Saudi Journal of Anaesthesia最新文献

{"title":"Remimazolam sedation during breast surgery under exclusive locoregional anesthesia in a super-obese patient.","authors":"Duccio Conti, Lara Gianesello, Vittorio Pavoni, Juri Valoriani","doi":"10.4103/sja.sja_256_26","DOIUrl":"10.4103/sja.sja_256_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"737-738"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673866","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":"Regional anesthesia in breast surgery: An Italian expert consensus - Part 2: Results from a network meta-analysis evaluating 103 randomized controlled trials on regional anesthesia techniques for mastectomy with or without axillary clearance.","authors":"Domenico P Santonastaso, Alessandro De Cassai, Eros Pilia, Francesco Coppolino, Gabriele Melegari, Federico Piccioni, Annalisa Boscolo, Tommaso Pettenuzzo, Fabrizio Fattorini, Andrea Tognù, Giuseppe Sepolvere, Paolo Scimia, Annalisa Curcio, Claude T Bagaphou, Antonio Coviello, Alessandra Morelli, Giorgia Boschetto, Diego Marandola, Dario Pietrantozzi, Antonio Clemente, Alessandra Gentili, Marco Rispoli, Giuseppe Lubrano, Dario M Mattiacci, Moana R Nespoli, Cristiano D'Errico, Fabio Costa, Giuseppe Pascarella, Federico Bizzarri, Giorgio Ranieri, Nicola Rocco, Tommaso Tonetti, Secondo Folli, Annabella de Chiara, Mario Tedesco, Elisabetta Pusceddu, Maria Grazia Frigo, Maria Caterina Pace, Pierfrancesco Fusco, Vanni Agnoletti","doi":"10.4103/sja.sja_226_26","DOIUrl":"10.4103/sja.sja_226_26","url":null,"abstract":"<p><p>Regional anesthesia techniques are increasingly used to improve analgesia and reduce opioid consumption after breast surgery. Several approaches have been proposed, including paravertebral block and different fascial plane blocks, but their comparative effectiveness remains uncertain. This network meta-analysis (NMA) aimed to compare the efficacy and safety of regional anesthesia techniques in patients undergoing mastectomy with or without axillary clearance. A systematic review and NMA of randomized controlled trials were conducted according to established methodological guidelines. Studies evaluating regional anesthesia techniques in patients undergoing mastectomy were included. Outcomes assessed were intraoperative opioid consumption, 24-hour postoperative morphine milligram equivalents (MMEs), pain at rest and with movement at 12 and 24 hours, postoperative nausea and vomiting (PONV), use of rescue analgesics, and the incidence of complications such as pneumothorax and local anesthetic systemic toxicity (LAST). Regional anesthesia techniques were associated with improved analgesic outcomes compared with LA infiltration or no regional block. Paravertebral block showed the most consistent benefit across outcomes, particularly for opioid consumption and postoperative pain. Fascial plane blocks demonstrated comparable performance to paravertebral blocks for most outcomes, although paravertebral blocks showed superior results for pain on movement. LA infiltration alone or the absence of regional anesthesia performed worse across most outcomes. Serious complications were rarely reported. Paravertebral block appears to provide the most consistent analgesic benefit for mastectomy when performed by experienced practitioners. Fascial plane blocks represent a reasonable alternative when a paravertebral block is not feasible. Simple surgical infiltration alone appears insufficient for optimal analgesia in major breast surgery.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"615-624"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673862","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":"Ultrasound-guided periconal block in severe ocular trauma: Avoiding general anesthesia.","authors":"Ana Luiza de Castro Carvalho, Ítala Ferreira de Jesus, Samuel Reis da Silva, Marina Ayres Delgado","doi":"10.4103/sja.sja_183_26","DOIUrl":"10.4103/sja.sja_183_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"738-740"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674088","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 qualitative study of emergency management ability of anesthetist nurses.","authors":"Zihan Jiang, Qian Song, Jie Cao, Quyun Zhang, Dongni Shi, Wenjing Jiao, Xinyan Zhu","doi":"10.4103/sja.sja_125_26","DOIUrl":"10.4103/sja.sja_125_26","url":null,"abstract":"<p><strong>Background: </strong>In China, most nurse anesthetists enter the profession from a general nursing background, often lacking specific expertise in anesthesia, procedural competencies, and Emergency management skills initially. Moreover, the absence of a uniform standardized training framework for new nurse anesthetists hinders their ability to respond to crisis and provide comprehensive anaesthesia care.