Saudi Journal of Anaesthesia最新文献

Background: In this prospective observational study, we aimed to determine the perioperative incidence and the risk factors of acute kidney injury after elective major abdominal surgery.

Methods: Adult patients who had undergone major elective abdominal surgery were included in the study. The patients were divided into Group AKI + and Group AKI, according to KDIGO criteria at 48 hours. Patients' demographic data, preoperative status, and laboratory data, operation-related data, and postoperative laboratory and follow-up data were noted. The patients were followed up for complications and mortality within three months after the operation date.

Results: In 425 patients included in the statistical analysis, the incidence of acute kidney injury after elective major abdominal surgery in our hospital was found to be 11.52% (49/425). In the multivariate analysis, postoperative continuation of vasopressor, mean arterial pressure <50 mmHg for at least 5 minutes, intraoperative 6% hydroxy-ethyl starch use, and high body mass index were found to be independent risk factors, in order of importance in increasing risk (OR 5.1, CI [1.4-18.9], P = 0,016; OR 3.9, CI [1.3-11.6], P = 0,014; OR 2.7, CI [1.1-6.8], P = 0,029; OR 1.2, CI [1.1-1.2], P < 0,001, respectively). 30- and 90-day mortality was found more frequently in patients who developed acute kidney injury.

Conclusions: In this study, we recommend modifying risk factors if possible, including avoiding 6% HES use and close blood pressure monitoring to reduce the incidence of postoperative acute kidney injury.

Objective: Postoperative airway complications pose significant risks in pediatric patients and are often multifactorial. Anatomical and physiological differences in children make predicting these complications challenging. This study examines the association between ultrasonographic (USG) measurements and postoperative airway complications, primarily focusing on the subglottic diameter-to-wall thickness difference ratio.

Methods: This prospective, double-blind study included pediatric patients aged 1-11 undergoing elective surgery between January and July 2024. Demographic and perioperative data, USG-measured airway diameters, wall thicknesses, and endotracheal tube (ETT) positions were recorded. The subglottic diameter-to-wall thickness difference ratio was the primary ultrasonographic measurement. Airway complications were assessed within the first postoperative hour, including cough, dysphonia, and laryngospasm. The relationship between USG measurements and complications was analyzed.

Results: Eighty patients were included, and airway complications were observed in 37.5% (n = 30). Patients with complications had lower height, subglottic diameter, and subglottic diameter-to-wall thickness difference ratio but higher subglottic wall and vocal cord thickness differences. In 70% (n = 20) of these cases, ETT had shifted superiorly from the second tracheal ring. The subglottic diameter-to-wall thickness difference ratio was significantly associated with complications (AUC 0.896, cutoff 32, sensitivity 80%, specificity 92%). ETT positioned above the second tracheal ring was also associated with increased complication risk (OR = 107.747, 95% CI: 5.305-2188.504, P = 0.002).

Conclusion: USG appears to be a valuable tool for assessing the association between the subglottic diameter-to-wall thickness difference ratio and postoperative airway complications in pediatric patients. Accurate evaluation of subglottic edema and proper ETT placement using USG may enhance patient safety.

Background: Ketamine has been shown to be an effective treatment at sub-anesthetic doses for various chronic pain conditions. This study assesses the relationship between oral ketamine and the incidence of adverse side effects in patients receiving long-term, moderate to high-dose tablets for chronic pain.

Materials and methods: All adult patients given prescriptions for oral ketamine from November 2019 to October 2023 were identified for our initial cohort. Patients were excluded if they failed to reach at least 80 mg per day during their treatment period or if their treatment periods lasted less than 90 days. Demographic variables, comorbidities, prescription information, and patient-reported side effects were recorded.

