Saudi Journal of Anaesthesia最新文献

{"title":"Acute postoperative pain management after living donor hepatectomy during the transition from an open to minimally invasive surgical approach.","authors":"Amer Majeed, Noon E Abdelgadir, Areej A G AlFattani, Muhammad Hafeez, Muhammad A Jahangir, Mohamad S Nagy","doi":"10.4103/sja.sja_415_24","DOIUrl":"10.4103/sja.sja_415_24","url":null,"abstract":"<p><strong>Background: </strong>Acute post-surgical pain is a common concern for patients undergoing living donor hepatectomy (LDH), potentially leading to unfavorable outcomes if not treated adequately. This study aimed to evaluate the impact of the transition of surgical techniques from open and laparoscopic to robot-assisted minimally invasive surgical (MIS) approach, and the different types of graft resection, including right, left, and left lateral partial lobectomy (LL), on analgesia requirements during the first two postoperative days.</p><p><strong>Methods: </strong>A single-center retrospective electronic chart review of all patients who underwent LDH procedures between 2018 and 2020 was performed.</p><p><strong>Results: </strong>Patients underwent LDH procedure (<i>n</i> = 414) through open (<i>n</i> = 93, 22%), laparoscopic (<i>n</i> = 68, 16%), or robot-assisted MIS (<i>n</i> = 253, 61%) approaches; and had right lobectomy (<i>n</i> = 215, 52%), left lobectomy (<i>n</i> = 121, 29%), or LL (<i>n</i> = 78, 19%). Postoperatively within the first 48 h, the pain reported on a 3-point Visual Analogue Scale (VAS), was mild 77%, moderate 21%, or severe only 2%. The laparoscopic approach and LL resection were associated with higher pain scores, whereas the robotic approach was the least painful overall.</p><p><strong>Conclusions: </strong>Robot-assisted MIS approach for LDH procedure resulted in lower acute pain scores when compared with other surgical approaches, obviating the need for intravenous (IV) patient-controlled analgesia (PCA).</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"14-20"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433759","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":"Evaluation of acute postoperative pain management after living donor nephrectomy during the transition from open access to laparoscopic and minimally invasive robotic surgical approach.","authors":"Amer Majeed, Noon E Abdelgadir, Areej A G AlFattani, Bilal Tufail, Muhammad Shabbir, Sajjad Rasool, Basel A Jobeir","doi":"10.4103/sja.sja_425_24","DOIUrl":"10.4103/sja.sja_425_24","url":null,"abstract":"<p><strong>Background: </strong>Living donor nephrectomies (LDN) at our institution transitioned from open access to laparoscopic and, more recently, to a minimally invasive robotic surgical approach between 2019 and 2022. Concurrently, postoperative analgesia transitioned from regional anesthesia to intravenous patient-controlled analgesia (PCA) and eventually to simple analgesics with additional rescue analgesic agents, as needed, in accordance with individual physicians' preferences. This retrospective study was designed to evaluate the impact of these changes on surgical practice on the analgesic requirements and effectiveness of postoperative pain management.</p><p><strong>Methods: </strong>Electronic records of all LDN cases operated between January 2019 and March 2022 were accessed, and a comparative analysis of patient demographics, surgical approach, duration of surgery, postoperative pain scores, and the analgesics administered within the first 48 h was performed.</p><p><strong>Results: </strong>LDN (<i>n</i> = 527) was performed via laparoscopic (<i>n</i> = 432, 82%), robotic (<i>n</i> = 87, 17%), and open (<i>n</i> = 8, 2%) approaches. All patients were administered regular paracetamol 1 g 6 hourly. IV PCA was used in 85% of cases, predominantly in the laparoscopic (99%) and open (75%) groups (LG and OG, respectively); in contrast, the robotic group (RG) was mostly treated without PCA (81.7%). A variety of analgesic techniques were employed for the remaining patients, including epidural (25% of OG) and rectus sheath/transversus abdominis plane (TAP) block (2% of LG). Additional rescue analgesics were administered to 98% of the patients; 92% of LG needed 1-3 analgesic agents, whereas all of the OG and 37% of RG needed 1-2 rescue analgesics. No correlation was found between patient demographics and surgery duration on pain scores or analgesic requirements.</p><p><strong>Conclusions: </strong>Robotic surgery was associated with the lowest postoperative pain scores and analgesic demand; laparoscopic resection was the most painful of all.