Saudi Journal of Anaesthesia最新文献

{"title":"Ultrasound-guided erector spinae plane block versus anterior quadratus lumborum block for postoperative analgesia after percutaneous nephrolithotomy: A randomized controlled study.","authors":"Yamini Arora, Pooja Singh, Pranita Mandal, Harish Kumar, Devashish Kaushal, Sunaina Tejpal Karna, Divyanshi Agrawal","doi":"10.4103/sja.sja_158_26","DOIUrl":"10.4103/sja.sja_158_26","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is associated with significant postoperative pain. Ultrasound-guided erector spinae plane block (ESPB) and anterior quadratus lumborum block (QLB) are increasingly used for analgesia; however, direct comparative evidence in PCNL remains limited. This randomized controlled study compared their analgesic efficacy following unilateral PCNL.</p><p><strong>Methods: </strong>Eighty-four adult patients (American Society of Anaesthesiologists I-III) were randomized to receive ESPB or anterior QLB. Three patients in each group had block failure. The primary outcome was time to first rescue analgesia. Secondary outcomes included Numeric Rating Scale (NRS) pain scores at rest and during movement at 1, 2, 6, 12, and 24 h, total tramadol consumption, complications, time to ambulation, and length of hospital stay.</p><p><strong>Results: </strong>Time to first rescue analgesia was significantly longer in Group E compared to Group Q (406.15 ± 161.97 min vs. 326.15 ± 155.61 min; mean difference 80 min; 95% CI 9-151; <i>P</i> = 0.022; Cohen's d = 0.50). At 2 h, fewer patients in Group E required rescue analgesia (7.7% vs. 25.6%; <i>P</i> = 0.033). NRS scores at rest and during movement were comparable at all time points. Total tramadol consumption over 24 h was similar; however, fewer patients in Group E required tramadol at 12 h (23.1 vs. 43.6%; <i>P</i> = 0.049). Complication rates, ambulation time, and length of hospital stay were comparable.</p><p><strong>Conclusion: </strong>Both ESPB and anterior QLB provide effective postoperative analgesia after PCNL. ESPB offers moderate effect size prolongation in time to first rescue analgesia, suggesting a modest early postoperative analgesic advantage without increased complications.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"592-598"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674128","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":"Factors associated with postoperative systemic inflammation in patients after major abdominal surgery.","authors":"Ranko Lazovic, Ognjenka Sarenac","doi":"10.4103/sja.sja_943_25","DOIUrl":"10.4103/sja.sja_943_25","url":null,"abstract":"<p><strong>Context: </strong>Inflammation in the perioperative period has been increasingly investigated along with its association with the surgical outcomes.</p><p><strong>Aims: </strong>The aim of this analysis was to examine the association of perioperatively administered lidocaine, amino acids, and magnesium on the CRP levels as an inflammation marker 3 days postoperatively.</p><p><strong>Settings and design: </strong>This was the secondary analysis of the data from the prospective, double-blind randomized study.</p><p><strong>Materials and methods: </strong>The study was conducted between 2011 and 2022 in the Clinical Centre of Montenegro and included total of 100 patients, randomized in two groups experimental and control.</p><p><strong>Statistical analysis used: </strong>Linear regression was used to examine the factors associated with the CRP level at 3 days postoperatively. All variables found to be significant in the univariate analyses were included in the multiple linear regression model, with CRP level 3 days after surgery as the outcome variable.</p><p><strong>Results: </strong>Mean CRP max was 173.97 mg/l. Multiple linear regression with CRP level at 3 days postoperatively as an outcome variable showed the association of CRP level at 3 days postoperatively with group in the study (experimental vs. control) and with the preoperative CRP levels.</p><p><strong>Conclusion: </strong>These results are in line with the notion of pharmacological and nutritional interventions aiming at the reduction of postoperative inflammation. Further studies are necessary to confirm these findings but also to shed the light on the underlying mechanisms, define the optimal dosing and timing of these interventions all aiming the maximum patient benefit.