Results: This study identified 193 patients who received oral ketamine prescriptions at our institution. One hundred forty-nine patients received 80 mg-159 mg per day, 24 patients received 160 mg-199 mg per day, and 20 patients received 200 mg-240 mg per day. In Group 1, 9 of the 149 patients (6.0%) reported 12 instances of side effects; in Group 2, 2 of the 24 patients (8.3%) reported 6 instances of side effects; in Group 3, 2 of the 20 patients (10%) reported 2 instances of side effects. The maximum average daily dosage was not associated with the number of reported side effects (P = 0.10). Age was the only covariate associated with the number of adverse side effects (P = 0.04).

Conclusion: Our results suggest that at daily doses above 80 mg and up to 240 mg, oral ketamine does not show a dose-dependent relationship in predicting the number of patient-reported side effects.

Background: Pneumatic tourniquets are used in orthopedic surgeries to provide a bloodless surgical area and reduce blood loss. Tourniquet inflation causes metabolic changes, leading to cerebral vasodilatation and increased intracranial pressure (ICP). A new noninvasive method to measure optic nerve sheath diameter (ONSD) via ultrasonography to detect the raised ICP is reliable, inexpensive, and can be repeated many times.

Materials and methods: In this prospective observational study, 23 patients aged between 16 and 60 years, undergoing elective lower limb orthopedic surgeries under spinal anesthesia were included. After pre-anesthetic evaluation and obtaining informed written consent, an ocular ultrasound was performed to measure baseline ONSD in both eyes. Spinal anesthesia was administered and A pneumatic thigh tourniquet was applied as close as possible to the limb root and inflated to 150 mmHg-250 mmHg above the systolic blood pressure. A total of 5 measurements of ONSD were taken by the investigator (anesthetist): before giving spinal anesthesia, after giving spinal anesthesia, before tourniquet deflation, within 5 min, and after 10 min of tourniquet deflation.

Results: In our study, the mean age of subjects was 34.57 ± 13.5 years. The majority were males (83%). The subjects showed an increase in ONSD after pneumatic tourniquet deflation in comparison with the baseline values, in the left eye [0.543 cm ± 0.021, P < 0.001] and the right eye [0.549 cm ± 0.021, P < 0.001], which were statistically significant.

Conclusion: The impact of pneumatic tourniquet deflation on ONSD measurements recorded by ultrasound in lower limb orthopedic surgeries was significant and this change occurred with a simultaneous increase in end-tidal carbon dioxide (EtCO₂).

Sturge-Weber Syndrome (SWS) is a non-familial neurocutaneous disease related to capillary-venous malformations affecting many parts, such as the brain, skin, eyes, face, and respiratory tract and characterized by facial capillary malformation (port wine stain), which is a highly complex and significant challenge for anaesthesiologists. Difficult ventilation and intubation are expected in patients with airway, mouth, lip, and facial involvement of angiomas. Soft induction intubation and extubation are required to prevent increased intracranial (ICP) and intraocular pressure (IOP). We aimed to present the case of a 36-year-old female patient with a hemangioma covering three-quarters of the oral cavity, pharynx, larynx, floor of the mouth, face, neck, and both arms, and her lower lip was significantly swollen and protruding due to the angioma, and she had macroglossia. Therefore, a comprehensive preoperative multidisciplinary approach to examining, evaluating, and closely monitoring these patients is crucial for successful anesthesia management.

Breast cancer is the most common malignancy among Saudi women, with Modified Radical Mastectomy (MRM) as a standard treatment, typically performed under general anesthesia (GA). However, GA poses significant risks to patients with multiple comorbidities. We present a 66-year-old female with invasive ductal carcinoma, complicated by scleroderma with interstitial lung disease, chemotherapy-induced heart failure, and hypertension, making GA a high-risk option. To optimize perioperative safety, thoracic epidural anesthesia (TEA) combined with a pectoralis nerve block (PECS2) was used instead. This approach provided effective surgical anesthesia, hemodynamic stability, and minimized opioid use. The patient tolerated the procedure well, with intraoperative hypotension managed by vasopressor support. She resumed oral intake within 6 hours, required minimal postoperative opioids, and was discharged on the third postoperative day without complications. This case highlights the feasibility and advantages of TEA with PECS2 block as a safe and effective alternative to GA in high-risk MRM patients. By reducing GA-related pulmonary and cardiac risks, improving postoperative pain control, and shortening hospital stays, this technique may enhance perioperative outcomes in select patients. Further studies are warranted to support the wider adoption of regional anesthesia in oncologic breast surgeries.

