Saudi Journal of Anaesthesia最新文献

Background: Healthcare providers use smartphones for various beneficial purposes, including education, communication, and remote patient monitoring. However, concerns have arisen about their potential to distract anesthesiologists in the operating room, potentially leading to catastrophic consequences. This study aimed to assess smartphone habits and attitudes among anesthesiologists at a tertiary care hospital in Riyadh, Saudi Arabia.

Materials and methods: A cross-sectional survey was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Anesthesiologists were surveyed using a questionnaire distributed via email and phone numbers. Hard copies of the questionnaire were also distributed in the operating rooms. Data are cleaned in Excel and analyzed using IBM SPSS 29.0.

Results: Our study included 123 participants, mostly male (n = 102, 82.9%), with a significant portion aged 31-40 years (n = 34, 27.6%). Most were consultants (n = 51, 41.5%), and 64.2% (n = 79) spent less than 25% of their working hours on smartphones. Despite 52.8% (n = 65) reporting distractions from smartphone use, only 29.3% (n = 36) supported restrictions in operating theaters. A significant association was found between age and perceptions of smartphone impact on patient care (P = 0.012), with younger anesthetists more likely to see a positive effect. Moreover, frequent smartphone users were more likely to perceive benefits in patient care (P = 0.038), and those not distracted by phones believed that smartphone usage improved care (P < 0.001). Finally, those not irritated by colleagues' phone use were more likely to report positive impacts on patient care (P < 0.001).

Conclusion: Our study highlights the pervasive use of smartphones among anesthesiologists, with many acknowledging both benefits and distractions. While a significant number perceive positive impacts on patient care, concerns about distraction remain, indicating the need for balanced guidelines in operating theaters.

This report discusses the anesthetic management of a 7-year-old child with aromatic L-amino acid decarboxylase (AADC) deficiency, a rare neurometabolic disorder. The patient underwent ventilation tube insertion and adenotonsillectomy. Similar to other adenotonsillectomy procedures, this surgery carries a higher risk of postoperative nausea and vomiting, necessitating a careful management strategy. We opted for dexamethasone as the primary antiemetic agent and limited opioid use to a single dose of fentanyl, while also incorporating dexmedetomidine for enhanced pain management alongside ketorolac and paracetamol. This case highlights the need for specialized anesthesia protocols for AADC deficiency patients to enhance safety and outcomes, particularly addressing the challenges of nausea and vomiting.

Background: In recent years, the use of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) for the treatment of pediatric hydrocephalus has gained increasing attention, particularly in North America and Africa. It has shown potential to enhance the efficacy of ETV alone and reduce the need for ventriculoperitoneal shunt placement. However, research on the potential side effects of CPC, particularly concerning postoperative sympathetic nervous system responses, remains limited. In our clinical practice, we observed that ETV + CPC may induce transient sympathetic storms, a phenomenon not yet reported in the literature, posing new challenges for postoperative anesthetic management and monitoring.

Objective: This study aims to report the phenomenon of transient sympathetic storm following ETV + CPC, analyze its potential mechanisms, and raise awareness among anesthesiologists and neurosurgeons to enhance recognition and management of this condition.

Methods: A retrospective analysis was performed on three pediatric patients with communicating hydrocephalus who underwent ETV + CPC at our hospital between January 2016 and December 2016 and subsequently developed transient sympathetic storm. The clinical features, intraoperative and postoperative conditions, and patient outcomes were analyzed to explore the relationship between the extent of CPC and the severity of sympathetic hyperactivity.

Results: All three patients developed varying degrees of sympathetic hyperactivity after surgery, including tachycardia, rapid breathing, increased muscle tone, tension, and limb tremors. The first case (6-month-old boy) underwent right-sided CPC and had the mildest response. The second case (6-month-old girl) underwent right-sided and partial left-sided CPC, exhibiting moderate response. The third case (21-month-old girl) underwent extensive bilateral CPC and had the most severe response with the longest duration. Sympathetic hyperactivity was positively correlated with the extent and intensity of CPC.

Conclusion: Transient sympathetic storm may occur after ETV + CPC, presenting challenges for postoperative anesthetic and neurosurgical care. The severity of sympathetic hyperactivity appears to correlate with the extent and intensity of CPC. Its mechanism is hypothesized to involve thermal injury to the bilateral thalamus and associated vasculature. Further research is required to better understand the side effects and complications of CPC. This study also supports the hypothesis that bilateral thalamic injury may trigger sympathetic hyperactivity, providing new evidence and insights into the mechanisms underlying paroxysmal sympathetic hyperactivity.

[This retracts the article on p. 209 in vol. 12, PMID: 29628829.].

Breast cancer surgery often results in significant postoperative pain, which can have psychological, physiological, and socio-economic consequences, and increase the risk of chronic pain. While locoregional anesthesia, including fascial blocks, has become essential in perioperative pain management, achieving adequate coverage in complex breast surgeries, especially with axillary dissection, remains challenging. This report presents a case of a 55-year-old woman undergoing left mastectomy with axillary lymph node dissection. A combination of a unilateral Erector Spinae Plane (ESP) block at the T2-T3 level and a Serratus Posterior Superior Intercostal Plane (SPSIP) block was performed preoperatively. The patient experienced minimal postoperative pain, with low pain scores (0/2) at 3, 12, and 48 hours post-surgery, requiring only one dose of paracetamol. The blocks provided effective analgesia, and the patient had no complications. The combined use of these two fascial blocks enhances coverage by targeting both intercostal and brachial plexus branches, offering a synergistic effect and the proximity of the block sites allows for efficient performance without repositioning the patient, reducing execution time. We believe the synergic combination of SPSIP and ESP blocks offers a promising strategy for pain management in breast cancer surgeries involving axillary dissection.