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"39-44"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433813","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":"Iatrogenic descending thoracic aorta perforation by pedicle screws as a delayed complication of scoliosis correction surgery. The anesthetic management and TEE role.","authors":"Ahmed Elrefaey","doi":"10.4103/sja.sja_369_24","DOIUrl":"10.4103/sja.sja_369_24","url":null,"abstract":"<p><p>A 29-year-old lady was referred to us with a rare complication of scoliosis correction surgery. She had two of the screws migrated and penetrated the descending thoracic aorta. She came to theater to have the screws removed and the aorta repaired endovascularly. The successful intervention needed a multidisciplinary team planning, coordinated work, and communication between the four involved teams: anesthesia, vascular surgery, interventional radiology, and spine surgery. There was a lot of anesthetic challenges that were new to us because of the rarity of that complication. In addition, it was another situation where the trans-esophageal echocardiography was found very useful and affected the decision making by visualizing the screws inside the aorta. The outcome was successful, and the patient was discharged home safely, hence, we would like to share our experience in managing this difficult case to help others who might find themselves in a similar situation.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"118-121"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433817","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":"Pulsed radiofrequency treatment for the management of trigeminal neuropathic pain following tooth extraction: A case report.","authors":"Mohammed Hassan, Conor Gormley, Paul Murphy","doi":"10.4103/sja.sja_450_24","DOIUrl":"10.4103/sja.sja_450_24","url":null,"abstract":"<p><p>Post-traumatic trigeminal neuropathic pain is one of the rare complications that could follow orofacial procedures such as dental extraction. The incidence of this type of pain following craniofacial trauma ranges between 3% and 13% depending on the type of surgery. The inferior alveolar and lingual nerves are commonly affected following molar tooth extraction. Pain usually differs from one patient to another concerning intensity and distribution. Pulsed radiofrequency treatment is one of the most widely used techniques in chronic pain management. It focuses on generating heat using radiofrequency waves at higher voltages than conventional radiofrequency while keeping tissue temperature below the neuro-destructive range. This report aims to highlight the benefit of using trigeminal ganglion pulsed radiofrequency to manage neuropathic pain following molar extraction.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"122-124"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433860","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 deep versus superficial continuous serratus anterior plane block for pain management in patients with multiple rib fractures: A prospective randomized double-blind clinical trial.","authors":"Mohamed F Mostafa, Mohamed Abdel-Moniem Bakr, Mohamed Ismail Seddik, Mohammed Mamdouh Mohammed Mahmoud, Gamal M A Ibrahim, Ahmed Talaat Ahmed","doi":"10.4103/sja.sja_493_24","DOIUrl":"10.4103/sja.sja_493_24","url":null,"abstract":"<p><strong>Background: </strong>Efficient analgesia is the cornerstone in multiple rib fractures (MRFs) management. The serratus anterior plane block (SAPB) shows promising outcomes. However, it is still provocative whether the superficial or deep approach is more effective in the SAPB procedure. We hypothesized that the deep approach of ultrasound (US)-guided continuous SAPB could be superior for MRFs pain management.</p><p><strong>Methods: </strong>Sixty-two adult patients having unilateral MRFs, were randomized into two groups to receive continuous superficial SAPB (group S, n = 31) or continuous deep SAPB (group D, n = 31). As a primary outcome, we compared pain numeric rating scale (NRS), while total analgesic consumption, incentive spirometer volume (IS-V), lung ultrasound score (LUSS), basal and 24-h serum beta-endorphin (BE) levels, and any adverse events were secondary outcomes.</p><p><strong>Results: </strong>There was a significant reduction in NRS in favor of group D when compared to group S at 30 minutes (<i>P</i> = 0.001) until 12 hours (<i>P</i> = 0.029); total analgesic consumption was significantly lower in group D (<i>P</i> = 0.005). A significant increase in the median IS-V in group D compared to group S at 90 minutes (<i>P</i> = 0.02) and 12h postblock (<i>P</i> = 0.004) LUSS was significantly lower in D group at 90 min, 12 h, and 24 h (<i>P</i> = 0.04, 0.001, 0.031). No significant differences as regards serum BE levels. No adverse events were noted.