Saudi Journal of Anaesthesia最新文献

Background and aim: Patient movement during magnetic resonance imaging (MRI) is the most frequent cause of artifacts and poor scan quality. Children cannot lie still. Thus, anesthesia is required to keep the child calm and immobile. This randomized double-blinded clinical trial compares the clinical effects of the addition of dexmedetomidine as premedication with ketofol on the quality of sedation. We hypothesized that the addition of dexmedetomidine would improve the quality of sedation.

Methods: A total of 132 children aged 6 months to 10 years were randomized into groups DK (dexmedetomidine-ketofol) and K (ketofol). DK received an intravenous bolus of dexmedetomidine (0.5 mcg/kg) as premedication 10 minutes prior. Both the groups were induced with ketofol (0.5 mg/kg), and sedation was maintained with propfol infusion (100 mcg/kg/min). The primary objective was the quality of sedation as assessed by the University of Michigan Sedation Scale. Image quality, requirement of rescue propofol dose, recovery, and adverse events were also studied. Data are given as median [interquartile range (IQR)] or frequency.

Results: All 132 children completed MRI scans. The DK group showed significantly better quality of sedation, 71% versus 47% of children, a median difference of 1 (-0.569 to -0.0969), P < .005, a better quality of scan, a reduced number of additional doses of propofol, and a decreased total dose of propofol. Hemodynamic parameters and recovery times for the two groups were similar. There were no significant side effects in both groups.

Conclusion: The quality of sedation and the quality of the MRI scan are greatly improved by administering dexmedetomidine (0.5 mcg/kg) 10 minutes before to induction. Additionally, this technique decreases the need of propofol and gives better hemodynamic stability without delaying the recovery time.

Introduction: The most commonly performed minimally invasive cardiac surgery (MICS) is lateral minithoracotomy, which requires one of the most painful incisions. Adequate postoperative pain management is essential for cardiac surgery to prevent perioperative complications. Thoracic epidural analgesia (TEA) is the gold standard for thoracotomy; however, it is still controversial because of the risk of epidural hematoma following systematic heparinization. The objective of our study was to investigate the safety and efficacy of TEA following MICS.

Methods: The clinical data of patients aged over 18 years who underwent elective MICS and received epidural analgesia along with general anesthesia between January 2014 and March 2019 were reviewed. Data were collected, including patient demographics, operative data, postoperative pain, postoperative course, and complications. Chronic pain was evaluated 6 months after discharge, and we defined it as a NRS score ≧3. Postoperative complications included epidural-related complications.

Results: Seventy patients were included in the analysis. The mean NRS score was below 2. We collected chronic pain data from 52 patients and found that 11 patients had chronic pain. TEA-related complications were not observed.

Conclusion: The current observational study revealed that TEA following lateral thoracotomy was effective for acute pain as well as chronic pain without causing any severe epidural-related complications. Protocols to prevent potential devastating complications, including epidural hematoma, should follow the American Society of Regional Anesthesia and Pain Medicine recommendation. If the rules are strictly followed, TEA can be a safe and effective pain management method for patients who undergo MICS.

Background: Neuromodulation has provided promising results in chronic pain management. Sacral neurostimulation (SNS) is a neuromodulatory technique, where the sacral nerve roots are electrically stimulated.

Objective: Evaluate the efficacy of the trial phase to control severe cancer pain in pelvic organs.

Design: Pilot study.

Methods: Chronic pelvic cancer pain patients were managed with morphine ≥ 60 mg daily, duloxetine 30 mg, and celecoxib 200 mg twice daily. Twenty-two adults were divided randomly into two equal groups: the SNS group (N = 11), received a sacral neurostimulator device and opioid analgesics, and the opioid group (N = 11), received increased opioid analgesics to control pain.

Results: Visual analog scale scores were decreased in the SNS group at 24 h, 4 days, 1, and 2 weeks in SNS compared to the opioid group, medians (IQR) [4 (3-5) vs 6 (5-7), 3 (3-4) vs 5 (5-6), 3 (3-4) vs 5 (5-6), and 3 (3-3) vs 5 (4-6) P < 0.001], daily morphine consumption was reduced in the SNS group compared to the opioid group, median (IQR) [90 (60-90) mg vs 120 (120-150) mg, P < 0.001] and [30 (30-60) mg vs 150 (120-180) mg] during the first and second weeks. The SNS group had a better life quality compared to the opioid group after 2 weeks, median (IQR) was (123 (122.5-124) vs 117 (117-118.5) P < 0.001), respectively.

Conclusion: The SNS trial device showed effectiveness in managing severe chronic pelvic cancer pain.

