Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_545_23
Victor Grech, Abdelazeem A Eldawlatly
The purpose of research is to seek answers and new knowledge. When conducted properly and systematically, research adds to humanity's corpus of knowledge and hence to our general advancement. However, this is only possible if reported research is accurate and transparent. Guidelines for all the major types of studies (STROBE, CONSORT, PRISMA, MOOSE, STARD, and SPIRIT) have been developed and refined over the years, and their inception, development, and application are briefly discussed in this paper. Indeed, there are currently over 250 of these guidelines for various types of medical research, and these are published by the EQUATOR network. This paper will also briefly review progress in acceptance and adoption of these guidelines.
{"title":"STROBE, CONSORT, PRISMA, MOOSE, STARD, SPIRIT, and other guidelines - Overview and application.","authors":"Victor Grech, Abdelazeem A Eldawlatly","doi":"10.4103/sja.sja_545_23","DOIUrl":"10.4103/sja.sja_545_23","url":null,"abstract":"<p><p>The purpose of research is to seek answers and new knowledge. When conducted properly and systematically, research adds to humanity's corpus of knowledge and hence to our general advancement. However, this is only possible if reported research is accurate and transparent. Guidelines for all the major types of studies (STROBE, CONSORT, PRISMA, MOOSE, STARD, and SPIRIT) have been developed and refined over the years, and their inception, development, and application are briefly discussed in this paper. Indeed, there are currently over 250 of these guidelines for various types of medical research, and these are published by the EQUATOR network. This paper will also briefly review progress in acceptance and adoption of these guidelines.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681533","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_378_23
Manu P Kesavankutty, Chinmaya Panda, Habib M R Karim, Subrata Singha, Sarita Agrawal
Background and objectives: Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH.
Material and methods: Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH.
Results: It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP <65 mm Hg (P = 0.01). However, IVCCI was found to be statistically insignificant if PSH was considered a 20% reduction in baseline MBP. The correlation matrix between IVCCI and PI showed Pearson's r-value of 0.525, indicating a substantial relationship between the two (P = 0.003). Multivariate logistic regression analysis had shown that neither IVCCI nor PI was a good predictor of PSH in parturients for both definition groups for PSH.
Conclusion: Although there is a modest correlation between PI and IVCCI, both cannot be used to predict postspinal hypotension in parturients undergoing elective lower-segment cesarean section (LSCS).
背景和目的:椎管内麻醉是选择性剖宫产的首选技术,其突出的副作用是椎管内麻醉后低血压(PSH)。这需要及早预测,以避免胎儿-产妇并发症的发生。本研究旨在评估灌注指数(PI)和下腔静脉塌陷指数(IVCCI)在预测PSH方面的诊断准确性:30名美国麻醉医师协会体格状态(ASA-PS)1级和2级的剖宫产产妇参加了研究。术前记录了 IVCCI、PI、基线收缩压(SBP)、舒张压(DBP)、平均血压(MBP)和心率(HR)。MBP 从基线下降 20% 或低于 65 mm Hg 即为 PSH。脊髓麻醉后,再次记录 SBP、DBP、MBP 和 HR 以诊断 PSH:在 PSH 定义的两个组别中,比较 PSH 组和非 PSH 组的 PI 没有发现任何统计学差异。当 PSH 被视为 MBP 时,IVCCI 明显更高(P=0.01)。然而,如果将 PSH 视为基线 MBP 降低 20%,则 IVCCI 在统计学上并不显著。IVCCI 和 PI 之间的相关矩阵显示,Pearson 的 r 值为 0.525,表明二者之间存在实质性关系(P = 0.003)。多变量逻辑回归分析表明,在 PSH 的两个定义组别中,IVCCI 和 PI 都不能很好地预测产妇的 PSH:结论:尽管 PI 和 IVCCI 之间存在一定的相关性,但两者都不能用于预测择期进行下段剖宫产术(LSCS)的产妇的椎管后低血压。
{"title":"The diagnostic accuracy of preoperative perfusion index as a predictor of postspinal anesthesia hypotension in parturients undergoing cesarean delivery: A prospective non-blinded observational study.","authors":"Manu P Kesavankutty, Chinmaya Panda, Habib M R Karim, Subrata Singha, Sarita Agrawal","doi":"10.4103/sja.sja_378_23","DOIUrl":"10.4103/sja.sja_378_23","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH.</p><p><strong>Material and methods: </strong>Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH.</p><p><strong>Results: </strong>It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP <65 mm Hg (<i>P</i> = 0.01). However, IVCCI was found to be statistically insignificant if PSH was considered a 20% reduction in baseline MBP. The correlation matrix between IVCCI and PI showed Pearson's r-value of 0.525, indicating a substantial relationship between the two (<i>P</i> = 0.003). Multivariate logistic regression analysis had shown that neither IVCCI nor PI was a good predictor of PSH in parturients for both definition groups for PSH.</p><p><strong>Conclusion: </strong>Although there is a modest correlation between PI and IVCCI, both cannot be used to predict postspinal hypotension in parturients undergoing elective lower-segment cesarean section (LSCS).</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681536","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_135_23
