Neuroanesthesia and Neurocritical Care Activities in Iran

Zahid Hussain Khan, MD, FCCM
Zahid Hussain Khan, MD, FCCM
Farzaneh Keneshlou, MD
Farzaneh Keneshlou, MD
Maryam Sadat Mosallaei, MD
Maryam Sadat Mosallaei, MD

Zahid Hussain Khan, MD, FCCM
Professor, Anesthesiology & Critical Care
Director, Policy Making Council (Anesthesiology Specialty)
Deputy for Research and International Affairs, Department of Anesthesiology & Critical Care
Tehran University of Medical Sciences, Tehran, Iran

Farzaneh Keneshlou, MD
Anesthesiologist and Fellowship in training, Clinical Neuroanesthesiology
Tehran University of Medical Sciences, Tehran, Iran

Maryam Sadat Mosallaei, MD
Anesthesiologist and Fellowship in Training, Clinical Neuroanesthesiology
Tehran University of Medical Sciences, Tehran, Iran

Iran proudly claims to have the stalwarts in medicine and surgery such as Avicenna, Zakarya Razi (Figure 1) and Hakim Jorjani who provided innovative thoughts that revolutionized our present-day medicine.1,2,3,4 Their teachings were taught for centuries in the European universities and they were in fact the torch bearers of modern medicine in the entire world.5 A retrospective look at the past highlights that modern medicine started during the reign of Qajar dynasty when Mirza Taghi Khan Amir Kabir, the Chancellor of Iran, inaugurated Darul - Fanon (Figure 2) in the year 1852. It was here that medicine was taught in the beginning as a discipline.6

History of Anesthesia in Iran

The first modern surgery was carried out in the year 1851 during which the Viennese physician Dr. Jakob Edward Polack anesthetized the patient with ether.7 Those who pioneered the teaching of anesthesia for the first time included Dr. Yahya Adl, a French trained surgeon, Dr. Ali Farr who specialized in anesthesia from the UK, Dr. M. Esmaeil Tashayood, who specialized in anesthesia from the USA, and Dr. Abdullah Mortazawi who obtained his FARCS from the UK.8 Among them, Prof. Adl is remembered as the father of modern surgery in Iran, and Prof. Tashayod is credited with the initiation of the teaching of anesthesia as a separate specialty in Iran.9 In the year 1955, under the supervision of Dr. Tashayood, anesthesia as a subject was introduced into the curriculum for medical students. The first center of anesthesia was started in Sina Hospital (Figure 3) in Tehran which was transferred after a decade to Imam Khomeini Hospital, formerly known as the Pahlavi Hospital (Figure 4).9 In the year 1968, anesthesia was separated from surgery as a separate department, and the first board examination in anesthesia was conducted in the year 1976 under the supervision of the Ministry of Higher Education.10 In 1987, it was decided to directly enroll interested applicants after graduation in the field of anesthesia and this practice continued to prevail until 1996.11 The main idea of directly enrolling fresh graduates in the field of anesthesia was to overcome the dearth of anesthesiologists in the country.12 After that, applicants were selected after having passed the entrance exam for residency training.13

The residency training was followed by board examination comprising both written and Objective Structured Clinical Examination (OSCE).14 In 2005, the total number of physicians including both GPs, dental surgeons, and specialists in Iran was 61,670 and the country had a population of 77 million.15 The population of Iran at present (2019) is 83 million.16

According to the census in the year 2018, Iran had a total of 39,398 specialists and subspecialists in the different fields of medicine and surgery. The number of qualified board-eligible and board-certified anesthesiologists was 3,327 in the year 2018.17 In the year 2019, this figure showed a spectacular rise and was documented as 41,310. At present there are a total of 1,48,035 hospital beds and 899 hospitals in the country.18

