Saudi Journal of Anaesthesia最新文献

{"title":"Cadaveric dissection studies in regional anesthesia - A comprehensive bibliographic analysis.","authors":"Abhijit S Nair, P M Navveen, Reshma Nath, Sandeep Diwan","doi":"10.4103/sja.sja_724_25","DOIUrl":"10.4103/sja.sja_724_25","url":null,"abstract":"<p><p>The anatomical basis and safety optimization of regional anesthesia techniques are supported by cadaveric studies. However, the development of this field of study has not been thoroughly documented. To map publication trends, collaborative networks, and emerging themes in cadaveric studies on regional anesthesia, we conducted a bibliometric analysis. A Scopus database search using the keywords 'cadaveric studies' and 'regional anesthesia' revealed 298 articles from inception till May 2025. The comma-separated values (CSV) file was uploaded to the VOS viewer and CiteSpace software for analyzing various bibliometric parameters like bibliographic coupling, citation, co-authorship, co-occurrence, and co-citation. The results revealed that most of the work was done and published in high-income countries (the United States, the United Kingdom, and Canada), in established universities (University of Toronto, Canada), and in high-impact journals (Regional Anesthesia and Pain Medicine). Future studies should prioritize multicenter, cross-cultural cadaveric validations, standardized anatomical nomenclature, and stronger collaboration among anatomists and anesthesiologists to translate cadaveric insights into clinical protocols and enhance patient safety.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"418-425"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779805","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":"Anesthetic considerations in smokers: A scoping review.","authors":"Ahad N Yamani, Abdulrahman Almazrooa","doi":"10.4103/sja.sja_576_25","DOIUrl":"10.4103/sja.sja_576_25","url":null,"abstract":"<p><p>Tobacco smoking is a well-established modifiable risk factor that significantly influences perioperative outcomes through complex physiological and pharmacological mechanisms. Despite widespread awareness of its long-term health consequences, a considerable proportion of surgical patients continue to smoke at the time of their procedures. The objective of this review is to synthesize current evidence regarding the impact of smoking on anesthetic management. Smoking induces chronic inflammation and structural changes in the respiratory tract, which may increase the risk of intraoperative hypoxemia, bronchospasm, and postoperative pulmonary complications. Cardiovascular risks are similarly elevated due to smoking-related endothelial dysfunction, increased sympathetic activity, and impaired myocardial oxygen balance. Moreover, nicotine and other components of tobacco smoke alter drug metabolism, particularly via hepatic enzyme induction, affecting the pharmacokinetics of commonly used anesthetics and analgesics. Smokers also exhibit altered pain perception and increased opioid requirements postoperatively, complicating analgesic strategies. In conclusion, an in-depth understanding of the multifaceted effects of smoking on anesthetic care is essential for optimizing outcomes and reducing perioperative morbidity in this high-risk group.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"399-404"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779807","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 novel technique of peripheral nerve blocks and sedation as primary anesthetic technique for adult emergency hip fracture surgery: A retrospective propensity matched study.","authors":"Angelina Low, David Bettan, Sean Jeffries, Avinash Sinha, Eric Pelletier, Oliver Cafferty, Pascal Laferriere-Langlois, Michel Malo, Thomas M Hemmerling","doi":"10.4103/sja.sja_891_25","DOIUrl":"10.4103/sja.sja_891_25","url":null,"abstract":"<p><strong>Background: </strong>No study has evaluated peripheral nerve block as the primary anesthetic technique in adult hip fracture surgery. This retrospective cohort study compares peri-operative outcomes between spinal anesthesia and peripheral nerve block with sedation (block-sedation) in adult emergency hip fracture surgery.</p><p><strong>Methods: </strong>Adult patients who underwent hip fracture repair at Fleury Hospital between 2018 and 2025 were screened (<i>n</i> = 503). Of these, patients receiving planned spinal anesthesia (<i>n</i> = 238) or block-sedation (<i>n</i> = 230) were identified. Primary outcome was the success rate of block-sedation in emergency hip fracture surgery, defined as the proportion of patients in whom block-sedation was used without conversion to another anesthetic technique. Secondary outcomes included peri-operative opioid requirement (MME), postoperative pain, intra-operative anesthetic requirements (i.e., ketamine, midazolam, propofol), post-anesthesia care unit (PACU) stay, hospital length of stay, and intra-operative hypotension requiring inotropes.