Wu Jinghua, Niu Xiong, Li Min
This study aimed to evaluate the effect of inverse ratio ventilation (IRV) strategy on cardiopulmonary function in obese patients under general anesthesia. Databases such as China National Knowledge Infrastructure (CNKI), Wangfang, WeiP, Web of Science, the Cochrane Library, and PubMed were systematically searched. All randomized controlled trials' literature on IRV during laparoscopic surgery in obese patients under general anesthesia was collected. After data were extracted and cross-checked, Rev Man 5.3 software was used for meta-analysis. Finally, five randomized controlled clinical trials (RCTs) were included in the meta-analysis, with a total of 312 patients. Compared with the conventional ventilation group, the inspiratory peak pressure was lower at pneumoperitoneum 30 min and pneumoperitoneum 60 min; the PaO2 and oxygenation index were higher at pneumoperitoneum 60 min, and mean airway pressure was higher at pneumoperitoneum 30 min and pneumoperitoneum 60 min; the dynamic lung compliance was superior at pneumoperitoneum 30 min and pneumoperitoneum 60 min. IRV applied to laparoscopic surgery in obese patients under general anesthesia not only reduces peak airway pressure and improves intraoperative oxygenation index and PaO2 but also enhances mean airway pressure and dynamic lung compliance, which has a specific lung protective effect. It can be used as an option for the mechanical ventilation model in obese patients in clinical practice.
{"title":"The effect of inverse ratio ventilation on cardiopulmonary function in obese laparoscopic surgery patients: A systematic review and meta-analysis.","authors":"Wu Jinghua, Niu Xiong, Li Min","doi":"10.4103/sja.sja_135_23","DOIUrl":"10.4103/sja.sja_135_23","url":null,"abstract":"<p><p>This study aimed to evaluate the effect of inverse ratio ventilation (IRV) strategy on cardiopulmonary function in obese patients under general anesthesia. Databases such as China National Knowledge Infrastructure (CNKI), Wangfang, WeiP, Web of Science, the Cochrane Library, and PubMed were systematically searched. All randomized controlled trials' literature on IRV during laparoscopic surgery in obese patients under general anesthesia was collected. After data were extracted and cross-checked, Rev Man 5.3 software was used for meta-analysis. Finally, five randomized controlled clinical trials (RCTs) were included in the meta-analysis, with a total of 312 patients. Compared with the conventional ventilation group, the inspiratory peak pressure was lower at pneumoperitoneum 30 min and pneumoperitoneum 60 min; the PaO2 and oxygenation index were higher at pneumoperitoneum 60 min, and mean airway pressure was higher at pneumoperitoneum 30 min and pneumoperitoneum 60 min; the dynamic lung compliance was superior at pneumoperitoneum 30 min and pneumoperitoneum 60 min. IRV applied to laparoscopic surgery in obese patients under general anesthesia not only reduces peak airway pressure and improves intraoperative oxygenation index and PaO2 but also enhances mean airway pressure and dynamic lung compliance, which has a specific lung protective effect. It can be used as an option for the mechanical ventilation model in obese patients in clinical practice.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681537","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_646_23
Min Hee Heo, Hwan Yong Choi, Kwanghyuk Lee, Ji Yeon Kim
Posterior reversible encephalopathy syndrome (PRES) is a disorder characterized by vasogenic edema affecting the posterior brain region. We report a case of PRES in a 36-year-old woman with preeclampsia who underwent an emergency cesarean section with spinal anesthesia. After surgery, she developed right leg weakness, headache, and seizures. Imaging showed white matter edema consistent with PRES. The exact cause of PRES is unclear, but elevated blood pressure and endothelial dysfunction are implicated. Tight blood pressure control in PRES is crucial for management, and prompt recognition and treatment are essential for favorable outcomes.
