Saudi Journal of Anaesthesia最新文献

Background: ChatGPT is an Artificial intelligence (AI) language model that enhances readability in medical writing. However, the prevalence of ChatGPT-generated articles in English medical literature has not been systematically studied. This research aims to evaluate the frequency of these manuscripts, their adoption across medical subspecialties, and the countries of origin for the publishing companies.

Methods: The term "delve" is primarily linked to ChatGPT-generated medical literature. In this observational study, we identified manuscripts as ChatGPT-generated based on this term in the title or abstract. We examined PubMed^® from December 01, 2022, to May 14, 2024, and applied descriptive statistics as needed.

Results: During the study period, 2.193.871 manuscripts were published in Pubmed^®. The term "delve" was found in the title and abstract of 1996 scientific manuscripts, suggesting that at least 0.09% of all publications were ChatGPT-generated. At the same time, PubMed^® hosted 982 journals. We report on those that published at least ten or more CHATGPT-derived manuscripts (top 25). Publishers with the highest number of ChatGPT-generated manuscripts were located in Switzerland (564; 27.6%), followed by the United States (552; 27.0%) and the United Kingdom (430; 21.0%). The Multidisciplinary Digital Publishing Institute (MDPI: 373; 20.3%) was the top publisher of ChatGPT-driven publications, followed by Elsevier (340; 18.5%) and Frontiers (160; 8.7%).

Conclusion: Since the introduction of ChatGPT, medical publications are increasingly ChatGPT-supported or generated with an uncertain amount of author auditing and editing. High-frequency publishers were located in first-world countries.

Increasing global life expectancy has expanded the surgical population, raising concerns about postoperative outcomes. Dementia, especially Alzheimer's disease (AD), poses a significant public health challenge. This meta-analysis investigates anesthesia exposure and AD risk. Following PRISMA 2020 guidelines, we systematically searched five databases (2014-2022) for observational studies evaluating dementia risk in adults ≥60 years undergoing surgery with anesthesia. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled odds ratios were calculated using a random-effects model, with subgroup and publication bias analyses conducted. Significant associations with dementia included hypertension (OR 1.36, 95% CI [1.16, 1.59]), hyperlipidemia (OR 1.19 [1.16, 1.22]), coronary artery disease (OR 2.45 [1.72, 3.50]), depression (OR 1.70 [1.27, 2.27]), and head injury (OR 1.31 [1.14, 1.51]). Subgroup analyses showed mixed results for age, surgery, and medication. Kidney-ureter-bladder surgery increased risk substantially (OR 2.52 [1.10, 5.76]). Publication bias was observed. No statistically significant association was found between general anesthesia and AD risk. However, significant heterogeneity, potential publication bias, inconsistent subgroups, and challenges in isolating anesthesia effects from surgery necessitate cautious interpretation. Large prospective cohort studies with standardized methods, adequate lag time, and rigorous confounder adjustments are imperative. Perioperative care optimization for older adults at risk of cognitive decline is clinically warranted.

Background: During continuous renal replacement therapy (CRRT), regional citrate anticoagulation (RCA) and bivalirudin are appealing alternatives since they provide excellent anticoagulation within the circuit without increasing the risk of bleeding. This study has been done to assess the hemofilter survival time, length of intensive care unit (ICU) stays, bleeding, thrombosis, and kidney function in bivalirudin and RCA.

Methods: A total of 40 patients who needed CRRT were enrolled in the study with acute kidney injury (AKI). The patients were divided into two groups of 20 each. RCA was used in the CRRT in the first group and bivalirudin in the second group according to protocol. We have monitored serum urea, serum creatinine, last 24 h urine output, hemoglobin (Hb), platelet count, prothrombin time (PT), international normalized ratio (INR), serum albumin, any bleeding complication, or any transfusion requirement pre-CRRT, during CRRT, and after CRRT.

Results: Hemofilter life span was found significantly longer in the citrate group than the bivalirudin group (67.75 ± 16.64 vs 50.65 ± 7.98, P < 0.001). Length of ICU stay is found to be non-significant between the groups (P > 0.05). Significant difference was found in S. Creatinine level and urine output from pre-CRRT to post-CRRT in both the groups (P < 0.05), but no significant difference was found in pre-CRRT, during CRRT, and post-CRRT between both the groups (P > 0.05). No significant difference was found in terms of mortality, bleeding, and transfusion between the groups (P > 0.05).

Conclusion: After observing the data and statistical evaluation, we found that RCA has a better hemofilter life span than bivalirudin without a significant difference in mortality, bleeding, or transfusion.

Local anesthetics are essential in dental practice, but their systemic effects can pose significant risks for medically compromised patients. This review aims to identify and evaluate the safest local anesthetic agents for use in dental procedures in patients with systemic medical conditions to minimize adverse outcomes and improve clinical safety. To achieve this, a comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published from January 2000 to April 2025. Thirty-five studies addressing local anesthetic use in patients with cardiovascular disease, hepatic or renal impairment, diabetes, thyroid disorders, bleeding tendencies, pregnancy, elderly populations, and amide allergies were included. Data were synthesized to develop clinical recommendations for anesthetic selection based on systemic conditions. Lidocaine remains the standard amide anesthetic, with a strong safety profile in pregnancy and diabetes. Mepivacaine, due to minimal vasodilation, is preferred in cardiovascular and thyroid disorders. Articaine's rapid plasma metabolism benefits patients with liver or kidney impairment. Prilocaine is effective for hepatic impairment but poses methemoglobinemia risks, especially in pregnancy. Chloroprocaine, an ester anesthetic, is recommended for patients with confirmed amide allergies. Emerging strategies, such as buffered formulations, low epinephrine anesthetics, and ultrasound guided techniques, may enhance safety in high risk groups. Local anesthetic selection must be tailored to each patient's medical status. Mepivacaine, lidocaine, and articaine are among the safest agents for various systemic conditions. An evidence based, condition specific approach enhances safety and treatment outcomes in medically compromised dental patients.

