Saudi Journal of Anaesthesia最新文献

{"title":"Comparative evaluation of artificial intelligence chatbots for real-time guidance during intraoperative anesthetic crises: A simulation-based study.","authors":"Abdallah Ahmed Mezel Al-Azzam, Zaid Alkhateeb, Ahmed Shahin, Isam Bsisu, Ramzi Alaqtash, Eyad Attoun, Hammam Rababa'a","doi":"10.4103/sja.sja_903_25","DOIUrl":"10.4103/sja.sja_903_25","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) chatbots are increasingly used in healthcare, but their ability to interpret anesthetic monitoring data during intraoperative crises remains unclear.</p><p><strong>Objective: </strong>To evaluate AI chatbots' responses to simulated anesthetic emergencies, with a focus on visual monitor interpretation compared to contextual case information.</p><p><strong>Methods: </strong>This simulation-based study was conducted using a high-fidelity patient monitor. Twenty intraoperative emergencies were designed as static monitor images with minimal clinical context. Five AI platforms, ChatGPT, Claude, Gemini, Copilot, and DeepSeek, were tested. Each scenario was submitted in a separate, new conversation with no advanced reasoning tools enabled. Six blinded evaluators scored 100 responses using the validated CLEAR tool. The primary outcome was the mean total score per chatbot; secondary outcomes included domain-specific scores and differences between visual and contextual scenarios.</p><p><strong>Results: </strong>ChatGPT achieved the highest mean score (4.4 ± 0.6), outperforming other platforms across all CLEAR domains (<i>P</i> < 0.001). Its accuracy was consistent between contextual (4.6 ± 0.3) and visual (4.1 ± 0.9) scenarios. DeepSeek scored the lowest overall score (2.7 ± 1.1), and had a mean 2.3 ± 1.1 in \"lack of false information\", often due to misinterpreting monitor values, reducing its visual scenario performance. Overall, contextual scenarios scores were higher than visual ones across all platforms.</p><p><strong>Conclusion: </strong>Among AI chatbots, ChatGPT demonstrated the most consistent and guideline-concordant responses to simulated anesthetic crises as of March 2025. This study provides a benchmark for evaluating clinical AI performance and supports the selective integration of such tools in anesthesia decision-making workflows.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"362-368"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779780","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 unique method for one-lung ventilation in pediatric thoracic surgery: Suction catheter and single-lumen tube approach: A case report.","authors":"Deema Siraj Abid, Hossam Al Oufi","doi":"10.4103/sja.sja_873_25","DOIUrl":"10.4103/sja.sja_873_25","url":null,"abstract":"<p><p>Effective one-lung ventilation (OLV) ensures optimal surgical exposure and isolation of the operative lung. This case describes a novel technique for achieving OLV in pediatric thoracic surgery using a suction catheter with a single-lumen endotracheal tube (SLT). An 11-year-old girl presented with a 2-day history of hemoptysis. Chest CT showed bronchial wall thickening and multifocal nodular opacities in the right upper lobe, suggesting pulmonary hemorrhage. After standard ASA monitoring, arterial and central venous lines were placed. The patient was intubated with a size 6.0 SLT and a size 10 suction catheter, guided into the left main bronchus under fiberoptic bronchoscopy. Tube position was confirmed by auscultation and chest X-ray. Intraoperatively, adhesions indicated prior embolization. The right upper lobe bronchus and vessels were ligated with LigaSure. Postoperative recovery was uneventful, and imaging on day five showed no pneumothorax. This simple, effective method facilitates safe OLV in pediatric thoracic surgery.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"467-469"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779727","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 the Raqeeb narcotic controlling system on tramadol prescriptions in surgical patients: A pre-post implementation study.","authors":"Yahya Almarhabi","doi":"10.4103/sja.sja_951_25","DOIUrl":"10.4103/sja.sja_951_25","url":null,"abstract":"<p><strong>Background: </strong>Tramadol hydrochloride, a Schedule III opioid, is the primary take-home narcotic for postoperative pain in Saudi Arabia, with a misuse prevalence of 11.4%-20%. On February 1, 2024, the Saudi Food and Drug Authority implemented the Raqeeb electronic monitoring system for real-time prescription tracking to curb abuse while maintaining legitimate access.