</p><p><strong>Objectives: </strong>This study aims to exploring the components of anesthesia nurses' emergency management abilities and to provide a foundation for establishing a comprehensive and systematic emergency management competency system for anesthesia nurses.</p><p><strong>Methods: </strong>A descriptive phenomenological research method was employed. Using purposive sampling, 13 anesthesia nurses and department managers from the anesthesia department of a Grade A tertiary general hospital were selected for semistructured interviews from January to February 2026. Thematic analysis was utilized for data analysis.</p><p><strong>Results: </strong>Four primary themes and thirteen subthemes were identified through the analysis. The themes include: (1) Emergency Response Knowledge Base; (2) Emergency Response Competency; (3) Teamwork and Communication Skills (4) Psychological Resilience and Reflective Practice. These themes and subthemes provide a detailed and structured overview of participants' experiences, and primary challenges from the training.</p><p><strong>Conclusions: </strong>This study demonstrates that the emergency management competency system for anesthesia nurses should be based on a foundational framework comprising an Emergency Response Knowledge Base, Emergency Response Competency, Teamwork and Communication Skills, Psychological Resilience, and Reflective Practice. Particular emphasis should be placed on the content and implications of Emergency Response Competency as well as Psychological Resilience and Reflective Practice. This approach is intended to refine a more comprehensive and rigorous assessment system for the emergency management competency of anesthesia nurses.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"577-585"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674069","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":"Endoscopic control for bronchial blockers: Experimental evaluation of single-lung ventilation strategies in simulation-based models.","authors":"Hussam Rajhi","doi":"10.4103/sja.sja_263_26","DOIUrl":"10.4103/sja.sja_263_26","url":null,"abstract":"<p><strong>Background: </strong>One-lung ventilation (OLV) is essential in thoracic anesthesia and is commonly achieved using double-lumen tubes or bronchial blockers (BBs). Recent visualization-integrated systems, such as VivaSight™, may improve procedural efficiency and safety, particularly for clinicians with limited BB experience.</p><p><strong>Methods: </strong>A preclinical simulation-based evaluation was conducted in a randomized crossover design using two experimental simulation models. In the first experimental model, a randomized crossover simulation manikin study was conducted that involved 21 anesthesiologists with minimal BB experience, comparing two BB-based lung isolation strategies: a visualization-integrated approach using VivaSight-EB™ and a conventional approach using EZ-Blocker™ with bronchoscopic guidance. In addition, the second experimental model involved a mixed-model randomized crossover simulation study that evaluated procedural workflow, operator experience, and cost-related outcomes. Twenty anesthesiologists with experience in lung-isolation performed two BB-based lung isolation strategies: blind placement of the EZ-Blocker™ and placement of the EZ-Blocker™ through a VivaSight™ single-lumen endotracheal tube. The primary outcome in the two simulation-based experiments was time to achieve left-lung exclusion.</p><p><strong>Results: </strong>In the simulation manikin experiment, 21 anesthesiologists with limited experience in lung isolation were involved and the visualization-integrated strategy achieved significantly faster left-lung exclusion compared with the conventional approach (32.1 ± 5.3 s vs 134.8 ± 56.6 s; <i>P</i> < 0.001). While in the mixed-model simulation experiment, 20 thoracic anesthesiologists with experience in lung-isolation techniques were involved and similar time advantages were observed, favoring the visualization-integrated strategy (34.6 ± 8.1 s vs 68.5 ± 19.5 s). Moreover, secondary outcomes consistently favored the visualization-integrated strategy, including higher operator satisfaction, fewer procedural failures, and lower procedure-related costs.</p><p><strong>Conclusion: </strong>The VivaSight-EB™ system demonstrated superior efficiency and workflow performance across both simulation environments. These findings support the potential clinical advantage of integrated visualization systems, particularly for operators with limited BB experience, and warrant further clinical evaluation.