Saudi Journal of Anaesthesia最新文献

Trigeminal neuralgia (TN) is a debilitating condition characterized by excruciating facial pain resulting from dysfunction in the trigeminal nerve. Treatment options are limited. Noninvasive pulsed radiofrequency (PRF) therapy is an emerging promising approach to managing TN. This therapy provides pain control without tissue damage or unpleasant side effects compared to invasive procedures. Here, we present five cases of trigeminal neuralgia successfully managed with noninvasive PRF therapy. Our case series contributes to the existing literature and supports the potential efficacy of noninvasive PRF therapy for TN.

Pycnodysostosis is a very rare autosomal recessive disease. This disorder presents with osteosclerosis, leading to fragile bones, short stature, craniofacial abnormalities, laryngomalacia, sleep apnea syndrome, and many other findings. Difficulty intubation is very common. In our case, we have a patient scheduled for a plastic surgery on her skull under general anesthesia (GA), but she could not lie in a flat position as this could lead to cyanosis and cardiac arrest. So, we have to intubate her in 45° back-up position. Intubation in positions different from the usual supine one probably because of severe laryngomalacia in this patient is possible but needs skilled anesthesiologists and trained personnel.

This case report highlights complexities in an intellectually disabled adult who ingested a chicken bone, resulting in a rare complication-superior thyroid artery injury. Presentation, diagnostic challenges, and a multidisciplinary approach are detailed. Initial attempts at esophagoscopy under general anesthesia were hindered by blood coughing, leading to a change of plan. Subsequent findings revealed mucosal edema and continuous bleeding from the site. Challenges in anesthetizing intellectually disabled individuals are emphasized, stressing tailored induction methods. The case concluded with successful embolization but developed neurological complication which was successfully managed showcasing the significance of a collaborative and adaptable approach.

Carcinoid crisis is a potentially fatal condition with severe hemodynamic instability. A 25-year-old female with metastatic pancreatic neuroendocrine tumor with recurrent carcinoid crises was posted for surgical debulking. Intraoperatively, the patient was on crisis during manipulation of the lesion by the surgeon, which was unresponsive to octreotide, infusions of phenylephrine, and norepinephrine agents. The patient was then effectively managed with adrenaline blouses at 10 µg along with infusion of adrenaline. Use of inotropes and vasopressors is not encouraged in carcinoid due to release of inflammatory mediators which can precipitate the hemodynamic instability. Here, we managed her with adrenaline boluses and infusion.

Arteriovenous malformation (AVM) of the head and neck, though rare, can present significant clinical challenges, particularly during dental procedures. This case report details the acute management of a 7-year-old girl with an AVM in the right mandible, with sudden, severe, torrential intraoral hemorrhage during an angioembolization procedure, necessitating immediate airway management and hemodynamic stabilization in a nonoperating room anesthesia (NORA) setting. Persistent bleeding led to a multidisciplinary intervention, including external carotid artery ligation and right hemimandibulectomy, achieving hemostasis. The case underscores the importance of meticulous planning, readiness with resuscitation and airway management equipment, and coordinated efforts among anesthesia and surgical teams in NORA settings to manage such critical situations effectively.

Background and aims: Low back pain is a common problem and a major burden to society. Transforaminal epidural steroid injection is one of the most effective treatment modalities for back pain. We aim to objectively quantify pain relief of lumbosacral radicular pain post transforaminal steroid injection by correlating perfusion index (PI), reflecting real-time peripheral blood flow change at the site of monitoring, controlled by sympathetic system with Numerical rate score (NRS) and SLRT improvement.

Material and methods: A prospective observational study, conducted at K.S Hegde Medical Academy, Mangaluru, from June 2021 to June 2022 as a time-bound study. After IEC clearance (IEC certificate number) for the procedure and study, patients undergoing transforaminal epidural steroid injection for lumbosacral radicular pain were enrolled, excluding those meeting the exclusion criteria. PI change and NRS score improvement were noted at 0, 5, 10, 15, and 30 minutes along with pre and post-procedure SLRT. Results were analyzed.

Results: A total of 40 patients were analyzed. PI change at 30 minutes was 2.113 from a baseline of 0.217. Median NRS of 5, improved to 0 and the mean SLRT of 45.17 to 61.45 at the end of 30 minutes. All changes are statistically significant with P (<0.01). correlation between the PI change with NRS is mild (-0.312).

Conclusion: PI change ratio shows an overall improvement in pain levels objectively, in a non-invasive, easy, and reliable way. Simultaneous improvement in both NRS and SLRT is clinically significant but cannot predict a correlated quantitative measure of pain relief.

This case report delves into pediatric lung isolation challenges and innovations in managing patients with pulmonary alveolar proteinosis undergoing whole lung lavage. The central focus is on a 5-year-old girl who initially encountered intraoperative complications, including bilateral pneumothorax and pulmonary edema. However, a subsequent attempt employing a Foley's catheter for lung isolation proved successful, with the patient displaying marked postoperative improvements. The case offers valuable insights into the intricate balance of anesthesia, ventilatory parameters, and the novel use of common medical equipment, like the Foley's catheter, for specialized procedures in pediatric pulmonology.