</p><p><strong>Results: </strong>Block-sedation was successful without conversion in 98.1% of patients; four patients (1.9%) required conversion to general anesthesia and were excluded from peri-operative outcomes. Median PACU stay was longer in the spinal group (54 min, IQR 42-72) compared with block-sedation (36 min, IQR 27-53; <i>P</i> < 0.001) The incidence of hypotension requiring inotropes was higher in the spinal group (53.0%) compared with the block-sedation group (19.4%; <i>P</i> < 0.001). Postoperative pain scores were comparable between groups (<i>P</i> = 0.126), and postoperative hospital length of stay was also similar (<i>P</i> = 0.416).</p><p><strong>Conclusion: </strong>In this propensity-matched cohort study, block-sedation was feasible and safe for MIS hip fracture surgeries, with a high success rate (>98%) and low conversion to general anesthesia.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"332-338"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779699","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":"Pulse pressure variation versus central venous pressure guided fluid management therapy in kidney transplant recipients: A single-blinded prospective randomized control study.","authors":"Saurabh Gupta, Divesh Arora","doi":"10.4103/sja.sja_915_25","DOIUrl":"10.4103/sja.sja_915_25","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) necessitates renal transplantation, where precise fluid management is essential for graft perfusion and function. Central venous pressure (CVP) is traditionally used, but the optimal strategy is uncertain. Pulse pressure variation (PPV), a dynamic index, may better predict fluid responsiveness. This randomized trial compared PPV- versus CVP-guided fluid therapy in kidney transplant recipients.</p><p><strong>Methods: </strong>Fifty ESRD patients undergoing renal transplantation were randomly divided into two groups (n = 25 each). Group A received intraoperative fluid therapy guided by PPV, while Group B followed CVP-guided fluid therapy. The primary outcome was total intraoperative fluid administered. Secondary outcomes included total urine output, time to onset of diuresis, incidence of hypotensive episodes, and post-reperfusion lactate levels. Data were analyzed with independent t-tests or Mann-Whitney tests for continuous variables and Fisher's exact test for categorical variables; <i>P</i> < 0.05 denoted significance.</p><p><strong>Results: </strong>Total fluid administration was significantly lower in the PPV group (1862 ± 327 mL) than in the CVP group (2480 ± 355 mL; <i>P</i> < 0.0001). Intraoperative urine output was higher with PPV guidance (996 ± 348 mL vs. 820 ± 141 mL; <i>P</i> = 0.026). The time to diuresis was shorter in the PPV group (median 1 min [IQR 1-2] vs. 2 min [IQR 1-3]; <i>P</i> = 0.0008). Incidence of hypotension and lactate levels post clamp release did not differ between groups.</p><p><strong>Conclusion: </strong>PPV-guided therapy reduced fluid requirements and accelerated diuresis without increasing hypotension or lactate levels, supporting dynamic over static preload indices for optimizing graft perfusion.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"369-374"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780123","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 Hennepin double tube technique: A breakthrough in airway management for tracheal tumor removal.","authors":"Paramitha P Hapsari, Muhammad R Aditya, Maya A Saphira","doi":"10.4103/sja.sja_628_25","DOIUrl":"10.4103/sja.sja_628_25","url":null,"abstract":"<p><p>A 47-year-old man was diagnosed with a tracheal mass with a narrowed airway at the level of vertebrae thoracalis 2-4 (T2 - T4). He was scheduled for sternotomy. The patient's clinical condition was considered ASA III. We used fiberoptic bronchoscopy (FOI) to visualize the tumor's location and employed double endotracheal tubes to manage the airway difficulties. The first endotracheal tube was inserted orally into the trachea until it passed the tumor to provide primary airway control. Once the ventilator was connected, the second tube was repositioned below the tumor to maintain airway patency. After the surgery, the patient was transferred to the intensive care unit (ICU) for close monitoring of maintaining respiratory stability and preventing complications. The patient recovered well with stable vital signs and effective pain control.