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"608-614"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674131","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":"Asystole during laryngoscopy with a videolaryngoscope in a patient with an anticipated difficult airway: A case report.","authors":"Ryosuke Osawa, Naoi Tsurumachi, Yohei Tamura, Takero Arai","doi":"10.4103/sja.sja_218_26","DOIUrl":"10.4103/sja.sja_218_26","url":null,"abstract":"<p><p>Asystole during tracheal intubation using a direct laryngoscope has been reported, but there has been no report of asystole during tracheal intubation using a videolaryngoscope. We report a case of asystole during videolaryngoscopy in a 76-year-old woman with marked tracheal deviation caused by a large thyroid adenoma. General anesthesia was induced with remimazolam 6 mg/kg/h, fentanyl 0.1 mg, and remifentanil 0.25 μg/kg/min, under apneic oxygenation using high-flow nasal oxygenation. After administration of rocuronium 40 mg, a McGrath™ MAC videolaryngoscope provided an excellent glottic view. Immediately before tracheal tube insertion, sudden bradycardia progressed to asystole. Laryngoscopy was discontinued, and intravenous atropine 0.5 mg was administered, resulting in the return of spontaneous cardiac activity within 10 s without chest compressions. The patient's vital signs remained stable after the event, and tracheal intubation was achieved without further complications. Anesthesiologists should remain vigilant for this rare but potentially life-threatening complication.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"726-728"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674136","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":"Non-technical skills and crisis resource management in the intensive care unit, Scoping review.","authors":"Mishari M Beragdar","doi":"10.4103/sja.sja_826_25","DOIUrl":"10.4103/sja.sja_826_25","url":null,"abstract":"<p><p>Crisis resource management (CRM) training focuses on developing these high-stakes, unexpected event-handling skills. The abilities under non-technical skills (NTS) are not directly connected to technical competence but are still vital for preserving patient safety, collaboration, the environment, facilities, and all ICU members. This scoping review article aimed to demonstrate how to manage a crisis in an intensive care unit using non-technical skills. This review article presented crisis resource management (CRM) training and major components of crisis management including leadership, effective communication, anticipation and planning, resource utilization, workload distribution, situational awareness and triage, and prioritization. This review identified non-technical skills used for crisis management in the ICU for patient safety and favorable outcomes. Uncorrected crisis management could lead to unintended patient outcomes that impact morbidity and mortality. Crisis resource management (CRM) training focuses on developing these high-stakes, unexpected event-handling skills. Non-technical skills application with well-evident different approaches of crisis management usually leads to the least side effects and complications.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"644-647"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674262","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":"Safety and efficacy of the external oblique intercostal plane block for postoperative analgesia in upper abdominal surgery: A systematic review and meta-analysis.","authors":"Rola Hamad Alseghair, Razan Abdullah Aljameeli, Rose Khalaf Alharbi, Liyan Khamis Abu Rukbah, Reham Ibrahim Alsahabi, Omar Almisnid","doi":"10.4103/sja.sja_69_26","DOIUrl":"10.4103/sja.sja_69_26","url":null,"abstract":"<p><p>The external oblique intercostal block (EOIB) is a novel regional anesthesia technique for upper abdominal surgery. However, its efficacy and safety compared to other analgesic strategies remain uncertain. This study aimed to evaluate the impact of EOIB on postoperative analgesia and recovery in adults undergoing upper abdominal surgery. PubMed, Web of Science, and the Cochrane Library were searched from inception until August 2025 for randomized controlled trials comparing EOIB to placebo, no block, or other regional techniques. Primary outcomes were 24-h postoperative opioid consumption and pain scores (rest/movement). Secondary outcomes included rescue analgesia requirement, opioid-related adverse effects, block-related complications, and recovery parameters. EOIB significantly reduced postoperative opioid consumption when compared with control at 24 h (SMD - 0.45; <i>P</i> < 0.001) and 48 h (SMD - 1.38, 95% confidence intervals [CI] -2.60 to - 0.16; <i>P</i> = 0.03). At rest, postoperative pain scores at 2, 4, 6, 12 and 24 h were all significantly lower (all <i>P</i> ≤ 0.03). Likewise, the reductions in pain during movement were only observed at 6, 12, and 24 h (all <i>P</i> ≤ 0.03). EOIB prolonged the duration until first rescue analgesia was initiated with a mean difference of 1.62 h (<i>P</i> < 0.001) and reduced the incidence of postoperative nausea and vomiting (OR 0.21, 95% CI 0.07-0.068). No significant differences were observed in overall rescue analgesia use. Overall, EOlB effectively reduces postoperative opioid consumption in upper abdominal surgery, particularly within the first 12 h with a favorable safety profile.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"675-694"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673925","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":"Thyroidectomy for multinodular goiter in Eisenmenger syndrome: Perioperative anesthetic management.","authors":"Salvatore Fabrizio Favitta, Roberto De Cicco, Danilo Santolamazza, Ersilia Luca, Marco Raffaelli, Paola Aceto","doi":"10.4103/sja.sja_213_26","DOIUrl":"10.4103/sja.sja_213_26","url":null,"abstract":"<p><p>Patients with Eisenmenger syndrome (ES), characterized by irreversible pulmonary vascular obstructive disease due to an intracardiac shunt, present a very high perioperative risk during noncardiac surgery. The risk is related to severe pulmonary hypertension, right ventricular dysfunction, and potential hemodynamic instability. We report the case of a 68-year-old woman with ES who underwent total thyroidectomy and parathyroidectomy for primary hyperparathyroidism associated with a compressive multinodular goiter. Following multidisciplinary evaluation, surgery was performed under bilateral cervical plexus block combined with analgosedation, with stable intraoperative hemodynamics and an uneventful recovery. This case suggests that regional anesthesia may represent a safe option for selected high-risk patients when managed by a multidisciplinary team.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"719-722"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674035","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":"Assessing patient knowledge and concerns about peripheral nerve blocks: Implications for preoperative education.","authors":"Deborah Choe, Kelly Lin, Mahsa Babaei, Daniel Abraham, Paul S Lee","doi":"10.4103/sja.sja_186_26","DOIUrl":"10.4103/sja.sja_186_26","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve blocks offer numerous advantages, including reduced postoperative pain, decreased opioid use, and faster recovery. Despite their benefits, patients' understanding of peripheral nerve blocks remains poorly characterized. This survey study aimed to assess patient knowledge of peripheral nerve blocks among individuals undergoing outpatient orthopedic surgery.</p><p><strong>Methods: </strong>Adult patients scheduled for outpatient orthopedic surgery and awaiting consent for peripheral nerve blocks between February 18, 2025 and July 3, 2025 at a single academic institution were eligible for inclusion. Pediatric and non-English-speaking patients were excluded. After providing written consent, participants completed a one-time written survey in the preoperative area on the day of surgery. The survey included 10 \"true/false\" statements assessing knowledge of peripheral nerve block mechanisms, applications, outcomes, and comparisons with general anesthesia. Participants also ranked concerns regarding potential complications, including neurological, vascular, and infectious ones, allergic/autoimmune reactions to anesthetic, and pain during the procedure.</p><p><strong>Results: </strong>Most patients reported limited prior understanding, with only 4.0% identifying as \"very knowledgeable.\" Only 27.7% reported receiving prior explanations about peripheral nerve blocks from a non-anesthesiologist physician. Neurological and infectious complications were ranked as the most concerning.</p><p><strong>Conclusion: </strong>This study identified significant knowledge gaps, particularly regarding continuous peripheral nerve blocks and distinctions between peripheral nerve blocks and general anesthesia. These findings highlight the need for targeted preoperative educational initiatives to support informed decision-making and improve patient-centered outcomes.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"560-566"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674079","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}