</p><p><strong>Conclusion: </strong>Either superficial or deep continuous SAPB can be used safely and effectively in managing pain related to MRFs. Notably, the deep approach offered superior analgesia and improved deep breathing compared to the superficial.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"58-64"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433141","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":"Comparing the priming methods of anesthesia circuits using passive and ventilator-assisted techniques-An exploratory study.","authors":"Indragandhi John, Krishnaprabu Ramaraj, Booma Devasagayam","doi":"10.4103/sja.sja_400_24","DOIUrl":"10.4103/sja.sja_400_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Priming the breathing circuit with a volatile agent plays a major role in inhalational induction. It depends on the fresh gas flow rate (FGF), concentration setting of the volatile agent, and time taken to attain the desired end-tidal concentration. The aim of the study is to compare ventilator-assisted priming (VAP) and a passive priming technique using different fresh gas flows (FGFs) in neonatal, pediatric, and adult anesthetic circuits with sevoflurane vaporizer.</p><p><strong>Methodology: </strong>An exploratory study was conducted on a single Datex ohmeda GE Inc. workstation using three different circuits. In both techniques, FGF with 100% oxygen and 8% sevoflurane vaporizer concentration was set at 2 L/min, 4 L/min, and 8 L/min corresponding to their three groups FGF-2, FGF-4, and FGF-8, respectively. The time taken to achieve 6% sevoflurane concentration at the patient end of the circuit was measured. In this study, we have explored various combinations of tidal volumes, respiratory rates with three different fresh gas flows, and their priming time with sevoflurane consumption.</p><p><strong>Results: </strong>The minimum time required to prime neonate, pediatric, and adult circuits using the ventilator-assisted technique to attain end-tidal sevoflurane 6% is 29 seconds, 39 seconds, and 61 seconds with 2 L/min FGF. Their corresponding sevoflurane consumptions are 0.25 ml for the neonate circuit, 0.78 ml for the pediatric circuit, and 2 ml for the adult circuit.</p><p><strong>Conclusion: </strong>The ventilator-assisted priming technique is an effective and quick method to attain end-tidal sevoflurane 6% with low FGF (2 L/min), low tidal volume (100 ml), maximum respiratory rate (20), and minimal sevoflurane consumption when compared to the passive priming technique.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"21-26"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433787","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":"Impact of laparoscopic surgeries on optic nerve sheath diameter (ONSD) in children.","authors":"Mohsina Yasmeen, Sumaiya Sabreen, Akshay Bettanayaka, Saraswathi Nagappa","doi":"10.4103/sja.sja_408_24","DOIUrl":"10.4103/sja.sja_408_24","url":null,"abstract":"<p><strong>Background: </strong>The pneumoperitoneum in laparoscopic surgeries elevates intracranial ICP because of the increased abdominal pressure, and ICP increases even further in the Trendelenburg position. A new noninvasive method to measure optic nerve sheath diameter (ONSD) via ultrasonography detects the raised ICP is reliable and inexpensive and can be repeated many times.</p><p><strong>Methods: </strong>In this prospective observational study, 23 pediatric patients aged between 5 and 16 years, undergoing elective laparoscopic procedures under general anesthesia, were included. After endotracheal intubation with proper aseptic precautions, ocular ultrasound was performed to measure baseline ONSD in both eyes. Later, pneumoperitoneum was established by maintaining the intra-abdominal pressure (IAP) at 12 cmH2O. Again, ONSD was estimated at 15 minutes of pneumoperitoneum and observed for any variation from the previous readings. The cutoff considered for ONSD was 5 mm, above which the intracranial pressure (ICP) was regarded as increased.</p><p><strong>Results: </strong>In our study, the mean age of subjects was 9.67 ± 5.18 years. The majority were males (60.9%). The subjects showed an increase in ONSD at the 15^th minute after inducing pneumoperitoneum using abdominal CO₂ insufflation, in comparison with the baseline values, in the left eye [4.67 ± 0.48, P 0.016] and the right eye [4.63 ± 0.43]. The readings of ONSD were observed to be <5 mm, not statistically significant.