Saudi Journal of Anaesthesia最新文献

To examine the role of Transcutaneous Electrical Nerve Stimulation (TENS) in pain management post-laparoscopic cholecystectomy (LC). An in-depth search was conducted on Google Scholar, PubMed, and Ovid MEDLINE from their inception until November 2024. We included randomized controlled trials and prospective studies that compared TENS for postoperative pain relief as determined by the Visual Analog Scale (VAS). The quality assessment using the GRADE and Cochrane risk of bias methods. Six trials, comprising a total of 423 patients, were included in the study. The meta-analysis of the VAS at different times yielded no significant reduction in pain observed postoperatively at 4 hours (MD: -0.70, CI: -1.97 to 0.57, P = 0.28); at 8 hours (MD: -0.75, CI: -2.15 to 0.65, P = 0.29); and at discharge (MD: -0.88, CI: -2.02 to 0.26, P = 0.13). While the included studies showed minimal risk of bias, the certainty of evidence by the GRADE assessment was deemed low. While some studies suggest a potential benefit of TENS in reducing postoperative pain, the current evidence remains inconclusive due to the variability in study design, TENS parameters, and outcome reporting. Additional high-quality RCTs are required.

Background: Neuraxial anesthesia (NA), specifically thoracic spinal anesthesia (TSA), offers several theoretical advantages when compared to the General Anesthesia (GA). This retrospective study compares TSA with the gold standard GA in elective colorectal laparoscopic surgery and evaluates the impact on respiratory functions.

Material and methods: The data used in this study were extracted from the medical records of 34 consecutive patients, who had undergone laparoscopic colon resection surgery in Melegnano Hospital-ASST Melegnano Martesana-Italy and had been administered NA or GA. Postoperative lung function was assessed via lung ultrasound [Lung Ultrasound Score(LUS)], and PaO₂/FiO₂ (P/F) ratio.

Results: The average duration of the surgical procedure was 201.9 ± 50.4 min (NA 191.1 ± 44.1 vs. GA 212 ± 55.3 min, P = 0.21). Arterial blood gas parameters showed a reduction in the postoperative values of P/F ratio (P/F: NA 387 ± 70 vs GA 342 ± 52, P = 0.049). LUS reveals a higher prevalence of atelectasis in the poster-inferior lung regions. After surgery, the pre- and post-operative LUS scores (Delta LUS) showed differences in the GA group (NA 1.8 ± 1.8 vs GA 3.8 ± 1.9, P = 0.003). The receiver operating characteristic (ROC) curve proved to be very accurate (area under the curve (AUC) = 0.898, P < 0.001) in predicting postoperative oxygen support, even more so in the GA group (2 in the NA group vs 7 in the GA).

Conclusions: In the context of a progressively aging population and an increase in the fragility of patients, NA with spontaneous ventilation appears to exert a minor impact on respiratory function compared to GA.

Noonan syndrome (NS) is an autosomal dominant multisystem disorder characterized by congenital cardiac defects, craniofacial anomalies, and hematological abnormalities. With an incidence of 1 in 1000 to 2500 live births, NS is one of the most common syndromes associated with congenital heart disease, second only to trisomy 21. Pregnant patients with NS present unique anesthetic challenges due to the syndrome's diverse manifestations and the physiological changes of pregnancy. This report describes a 28-year-old woman with NS who underwent elective cesarean delivery at 36 weeks of gestation. Her medical history included repaired congenital heart defects, pulmonary stenosis, severe scoliosis, and asthma. Spinal anesthesia was successfully employed using a low-dose combination of local anesthetics and opioids to achieve effective sensory block while maintaining hemodynamic stability. The patient's normal coagulation profile allowed neuraxial anesthesia to be a feasible option despite potential technical difficulties associated with spinal abnormalities. This case underscores the importance of a multidisciplinary approach to pregnant patients with NS, including comprehensive preoperative evaluation and individualized anesthetic planning. Neuraxial anesthesia can be a safe and effective option when tailored to the patient's specific physiology, ensuring optimal maternal and fetal outcomes while minimizing risks.

Electrical storm (ES) is a rare and life-threatening cardiac emergency characterized by recurrent ventricular arrhythmias, posing unique challenges when it occurs during pregnancy. We report the case of a 28-year-old woman presenting with refractory ES in the late stages of a dichorionic-diamniotic twin pregnancy. Initial management included emergent cesarean delivery under general anesthesia due to maternal hemodynamic instability and fetal bradycardia. Despite pharmacological stabilization and multiple synchronized cardioversions, the arrhythmia persisted, necessitating catheter ablation to restore sinus rhythm. Multidisciplinary collaboration involving anesthesiology, obstetrics, cardiology, and electrophysiology ensured a favorable outcome for both mother and neonates, with no long-term complications. This case highlights the critical importance of tailored, interdisciplinary approaches in managing ES during pregnancy and underscores the need for resource optimization and rapid decision-making to balance maternal and fetal safety. Future investigations should focus on identifying potential triggers and improving protocols for the management of ES in high-risk pregnancies.