{"title":"A complex case of posterior reversible encephalopathy syndrome after combined spinal epidural of preeclampsia parturient: A case report.","authors":"Min Hee Heo, Hwan Yong Choi, Kwanghyuk Lee, Ji Yeon Kim","doi":"10.4103/sja.sja_646_23","DOIUrl":"10.4103/sja.sja_646_23","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome (PRES) is a disorder characterized by vasogenic edema affecting the posterior brain region. We report a case of PRES in a 36-year-old woman with preeclampsia who underwent an emergency cesarean section with spinal anesthesia. After surgery, she developed right leg weakness, headache, and seizures. Imaging showed white matter edema consistent with PRES. The exact cause of PRES is unclear, but elevated blood pressure and endothelial dysfunction are implicated. Tight blood pressure control in PRES is crucial for management, and prompt recognition and treatment are essential for favorable outcomes.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681439","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_536_23
Khalid Ibrahim Aljonaieh, Sadal Aldakhil
A sympathetic crashing pulmonary edema (SCAPE) is an emergency medical situation necessitating early recognition and treatment. We present a case of a 15-years old male who underwent a toenail excision of his left big toe and who developed SCAPE postoperatively. The low incidence of SCAPE intraoperatively makes it challenging for anesthesiologists to diagnose it. It occurs unexpectedly and precipitously, and it may increase the risks of morbidity and mortality if it is not treated promptly. Our aim is to raise awareness of how to abruptly manage such cases.
{"title":"Pulmonary edema: A complication of post-complete ingrown toenail excision. A case report.","authors":"Khalid Ibrahim Aljonaieh, Sadal Aldakhil","doi":"10.4103/sja.sja_536_23","DOIUrl":"10.4103/sja.sja_536_23","url":null,"abstract":"<p><p>A sympathetic crashing pulmonary edema (SCAPE) is an emergency medical situation necessitating early recognition and treatment. We present a case of a 15-years old male who underwent a toenail excision of his left big toe and who developed SCAPE postoperatively. The low incidence of SCAPE intraoperatively makes it challenging for anesthesiologists to diagnose it. It occurs unexpectedly and precipitously, and it may increase the risks of morbidity and mortality if it is not treated promptly. Our aim is to raise awareness of how to abruptly manage such cases.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681530","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_710_23
Khushboo Pandey, Wasimul Hoda
Cannabis derivatives have been conventionally employed globally for their curative and restorative properties for various ailments. However, its recreational use and consequent legal restrictions have substantially cramped its scientific research. An emerging interest regarding the profound therapeutic potential of cannabinoids has been observed among clinicians. Despite a rich cultural background, high-quality research on cannabinoids is lacking in the Indian scenario. This review readdresses the challenges on this front and brings an insight into the current status of cannabinoids and their utility in scientific exploration. Cannabinoids have a significant medicinal value in various clinical disorders. Its use so far has been based on scarce resources and corroborations, as evidence-based substantiation is limited. Through this review article, we emphasize the remarkable role enacted by cannabinoids in the treatment of various clinical disorders and an utterly significant need to formulate stringent research methodologies to promote its systematic investigation.
