Saudi Journal of Anaesthesia最新文献

{"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}

{"title":"Letter to Editor regarding \"Ultrasound-guided erector spinae plane block versus modified thoracolumbar interfascial plane block in lumbar spine surgeries: A randomized controlled trial\".","authors":"Wasimul Hoda, Ranjitha Nethaji","doi":"10.4103/sja.sja_243_26","DOIUrl":"10.4103/sja.sja_243_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"740-742"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674228","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":"NIM TriVantage™ electromyogram endotracheal tube kinking and the preclusion using a tube stand in patients undergoing thyroid surgery.","authors":"Kensuke Suzuki, Shingo Kawashima, Atsushi Kobayashi, Tetsuro Kimura, Yoshiki Nakajima, Hiroyuki Kinoshita","doi":"10.4103/sja.sja_324_26","DOIUrl":"10.4103/sja.sja_324_26","url":null,"abstract":"<p><strong>Background: </strong>The NIM TriVantage™ electromyogram endotracheal tube (NIM [Nerve Integrity Monitoring] tube) is positioned at the midline of the mouth, as the electrodes must attach to both sides of the vocal cords for neural monitoring during thyroid surgery. The tube possibly kinks below the slip joint, resulting in ventilatory disturbance. We examined whether kinking of the NIM tube altered ventilation in a simulation model and assessed whether using a tube stand during thyroid surgery prevented such kinking and associated ventilatory instability.</p><p><strong>Methods: </strong>We assessed the impact of bending warmed (32°C) NIM tubes (7.0- and 8.0-mm ID, <i>n</i> = 10 per group) on airway pressure and measured tidal volume within a simulator. Additionally, we investigated whether a custom-designed tube stand could mitigate ventilatory impairment when employing a midline-fixed NIM tube in patients undergoing thyroid surgery.</p><p><strong>Results: </strong>In a simulator, 75° bending of the NIM (7.0 mm) tube significantly augmented airway pressure (31 [28 to 34] cmH₂O, median [IQR], <i>P</i> < 0.001), and 60° and 75° bending of it caused a slight, but significant decrease in the measured tidal volume compared with 0° bending. Using our custom tube stand prevented kinking of the 7.0-mm NIM tube, with no clinically meaningful changes in airway pressure or delivered tidal volume during surgery.</p><p><strong>Conclusions: </strong>The NIM (7.0 mm) tube is vulnerable to kinking-induced ventilatory impairment in the clinical setting, and a tube stand prevents this issue. We recommend using a tube stand during thyroid surgery to ensure safe and effective neural monitoring.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"632-637"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674221","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":"Conscious sedation as a potential optimal anesthetic regimen for endoscopic retrograde cholangiopancreatography in elderly frail patients: A prospective, single-blind, randomized controlled trial.","authors":"Chao Li, Na Zeng, Fang Wang, Yiqiang Zhang, Danxu Ma, Haijun Hou","doi":"10.4103/sja.sja_94_26","DOIUrl":"10.4103/sja.sja_94_26","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of adverse cardiovascular events (ACVs) in elderly frail patients undergoing emergency endoscopic retrograde cholangiopancreatography (ERCP), and to explore a safe and comfortable anesthetic regimen suitable for this specific population.</p><p><strong>Materials and methods: </strong>A single-center, prospective, single-blind, randomized controlled trial was conducted. Patients aged 70-90 years scheduled for emergency ERCP were enrolled and randomly divided into two groups: the conscious sedation group (Group S) and the intravenous general anesthesia group (Group A). Basic clinical data of the patients were recorded. During ERCP, the occurrence of ACVs was documented, including hemodynamic fluctuations exceeding 20% of the baseline value, angina pectoris, myocardial infarction, cardiac arrest, acute heart failure, myocardial ischemia, pulmonary embolism, and various arrhythmias. Additionally, adverse reactions such as hypoxemia, body movement, and cough during the procedure were monitored. The effects of different anesthetic methods on ACVs in elderly frail patients undergoing emergency ERCP were compared, and the satisfaction of patients, anesthesiologists, and endoscopists was evaluated.</p><p><strong>Results: </strong>A total of 108 patients undergoing emergency ERCP were enrolled and randomly assigned to Group S (<i>n</i> = 53) and Group A (<i>n</i> = 55). The results showed that there was a statistically significant difference in the incidence of ACVs between the two groups (17% vs. 40%, <i>P</i> < 0.05). Compared with Group A, Group S had a significantly lower incidence of blood pressure and heart rate fluctuations ≥20% of the baseline value (13.2% vs. 25.5%, <i>P</i> < 0.05), and new-onset arrhythmias (5.7% vs. 18.2%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Compared with intravenous general anesthesia, conscious sedation can reduce fluctuations in blood pressure and heart rate, and decrease the incidence of adverse cardiovascular events in elderly frail patients undergoing emergency ERCP.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"567-576"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674104","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":"Erector spinae plane versus transversus abdominis plane block for hysterectomy: Beyond statistical significance.","authors":"Alessandro De Cassai, Giulia Aviani Fulvio, Burhan Dost, Annalisa Boscolo","doi":"10.4103/sja.sja_229_26","DOIUrl":"10.4103/sja.sja_229_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"489-490"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674167","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":"Erratum: Is intranasal dexmedetomidine superior to oral chloral hydrate for procedural sedation in children: A systematic review.","authors":"","doi":"10.4103/sja.sja_523_26","DOIUrl":"10.4103/sja.sja_523_26","url":null,"abstract":"<p><p>[This corrects the article on p. 82 in vol. 16, PMID: 35261594.].