History of Neuroanesthesia and Neurocritical Care in Iran

Currently, there are 20 medical universities in Iran, which train residents in neurosurgery and conduct fellowship training in stereotactic surgery, spine and pediatric neurosurgery. A total of 37 medical universities offer residency training in anesthesiology. Fellowship training has been offered in pain, neuroanesthesiology, pediatric anesthesiology, cardiac anesthesiology, organ transplant, and pediatric ICU.13 Neurosurgeries commonly conducted by the tertiary centers include brain, base of skull, pituitary, stereotactic, epilepsy surgery, awake craniotomy, and spine surgery including scoliosis surgery. Deep brain stimulation has also been performed in some of the tertiary centers. The clinical fellowship in neuroanesthesia was started in the year 2008. Qualified anesthesiologists who passed the written and oral exams were enrolled to undergo a subspecialty training in neuroanesthesia and neurocritical care for a period of 18 months, which includes practical training in the subspecialty and research work. Currently there are two centers in Tehran (Tehran University of Medical Sciences and Shaheed Behishti University) and one center in Esfahan that have been approved by the Ministry of Health to run the clinical fellowship program in neuroanesthesia and neurocritical care.14 The principal author of this text (Dr. Zahid Hussain Khan) is the Program Director of Clinical Fellowship in Neuroanesthesia at Tehran University of Medical Sciences. He has also had the privilege of serving as the Guest Editor for the Journal of Anesthesia & Analgesia with Steven L. Shafer as its Editor-in-Chief (Figure 5). The Department of Anesthesiology and Critical Care has the honor of having published two books at the international forum titled, ‘Airway Management’, Springer 2014, edited by Dr. Zahid Hussain Khan and ‘Challenging Topics in Neuroanesthesia and Neurocritical Care’, Springer 2017, editor Dr. Zahid Hussain Khan). TUMS also publishes two quarterly journals, Archives of Neuroscience and Archives of Anesthesiology and Critical Care. The construction of an exclusive neurosurgical hospital resembling the structure of a brain has been started in the outskirts of Tehran similar to the one that was built in Hannover, Germany (Figure 6).

Intensive Care Units (ICUs) initially became operable in 1950 in hospitals affiliated with the three oldest medical universities.9 Presently there are around 5500 ICU beds all over the country which are supervised either by anesthesiologists or intensivists. The ICUs include patients of neurosurgical, cardiac, general system, pediatric, neonatal, trauma, and toxicology.9 ICU training initially started as a fellowship training in the year 2005, in three medical universities, but later was changed to a subspecialty and the training period extended up to a period of two years.14 In the year 2019, the 33rd Board Examinations were conducted in all subspecialties, and the 66th Board Examinations in all the specialties related to all fields of medicine and surgery.13 Correct strategic planning by the Ministry of Health and the universities country-wide provided adequate and ample opportunities for all qualified graduates to enter the different fields of a residency program, resulting in most of the surgeries being conducted in all the 37 provinces of the country. Complicated and complex surgeries, however, are managed at the tertiary centers.

The Future

All types of surgeries are being conducted in Iran as the country claims to have both the trained personnel and modern equipment. In the years to come, Iran would become a referral center in the Middle East for patients undergoing complicated and complex surgeries including heart, liver, kidney, and pancreas transplants. It is hoped that the specialists in the country would offer all the services and reach at par with the countries in the developed world.

Figures & Legends

Figure 1

Figure 1:  Al-Mansuri fi -tib, Mohammad ibn - e Zakariya Razi,484 Lunar Hejria

Figure 2

Figure 2: Dar-al-Fanoon, the first modern educational institution in Iran, 1850.

Figure 3

Figure 3: Sina Hospital, the first educational hospital in Tehran, Iran. Established in 1873.

Figure 4

Figure 4: Imam Khomeini Hospital Complex (Tehran), former Pahlavi Hospital, Established in 1937.

Figure 5

Figure 5: Steven L. Shafer (Editor-in-Chief), and Zahid Hussain Khan (Guest Editor), Journal of Anesthesia & Analgesia.

Figure 6

Figure 6: Neurosurgical hospital resembling "Brain" under construction on the outskirts of Tehran.


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  5. Khan ZH, Minagar M, Dehghan – Tezerjani M, Javadi SAH. A note about the ancestral origin of Abu Al Husain Ibn Abdullah Ibn Sina, Avicenna (980-1037 CE). World Neurosurg 2020; 135:173-175. DOI: 10.1016/j.wneu 2019.12.051.
  6. Ekhtiar M, 1994. The Dar al _ Funun: Educational refarm and cultural development in Gajar Iran. PH.D. Dissertation, New York University, USA.
  7. Hedayaty J. The history of contemporary medicine in Iran; 2003. Dio: 610/955.
  8. On the occasion of the 70th year of establishment of the Tehran University of Medical Sciences. 1934-2009. Tehran University Predd;2009. p.17-18.
  9. and intensive care/history


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