</p><p><strong>Objectives: </strong>To evaluate Raqeeb's impact on tramadol prescribing in surgical patients and compare outcomes with international prescription drug monitoring programs (PDMPs).</p><p><strong>Methods: </strong>Retrospective cohort study of all adult patients (≥18 years) receiving tramadol prescriptions at a tertiary hospital in Saudi Arabia (April 2023 to June 2025), divided into pre-Raqeeb and post-Raqeeb periods. All tramadol prescriptions (acute postoperative and chronic/non-surgical indications) were included. Monthly rates were normalized; comparisons used <i>t</i>-tests and chi-square tests.</p><p><strong>Results: </strong>Monthly tramadol prescription rates in surgical patients decreased 43% (from 10.6 to 6.1 prescriptions/month). Mean dispensed quantity increased from 17.0 ± 7.6 to 21.5 ± 12.9 tablets (<i>P</i> = 0.003). Prescriptions issued by the surgical team fell from 86% to 48% (<i>P</i> < 0.001); prescriptions linked to a recent surgical procedure declined from 67% to 51% (<i>P</i> = 0.033). Anorectal procedures dropped 81%, while breast surgery increased 117%. Mean patient age rose from 50 ± 16 to 56 ± 15 years (<i>P</i> = 0.012). Repeat prescriptions remained stable (33% vs. 29%).</p><p><strong>Conclusion: </strong>Raqeeb achieved a 43% reduction in tramadol prescriptions among surgical patients-exceeding typical PDMP postoperative reductions (5%-30%)-with a shift toward older patients and chronic indications, without apparent barriers to legitimate access.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"375-379"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779958","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":"Thoracic spinal anesthesia for emergency derivative colostomy in a turner syndrome patient.","authors":"Paolo Scimia, Antonio De Cato, Mattia Frischia, Luca Gentili","doi":"10.4103/sja.sja_124_26","DOIUrl":"10.4103/sja.sja_124_26","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"485-486"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779679","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":"Randomized controlled trial to compare post operative analgesia between ultrasound guided quadratus lumborum and erector spinae plane block in children undergoing pyeloplasty.","authors":"Nainsheet Kaur, Maitree Pandey, Preeti G Varshney, Raksha Kundal","doi":"10.4103/sja.sja_801_25","DOIUrl":"10.4103/sja.sja_801_25","url":null,"abstract":"<p><strong>Background: </strong>Erector spinae plane block (ESPB) and quadratus lumborum block (QLB) have demonstrated efficacy in providing postoperative analgesia following abdominal surgeries. However, evidence regarding their effectiveness in pediatric renal surgeries remain limited. The present study aimed to compare the duration of postoperative analgesia between ultrasound-guided quadratus lumborum and erector spinae plane blocks in children undergoing open pyeloplasty.</p><p><strong>Methods: </strong>Sixty children undergoing pyeloplasty, aged between 6 months and 7 years were randomized to receive ultrasound guided ESPB or QLB after induction of general anesthesia. Time to first rescue analgesia, total analgesic requirement, and time to perform the block were observed.</p><p><strong>Results: </strong>The time to first rescue analgesia was 1040 ± 99 min in QLB group as compared to 889 ± 67 min in ESPB group (<i>P</i> < 0.001). Mean total analgesic requirement (fentanyl) in 24 hours was lower in QLB group as compared to ESPB group (1.77 ± 1.36 μg/kg and 3.9 ± 0.80 μg/kg, respectively) (<i>P</i> < 0.001). The mean total time to perform block was 246 ± 107 sec in QLB group and 140 ± 80 sec in ESPB group (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Ultrasound guided quadratus lumborum block provides longer duration of postoperative analgesia with lesser total analgesic requirement as compared to erector spinae plane block in children undergoing pyeloplasty, with marginally longer time to administer quadratus lumborum block.