Saudi Journal of Anaesthesia最新文献

{"title":"Role of transcranial Doppler pulsatility index for predicting neurological deterioration in mild-to-moderate traumatic brain injury patients in intensive care unit.","authors":"Sachreet Kaur, Nisha Rani","doi":"10.4103/sja.sja_824_25","DOIUrl":"10.4103/sja.sja_824_25","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a leading cause of death and long-term disability worldwide, particularly among young adults in low- and middle-income countries. Even patients presenting with mild-to-moderate TBI may experience secondary neurological deterioration due to evolving intracranial pathology. Early identification of patients at risk remains challenging. Transcranial Doppler (TCD) ultrasonography provides a noninvasive bedside assessment of cerebral hemodynamics, and the pulsatility index (PI) reflects downstream cerebrovascular resistance and intracranial compliance.</p><p><strong>Methods: </strong>This prospective observational study included 100 adult patients with mild-to-moderate TBI admitted to a tertiary care intensive care unit (ICU). Demographic data, mechanism of injury, clinical status, and computed tomography (CT) findings were recorded. TCD examination was performed at admission to measure middle cerebral artery velocities and calculate PI. Patients were followed for seven days. Neurological deterioration was defined as a decrease in Glasgow Coma Scale score by ≥2 points, requirement of mechanical ventilation, or need for neurosurgical intervention. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the predictive value of PI.</p><p><strong>Results: </strong>Neurological deterioration occurred in 22% of patients. Admission PI was significantly higher in patients who deteriorated compared with those who remained stable (1.35 ± 0.18 vs. 1.14 ± 0.17; <i>P</i> < 0.001). ROC analysis demonstrated that PI predicted neurological deterioration with an area under the curve of 0.82 (95% confidence interval (CI): 0.73-0.91). A PI cutoff value of ≥1.25 yielded a sensitivity of 77% and a specificity of 80%. On multivariate analysis, admission PI ≥1.25 independently predicted neurological deterioration (adjusted OR 4.3; 95% CI 1.7-10.8).</p><p><strong>Conclusion: </strong>Admission PI measured by TCD is a reliable, noninvasive predictor of early neurological deterioration in patients with mild-to-moderate TBI and may aid early risk stratification in the ICU.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"525-532"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative total tau as a biomarker of postoperative delirium after major cardiac surgery: A prospective cohort study.","authors":"Mohamed R Mahmoud, Ali T Abdelwahab, Tarek A Abdelzaher, Mohamed M Ali, Salman Hamdy Mohamed Elsaghir, Hassan Mokhtar Elshorbagy Hetta","doi":"10.4103/sja.sja_117_26","DOIUrl":"10.4103/sja.sja_117_26","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is a frequent and serious complication in older adults undergoing cardiac surgery with cardiopulmonary bypass (CPB). Identifying blood-based biomarkers of neuronal injury could facilitate early risk stratification. Total tau (t-tau), a microtubule-associated protein released during axonal damage, may serve as a candidate marker.</p><p><strong>Methods: </strong>In this prospective cohort study, 89 adults aged ≥60 years undergoing elective cardiac surgery with CPB were evaluated. Plasma t-tau levels were measured preoperatively and on postop D1 and D3. Cognitive and functional outcomes were assessed.</p><p><strong>Results: </strong>Delirium was diagnosed in 53% of patients on Postop D1 and 42% on postop D3. T-tau increased significantly from baseline (median 1.46 pg/mL) to postop D1 (3.13 pg/mL; <i>P</i> < 0.001), declining on postop D3 (1.89 pg/mL; <i>P</i> < 0.001 vs baseline). Patients with delirium had significantly higher t-tau levels postoperatively and greater t-tau changes from baseline. Postop D1 t-tau independently predicted postop D3 delirium (OR 4.16, 95% CI 2.39-7.23; <i>P</i> < 0.001). Receiver operating characteristic analysis showed excellent diagnostic performance, with an AUC of 0.905 for postop D1 tau levels in predicting postoperative delirium on postop D3.</p><p><strong>Conclusion: </strong>Dynamic elevations in t-tau may predict postoperative delirium and neurocognitive decline after cardiac surgery with CPB. Therefore, t-tau may represent a promising candidate biomarker requiring external validation for risk stratification and monitoring of early postoperative delirium in older surgical patients.