR‐499‐5p, miR‐10b, miR‐96, miR‐339‐5p, and miR‐483‐3p, alongside the downregulation of miR‐139‐5p, and miR‐194‐5p. Many of these miRNAs are implicated in cardiac pathophysiology, particularly in myocardial injury following cardioplegia in on‐pump cardiac surgery. Conclusion While current applications of discovered miRNAs primarily focus on early diagnosis and prognosis of cardiac conditions, their therapeutic potential holds promise for revolutionizing the management of various heart diseases in the future. By elucidating the intricate roles of miRNAs in cardiac health and disease, this review underscores the importance of harnessing their therapeutic potential for improved patient outcomes.

Background:l-carnitine, with anti-inflammatory and antioxidant properties, may help prevent liver damage caused by factors including hypoxia, hemodynamic instability, heparin-protamine reactions, and transfusion-related complications. This study evaluates the effect of preoperative oral l-carnitine on liver function in pediatric patients undergoing congenital heart disease repair. Methods:This randomized, double-blind clinical trial assessed l-carnitine's impact on liver function in children aged 6-60 months after cardiac surgery for congenital heart defects. All patients underwent on-pump cardiac surgery following a standardized institutional protocol, including systemic heparinization (300 IU/kg) prior to cardiopulmonary bypass and reversal with protamine sulfate post-bypass (1 mg per 100 IU of heparin). Blood transfusion was guided by intraoperative hemoglobin levels (<8 g/dL threshold). Re-exploration criteria included ongoing hemodynamic instability, chest drainage >5 mL/kg/h for >3 hours, or evidence of tamponade on echocardiography. Results:A total of 60 patients participated in the study, the l-carnitine group showed a faster recovery in liver function, with significantly lower aspartate aminotransferase (AST) levels by day 7 compared to the control group. Alanine aminotransferase and lactate dehydrogenase levels were higher in the l-carnitine group at baseline but evened out over time. Alkaline phosphatase levels were significantly higher in the l-carnitine group by day 7. The l-carnitine group also had lower indirect bilirubin levels by day 7, suggesting improved liver recovery. Conclusion:The findings suggest that l-carnitine may aid liver recovery and affect specific biochemical markers in pediatric patients following surgery. This points to its potential therapeutic role in enhancing recovery outcomes in this group.

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.

The application of artificial intelligence (AI) is progressing as a revolutionary force in medicine. Growing evidence in clinical practice has set foot into anesthesiology, undertaking all its related tasks. Airway management, a complex multimodal function known as the main proficiency of any anesthesiologist, has also been subjected by AI-assisted technologies. The current study aims to review the potential of AI in the management of airway challenges. Therefore, we classified the current data into several categories to get deep into their development status, as well as introduce further initiatives for future research in this context.

This text explores the integration of artificial intelligence (AI) into pediatric anesthesiology, highlighting its potential to enhance safety, efficiency, and decision-making throughout the perioperative period. It addresses the unique challenges of pediatric anesthesia, including physiologic differences, limited communication, and congenital conditions. AI applications are being developed for operating room management, airway assessment, intraoperative monitoring, and postoperative care. These tools show promise in predicting surgical cancellations, difficult airways, hypoxia, and optimal intubation parameters. However, pediatric-specific data and tailored algorithms are essential, as adult models are often unsuitable. The study underscores the need for rigorous research and ethical application.

Background:Postoperative delirium is a significant problem that deteriorates the cognitive state of patients after cardiac surgery, which can be a short- or long-term complication. Objectives:This study was conducted to evaluate the efficacy of dexmedetomidine, commenced simultaneously with anesthesia induction and continued throughout the surgical operation, on postoperative delirium after cardiac surgery with cardiopulmonary bypass. Methods:This randomized, double-blind, case-control trial was conducted on sixty-one patients undergoing cardiac surgery. The patients were randomly divided into dexmedetomidine (case) and normal saline (control) groups. The primary outcome was the incidence of delirium, as screened by the Confusion Assessment Method for the ICU (CAM-ICU). Results:There was no distinction in CAM-ICU outcomes between the two groups at 6 and 24 hours postoperatively. However, the difference in non-positive CAM-ICU results was statistically significant at 24 hours for +1 and -1 Richmond Agitation-Sedation Scale scores. Conclusions:Starting dexmedetomidine before cardiopulmonary bypass did not significantly affect the delirium rate based on CAM-ICU assessments. Further research examining larger groups is necessary to clarify the efficacy of perioperative dexmedetomidine on postoperative delirium.