</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"743"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674112","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 pain relief in percutaneous nephrolithotomy: A randomised trial of ultrasound-guided erector spinae plane block compared to peri-tubal anaesthetic infiltration.","authors":"Prerna Varma, Rishu Chaudhary, Komal Anil Gandhi, Aditya Prakash Sharma, Suman Arora","doi":"10.4103/sja.sja_44_26","DOIUrl":"10.4103/sja.sja_44_26","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to compare peri-tubal local anaesthetic (LA) infiltration with ultrasound-guided erector spinae plane block (ESPB) as an analgesic technique for percutaneous nephrolithotomy (PCNL) surgeries. The study hypothesised that patients receiving ESPB would require postoperative rescue analgesics later as compared to those receiving LA infiltration.</p><p><strong>Methods: </strong>The study is a prospective, single-blinded, randomised clinical trial. Fifty-two adult patients undergoing unilateral PCNL were randomly allocated into the ESPB group (<i>n</i> = 26) or the LA infiltration group (<i>n</i> = 26). The block group received ultrasound-guided ESPB with 0.4 ml/kg of 0.5% ropivacaine preoperatively, while the LA infiltration group received 0.4 ml/kg of 0.5% ropivacaine in the peri-tubal track in two divided doses. The study's primary outcome was the time to first rescue analgesia, which was calculated from the patient's arrival in the post-anaesthesia care unit to the first patient-controlled analgesia pump bolus dose.</p><p><strong>Results: </strong>The mean (standard deviation) time to first analgesia was 2.3 (0.48) h in the LA infiltration group and 20.7 (6.1) h in the ESPB group, with a difference in means of - 18.4 h (99% confidence interval, -21.8 to - 14.9; <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Ultrasound-guided ESPB provides superior perioperative analgesia compared to peri-tubal LA infiltration in PCNL surgeries, offering significantly improved pain relief during movement in the ESPB group.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"538-544"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674224","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":"Interpreting heterogeneity and effect size in meta-analysis of Suzetrigine for acute pain.","authors":"Tuhin Mistry, Abhijit S Nair","doi":"10.4103/sja.sja_137_26","DOIUrl":"10.4103/sja.sja_137_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"734-735"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674086","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":"Understanding interaction between patients and nurse anesthetists. A systematic review of qualitative and quantitative studies.","authors":"Ferid Krupic, Melissa Krupic","doi":"10.4103/sja.sja_264_26","DOIUrl":"10.4103/sja.sja_264_26","url":null,"abstract":"<p><strong>Background: </strong>Interaction between healthcare professionals and patients is a complex process influenced by communication, environmental, individual, and organizational factors.</p><p><strong>Objective: </strong>To synthesize qualitative and quantitative evidence and identify key characteristics of effective interaction between patients and nurse anesthetists during the perioperative period.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, MEDLINE, CINAHL, Embase, and the Cochrane Library to identify qualitative and quantitative studies examining factors influencing interaction between patients and nurse anesthetists in the perioperative setting.</p><p><strong>Results: </strong>Both facilitators and barriers to effective interaction were identified. Facilitators included respectful, patient-centered care, a supportive work environment, and clear, timely communication. Barriers included negative staff attitudes, procedural stress, interpersonal conflicts, exposure to violence, and communication challenges such as low speech volume, unclear articulation, and limited language proficiency. Effective communication was associated with improved patient safety, enhanced team cohesion, and more efficient information exchange. However, increased reliance on advanced technology may reduce patient engagement and interpersonal communication within the healthcare team.</p><p><strong>Conclusion: </strong>Nurse anesthetists play a critical role in supporting patients during potentially stressful perioperative experiences. Organizational factors, time constraints, and communication strategies may influence the quality of patient-provider interaction. Further research is needed to determine how these factors can be optimized to improve perioperative care and patient outcomes.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"599-607"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674236","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":"Extremely low regional cerebral oxygen saturation during general anesthesia in severe sepsis: A report of two cases.","authors":"Ye Lin Jeon, Jun Hyun Kim, Sang Il Lee, Kyung Woo Kim","doi":"10.4103/sja.sja_345_26","DOIUrl":"10.4103/sja.sja_345_26","url":null,"abstract":"<p><p>Near-infrared spectroscopy-based cerebral oximetry is commonly used to detect cerebral hypoxia during anesthesia. However, the clinical significance of extremely low regional cerebral oxygen saturation (rSO₂) in noncardiac surgery in severe sepsis remains unclear. We report two patients with severe sepsis who underwent emergency noncardiac surgery under general anesthesia. In both cases, systemic parameters, including arterial blood pressure, arterial oxygen saturation, and bispectral index, were within clinically acceptable ranges. Nevertheless, intraoperative rSO₂ decreased to 15% (the lowest measurable value) bilaterally and persisted throughout the surgery. Both patients developed refractory shock and severe metabolic derangements and died shortly thereafter. We report these cases to highlight an unusual monitoring pattern in which extreme rSO₂ depression occurred in the context of severe sepsis and to raise the question of its physiological significance and clinical implications.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"723-725"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674089","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}