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"550-559"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative care of a large left bronchoesophageal fistula complicated by achalasia cardia for video-assisted transthoracic BEF repair: A case report.","authors":"Anshul Singh, Atma Pradeep, Nishant Patel","doi":"10.4103/sja.sja_54_26","DOIUrl":"10.4103/sja.sja_54_26","url":null,"abstract":"<p><p>This case report details the anesthetic management of a young male in his early thirties presenting with a benign left-sided bronchoesophageal fistula (BEF) secondary to tuberculosis, superimposed upon type 1 achalasia cardia posted for video-assisted thoracoscopic surgery (VATS) transthoracic BEF repair. Gentle intermittent positive pressure ventilation to prevent air leakage through fistula, taking extreme aspiration precautions, and avoidance of positive pressure ventilation postoperatively is key anesthetic considerations. The feasibility of VATS repair for complex fistulas relies entirely on the anesthesiologist's ability to provide a quiet, collapsed operative field, reinforcing the symbiosis between the surgical and anesthetic teams.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"702-705"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving concepts in visceral obesity: What anesthesiologists need to know.","authors":"Rohan Magoon, Nitin Choudhary, Jes Jose","doi":"10.4103/sja.sja_828_25","DOIUrl":"10.4103/sja.sja_828_25","url":null,"abstract":"<p><p>Obesity, an ever-evolving global epidemic, continues to offer some of the most controversial and at times, polarizing debates in the modern-day medicine; whether it is for the formers' ethnic intricacies, or for that matter, its potential outcome associations. Given the far-reaching implications of obesity however, the recent developments in characterization of the same, are of special interest to an anesthesiologist caring for this predilected cohort of patients. The expert propositions, in this regard, outline the much-required need to think beyond the body mass index (BMI), traditionally used to define obesity. To that effect, motivated by the understanding of obesity as an adiposity-based chronic disease, visceral obesity has gained particular attention with the cost-effective and adaptable anthropometric measures: waist circumference, waist-to-hip ratio, and of late waist-to-height ratio, outperforming the isolated predictive and prognostic utility of BMI in the corresponding literature. Moreover, it is for the concept of visceral obesity that may aid in the distinction of metabolically unhealthy obesity from the metabolically healthy obesity. Hence, focusing the evolving updates on visceral obesity, the index narrative review comprehensively discusses the topic, underlining the points relevant to anesthesiologists, such as cardiometabolic risk profiling, relationship to metabolic syndrome, metabolic inflammation, operative outcomes, the perplexity surrounding \"obesity paradox,\" and the useful insights provided by critical care medicine and the viral pandemic.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"648-654"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the impact of operating room simulations on communication skills and patient safety (EIORS-CPS).","authors":"Walid M R Badwi, Mohamed B Delvi, Jumana Baaj, Imad Chehab, Ismail A Elzogari, Fatma Walid, Salma Walid, Mohammed Alshibuikey","doi":"10.4103/sja.sja_946_25","DOIUrl":"10.4103/sja.sja_946_25","url":null,"abstract":"<p><strong>Background: </strong>The WHO Surgical Safety Checklist is a cornerstone of perioperative safety, yet its effective implementation hinges on nontechnical skills like communication. High-fidelity simulation (HFS) is a promising tool for training these competencies. This study evaluated the impact of HFS on anesthesiology students' perceptions of patient safety, specifically examining the mediating role of improved communication through the checklist. A convergent parallel mixed-methods study was conducted with 137 fourth-year medical students specializing in anesthesiology. Participants completed a SimMan3G-based operating room simulation centered on the WHO Checklist. Quantitative data from a postsimulation survey (Likert-scale items on realism, communication, and safety) were analyzed using descriptive statistics, Pearson correlation, and causal mediation analysis via Ordinary Least Squares regression. Qualitative feedback was analyzed thematically.