Thomas Cheriyan, Kevin Bai, Shreya Bayyapureddy, A. Dua, Paramvir Singh, Zhuo Sun, Chhaya Patel, Vikas Kumar
Randomized controlled trials (RCTs) investigating the efficacy of bispectral index (BIS) to reduce intra-operative awareness (IOA) have reported conflicting results. The purpose of this meta-analysis is to consolidate results from RCTs to assess the efficacy of BIS in reducing IOA when compared to controls. Secondary outcomes included time to extubation, time to spontaneous and/or verbal eye opening, PACU discharge time, and utilization of inhaled anesthetics. RCTs which reported on one of the primary and/or secondary outcomes were included. Literature search utilized keywords “randomized control trial” and “intraoperative awareness.” Meta-analysis was performed using RevMan 5. Twenty-seven RCTs were included in the study with a total of 35,585 patients, with 18,146 patients in the BIS and 17,439 in the control group. Eighteen of 14,062 patients (0.12%) and 42 of 16,765 (0.25%) reported definite IOA in the BIS and control group, respectively, with no statistically significant difference. BIS was effective in reducing the time to spontaneous eye opening by an average of 1.3 minutes and the time to extubation by an average of 1.97 minutes. There was no difference in PACU discharge times among the groups. There was a significant decrease in consumption of sevoflurane but no difference in desflurane and propofol compared to the control group. While BIS monitoring results in decreased incidence of intra-operative awareness by half, it was not statistically significant. BIS provides modest benefits with regard to reducing the time to extubation, the time to spontaneous eye opening, and consumption of sevoflurane. Level of evidence: I.
{"title":"Effect of bispectral index on intra-operative awareness: A meta-analysis of randomized controlled studies","authors":"Thomas Cheriyan, Kevin Bai, Shreya Bayyapureddy, A. Dua, Paramvir Singh, Zhuo Sun, Chhaya Patel, Vikas Kumar","doi":"10.4103/sja.sja_74_24","DOIUrl":"https://doi.org/10.4103/sja.sja_74_24","url":null,"abstract":"\u0000 \u0000 Randomized controlled trials (RCTs) investigating the efficacy of bispectral index (BIS) to reduce intra-operative awareness (IOA) have reported conflicting results. The purpose of this meta-analysis is to consolidate results from RCTs to assess the efficacy of BIS in reducing IOA when compared to controls. Secondary outcomes included time to extubation, time to spontaneous and/or verbal eye opening, PACU discharge time, and utilization of inhaled anesthetics.\u0000 \u0000 \u0000 \u0000 RCTs which reported on one of the primary and/or secondary outcomes were included. Literature search utilized keywords “randomized control trial” and “intraoperative awareness.” Meta-analysis was performed using RevMan 5.\u0000 \u0000 \u0000 \u0000 Twenty-seven RCTs were included in the study with a total of 35,585 patients, with 18,146 patients in the BIS and 17,439 in the control group. Eighteen of 14,062 patients (0.12%) and 42 of 16,765 (0.25%) reported definite IOA in the BIS and control group, respectively, with no statistically significant difference. BIS was effective in reducing the time to spontaneous eye opening by an average of 1.3 minutes and the time to extubation by an average of 1.97 minutes. There was no difference in PACU discharge times among the groups. There was a significant decrease in consumption of sevoflurane but no difference in desflurane and propofol compared to the control group.\u0000 \u0000 \u0000 \u0000 While BIS monitoring results in decreased incidence of intra-operative awareness by half, it was not statistically significant. BIS provides modest benefits with regard to reducing the time to extubation, the time to spontaneous eye opening, and consumption of sevoflurane.\u0000 Level of evidence: I.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Rovetta, M. Mansournia, Alessandro Vitale, Vincenzo Accurso