{"title":"Cannabinoids in anesthesia and chronic pain: Where do we stand?","authors":"Khushboo Pandey, Wasimul Hoda","doi":"10.4103/sja.sja_710_23","DOIUrl":"10.4103/sja.sja_710_23","url":null,"abstract":"<p><p>Cannabis derivatives have been conventionally employed globally for their curative and restorative properties for various ailments. However, its recreational use and consequent legal restrictions have substantially cramped its scientific research. An emerging interest regarding the profound therapeutic potential of cannabinoids has been observed among clinicians. Despite a rich cultural background, high-quality research on cannabinoids is lacking in the Indian scenario. This review readdresses the challenges on this front and brings an insight into the current status of cannabinoids and their utility in scientific exploration. Cannabinoids have a significant medicinal value in various clinical disorders. Its use so far has been based on scarce resources and corroborations, as evidence-based substantiation is limited. Through this review article, we emphasize the remarkable role enacted by cannabinoids in the treatment of various clinical disorders and an utterly significant need to formulate stringent research methodologies to promote its systematic investigation.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681445","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_549_23
Sultan A Meo, Abdelazeem A Eldawlatly, Tehreem Sultan
Background: The geo-strategic position of Pakistan on the world map is incredibly important and idyllic as the country is considered the gateway to central Asia. Pakistan has faced political instability for the last three decades, causing a brain drain and adversely affecting socioeconomic growth. This study aims to investigate the impact of an unstable environment on the brain drain of highly skilled professionals, healthcare workers, researchers, and research productivity in Pakistan from January 2000 to December 2022.
Material and methods: The data were recorded from the World Bank, the Higher Education Commission (HEC) Pakistan, the Pakistan Medical and Dental Council (PMDC), the Bureau of Emigration and Overseas Employment (BEOS), Pakistan, Academic Ranking of World Universities (ARWU), and Web of Science Clarivate Analytics. Initially, 32 documents were selected in this study, and finally, eight fact sheets, official government websites, and international organizations were included.
Results: The result revealed that due to political instability, in 2022 about 832,339 highly qualified and accomplished experts headed abroad, among them 17976 (2.15%) were highly qualified and 20865 (2.50%) were highly competent professionals. These include accountants 7197 (0.86%), engineers 6,093 (0.73%), agricultural experts 3,110 (0.37%), doctors 2,464 (0.29%), computer experts 2,147 (0.25%), nurses and paramedics 1768 (0.21%), technicians 23347 (2.80%), electricians 20322 (2.44%), and schools and university faculty 1004 (0.12%). Pakistan has a total of 380 Higher Education Commission-indexed academic journals, among them 11 (2.89%) academic journals were indexed in the Web of Science and 23 journals were placed in the Web of Science emerging indexing. Among these journals, only one journal surpassed the impact factor of more than 2.0. The quartile ranking of Pakistani journals is 01 journal in Q2; 02 in Q3; and the remaining 08 journals in Q4. From August 1947 to December 2022, Pakistan produced a total of 259249 research articles, and from January 2000 to December 2022, the number of articles published was 248457 (95.83%). Since the last 22 years, the trend of research publications was continuously increased; however, the rising trend decreased in 2022 with a declined rate of 1263 (3.42%).
Conclusion: The unstable sociopolitical environment in Pakistan caused a brain drain of highly qualified and skilled professionals and impaired the global standing of universities, academic journals, and research productivity in Pakistan. Pakistan must resolve the instability and establish sustainable policies to minimize the brain drain of highly qualified and skilled experts and convalesce their academic institutes and their research productivity for the development of the nation.