Background: Postoperative pain after laparoscopic surgery can include referred shoulder pain, visceral pain, and incisional pain, often due to CO₂ insufflation and peritoneal irritation. Although opioids are widely used for pain management, their side effects, such as sedation, nausea, and constipation, can delay recovery and increase costs. Opioid-free anesthesia (OFA) is an emerging alternative that aims to relieve pain using non-opioid medications, reducing these risks and potentially enhancing recovery.

Methods: This single-center, prospective, randomized controlled trial included neonates and infants (ASA 1 and 2) undergoing laparoscopic or endoscopic surgeries. Participants randomly received either opioid-based anesthesia (OA) with intravenous fentanyl at induction, followed by continuous infusion or OFA with ketamine at induction, followed by infusion. The primary outcome was postoperative pain, assessed using the Neonatal Infant Pain Scale (NIPS) on admission to the post-anesthesia care unit (PACU). Secondary outcomes included pain scores at intervals up to 12 h postoperatively.

Results: NIPS scores were significantly higher in the OFA group in the PACU, with more patients experiencing moderate pain (NIPS >4) in the first hour (41.7%, n = 20 vs. 16.6%, n = 8, respectively; P < 0.001). Both approaches demonstrated similar intraoperative stability, recovery, and safety, suggesting that either method can be chosen based on clinical requirements.

Conclusions: OA with fentanyl offered superior immediate postoperative analgesia compared to OFA with ketamine, while both approaches demonstrated comparable intraoperative stability, recovery profiles, and safety, supporting their use based on clinical needs and patient-specific factors.

Background: Existing studies on anesthesiologists' attitudes toward artificial intelligence (AI) leave a global understanding underexplored. This cross-sectional study aims to investigate Turkish anesthesiologists' attitudes toward AI, examining its perceived benefits, limitations, and associated ethical concerns. Insights from this study aim to enhance understanding of AI's role in anesthesiology within a cultural and ethical context.

Methods: This nationwide study surveyed Turkish anesthesiologists. Descriptive statistics summarized categorical variables, Pearson's Chi-square test compared variables between groups. Binary logistic regression analyzed associations between demographic factors and positive attitudes toward AI.

Results: Among 293 valid responses, 69.6% of participants expressed positive attitudes toward AI. Gender (P = 0.01), employment setting (P < 0.001), and prior AI experience (P < 0.001) were significant predictors of positive attitudes. AI applications most frequently endorsed included preoperative assessments (93.1%), academic support (95.2%), and medical education (91.2%). Ethical concerns were prominent, with liability ambiguity (87.3%) and privacy issues (62.8%) being the most cited. Logistic regression revealed that participants aged 46-55 were significantly more likely to exhibit positive attitudes (OR = 3.744, P = 0.03), while those with over 15 years of experience were less likely to do so (OR = 0.105, P = 0.04).

Conclusions: Turkish anesthesiologists exhibited predominantly positive attitudes toward AI, with prior experience playing a significant role in shaping perceptions. While AI was embraced for academic, educational, and noninvasive tasks, skepticism was present toward its application in invasive procedures. These findings highlight AI's potential to enhance efficiency and patient safety while underscoring the need for comprehensive legal and ethical frameworks.

Background: Caudal block is a widely practiced regional anesthetic technique in pediatric patients undergoing infraumbilical and lower limb surgeries. However, assessing its effectiveness intraoperatively remains a challenge due to limitations in conventional clinical evaluation methods, especially under general anesthesia. The perfusion index (PI), a noninvasive indicator of peripheral perfusion, has emerged as a potential early marker of successful neuraxial block.

Aim: To evaluate the perfusion index as a primary predictor of successful caudal block in children undergoing elective infraumbilical and lower limb surgeries, and to compare it with traditional hemodynamic parameters.

Methods: This prospective observational study was conducted over two years at a tertiary care center. A total of 80 pediatric patients (ASA I-II, aged 1-8 years) undergoing elective surgeries under general anesthesia with caudal block were enrolled. PI, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at multiple time intervals post-block. The primary outcome was the change in PI; secondary outcomes included changes in hemodynamic parameters.

Results: A significant increase in PI was observed as early as 3 minutes after caudal block, rising from a baseline of 1.55 ± 1.08 to 3.96 ± 1.94 (P < 0.001), with a peak at 30 minutes (5.23 ± 1.42). In contrast, SBP, DBP, and MAP showed significant reductions only after 15 minutes. SpO₂ remained stable throughout. The early rise in PI correlated with successful block onset and duration, making it a reliable early predictor compared to delayed hemodynamic changes.