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"449-451"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779462","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":"Fascial plane blocks as diagnostic keys to persistent pain after hip replacement: Sequential PENG and sacral ESP approach.","authors":"Luca Gentili, Paolo Scimia, Ilaria Silvi, Chiara Angeletti","doi":"10.4103/sja.sja_892_25","DOIUrl":"10.4103/sja.sja_892_25","url":null,"abstract":"<p><p>Persistent pain after total hip arthroplasty (THA) remains a diagnostic and therapeutic challenge, often related to extra-articular or neuropathic mechanisms rather than prosthetic failure. We report the case of a 70-year-old female with chronic suprainguinal, anterolateral thigh and gluteal pain who underwent right THA in 2023. Lumbar MRI performed before surgery showed L4-L5-S1 disc protrusions, initially considered incidental. Despite correct prosthesis positioning, postoperative pain persisted identically to preoperative symptoms. A pericapsular nerve group (PENG) block with ropivacaine 0.1% (20 ml) and methylprednisolone 40 mg provided near-complete anterior pain relief within 6 hours. Two weeks later, a sacral erector spinae plane block with ropivacaine 0.1% (20 ml) and methylprednisolone 20 mg, combined with a repeat PENG, achieved complete and lasting pain resolution. At 90-day follow-up, the patient remained pain-free. Thorough preoperative assessment, including diagnostic nerve blocks, may help prevent unnecessary arthroplasty in atypical hip pain.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"459-462"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780051","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":"Effect of e-health literacy on preoperative anxiety in patients undergoing gynecologic surgery: A cross-sectional study.","authors":"Merve B Yediyıldız, İrem Durmuş, Kübra Taşkın, Esra Keleş, Ayşe Demirden, Hülya Y Ak, Murat Api","doi":"10.4103/sja.sja_715_25","DOIUrl":"10.4103/sja.sja_715_25","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety (PA) is a common condition that can negatively affect surgical outcomes. As digital health resources become more integrated into patient care, e-health literacy (eHL) is gaining importance as a determinant of surgical readiness and emotional well-being. This study aimed to evaluate the relationship between eHL and PA in patients undergoing elective gynecologic surgery.</p><p><strong>Methods: </strong>This cross-sectional study was conducted at a tertiary hospital between June and November 2024. Patients scheduled for elective gynecologic surgery were included. Participants completed the sociodemographic form, eHealth Literacy Scale (eHEALS), and the State-Trait Anxiety Inventory (STAI-I and STAI-II) during their preoperative anesthesia consultation.</p><p><strong>Results: </strong>A total of 325 patients scheduled for elective gynecologic surgery were included. The mean eHEALS score was 35.1 ± 8.4, with 47.7% of patients classified as having high eHL. Patients with higher eHL were significantly younger (<i>P</i> < 0.05), had lower BMI (<i>P</i> < 0.05), and had higher educational attainment (<i>P</i> < 0.05). High eHL was associated with lower state anxiety scores (38.3 ± 8.6 vs. 47.2 ± 7.7, <i>P</i> < 0.05) and trait anxiety scores (42.2 ± 7.7 vs. 49.4 ± 8.2, <i>P</i> < 0.05). Patients with higher eHL reported lower postoperative pain scores and were more likely to perceive themselves as well-informed about their surgery (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>Higher eHL is significantly associated with lower PA in patients undergoing gynecologic surgery. These findings highlight the importance of digital health competencies in surgical preparedness.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"249-254"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779883","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":"Another regional analgesic block for total knee arthroplasty!","authors":"Pranjali Kurhekar, Srinidhi Narayanan, Buddhan Rajarathinam","doi":"10.4103/sja.sja_923_25","DOIUrl":"10.4103/sja.sja_923_25","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"479"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779827","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":"Preoperative hypoalbuminemia as a prognosis indicator in patients with surgical sepsis and septic shock.","authors":"Van Minh Nguyen, Anh Nguyen Tran Dieu, Hoang Bach Nguyen, Xuan Thinh Tran, Thi Thuy Nga Bui, Tran Huu Thong, Jordan Francke, Thang Phan","doi":"10.4103/sja.sja_627_25","DOIUrl":"10.4103/sja.sja_627_25","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis and septic shock are among the leading causes of morbidity and mortality worldwide. Hypoalbuminemia is commonly observed preoperatively and may serve as a prognostic factor for predicting severity of sepsis and septic shock.