</p><p><strong>Conclusion: </strong>USG-guided ONSD measurements serve as a valuable tool in ensuring optimal intra-abdominal pressures and safe administration of anesthesia for patients undergoing laparoscopic surgery, particularly those vulnerable to an increase in ICP.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"34-38"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433825","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":"Comparison of oxygen supplementation by nasal cannula with suction versus air insufflation without suction under drapes during monitored anesthesia care in adult cataract surgery-A randomized non-inferiority trial.","authors":"Subramaniam Shanmugam Arivazhakan, Hemavathi Balachander, Sakthirajan Panneerselvam, Kirthiha Govindaraj, Priya Rudingwa","doi":"10.4103/sja.sja_312_24","DOIUrl":"10.4103/sja.sja_312_24","url":null,"abstract":"<p><strong>Background: </strong>Patients with multiple co-morbidities undergoing cataract surgery are at risk of hypoxia and hypercarbia secondary to the rebreathing of the accumulated carbon dioxide under the surgical drapes. They are also at risk of fire accidents due to the hyperoxic condition secondary to oxygen supplementation.</p><p><strong>Objectives: </strong>The main aim of the study was to determine the lowest level of hemoglobin oxygen saturation while providing medical air in comparison with oxygen. Our hypothesis is that providing medical air will be non-inferior to oxygen administration in preventing hypoxia and rebreathing in these patients.</p><p><strong>Methods: </strong>This randomized non-inferiority trial was conducted in a single center Tertiary care hospital, over a study period of March 2020 to February 2021. Fifty-six adult patients with equal gender distribution undergoing cataract surgery with multiple comorbid conditions without sedative premedications were included in the study and randomized into either Group \"O\" (<i>n</i> = 28) who received oxygen @ 4 l min^-1 through a nasal cannula with suction, and Group \"A\" (<i>n</i> = 28) who received medical air @10 l min^-1 through the circle breathing system under the drapes. The main outcome measured was the lowest hemoglobin oxygen saturation (SPO₂), the highest end-tidal carbon dioxide (hETCO₂), and the highest fraction of inspired carbon dioxide levels (hFiCO₂).</p><p><strong>Results: </strong>The lowest mean SPO₂ measured was found to be similar between Group O and Group A with 98.8 ± 0.7 and 98.4 ± 0.9 (<i>P</i> = 0.081), respectively. The highest mean ETCO₂ and mean FiCO₂ values were also comparable between the Group O <i>versus</i> Group A with 32.8 ± 2.1 <i>versus</i> 33.3 ± 2.2 (<i>P</i> = 0.464), and 4.5 ± 1.4 <i>versus</i> 4.8 ± 1.8 (<i>P</i> = 0.464) respectively.</p><p><strong>Conclusion: </strong>We conclude that the supplementation of compressed medical air under surgical drapes is non-inferior to nasal oxygen supplementation under regional anesthesia without causing hypoxia and hypercarbia by conserving valuable hospital resources.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"1-7"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433806","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":"Bronchial blocker placement for massive hemoptysis.","authors":"Ryan L Loncar, Elliott J Chiartas, Sheryl Modlin, Jibran Ikram, Sabry Ayad","doi":"10.4103/sja.sja_380_24","DOIUrl":"10.4103/sja.sja_380_24","url":null,"abstract":"<p><p>Massive hemoptysis is a life-threatening pathology requiring emergent intervention to prevent airway obstruction and hypovolemic shock. Intubation followed by lung isolation should be urgently performed. We elected to place Fuji Uniblocker (Fuji Systems Corporation, Tokyo, Japan) through an endotracheal tube to isolate a hemorrhage secondary to a cavitary lung lesion caused by a large pulmonary embolus. This article examines lung isolation strategies and addresses the advantages and disadvantages in patients with massive hemoptysis.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"108-111"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433766","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":"Comment on \"Anesthetic considerations of EXIT procedure: A case report\".","authors":"Raghuraman M Sethuraman","doi":"10.4103/sja.sja_624_24","DOIUrl":"10.4103/sja.sja_624_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"151-152"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433769","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}