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"327-331"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780178","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":"Refractory cardiac arrest during epidural anesthesia for caesarean section in a patient with supra-systemic pulmonary hypertension rescued by VA ECMO.","authors":"Nisar A Soomro, Raed S Altowairki, Riaz N Ahmed, Wesam I Kurdi","doi":"10.4103/sja.sja_899_25","DOIUrl":"10.4103/sja.sja_899_25","url":null,"abstract":"<p><p>Patients with severe pulmonary arterial hypertension (PAH) tolerate the hemodynamic changes of pregnancy poorly and should be referred early to an experienced expert multidisciplinary team (MDT) in a tertiary care center early in pregnancy. Idiopathic pulmonary arterial hypertension, which is PAH without a known cause, is classified under group 1 of WHO classification of pulmonary hypertension. Current consensus guidelines and expert opinion recommend scheduled caesarean section under epidural anesthesia or combined low dose spinal-epidural anesthesia as the preferred mode of delivery and anesthesia in patients with PAH. However severe hemodynamic instability secondary to pulmonary hypertensive crises (PHC) or right ventricular failure can occur during the perioperative period and can precipitate refractory cardiac arrest. In this situation, timely institution of veno-arterial extracorporeal membrane oxygenation (VAECMO) can be lifesaving. Here we report the case of a patient with severe idiopathic PAH, who developed pulmonary hypertensive crisis, catecholamine-resistant hypotension and refractory cardiac arrest during establishment of epidural anesthesia for elective caesarean section, who was successfully rescued with VA ECMO.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"470-472"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780186","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":"Association of high thoracic erector spinae plane block and serratus posterior superior intercostal plane block for postoperative analgesia in rib removal surgery.","authors":"Paolo Scimia, Massimiliano L D'Agostino, Antonio De Cato, Luca Gentili","doi":"10.4103/sja.sja_819_25","DOIUrl":"10.4103/sja.sja_819_25","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"476-477"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779834","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 awake axillofemoral bypass.","authors":"Khalid Nasser Bin Ghali, Raed Sami Altowairki, Muzackir Abubaker Mohammed","doi":"10.4103/sja.sja_818_25","DOIUrl":"10.4103/sja.sja_818_25","url":null,"abstract":"<p><p>Aortoiliac occlusive disease is the severe form of peripheral arterial disease requiring complex vascular reconstruction, typically performed under general anesthesia (GA). However, GA carries increased risks in patients with significant comorbidities. We report a case of a 61-year-old male with chronic aortoiliac occlusion, uncontrolled hypertension, sepsis, and heavy smoking, presenting with bilateral limb ischemia and sensory-motor deficits. He underwent axillary-to-bilateral femoral artery bypass and right above-knee amputation under thoracic epidural anesthesia (TEA) combined with peripheral nerve blocks (PNB) and light sedation. A T4-L2 sensory block was achieved with stable hemodynamics throughout the 7-hour surgery, with minor hypotension managed by ephedrine. Postoperative analgesia with continuous epidural bupivacaine-fentanyl infusion and multimodal therapy provides excellent pain control. The patient required only brief ICU monitoring and was transferred to the ward without complications. This case demonstrates the feasibility and safety of TEA with PNB as an alternative to GA in high-risk vascular patients, offering effective anesthesia, hemodynamic stability, and superior pain control while minimizing perioperative risks.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"456-458"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779470","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":"Effectiveness of dexmedetomidine versus fentanyl on postoperative pain and recovery after pediatric tonsillectomy: A retrospective cohort study.","authors":"Mohammad Jallad, Bander AlAnazi, Abdulaziz Aloqbawi, Muneera Albuthi, Ahmed Haroun M Mahmoud, Muhammad Imran Khan, Abdullah AlDhuwaihy, Faisal Alzuhayri, Mostafa Nagy","doi":"10.4103/sja.sja_788_25","DOIUrl":"10.4103/sja.sja_788_25","url":null,"abstract":"<p><strong>Background: </strong>Pediatric tonsillectomy is commonly associated with significant postoperative pain. Opioids remain a mainstay for perioperative analgesia but carry risks of respiratory depression and prolonged recovery, especially in patients with obstructive sleep apnea (OSA). Dexmedetomidine, an alpha-2 adrenergic agonist, provides sedation and analgesia with minimal respiratory depression.