With the advent of minimally invasive surgeries, robot-assisted techniques have gained popularity because they overcome various shortcomings of standard laparoscopic surgeries. Despite the associated costs and limitations among the pediatric population, surgeon comfort due to the ergonomic design, in combination with enhanced three-dimensional high-fidelity imaging and tissue handling, may offer better surgical and postoperative outcomes. However, robotic surgeries require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel. Anesthesiologists should become well versed with these changes by learning the basic features of robotic surgical systems to offer appropriate anesthetic care and promote patient safety. In this original case report, we present a 3-year-old child posted for robot-assisted left heminephrectomy and excision of the lower megaureter. It provides instructive significance for anesthesia management, especially taking into account the age of the patient and associated concerns.

Background: For high-risk patients, adding a third antiemetic drug to dual postoperative nausea and vomiting (PONV) prophylaxis is controversial. Given the established antiemetic properties of midazolam, this study compared the combination of low-dose dexamethasone-ondansetron and midazolam with high-dose dexamethasone-ondansetron.

Methods: A total of 300 female patients scheduled for breast surgery were recruited and randomly assigned to two groups. The DO group received dexamethasone 8 mg and ondansetron 4 mg, whereas the DOM group received dexamethasone 4 mg, ondansetron 4 mg, and midazolam 0.04 mg/kg. The primary outcome was the incidence of PONV within 24 h. Secondary outcomes were PONV severity, antiemetic requirement, blood glucose levels, satisfaction and sedation scores, time to eye opening and extubation, pain outcome, and sore throat.

Results: Primary outcome analysis included 298 patients. Incidence of PONV within the first 24 h after surgery occurred in 52 of 150 (35%) patients in the DO group and 33 of 148 (22%) patients in the DOM group (adjusted risk ratio, 0.63; 95% confidence interval, 0.45-0.88; P = 0.007). The antiemetic requirement was significantly greater in the DO group compared with the DOM group (P = 0.034). However, a significantly higher sedation level and longer time for eye-opening and extubation were observed in the DOM group (P < 0.05).

Conclusion: Compared to high-dose dexamethasone and ondansetron alone, midazolam combined with low-dose dexamethasone and ondansetron decreased the incidence of PONV in patients undergoing breast surgery; however, it increased the sedation level in the early postoperative period.

Background: Alkalization of local anesthetics may have an impact on alleviating the injection pain by buffering these solutions with sodium bicarbonate. The present study aimed to evaluate the pain during local anesthetic buccal infiltration for the maxillary canines after adding sodium bicarbonate 8.4% during local anesthesia.

Materials and methods: A buffered 2% lidocaine with 1:80,000 epinephrine and sodium bicarbonate 8.4% was used for one site, and an unbuffered 2% lidocaine with 1:80,000 epinephrine was used for the other site at the same appointment. Two groups of volunteers (15 male and 15 female) participated. Each participant received 0.6 mL of the anesthetic solution. Injection discomfort was assessed using a visual analog scale.

Results: 73% and 93% of patients in group 1 experienced pain in sites A and B, respectively, during the injection, whereas 80% and 100% of patients in group 2 experienced pain in sites A and B, respectively, during the injection. Both groups showed a significant difference in pain scores between the two injected sites (P ˂ 0.01).

Conclusion: Upper canine infiltration anesthesia with buffered lidocaine and epinephrine with sodium bicarbonate has less pain during injection than when unbuffered lidocaine with epinephrine is used.

Background: Undesirable injuries during the intraoperative period, such as pressure injuries caused by improper positioning, medical devices, or adhesive tapes, can lead to patient harm and decreased satisfaction. This study aims to identify the risk factors of pressure injuries during the intraoperative period and the characteristics of these injuries.

Methods: A retrospective case-control study was conducted at King Khaled University Hospital in Riyadh, Saudi Arabia. Data were collected from the hospital incident reporting system and electronic medical records for incidents reported from January 1, 2022 to December 31, 2022. Inclusion criteria consisted of all patients with a reported pressure injury, including pressure ulcers, medical adhesive-related skin injuries, or medical device-related pressure injuries, occurring at least once during surgery.

Results: Among the 113 patients, 57 (50.44%) had intraoperative pressure injuries (cases), while 56 (49.56%) did not (controls). The most common locations for pressure injuries were the lips (33.33%). Most of these injuries were classified as Medical Adhesive-Related Skin Injury (61.40%). Stage 1 injuries were observed in 47 cases (82.46%), while Stage 2 injuries were observed in 10 cases (17.54%). Duration of surgery and device tightness were identified as significant risk factors (P < 0.001).

Conclusion: This case-control study identified the duration of surgery and device tightness as significant risk factors for intraoperative pressure injuries. The findings emphasize the importance of implementing evidence-based prevention strategies. Healthcare professionals should prioritize staff education and training, while future research should focus on conducting prospective, multicenter studies and developing risk assessment tools and innovative medical devices.