{"title":"Impact of unstable environment on the brain drain of highly skilled professionals, healthcare workers, researchers, and research productivity in Pakistan.","authors":"Sultan A Meo, Abdelazeem A Eldawlatly, Tehreem Sultan","doi":"10.4103/sja.sja_549_23","DOIUrl":"10.4103/sja.sja_549_23","url":null,"abstract":"<p><strong>Background: </strong>The geo-strategic position of Pakistan on the world map is incredibly important and idyllic as the country is considered the gateway to central Asia. Pakistan has faced political instability for the last three decades, causing a brain drain and adversely affecting socioeconomic growth. This study aims to investigate the impact of an unstable environment on the brain drain of highly skilled professionals, healthcare workers, researchers, and research productivity in Pakistan from January 2000 to December 2022.</p><p><strong>Material and methods: </strong>The data were recorded from the World Bank, the Higher Education Commission (HEC) Pakistan, the Pakistan Medical and Dental Council (PMDC), the Bureau of Emigration and Overseas Employment (BEOS), Pakistan, Academic Ranking of World Universities (ARWU), and Web of Science Clarivate Analytics. Initially, 32 documents were selected in this study, and finally, eight fact sheets, official government websites, and international organizations were included.</p><p><strong>Results: </strong>The result revealed that due to political instability, in 2022 about 832,339 highly qualified and accomplished experts headed abroad, among them 17976 (2.15%) were highly qualified and 20865 (2.50%) were highly competent professionals. These include accountants 7197 (0.86%), engineers 6,093 (0.73%), agricultural experts 3,110 (0.37%), doctors 2,464 (0.29%), computer experts 2,147 (0.25%), nurses and paramedics 1768 (0.21%), technicians 23347 (2.80%), electricians 20322 (2.44%), and schools and university faculty 1004 (0.12%). Pakistan has a total of 380 Higher Education Commission-indexed academic journals, among them 11 (2.89%) academic journals were indexed in the Web of Science and 23 journals were placed in the Web of Science emerging indexing. Among these journals, only one journal surpassed the impact factor of more than 2.0. The quartile ranking of Pakistani journals is 01 journal in Q2; 02 in Q3; and the remaining 08 journals in Q4. From August 1947 to December 2022, Pakistan produced a total of 259249 research articles, and from January 2000 to December 2022, the number of articles published was 248457 (95.83%). Since the last 22 years, the trend of research publications was continuously increased; however, the rising trend decreased in 2022 with a declined rate of 1263 (3.42%).</p><p><strong>Conclusion: </strong>The unstable sociopolitical environment in Pakistan caused a brain drain of highly qualified and skilled professionals and impaired the global standing of universities, academic journals, and research productivity in Pakistan. Pakistan must resolve the instability and establish sustainable policies to minimize the brain drain of highly qualified and skilled experts and convalesce their academic institutes and their research productivity for the development of the nation.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681456","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_384_23
Jatuporn Eiamcharoenwit, Phuping Akavipat
Background: Various complications occur in patients undergoing deep brain stimulation (DBS) surgery. The objective of this study was to determine the incidence of complications in patients with Parkinson's disease who underwent DBS surgery and identify the risk factors, especially anesthetic factors.
Methods: A retrospective cohort study was performed between May 2015 and December 2022. Based on a review of medical charts, patients aged 18 years or older who underwent DBS surgery at a tertiary neurological center in Thailand were recruited. Univariate analysis using the Chi-square test or Fisher's exact test was performed to compare patients with and without complications. Multivariate logistic regression analysis was performed to identify the predictive factors for complications.
Results: The study included 46 patients. The most common complication during DBS electrode placement was hypertension (30/46, 65.2%), and 19 patients (41.3%) who developed hypertension did not receive antihypertensive treatment. The most common complication during battery placement was clinical hypotension (14/46, 30.4%). The most common postoperative complication was delirium (6/46, 13.0%). In the multivariate analysis, no significant independent risk factors for overall complications after DBS surgery were identified.
Conclusions: Hypertension during DBS electrode insertion was the most common perioperative complication. Hemodynamic instability is preventable and manageable, and vigilant and prompt treatment should be provided during DBS surgery.