</p><p><strong>Objective: </strong>To compare intraoperative induction with fentanyl versus dexmedetomidine and their effects on postoperative pain, post-anesthesia care unit (PACU) length of stay, and opioid consumption in children undergoing tonsillectomy.</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of pediatric patients aged 3-16 years, who underwent tonsillectomy at King Abdullah Specialized Children's Hospital between January 2024 and December 2024. Patients were grouped by intraoperative induction regimen: fentanyl or dexmedetomidine. Outcomes included PACU pain scores, postoperative opioid use, PACU stay, adverse events, and hospital stay. Shapiro-Wilk was used to test normality; Mann-Whitney U was used when comparing continuous variables, and chi-square/Fisher was used when comparing categorical variables. Controlled logistic and linear regressions were used to adjust for the age, weight, and duration of a surgery. The analyses were conducted using Python 3.10.</p><p><strong>Results: </strong>A total of 250 patients were analyzed (dexmedetomidine <i>n</i> = 125; fentanyl <i>n</i> = 125). PACU pain scores did not differ significantly between groups (<i>P</i> = 0.154). Postoperative morphine use was not significantly different (<i>P</i> = 0.316). Median PACU stay was longer in the dexmedetomidine group (<i>P</i> = 0.002). Adverse event rates were lower in the adjusted analysis (OR: 0.11; 95% CI: 0.014-0.926). Hospital stay was comparable.</p><p><strong>Conclusion: </strong>Dexmedetomidine induction provides comparable analgesia to fentanyl while reducing adverse events, although it is associated with longer PACU stay. It may represent a safe opioid-sparing option in pediatric tonsillectomy, particularly in high-risk children.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"245-248"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779914","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 pain management among postoperative patients in Saudi Arabia: A cross-sectional study.","authors":"Rothana M Aljehani, Yara Alorfi, Lama Alharbi, Haneen Alharbi, Sadeem Alharbi, Miad Alhamrani, Mohammed Almarjan","doi":"10.4103/sja.sja_806_25","DOIUrl":"10.4103/sja.sja_806_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain is one of the most common and distressing consequences of surgery, with inadequate pain management contributing to delayed recovery, increased morbidity, and reduced patient satisfaction. Despite advances in analgesic techniques, patients in many healthcare systems continue to report poor outcomes. This study aimed to evaluate pain management practices and patient satisfaction among postoperative patients in Saudi Arabia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from June to September 2025 across multiple hospitals in Saudi Arabia. A total of 688 adult patients who had undergone surgery within the previous 1-4 weeks participated. Data were collected using a structured, bilingual questionnaire covering demographics, surgical type, pain experience, methods of pain assessment, management strategies, satisfaction levels, and cultural influences on pain expression. Statistical analyses included descriptive statistics, Chi-square tests, independent <i>t</i>-tests, and one-way analysis of variance (ANOVA), with significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Of the 688 participants, 52.8% were female, and the majority (95.3%) were Saudi nationals. Most respondents were treated in government hospitals (63.5%) and underwent general (26.9%) or obstetric/gynecological surgery (19.5%). The mean postoperative pain score was 5.29 (SD: 2.94), with 76.2% reporting pain. Pain assessment was inconsistent; 39.4% reported being assessed using numeric scales, while an equal proportion indicated no assessment. The most common management methods were intravenous analgesics (52.2%) and oral medications (44.6%), with nonpharmacological approaches rarely used (1.5%). Overall satisfaction was moderate to high, with 78.8% reporting being satisfied or very satisfied.</p><p><strong>Conclusion: </strong>Postoperative pain remains prevalent and often under-assessed in Saudi Arabia. Although satisfaction levels were generally favorable, significant disparities exist across sex, age, and surgical type. Standardizing pain assessment tools and implementing tailored, multimodal management strategies could improve patient outcomes and overall satisfaction.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"302-308"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780020","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}