Post-dural puncture headache (PDPH) is a common complication of epidural anesthesia, especially after accidental dural puncture (ADP), while intracranial subdural hematoma (ISH) is a rare but serious complication. In this report, we describe the case of a 31-year-old pregnant woman who received epidural anesthesia during labor, and accidentally had a dural puncture, resulting in headache and subdural hematoma. A burr hole drainage was performed. The drainage tube was removed 8 days later, and she was discharged after her condition improved. Intracranial hemorrhage after accidental epidural puncture is very rare, and this potentially life-threatening complication needs to be taken seriously.

Background: Postoperative pulmonary complications (PPCs) are a major cause of morbidity in orthopedic surgery, yet the Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) score remains under-validated in Saudi populations with unique metabolic and environmental risk profiles.

Methods: We conducted a prospective cohort study (2024-2025) of 600 adults undergoing elective/urgent orthopedic surgery at King Abdulaziz Medical City. Using a prespecified +5-point adjustment for cemented arthroplasty (accounting for bone cement implantation syndrome), we calculated ARISCAT scores preoperatively and assessed PPCs within 7 days using European Society of Anesthesiology and Intensive Care criteria. Secondary outcomes included intensive care unit admissions, length of stay (LOS), and hospitalization costs.

Results: The overall PPC incidence was 19.2%, with stepwise increases by risk category: 4.1% (low risk, ≤25 points), 17.3% (intermediate), and 44.8% (high-risk, ≥45; P < 0.001). The model demonstrated excellent discrimination (area under the curve [AUC] = 0.83, 95% confidence interval [CI] 0.78-0.88) and calibration (P = 0.27). High-risk patients had 5.2× greater PPC odds (adjusted odds ratio [OR] 5.2, 95% CI: 3.1-8.7), 3.1-day longer LOS, and $2350 higher costs versus low-risk patients (all P < 0.001). Cemented arthroplasty independently predicted PPCs (OR 1.8, 95% CI: 1.1-3.0).

Conclusion: This prospective Saudi validation demonstrates ARISCAT's strong predictive performance in orthopedic surgery, with notable enhancement when applying the cemented procedure modification. The substantial clinical burden observed in high-risk patients (44.8% PPC rate) and the associated economic impact highlight an urgent need for targeted preoperative optimization and resource-stratified care pathways. These findings reinforce ARISCAT's utility in guiding surgical planning and underscore the value of tailoring risk assessment tools to the unique metabolic and environmental risk profile of Saudi orthopedic populations.

Background: Goal-directed fluid therapy with dynamic variables enhances tissue oxygen delivery. A prospective, randomized comparative study was designed with stroke volume variation (SVV) and plethysmography variability index (PVI) to study fluid responsiveness, fluid requirement, and postoperative complications.

Materials and methods: A total of 68 patients undergoing major abdominal oncosurgeries were randomly allotted to the SVV or PVI group. SVV was measured with the FlotracEV1000 arterial pressure-based waveform analyzer, and for values >11, a colloid bolus of 200 mL was given. PVI was measured with a MasimoRad-97 plethysmography analyzer as variations in the pulse oximeter plethysmography waveform amplitude, and for values >11, a colloid bolus of 200 mL was given. Fluid response was noted in both groups.

Results: Total fluids (P = 0.058) and colloids (P = 0.268) given were comparable in both groups. Crystalloids required were less in PVI versus SVV, with (P = 0.034). Fluid responsiveness for SVV (84.7%) and PVI (83.8%) was good and values statistically comparable (P = 0.884). In SVV, the receiver operating characteristic (ROC) (AUC) was 0.50, which implies that pre-bolus SVV cannot be considered as a predictor of sensitivity for fluid responsiveness. In PVI (AUC), it was 0.70, which implies that prebolus PVI can be considered as a predictor of sensitivity for fluid responsiveness. Postoperative serum lactate and creatinine values were normal, and SICU stay was short and statistically comparable between the two groups. Bowel sounds appeared earlier in PVI (P < 0.03) patients.

Conclusion: Both SVV and PVI are valid predictors for fluid responsiveness and guides for fluid therapy: reduced postoperative complications and length of stay noted in both groups. PVI is a more sensitive dynamic variable than SVV.

Malignant hyperthermia (MH) remains the monster every anesthesiologist can meet suddenly in the OR. It is a rare but life-threatening hypermetabolic reaction triggered by certain anesthetic agents. Here we present a case of a 40-year-old male, who developed MH 45 min after induction of anesthesia for functional endoscopic sinus surgery (FESS) in King Abdulaziz Medical City in KSA. It was not the first time the patient was exposed to general anesthesia, with no relevant family history. Early recognition, prompt administration of dantrolene, and aggressive supportive measures resulted in full recovery. Despite the full recovery from metabolic derangements, he developed upper extremity DVT in the same limb dantrolene was administered.