{"title":"How to read P-values and confidence intervals in public health studies","authors":"Alessandro Rovetta, M. Mansournia, Alessandro Vitale, Vincenzo Accurso","doi":"10.4103/sja.sja_128_24","DOIUrl":"https://doi.org/10.4103/sja.sja_128_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Tantry, Vasantha Shetty, Aarti Deepak, Sumesh Murali, Murali S. B. Golitadka, Shreejith K. Menon, Sunil P. Shenoy, Dinesh Kadam
The use of intrathecal (IT) dexamethasone during subarachnoid block (SAB) has not been evaluated. There are no pooled data available to decide on the optimal regimen of IT dexamethasone during SAB, irrespective of the type of surgery. There is uncertainty about its dosage, effectiveness, and safety, and a need to establish clear guidelines on its use. Our objective was to evaluate the effectiveness and safety of use of IT dexamethasone during SAB. We performed a meta-analysis (PROSPERO, CRD42022304944) of trials that included patients who underwent a variety of surgical procedures under SAB. Patients received concomitant IT dexamethasone as an adjuvant to spinal local anesthetics. The analyzed outcomes included sensory and motor effects as well as adverse and/or beneficial side effects. Subgroup analysis was planned based on different doses used. Trial sequential analysis (TSA) was used to estimate the required sample size information (RIS) for each outcome. Eighteen studies (2531 participants) were included in this analysis. Addition of IT dexamethasone (4-8 mg) to heavy bupivacaine effectively prolonged the duration of sensory blockade (mean difference, MD = 63.8 minutes; [95% confidence interval, CI, 33.1-94.5], P < 0.0001), two-segment regression time (MD = 20.1[95% CI, 0.96-39.2], P = 0.04) and first rescue analgesic time (MD = 143.3 [95% CI, 90.3-196.0], P = 0.001). Subgroup analyses revealed superior effects of 8 mg dose over 4 mg for sensory and analgesic effects. The effect of dexamethasone on duration of motor blockade was inconclusive. Additionally, lower risk ratios (RRs) were recorded for spinal anesthesia-related hypotension (RR = 0.74 [95% CI, 0.6-0.9], P = 0.0003) and nausea/vomiting (RR = 0.62 [95% CI, 0.41-0.93], P = 0.02) in the dexamethasone group. For outcomes such as sensory blockade, analgesia, and hypotension, the required information size was reached during TSA. In conclusion, IT dexamethasone, used as an adjuvant to spinal local anesthetic, especially at the dose of 8 mg, increases sensory blockade duration and the time for request of the first rescue analgesic. SAB-induced side effects such as hypotension, nausea, and vomiting are lesser with the use of IT dexamethasone. However, further studies are necessary to draw meaningful conclusions on its safety profile.
蛛网膜下腔阻滞（SAB）期间使用鞘内地塞米松的情况尚未进行评估。目前还没有综合数据来确定蛛网膜下腔阻滞期间使用 IT 地塞米松的最佳方案，无论手术类型如何。地塞米松的剂量、有效性和安全性都存在不确定性，因此需要制定明确的使用指南。我们的目的是评估在 SAB 期间使用 IT 地塞米松的有效性和安全性。我们进行了一项荟萃分析（PROSPERO，CRD42022304944），研究对象包括在 SAB 下接受各种外科手术的患者。患者同时接受 IT 地塞米松作为脊髓局麻药的辅助药物。分析结果包括感觉和运动影响以及不良和/或有益副作用。根据所用剂量的不同，计划进行分组分析。试验序列分析（TSA）用于估算每种结果所需的样本量信息（RIS）。本次分析共纳入了 18 项研究（2531 名参与者）。在重型布比卡因中加入 IT 地塞米松（4-8 毫克）可有效延长感觉阻滞的持续时间（平均差，MD = 63.8 分钟；[95% 置信区间，CI，33.1-94.5]，P < 0.0001）、两段回归时间（MD = 20.1[95% CI, 0.96-39.2]，P = 0.04）和首次镇痛抢救时间（MD = 143.3 [95% CI, 90.3-196.0]，P = 0.001）。分组分析显示，8 毫克剂量的感觉和镇痛效果优于 4 毫克。地塞米松对运动阻滞持续时间的影响尚无定论。此外，地塞米松组脊髓麻醉相关低血压（RR = 0.74 [95% CI, 0.6-0.9]，P = 0.0003）和恶心/呕吐（RR = 0.62 [95% CI, 0.41-0.93]，P = 0.02）的风险比（RRs）较低。对于感觉阻滞、镇痛和低血压等结果，TSA期间达到了所需的信息量。总之，IT 地塞米松作为脊髓局麻药的辅助用药，尤其是 8 毫克剂量时，可延长感觉阻滞时间，并延长首次申请抢救性镇痛药的时间。使用 IT 地塞米松后，SAB 引起的低血压、恶心和呕吐等副作用会减少。不过，要对其安全性得出有意义的结论，还需要进一步的研究。