Background: We proposed that the L3 paravertebral block (PVB) combined with the retro-psoas compartment block (RPCB) would provide a better postoperative analgesia for total knee arthroplasty (TKA) than the femoral nerve block (FNB) alone.

Materials and methods: A total of 66 patients scheduled for TKA were randomly allocated to receive either FNB or L3 PVB-RPCB. Postoperative patient-controlled analgesia with intravenous sufentanil was administered. The primary endpoint was the total sufentanil consumption within the first 24 hour postoperative. Secondary outcomes assessed included pain intensity, sensory dermatomal coverage 20 min after administering the blocks, rescue analgesia requests, satisfaction scores, and the incidence of nausea, vomiting, itching, and posterior knee pain.

Results: Patients in the L3 PVB-RPCB group consumed significantly less sufentanil in the first 24-hour post-surgery compared to those who received an FNB, with intake measuring 30 [28 to 33] ug versus 43 [37 to 46] ug, respectively, (P < 0.01). Furthermore, the pain scores were significantly lower in patients with L3 PVB-RPCB at 6 hour and 12 hours at rest (P < 0.01), and at 12 hours on movement (P < 0.01). This group also showed a reduced need for rescue analgesia and experienced less posterior knee pain (P < 0.01). There were no significant differences in satisfaction scores or in the occurrence of opioid-related side effects.

Conclusion: The reduction of sufentanil consumption within the initial 24 hour after TKA demonstrates a beneficial effect of L3 PVB-RPCB over the FNB in providing the postoperative analgesia.

Background: Recommended prophylaxis against postspinal hypotension includes vasopressor infusions needing continuous and accurate titration preferably with infusion pumps, along with close blood pressure monitoring. In resource constrained settings with high volume obstetric care such intensive management may be difficult for every patient. Thus a dependent, simple tool without need of advanced technology to predict postspinal hypotension is desirable. Although PRAM score is such a tool it has never been validated.

Aim: To validate previously formulated bed-side PRAM score (also after adding postspinal tachycardia as a variable) for predicting postspinal hypotension.

Materials and methods: This prospective study included 371 consenting patients scheduled for elective/emergency cesarean delivery using standardized spinal block. Postspinal hypotension was defined as systolic blood pressure <80% of baseline or <90mmHg, whichever was higher (upto 15 minutes after baby delivery); and managed with boluses of phenylephrine (50 μg i.v.) till resolution. PRAM score included grade of 1 for each of: baseline heart rate >90 bpm, mean arterial pressure <90 mmHg and age >25 years minutes. Postspinal tachycardia was an increase in heart rate by >10 bpm within 5 minutes.

Results: Incidence of postspinal hypotension was 49.3%, with median onset time of 3 minutes, number of hypotensive episodes ranging from 0 to 5, and amount of phenylephrine required 50-300 μg. ROC analysis showed significant predictive value of PRAM score for postspinal hypotension, with an AUC of 0.578 [95% CI: 0.520-0.636] (P= 0.008); and sensitivity of 89% at cut-off value of PRAM score= 1. When including tachycardia within the first 5 minutes post-block, modified PRAM score had improved predictive accuracy with AUC of 0.601 [95% CI: 0.544-0.659] (P = 0.001).

Conclusion: The PRAM score effectively predicts postspinal hypotension during cesarean delivery.

Sublingual dexmedetomidine under the tradename of IgalmiTM is the first and only FDA-approved sedative agent for treating agitation in schizophrenia and bipolar I or II patients. This article highlights the benefits and adverse effects associated with this novel route of administration of dexmedetomidine and its potential to emerge as a promising sedative agent.