Background: Robotic-assisted laparoscopic prostatectomy (RALP) poses challenges in ventilation and oxygenation due to steep Trendelenburg positioning and pneumoperitoneum. This study aims to investigate the impact of steep Trendelenburg and pneumoperitoneum on respiratory mechanics, novel oxygenation, and saturation indices.

Methods: Mechanical ventilator, blood gas, and hemodynamic parameters were recorded for 56 RALP patients at three periods (pre-Trendelenburg, Trendelenburg and pneumoperitoneum, post-Trendelenburg). Oxygenation and saturation indices (OIs and OSIs) were calculated and compared using one-way repeated measures ANOVA with Bonferroni post hoc tests.

Results: Elastance, Pplato, Ppeak, Pmean, MP_tot, MP_dyn, DP, OI-P_mean, OI-MP_tot, OI-MP_dyn, OI-DP, OSI-P_mean, OSI-MP_tot, OSI-MP_dyn, and OSI-DP significantly increased with Trendelenburg positioning and pneumoperitoneum. Despite a reduction in the post-Trendelenburg period, these indices remained significantly elevated compared to pre-Trendelenburg levels. C_dyn, C_stat, PaO₂, PaO₂/FiO₂, and PaO₂/FiO₂*PEEP significantly decreased with Trendelenburg positioning and pneumoperitoneum.

Conclusions: In RALP, pneumoperitoneum and Trendelenburg positioning led to significant increases in respiratory mechanics (Pmean, DP, MP) and oxygenation and saturation indices (OI-P_mean, OI-MP_tot, OI-MP_dyn, OI-DP, OSI-P_mean, OSI-MP_tot, OSI-MP_dyn, OSI-DP). These new oxygenation indices may assist clinicians in optimizing the cost-gain balance in perioperative lung-protective ventilation strategies.

Background: Myasthenia gravis (MG) patients undergoing surgery may opt for general anesthesia without neuromuscular blocking agents (NMBAs). The univent tube, featuring a single lumen with bronchial blockers, is known for its flexibility and preference in challenging intubations, reducing airway damage during one-lung ventilation. This study assesses the safety and feasibility of utilizing the univent tube for thoracoscopic thymectomy in MG patients under general anesthesia without NMBAs, complemented by airway topical anesthesia.

Methods: In this single-center, prospective observational study, 83 consecutive MG patients underwent thoracoscopic thymectomy with univent tube intubation. General anesthesia without NMBAs and airway topical anesthesia were administered. Emphasis was placed on intubation conditions, surgical aspects, intraoperative respiratory, and airway complications.

Results: Clinically acceptable intubation conditions were achieved in 99% of patients, with 80% rated as 'excellent' and 19% as 'good.' No cases experienced intubation failure, and 2% exhibited reactions to tracheal tube insertion. Higher MG stages correlated with more favorable intubation conditions, particularly during laryngoscopy. Surgical conditions were excellent in 89%, and blocking the right lung increased total lung collapse, enhancing surgical conditions. Intraoperative ventilation was sufficient for all cases. Incidences of bronchial and vocal cord injuries were 6% and 10%, respectively, with no hematoma cases. Postoperative sore throat (12%) and hoarseness (6%) resolved within three days.

Conclusions: Despite the potential benefits of NMBAs, the univent tube proved safe and effective for thoracoscopic thymectomy in MG patients without NMBAs, with higher MG stages associated with improved intubation conditions and enhanced surgical conditions with right-side bronchial blockage.

Background: Trauma causes a state of hypercoagulability, and its presence is common early in the injury course. D-dimer (DD), considered a good screening tool for coagulation activation and higher plasma levels, has been associated with unfavorable outcomes. Hence, in trauma, measuring DD levels may help provide useful prognostic information. The aim of the study was to find whether DD levels at the time of admission can predict the outcome of patients.

Methods: This prospective observational studied 205 adult patients of age group 18-60 years, presenting to trauma emergency within 24 h of injury and blood samples collected within this period. The primary outcome was to assess whether DD levels at admission predicted outcome. Association of DD levels with injury severity score, with blunt or penetrating trauma, time from injury to admission, and to hospital stay were secondary outcomes. A value of DD >250 ng/ml was considered elevated.

Results: The DD levels were significantly higher in patients who died than those who were discharged [2316.28 (384.5,3331.18) vs 498.03 (140,693), P = 0.001]. On receiver operating characteristic analysis, a cutoff value of 1793.35 ng/ml for serum DD was obtained with sensitivity and specificity values of 72.7% and 60.8%, respectively. The odds of death in patients were 5.87 [95% CI 1.67 to 20.51] times more when DD >1793.35 ng/ml (P = 0.002).

Conclusion: Our study demonstrates that DD levels at admission were high among nonsurvivors compared to survivors. A cutoff value of more than 1793.35 ng/ml is associated with an unfavorable outcome.