{"title":"Efficacy and safety of adjuvant intrathecal dexamethasone during spinal anesthesia: A systematic review and meta-analysis","authors":"T. Tantry, Vasantha Shetty, Aarti Deepak, Sumesh Murali, Murali S. B. Golitadka, Shreejith K. Menon, Sunil P. Shenoy, Dinesh Kadam","doi":"10.4103/sja.sja_112_24","DOIUrl":"https://doi.org/10.4103/sja.sja_112_24","url":null,"abstract":"The use of intrathecal (IT) dexamethasone during subarachnoid block (SAB) has not been evaluated. There are no pooled data available to decide on the optimal regimen of IT dexamethasone during SAB, irrespective of the type of surgery. There is uncertainty about its dosage, effectiveness, and safety, and a need to establish clear guidelines on its use. Our objective was to evaluate the effectiveness and safety of use of IT dexamethasone during SAB. We performed a meta-analysis (PROSPERO, CRD42022304944) of trials that included patients who underwent a variety of surgical procedures under SAB. Patients received concomitant IT dexamethasone as an adjuvant to spinal local anesthetics. The analyzed outcomes included sensory and motor effects as well as adverse and/or beneficial side effects. Subgroup analysis was planned based on different doses used. Trial sequential analysis (TSA) was used to estimate the required sample size information (RIS) for each outcome. Eighteen studies (2531 participants) were included in this analysis. Addition of IT dexamethasone (4-8 mg) to heavy bupivacaine effectively prolonged the duration of sensory blockade (mean difference, MD = 63.8 minutes; [95% confidence interval, CI, 33.1-94.5], P < 0.0001), two-segment regression time (MD = 20.1[95% CI, 0.96-39.2], P = 0.04) and first rescue analgesic time (MD = 143.3 [95% CI, 90.3-196.0], P = 0.001). Subgroup analyses revealed superior effects of 8 mg dose over 4 mg for sensory and analgesic effects. The effect of dexamethasone on duration of motor blockade was inconclusive. Additionally, lower risk ratios (RRs) were recorded for spinal anesthesia-related hypotension (RR = 0.74 [95% CI, 0.6-0.9], P = 0.0003) and nausea/vomiting (RR = 0.62 [95% CI, 0.41-0.93], P = 0.02) in the dexamethasone group. For outcomes such as sensory blockade, analgesia, and hypotension, the required information size was reached during TSA. In conclusion, IT dexamethasone, used as an adjuvant to spinal local anesthetic, especially at the dose of 8 mg, increases sensory blockade duration and the time for request of the first rescue analgesic. SAB-induced side effects such as hypotension, nausea, and vomiting are lesser with the use of IT dexamethasone. However, further studies are necessary to draw meaningful conclusions on its safety profile.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Jyothi, M. Mitragotri, D. Ladhad, Madhuri S. Kurdi, Mahesh D. Kurugodiyavar, Sanjivani Jadhav
Splanchnic nerve block (SPN) with local anesthetic and steroid is used to relieve the pain of chronic pancreatitis. However, it does not provide long-lasting relief. We hypothesize that the use of 70% alcohol will give adequate analgesia for more than months. The primary objective was to find out the analgesic efficacy of the use of 70% alcohol with SPN. Secondary objectives included the incidence of side effects, analgesic consumption postintervention, quality of life (QOL) assessed via a self-reported quality of life scale, and repeat block during the 1-year follow-up period. Retrospective analysis of all patients with chronic pancreatitis who received bilateral SPN over the last 4 years. SPN was performed using the posterior retrocrural approach with the patient in the prone position as described in the literature using a 23 G × 90 mm spinal needle bilaterally at the level of T12 using C-arm/fluoroscopy guidance. Data were collected from the procedure book of the pain clinic and medical records. Quantitative data for change in pre- to post-block VAS score was collected using the non-parametric Wilcoxon signed ranks test. The baseline VAS, post-procedure VAS, and VAS at 3 months follow-up was 7.69 ± 1.3,2.44 ± 0.96 and 1.56 ± 1.15. A pairwise comparison of VAS performed between baseline and immediate post-procedure, baseline, and VAS at 3 months was found to be highly significant. Fluoroscopy-guided neurolytic SPN with 70% alcohol gives significant pain relief for more than 3 months. It also leads to improvement in 3 months QOL.