</p><p><strong>Methodology: </strong>A cross-sectional, prospective descriptive study was conducted on 122 surgical adult patients diagnosed with sepsis or septic shock according to the Sepsis-3 criteria. All patients were admitted to the intensive care unit from April 2023 to May 2024.</p><p><strong>Results: </strong>A total of 46 patients (37.7%) were diagnosed with sepsis and 76 patients (62.3%) developed septic shock. The septic shock group had significantly longer hospital stays compared to the sepsis group (7 days vs. 4 days, respectively) and higher mortality rates (52.6% vs. 10.9%, respectively). Hypoalbuminemia was present in 89.3% of all patients, with 22.1% patients having severe hypoalbuminemia. There was a significant difference in mortality rates between patients with hypoalbuminemia and normal albumin level (40.4% vs. 7.7%, respectively). The mortality rate of severe hypoalbuminemia patients was also higher (48.1%) than non-severe hypoalbuminemia (37.8%) and normal albumin levels (7.7%). The adjusted odds ratio for post-operative in-hospital death comparing patients with hypoalbuminemia and patients with normal albumin level was 8.12 [1.02-64.73]. A preoperative hypoalbuminemia with cutoff of 29.8 g/L was the prognostic factor for mortality with an area under the receiver operating characteristic curve (AUROC) of 67.3%, sensitivity of 78.6%, and specificity of 56.6%.</p><p><strong>Conclusions: </strong>Preoperative albumin level was the potential prognostic indicator for severity and should be considered in the risk stratification model for patients with surgical sepsis and septic shock.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"344-350"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780128","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":"Opioid stewardship program implementation in pediatric surgeries: A systematic review.","authors":"Ahmed H Mahmoud, Rayan Muawad, Plino S Ruiz, Maha M Alkharisi, Hind Z Aljedani, Manar A Alhifzi, Sarah O Alobaidy, Maysoon A Abdelhamid, Raghad S Aloubili, Norah N Almutairi, Seham S Alshalahi, Abdullah AlDhuwaihy","doi":"10.4103/sja.sja_749_25","DOIUrl":"10.4103/sja.sja_749_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative opioid use in pediatric surgeries presents significant challenges due to associated risks such as dependence, oversedation, and misuse. Opioid stewardship programs (OSPs) aim to mitigate these risks by promoting appropriate opioid prescribing and multimodal pain strategies.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of current OSPs and their impact on opioid prescribing practices in pediatric surgeries.</p><p><strong>Methods: </strong>We systematically searched PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, and Web of Science for English language studies (2011-2024) that described opioid stewardship initiatives in pediatric surgery. Eighteen studies were included. We included randomized controlled trials, observational studies, and systematic reviews, excluding studies without a formal OSP, studies exclusively focusing on adults, and those without any specific outcomes. Data extraction and quality assessment were performed independently by multiple reviewers. Risk of bias was evaluated using Cochrane and ROBINS-I tools.</p><p><strong>Results: </strong>Eighteen studies were included with sample sizes ranging from 81 to more than 83,000 patients. The key interventions included opioid prescribing protocols, and guidelines, provider education about opioid use, and alternative pain management options to limit opioid dependence. All the studies reported reduction in opioid prescribing rates. There was reduction in discharge prescriptions from 68.4% to 10.7% after introducing consent (<i>P</i> < 0.001). There were no significant increases in emergency department visits related to reduced opioid prescribing. Pain scores remained stable, and oversedation events were reduced in some settings.</p><p><strong>Conclusion: </strong>Structured opioid stewardship interventions including protocols and guidelines, combined with targeted education and improved pain management techniques, effectively reduce opioid use while preserving adequate pain control. Future multicenter trials and studies will be required to further optimize opioid stewardship interventions and maximize patient outcomes.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"426-438"},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780135","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}