</p><p><strong>Results: </strong>An overwhelming majority of students perceived the checklist as effective for improving communication (86.1%, Mean =4.3 / 5) and enhancing patient safety (85.4%, Mean =4.3 / 5). A strong correlation was found between communication and safety perceptions (r = 0.89, <i>P</i> < 0.001). Mediation analysis revealed a significant total effect of simulation realism on safety perception (β =0.52, <i>P</i> < 0.001). This effect was fully mediated by perceived improvement in communication (indirect effect: β =0.42, 95% Boot CI [0.31, 0.54]; direct effect: β =0.10, <i>P</i> = 0.118). Qualitative analysis reinforced this, identifying 'Communication is Safety' as a central theme.</p><p><strong>Conclusions: </strong>HFS using SimMan3G is highly effective in fostering a strong perceived culture of patient safety among anesthesiology students. This effect is primarily driven by the simulation's ability to demonstrate that the WHO Checklist improves team communication, which students then link to enhanced safety. Educational efforts should maximize realism and explicitly articulate the communication-safety nexus.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"508-514"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel fascial plane block for pediatric open pyeloplasty: Clinical experience with the quadro-iliac plane block-A report of five cases.","authors":"Himangi Bhokare, Anu Kewlani","doi":"10.4103/sja.sja_118_26","DOIUrl":"10.4103/sja.sja_118_26","url":null,"abstract":"<p><p>Open pyeloplasty in children is often associated with significant postoperative pain, and providing effective analgesia while limiting opioid exposure remains challenging. We describe our experience with the ultrasound-guided Quadro-Iliac Plane Block (QIPB), a recently described fascial plane block, in five children aged 2-7 years undergoing open pyeloplasty. Following induction of general anesthesia, a unilateral QIPB was performed using 0.2% ropivacaine (0.5 mL/kg). Postoperative pain was assessed using the FLACC scale over 24 hours, and the need for rescue analgesia was documented. All children had low pain scores in the early postoperative period, with median FLACC scores remaining ≤3. Three patients required a single dose of rescue fentanyl between 13 and 16 hours postoperatively, likely corresponding to block wear-off. No adverse effects, motor weakness, nausea, or vomiting were observed. Our experience suggests that QIPB may offer effective, opioid-sparing, and motor-preserving analgesia for pediatric open pyeloplasty, although larger controlled studies are needed.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"729-731"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinothorax: A case report.","authors":"Emily L Stevens, Jackson S Stevens, Jose Navas-Blanco","doi":"10.4103/sja.sja_926_25","DOIUrl":"10.4103/sja.sja_926_25","url":null,"abstract":"<p><p>Urinothorax is a rare pleural effusion resulting from urine accumulation in the pleural space, commonly secondary to obstructive uropathy, surgical injury, or trauma. This case presents a 60-year-old female with renal calculi presenting preoperatively for elective cystoscopy and lithotripsy who endorsed chest discomfort and hypoxia was found to have a left chest mass, ultimately diagnosed as a large urinothorax. This case reviews the causes of urinothorax, its treatments, and its anesthetic implications.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"710-712"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of transversus abdominal plane block on maternal-infant bonding after cesarean delivery: A randomized controlled study.","authors":"Nezir Yilmaz, Hakan Haydarlar, Zeliha Bozkurt, Fatih Ertaş, Dilara Doymaz, Damla Yilmaz","doi":"10.4103/sja.sja_102_26","DOIUrl":"10.4103/sja.sja_102_26","url":null,"abstract":"<p><strong>Context: </strong>Effective postoperative analgesia after cesarean delivery is essential for early functional recovery. Ultrasound-guided transversus abdominis plane (TAP) block reduces postoperative pain and opioid consumption; however, its effects beyond analgesia remain unclear.</p><p><strong>Aims: </strong>To evaluate the effects of TAP block on postoperative pain, maternal self-efficacy, and early recovery after elective cesarean delivery.</p><p><strong>Settings and design: </strong>This prospective randomized study was conducted at a tertiary care center between December 2024 and March 2025.