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"515-518"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674174","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":"Significance of neuromuscular monitoring in laparoscopic Heller's myotomy.","authors":"M Aravind, Sana Yasmin Hussain","doi":"10.4103/sja.sja_146_26","DOIUrl":"10.4103/sja.sja_146_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"735-737"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673928","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":"Use of extracorporeal cardiopulmonary resuscitation in malignant hyperthermia-induced sudden cardiac arrest - A case study.","authors":"Ewa Woźnica-Niesobska, Wojciech Środa, Goutam Chourasia, Tomasz Jurek","doi":"10.4103/sja.sja_131_26","DOIUrl":"10.4103/sja.sja_131_26","url":null,"abstract":"<p><p>Malignant hyperthermia is a rare but potentially fatal complication of general anesthesia caused by inhalational anesthetics and depolarizing skeletal muscle relaxants. The mechanism of the disease involves an uncontrolled increase in skeletal muscle metabolism as a result of abnormal calcium regulation. Early diagnosis, immediate discontinuation of the triggering agent, and rapid administration of dantrolene are crucial for patient survival. We present the case of a 32-year-old man who underwent elective rhinoseptoplasty at a city 1-day surgery clinic where dantrolene was not available. During the procedure, the patient experienced an increase in body temperature, followed by cardiac arrest. The patient was transferred to the emergency department of a tertiary care university hospital, where dantrolene treatment was initiated and the patient was qualified for extracorporeal cardiopulmonary resuscitation. Despite several hours of intensive care, the patient died.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"716-718"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674211","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 comparative study to assess the efficacy of atomized versus drops administration of intranasal midazolam as premedication in pediatric patients undergoing elective surgery under general anesthesia-A prospective randomized double-blind study.","authors":"Parag Mandaknalli, Imran Sholapur, Rachana Shivanand Kori","doi":"10.4103/sja.sja_355_26","DOIUrl":"10.4103/sja.sja_355_26","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is one of the major challenges in perioperative care of pediatric surgical patients. Intranasal midazolam is a preferred route of drug administration owing to its ease of administration, non-invasive delivery, and rapid absorption through the highly vascular nasal mucosa, but the method of administration affects the efficacy.</p><p><strong>Aim: </strong>To compare the efficacy of atomized versus drop administration of intranasal midazolam (0.3 mg/kg) as a premedication in pediatric patients aged 2-6 years undergoing elective surgery under general anesthesia.</p><p><strong>Methods: </strong>This prospective double-blind study was conducted in 60 pediatric patients randomly allocated into the Atomized Group or the nasal drops group. Drug acceptance by a 4-point Medicine Acceptance Scale, Sedation, anxiolysis at the time of shifting, assessed by the Parental Separation Anxiety Scale (PSAS), and adverse events.</p><p><strong>Results: </strong>Drug acceptance was superior in the atomized group compared to the nasal drops group (56.7% vs 3.3%; <i>P</i> < 0.001). The atomized group demonstrated statistically significantly higher sedation scores (2.53 ± 0.776 vs. 1.93 ± 0.583; <i>P</i> = 0.001) at 5 mins, indicating faster onset of sedation. PSAS scores were better in the atomized group (1.17 ± 0.592 vs. 1.53 ± 0.629; <i>P</i> = 0.024). Incidence of adverse events was comparable between both groups (<i>P</i> = 0.379), and no respiratory depression or hemodynamic instability was noted.</p><p><strong>Conclusion: </strong>Atomized intranasal midazolam via mucosal atomization device is superior to conventional nasal drops in achieving higher drug acceptance, faster sedation, and better parental separation anxiolysis in pediatric patients.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"638-643"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674004","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":"Modernizing perioperative fasting: Liberal clear liquids, glucagon-like peptide-1 receptor agonists, and point-of-care gastric ultrasound.","authors":"Burhan Dost, Esra Turunc, Madan Narayanan, Kiran Koneti, Dario Bugada, Yunus Emre Karapinar, Alessandro De Cassai","doi":"10.4103/sja.sja_91_26","DOIUrl":"10.4103/sja.sja_91_26","url":null,"abstract":"<p><p>Preoperative fasting was historically introduced to reduce pulmonary aspiration during anesthesia; however, contemporary evidence increasingly challenges the assumption that \"longer is safer.