{"title":"Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study.","authors":"Jatuporn Eiamcharoenwit, Phuping Akavipat","doi":"10.4103/sja.sja_384_23","DOIUrl":"10.4103/sja.sja_384_23","url":null,"abstract":"<p><strong>Background: </strong>Various complications occur in patients undergoing deep brain stimulation (DBS) surgery. The objective of this study was to determine the incidence of complications in patients with Parkinson's disease who underwent DBS surgery and identify the risk factors, especially anesthetic factors.</p><p><strong>Methods: </strong>A retrospective cohort study was performed between May 2015 and December 2022. Based on a review of medical charts, patients aged 18 years or older who underwent DBS surgery at a tertiary neurological center in Thailand were recruited. Univariate analysis using the Chi-square test or Fisher's exact test was performed to compare patients with and without complications. Multivariate logistic regression analysis was performed to identify the predictive factors for complications.</p><p><strong>Results: </strong>The study included 46 patients. The most common complication during DBS electrode placement was hypertension (30/46, 65.2%), and 19 patients (41.3%) who developed hypertension did not receive antihypertensive treatment. The most common complication during battery placement was clinical hypotension (14/46, 30.4%). The most common postoperative complication was delirium (6/46, 13.0%). In the multivariate analysis, no significant independent risk factors for overall complications after DBS surgery were identified.</p><p><strong>Conclusions: </strong>Hypertension during DBS electrode insertion was the most common perioperative complication. Hemodynamic instability is preventable and manageable, and vigilant and prompt treatment should be provided during DBS surgery.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681457","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_104_23
Narjes Alotaibi, Mahmoud Althaqafi, Abdullah Alharbi, Ahmed Thallaj, Abdulaziz Ahmad, Abdullah Aldohayan, Fahad Bamehriz, Abdelazeem Eldawlatly
Background: Anesthesia with deep neuromuscular block for laparoscopic surgery may result in less postoperative pain with lower intra-abdominal pressure. However, the results in the existing literature are controversial. This study aimed to evaluate the effect of deep versus moderate neuromuscular block (NMB) on the postoperative recovery characteristics after laparoscopic sleeve gastrectomy (LSG) for weight loss surgery.
Methods: This is parallel-group, randomized clinical trial. The study was conducted at a tertiary care center. Patients undergoing LSG were included. Patients were randomly assigned to either deep (post-tetanic count 1-2) or moderate (train-of-four 1-2) NMB group. The primary outcomes were numeric rating scale scores of the postoperative pain at rest and postoperative shoulder pain. The secondary outcomes were the length of hospital stay (LOS) and postoperative complications. The statistics were performed using StatsDirect statistical software (Version 2.7.9).
Results: Two groups were identified: Group D (deep NMB), 29 patients, and Group M (moderate NMB), 28 patients. The BMI mean values for groups D and M were 44 and 45 kg/m2 respectively (P > 0.05). The mean durations of surgery for were 46.7 min and 44.1 min for groups M and D, respectively (P > 0.05). The mean train-of-four (TOF) counts were 0.3 and 0 for groups M and D, respectively (P < 0.05). The mean times from giving reversal agent to tracheal extubation (minutes) were 6.5 and 6.58 min for groups M and D, respectively (P > 0.05). In the recovery room, the means of pain scores were 3 and 4 for groups M and D, respectively (P > 0.05). Upon admission to the surgical ward, the median values of the pain score were non-significant (P > 0.05) (95% CI: 0.4-0.7). The opioid consumption in the recovery room was non-significant between both groups (P > 0.05) (95% CI: 0.3-0.6). Postoperative shoulder pain was non-significant between both groups (P > 0.05) (95% CI: 0.4-0.7). The median values of surgeon opinion of both groups were non-significant (P > 0.05). Regarding the LOS, the mean values of groups D and M were 1.20 and 1.21 days, respectively (P > 0.05).
Conclusions: There was no significant difference between moderate and deep NMB techniques in terms of duration of the surgical procedure, postoperative pain, shoulder pain, and length of hospital stay. Further studies on a larger sample size are required to investigate the long-term recovery characteristics of patients with obesity undergoing LSG.