</p><p><strong>Materials and methods: </strong>Women undergoing elective cesarean section under spinal anesthesia were randomized to receive either bilateral ultrasound-guided TAP block (20 mL of 0.25% bupivacaine per side) or standard analgesia. Maternal self-efficacy was assessed at 48 hours postpartum using the Parent Self-efficacy Scale. Secondary outcomes included postoperative pain scores, time to first breastfeeding and mobilization, rescue analgesic use, neonatal caregiving duration within 24 hours, and length of hospital stay.</p><p><strong>Statistical analysis used: </strong>Appropriate parametric or non-parametric tests were applied, with <i>P</i> < 0.05 considered statistically significant.</p><p><strong>Results: </strong>A total of 128 patients completed the study. The TAP block group showed significantly lower pain scores, reduced rescue analgesic requirements, earlier breastfeeding and mobilization, longer neonatal caregiving duration, shorter hospital stay, and higher maternal self-efficacy scores (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Ultrasound-guided TAP block provides effective analgesia and supports early functional recovery after cesarean delivery, with additional benefits on maternal self-efficacy.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"519-524"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-low dose continuous spinal anesthesia for major orthogeriatric surgery in a high cardiovascular risk patient on chronic aspirin therapy: A case report.","authors":"Francesco Tasso, Emilia Cialdella, Mattia Loppini, Giuseppe Monteleone","doi":"10.4103/sja.sja_864_25","DOIUrl":"10.4103/sja.sja_864_25","url":null,"abstract":"<p><p>We present the case of a 78-year-old man (ASA III), with chronic ischemic heart disease, moderate aortic stenosis, hypertension, diabetes, and renal failure undergoing a second revision hip arthroplasty. Continuous spinal anesthesia (CSA) was performed using an ultra-low dose of 6.25 mg 0.25% isobaric levobupivacaine (3.75 mg + 2.5 mg) without adjuvants, preserving the possibility of incremental dosing if necessary. Intraoperative monitoring documented exceptional hemodynamic stability throughout the entire procedure (180 min), with mean arterial pressure maintained between 75 and 84 mmHg and heart rate between 63 and 70 bpm, without requiring vasopressors. The sensory block (T10) and motor block (Bromage 3) were adequate and regressed to Bromage 0 by the end of the procedure. The patient remained spontaneously breathing room air with an SpO₂ >98%. The presented case demonstrates that ultra-low dose CSA may represent a valuable option for reducing the perioperative risk in carefully selected high-risk orthogeriatric patients.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"698-701"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute middle cerebral artery thrombosis in the early postoperative period after total knee arthroplasty under general anesthesia: A case report.","authors":"Kwanghyuk Lee, Sang Il Lee, Jun Hyun Kim, Min Hee Heo","doi":"10.4103/sja.sja_66_26","DOIUrl":"10.4103/sja.sja_66_26","url":null,"abstract":"<p><p>Postoperative stroke after noncardiac, non-neurologic surgery is rare but can lead to devastating outcomes. Although venous thromboembolism is a well-known complication after total knee arthroplasty (TKA), arterial thrombosis, particularly involving large cerebral vessels, is exceedingly uncommon. A 72-year-old woman with hypertension, diabetes mellitus, and hyperlipidemia underwent left TKA under general anesthesia. On postoperative day (POD) 2, she developed acute mental change and right-sided weakness temporally coinciding with transfusion of leukocyte-depleted red blood cells. Brain computed tomography angiography revealed left middle cerebral artery (MCA) occlusion. Mechanical embolectomy successfully retrieved a red thrombus and recanalized the occluded vessel, and the patient gradually recovered, being transferred for rehabilitation on POD 28. This case demonstrates that acute cerebral artery thrombosis can occur even in the absence of cardiac embolic sources after TKA. The early detection of the symptoms related to stroke and prompt evaluation for large-vessel occlusion are essential for the reduction of mortality.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"706-709"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}