\" Aspiration is a rare event and is primarily determined by patient- and procedure-related risk factors rather than fasting duration alone, whereas prolonged fasting is consistently associated with patient discomfort and adverse physiological consequences. Risk assessment has become more complex with emerging clinical factors, most notably the widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which may delay gastric emptying and lead to residual solid gastric contents despite adherence to guideline-recommended fasting intervals. International recommendations for perioperative GLP-1 RA management remain heterogeneous, underscoring the need for pragmatic, risk-stratified strategies that balance aspiration risk mitigation with metabolic stability. Point-of-care gastric ultrasound is increasingly recognized as a valuable bedside decision-support tool, enabling qualitative and quantitative assessment of gastric contents in uncertain or high-risk scenarios and informing airway management and procedural timing. This review synthesizes the current evidence supporting liberal preoperative intake of clear liquids and highlights the transition from rigid, time-based rules toward individualized, physiology-informed approaches to perioperative hydration and nutrition.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 3","pages":"665-674"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674191","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 impact factor and citescore.","authors":"Nitin K Borkar, Abhijit S Nair, Shilpa Meshram","doi":"10.4103/sja.sja_928_25","DOIUrl":"10.4103/sja.sja_928_25","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"480-481"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779672","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":"Adapting enhanced recovery after surgery protocols for day-care surgeries under general anesthesia at a tertiary care ophthalmic setting.","authors":"Sujata Rawlani, Priyanka P Karnik, Shalini Subramanian, Raja Narsingrao","doi":"10.4103/sja.sja_644_25","DOIUrl":"10.4103/sja.sja_644_25","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elective ophthalmic day-care surgeries conducted under general anesthesia at the tertiary care ophthalmic center.</p><p><strong>Methods: </strong>This prospective observational study included 70 patients aged above 1 month undergoing elective ophthalmic surgery under general anesthesia. Key ERAS elements were adapted, including structured preoperative counselling, optimized fasting, multimodal analgesia, prophylaxis for postoperative nausea and vomiting (PONV), early oral intake, and use of the Aldrete score for discharge readiness. Pain was assessed using age-appropriate scoring systems like Visual Analogue Scale (VAS), Face, Legs, Activity, Cry, Consolability (FLACC) and patient feedback was obtained using a validated questionnaire. Data were analyzed using SPSS.</p><p><strong>Results: </strong>Mean fasting durations were 7.04 ± 1.2 hours for solids and 3.02 ± 1.22 hours for clear liquids. A low-dose opioid regimen combined with paracetamol ensured effective pain control; only a small number of patients required rescue analgesia. The overall incidence of PONV was low (8.6%), and early oral fluid intake was well tolerated. Most participants reported high satisfaction with their perioperative experience, with 91.4% scoring 4 or 5 on a 5-point scale. No adverse events or delayed discharges were observed.</p><p><strong>Conclusion: </strong>Integrating ERAS principles into ophthalmic day-care anesthesia is feasible and associated with improved recovery, reduced discomfort, and high patient satisfaction. A structured, multidisciplinary approach tailored to the ambulatory context can enhance perioperative care without compromising safety.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"268-280"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779702","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":"Incidence and risk factors of preoperative anxiety among surgical patients in King Abdulaziz University Hospital.","authors":"Ghader Jamjoum, Alwaleed Hesham Kaneetah, Fahad Mesfer Alghamdi, Abdulelah Abdulsalam M Albatati, Abdulaziz Othman M Alnahdi, Fawaz Saleh B Almuntashiri, Abdullah Mahmoud Masoud Mahmoud, Amani Hussain Alhebaishi, Ashraf Maghrabi","doi":"10.4103/sja.sja_617_25","DOIUrl":"10.4103/sja.sja_617_25","url":null,"abstract":"<p><strong>Introduction: </strong>Anxiety is a feeling of discomfort that often involves emotions such as worry and fear. This feeling tends to intensify when someone is facing surgery. Preoperative anxiety (POA) is a common psychological condition among patients preparing for surgery, which can lead to adverse postoperative outcomes, including increased pain, delayed recovery, and a higher risk of infection. Despite its significant clinical impact, research on POA in Saudi Arabia, particularly in the Western region, is limited. This study aims to assess the incidence of POA and identify its risk factors among surgical patients at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia.</p><p><strong>Methodology: </strong>This single-center cross-sectional study was conducted in 2024 at KAUH in the Department of Surgery, a tertiary care center. The study included 70 adult inpatients scheduled for surgery under anesthesia. Data were collected using a structured questionnaire covering demographic characteristics, medical history, surgical experiences, and fears of pain or complications. A validated tool, the Amsterdam Preoperative Anxiety and Information Scale (APAIS), was used to assess anxiety levels. Statistical analysis was performed using SPSS version 26, applying Chi-square tests, Spearman's correlation, and logistic regression to determine significant predictors of preoperative anxiety (POA).</p><p><strong>Results: </strong>Among the 70 participants, 77.1% were female, with a mean age of 35-44. The incidence of preoperative anxiety (POA) was 41.4%. Female gender was significantly associated with higher anxiety levels (89.7% vs. 10.3% in males, <i>P</i> = 0.036). Other significant risk factors included fear of postoperative pain (62.1% vs. 31.7%, <i>P</i> = 0.01) and fear of surgical complications (58.6% vs. 39.3%, <i>P</i> = 0.041). No significant association was found between POA and factors such as chronic disease, previous surgical history, or ASA classification.</p><p><strong>Conclusion: </strong>POA affects 41.4% of patients, especially females and those worried about pain and complications. This highlights the need for psychological assessments and clear patient education before surgery. Interventions like counseling and straightforward discussions about pain management can help reduce anxiety and improve surgical outcomes. Future research should focus on long-term studies to investigate these connections further.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"380-388"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779984","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":"Rectus sheath block as the sole anesthesia technique for open surgical repair of umbilical hernias: A retrospective cohort study.","authors":"Emma L Rispler, David L Bettan, Alexander Valerio, Sean D Jeffries, Avinash Sinha, Thomas M Hemmerling","doi":"10.4103/sja.sja_834_25","DOIUrl":"10.4103/sja.sja_834_25","url":null,"abstract":"<p><strong>Background: </strong>The rectus sheath block is a regional anesthetic technique that provides effective analgesia for midline abdominal surgeries. This study evaluated the feasibility of the rectus sheath block as the sole anesthetic technique for open umbilical hernia repair.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted at a single secondary care hospital between 2017 and 2024. A total of 201 adult patients who had an elective open umbilical hernia repair with a pre-operative rectus sheath block were included. Patients were stratified into two groups with respect to their anesthetic plan: rectus sheath block only and rectus sheath block with general anesthesia. Primary outcomes were conversion rate to general anesthesia in the rectus sheath block group, post-anesthesia care unit recovery times, and postoperative pain scores. Data were analyzed using non-parametric tests under the intention-to-treat principle, and a two-sided <i>P</i> < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The conversion rate to general anesthesia was 1.19%. The rectus sheath block group had significantly shorter post-anesthesia care unit recovery times (26.67 ± 13.57 min vs. 49.64 ± 23.91 min; <i>P</i> < 0.001) and lower postoperative morphine milligram equivalent consumption (0.321 ± 1.513 mg vs. 2.955 ± 4.381 mg; <i>P</i> < 0.001) compared with the rectus sheath block with general anesthesia group. Postoperative pain scores were comparable between groups (<i>P</i> = 0.170).</p><p><strong>Conclusion: </strong>The rectus sheath block is an effective sole anesthetic technique for open umbilical hernia repair, with a low conversion rate to general anesthesia.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"261-267"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780182","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}