{"title":"A case series of fluoroscopy-guided neurolytic splanchnic nerve block for chronic pancreatitis pain","authors":"B. Jyothi, M. Mitragotri, D. Ladhad, Madhuri S. Kurdi, Mahesh D. Kurugodiyavar, Sanjivani Jadhav","doi":"10.4103/sja.sja_86_24","DOIUrl":"https://doi.org/10.4103/sja.sja_86_24","url":null,"abstract":"\u0000 \u0000 Splanchnic nerve block (SPN) with local anesthetic and steroid is used to relieve the pain of chronic pancreatitis. However, it does not provide long-lasting relief. We hypothesize that the use of 70% alcohol will give adequate analgesia for more than months.\u0000 \u0000 \u0000 \u0000 The primary objective was to find out the analgesic efficacy of the use of 70% alcohol with SPN. Secondary objectives included the incidence of side effects, analgesic consumption postintervention, quality of life (QOL) assessed via a self-reported quality of life scale, and repeat block during the 1-year follow-up period.\u0000 \u0000 \u0000 \u0000 Retrospective analysis of all patients with chronic pancreatitis who received bilateral SPN over the last 4 years.\u0000 \u0000 \u0000 \u0000 SPN was performed using the posterior retrocrural approach with the patient in the prone position as described in the literature using a 23 G × 90 mm spinal needle bilaterally at the level of T12 using C-arm/fluoroscopy guidance. Data were collected from the procedure book of the pain clinic and medical records.\u0000 \u0000 \u0000 \u0000 Quantitative data for change in pre- to post-block VAS score was collected using the non-parametric Wilcoxon signed ranks test.\u0000 \u0000 \u0000 \u0000 The baseline VAS, post-procedure VAS, and VAS at 3 months follow-up was 7.69 ± 1.3,2.44 ± 0.96 and 1.56 ± 1.15. A pairwise comparison of VAS performed between baseline and immediate post-procedure, baseline, and VAS at 3 months was found to be highly significant.\u0000 \u0000 \u0000 \u0000 Fluoroscopy-guided neurolytic SPN with 70% alcohol gives significant pain relief for more than 3 months. It also leads to improvement in 3 months QOL.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spine fixation surgery for traumatic vertebral fractures is associated with severe pain and is often difficult to control. Traditionally systemic opioids have been the mainstay of analgesia for these procedures, which can lead to hyperalgesia, nausea, ileus, sedation, cognitive impairment, dependence, etc., limiting usage of opioids. The Erector spinae plane block (ESPB) is a novel ultrasound-guided procedure with easily identifiable sonoanatomy. We hypothesized that a multimodal approach involving ESPB to a conventional analgesic regimen with local infiltration for patients undergoing major traumatic spine surgeries might provide better perioperative analgesia and reduce the need for postoperative opioid requirements. A randomized control prospective trial was conducted on 34 ASA grade I –II patients aged 18 to 65 years who were scheduled to undergo elective posterior spine fixation surgery with ASIA B to E after traumatic spine fracture under general anesthesia. Patients were randomized to Group A which included patients who received general anesthesia with ESPB, and Group B, or the control group, included patients who received general anesthesia with systemic analgesics and postoperative local infiltration without ESPB. Intraoperative total fentanyl consumption, VAS score at 0, 3, 6, 12, 18, and 24 hours, time to activate patient-controlled analgesia (PCA) pump, total morphine consumption, and opioid-related side effects were monitored and compared in both groups. Postoperative PCA morphine consumption was significantly lower in group A patients who received ESPB than those in the control group (17.06 ± 9.59 vs 37.82 ± 9.88 P value = <0.0001). VAS scores at rest and movement at 0, 3, 6, 9, 12, 18, and 24 hours were significantly lower (P value = 0.05) in the ESPB group compared with the control group at all time points. Bilateral ultrasound-guided Erector spinae plane block, when administered in traumatic spine patients undergoing spine fixation surgery, provides better analgesia with statistically decreased VAS scores and less postoperative opioid requirement.