{"title":"The impact of moderate versus deep neuromuscular blockade on the recovery characteristics following laparoscopic sleeve gastrectomy: A randomized double blind clinical trial.","authors":"Narjes Alotaibi, Mahmoud Althaqafi, Abdullah Alharbi, Ahmed Thallaj, Abdulaziz Ahmad, Abdullah Aldohayan, Fahad Bamehriz, Abdelazeem Eldawlatly","doi":"10.4103/sja.sja_104_23","DOIUrl":"10.4103/sja.sja_104_23","url":null,"abstract":"<p><strong>Background: </strong>Anesthesia with deep neuromuscular block for laparoscopic surgery may result in less postoperative pain with lower intra-abdominal pressure. However, the results in the existing literature are controversial. This study aimed to evaluate the effect of deep versus moderate neuromuscular block (NMB) on the postoperative recovery characteristics after laparoscopic sleeve gastrectomy (LSG) for weight loss surgery.</p><p><strong>Methods: </strong>This is parallel-group, randomized clinical trial. The study was conducted at a tertiary care center. Patients undergoing LSG were included. Patients were randomly assigned to either deep (post-tetanic count 1-2) or moderate (train-of-four 1-2) NMB group. The primary outcomes were numeric rating scale scores of the postoperative pain at rest and postoperative shoulder pain. The secondary outcomes were the length of hospital stay (LOS) and postoperative complications. The statistics were performed using StatsDirect statistical software (Version 2.7.9).</p><p><strong>Results: </strong>Two groups were identified: Group D (deep NMB), 29 patients, and Group M (moderate NMB), 28 patients. The BMI mean values for groups D and M were 44 and 45 kg/m2 respectively (<i>P</i> > 0.05). The mean durations of surgery for were 46.7 min and 44.1 min for groups M and D, respectively (<i>P</i> > 0.05). The mean train-of-four (TOF) counts were 0.3 and 0 for groups M and D, respectively (<i>P</i> < 0.05). The mean times from giving reversal agent to tracheal extubation (minutes) were 6.5 and 6.58 min for groups M and D, respectively (<i>P</i> > 0.05). In the recovery room, the means of pain scores were 3 and 4 for groups M and D, respectively (<i>P</i> > 0.05). Upon admission to the surgical ward, the median values of the pain score were non-significant (<i>P</i> > 0.05) (95% CI: 0.4-0.7). The opioid consumption in the recovery room was non-significant between both groups (<i>P</i> > 0.05) (95% CI: 0.3-0.6). Postoperative shoulder pain was non-significant between both groups (<i>P</i> > 0.05) (95% CI: 0.4-0.7). The median values of surgeon opinion of both groups were non-significant (<i>P</i> > 0.05). Regarding the LOS, the mean values of groups D and M were 1.20 and 1.21 days, respectively (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>There was no significant difference between moderate and deep NMB techniques in terms of duration of the surgical procedure, postoperative pain, shoulder pain, and length of hospital stay. Further studies on a larger sample size are required to investigate the long-term recovery characteristics of patients with obesity undergoing LSG.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681459","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}
Pub Date : 2024-01-01Epub Date: 2024-01-02DOI: 10.4103/sja.sja_347_23
Min H Heo, Miji Cho, Sang-Il Lee, Kyung W Kim
Spinal anesthesia usually lasts up to two hours, but an infusion of IV dexmedetomidine can prolong it to three to four hours. We report two cases where single spinal anesthesia with IV dexmedetomidine was maintained for more than six hours during tibia fracture surgery. The spinal anesthesia was maintained for 350 and 390 minutes without another medication, and the sensory level confirmed after the surgery was T10 and L1. Dexmedetomidine can very-prolong the duration of spinal anesthesia beyond what has been reported. However, longer infusion times can also result in longer recovery times.
{"title":"Very long-lasting spinal anesthesia with dexmedetomidine: A report of two cases.","authors":"Min H Heo, Miji Cho, Sang-Il Lee, Kyung W Kim","doi":"10.4103/sja.sja_347_23","DOIUrl":"10.4103/sja.sja_347_23","url":null,"abstract":"<p><p>Spinal anesthesia usually lasts up to two hours, but an infusion of IV dexmedetomidine can prolong it to three to four hours. We report two cases where single spinal anesthesia with IV dexmedetomidine was maintained for more than six hours during tibia fracture surgery. The spinal anesthesia was maintained for 350 and 390 minutes without another medication, and the sensory level confirmed after the surgery was T10 and L1. Dexmedetomidine can very-prolong the duration of spinal anesthesia beyond what has been reported. However, longer infusion times can also result in longer recovery times.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681463","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}