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Background: After graduation, physicians should be able to provide professional and safe services without the need for supervision by their clinical professors, mandating a competency-based medical education (CBME) approach. Objectives: This study aimed to develop a national model of entrustable professional activities (EPAs) based on our experiences in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU). Methods: The primary EPA design plan was designed in a 10-step model as a career roadmap for the project. The texts were prepared according to a consensus-based approach. On the other hand, the texts were reviewed and revised by a broad team of faculty in a daily workshop. Results: The final product included 14 topics for EPA as the first round of targeting topics for anesthesiology residents. The texts were developed using previous studies and were standardized considering national standards. Conclusions: We described a clear path toward designing and implementing EPAs in anesthesiology residency programs to improve the quality of the graduated residents. Though the basic theory is the same, each country needs its formula for implementing the process.

Background: Current knowledge on antioxidant properties of anesthetics is inconclusive. Nevertheless, experiments on different anesthesia-related drugs and techniques are growing. Objectives: The aim of this prospective blinded randomized study was to assess the effect of dexmedetomidine (Dex) infusion during anesthesia on oxidative stress resulting from lumbar laminectomy. Methods: The antioxidant activity of Dex compared to placebo (normal saline) was evaluated by measuring the antioxidant enzyme activity of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX). A total of 56 patients who underwent laminectomy surgery were allocated into two groups of intervention and control. Dex group received 0.6 µg.kg-1 dexmedetomidine infusion before induction of anesthesia over 15 minutes, followed by 0.4 µg.kg-1.hr-1 maintenance. Control group received the same volume and sequence of normal saline. Anesthesia protocol was similar in both groups. The antioxidant activity of the previously mentioned enzymes was measured at the beginning of the anesthesia (T1) and after surgery (T2). Propofol consumption, hemodynamic indices, shivering, bleeding volume, and pain Numeric Rating Scale (NRS) were recorded. Results: Although the serum levels of CAT and GPX increased during the procedure, these changes were not significant (P-values 0.579 and 0.762, respectively). Also, the mean SOD level did not change over time in any of the groups, and it was not meaningfully different between the groups at any of the predetermined times (P-value 0.665). Conclusions: As expected, Dex decreased propofol consumption, mean heart rate, mean arterial pressure, and pain intensity allover the perioperative period. It seems that adding Dex to anesthesia regimen during laminectomy had no dominant antioxidant effects.

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.

Background: Dexmedetomidine protective effects on apoptosis in the brain and peripheral organs have been reported in vivo and in vitro. Apoptotic factors of cerebrospinal fluid (CSF) may influence the prognosis of patients undergoing open discectomy surgery. Objectives: This study evaluated the effect of intrathecal dexmedetomidine administration on the CSF levels of apoptotic factors and clinical outcomes in patients undergoing lumbar discectomy. Methods: This clinical trial was conducted on patients undergoing open lumbar discectomy. Forty patients were randomly divided into control and dexmedetomidine groups. In the dexmedetomidine group, 0.1 μg/kg of dexmedetomidine was intrathecally injected after anesthesia induction. Patients’ hemodynamic status during surgery was recorded; additionally, their pain scores were recorded by the Numeric Rating Scale (NRS) in the recovery room. The levels of apoptotic factors including Bax/Bcl-2 and caspase-3 in the CSF were measured at the beginning and end of discectomy, and the results were compared between the two groups. Results: Of the 40 evaluated patients, the mean levels of caspase-3 in the intervention and control groups were 2.28 ± 0.35 and 2.34 ± 0.32 ng/mL before surgery and 2.56 ± 0.42 and 2.72 ± 0.39 ng/mL after surgery, respectively. The levels of Bax/Bcl-2 in the intervention and control groups were 1.01 ± 0.11 and 0.89 ± 0.07 before surgery and 1.28 ± 0.14 and 1.16 ± 0.19 after surgery, respectively. The levels of these two factors were not significantly different. However, the NRS scores were significantly lower in the dexmedetomidine group than in the control group. Conclusions: Intrathecal dexmedetomidine could significantly and safely reduce the NRS score in the intervention group but did not have any significant effect on the CSF levels of apoptotic factors before and after lumbar discectomy surgery.

In the current study, we reported a successfully managed case of giant cerebral hydatid cyst in a 59-year-old male. Cerebral hydatid disease is a rare manifestation of echinococcosis representing 1% - 2% of all cases with hydatid disease. The mainstay of its treatment is surgical excision of entire intracranial cystic lesion, avoiding intra-operative rupture, which can result in subsequent recurrence or anaphylactic reaction. The surgery can be associated with intraoperative complications (including anaphylaxis, bleeding, neurological deficits, development of subdural effusion, epidural hematoma, and pneumocephalus), especially in the cases where the cyst is infected. All of these complications are of significant concern for the anesthesiologists. Thus, it is of paramount importance for anesthesiologists to consider the intra-operative challenges and possible required actions preoperatively.

A case of Churg-Strauss syndrome with schwannoma of T12 in a middle-aged female with large hepatic hemangioma was presented with special emphasis on its anesthetic management and therapeutic protocol. To the authors' best knowledge, it was the first report of a case with a myriad of symptomatology.