外伤性脊椎骨折的脊椎固定手术会带来剧烈疼痛，而且往往难以控制。传统上，全身性阿片类药物一直是此类手术的主要镇痛药物，但这可能导致痛觉减退、恶心、回肠梗阻、镇静、认知障碍、依赖性等，从而限制了阿片类药物的使用。脊骨后肌平面阻滞（ESPB）是一种新型的超声引导手术，其声像解剖结构易于识别。我们假设，在对接受脊柱大创伤手术的患者进行局部浸润的传统镇痛方案的基础上，采用一种包含 ESPB 的多模式方法，可能会提供更好的围手术期镇痛效果，并减少术后对阿片类药物的需求。 一项随机对照前瞻性试验对 34 名年龄在 18 至 65 岁之间、计划在全身麻醉下接受脊柱创伤性骨折后选择性脊柱后路固定手术并使用 ASIA B 至 E 的 ASA I - II 级患者进行了研究。患者被随机分为 A 组和 B 组，A 组包括接受全身麻醉并使用 ESPB 的患者，B 组或对照组包括接受全身麻醉并使用全身镇痛药和术后局部浸润但不使用 ESPB 的患者。两组患者的术中芬太尼总用量、0、3、6、12、18 和 24 小时的 VAS 评分、启动患者自控镇痛（PCA）泵的时间、吗啡总用量以及与阿片类药物相关的副作用均接受了监测和比较。 接受ESPB治疗的A组患者术后PCA吗啡消耗量明显低于对照组（17.06 ± 9.59 vs 37.82 ± 9.88，P值= <0.0001）。在所有时间点上，ESPB 组与对照组相比，在 0、3、6、9、12、18 和 24 小时休息和运动时的 VAS 评分均显著降低（P 值 = 0.05）。 对接受脊柱固定手术的外伤性脊柱患者进行双侧超声引导下脊柱后凸平面阻滞，可提供更好的镇痛效果，VAS评分明显降低，术后对阿片类药物的需求也更少。
{"title":"Bilateral ultrasound-guided erector spinae plane block for postoperative pain relief in major traumatic spine surgery: A randomized controlled trial","authors":"Baby Pegu, Babita Gupta, Arshad Ayub","doi":"10.4103/sja.sja_694_23","DOIUrl":"https://doi.org/10.4103/sja.sja_694_23","url":null,"abstract":"\u0000 \u0000 Spine fixation surgery for traumatic vertebral fractures is associated with severe pain and is often difficult to control. Traditionally systemic opioids have been the mainstay of analgesia for these procedures, which can lead to hyperalgesia, nausea, ileus, sedation, cognitive impairment, dependence, etc., limiting usage of opioids. The Erector spinae plane block (ESPB) is a novel ultrasound-guided procedure with easily identifiable sonoanatomy. We hypothesized that a multimodal approach involving ESPB to a conventional analgesic regimen with local infiltration for patients undergoing major traumatic spine surgeries might provide better perioperative analgesia and reduce the need for postoperative opioid requirements.\u0000 \u0000 \u0000 \u0000 A randomized control prospective trial was conducted on 34 ASA grade I –II patients aged 18 to 65 years who were scheduled to undergo elective posterior spine fixation surgery with ASIA B to E after traumatic spine fracture under general anesthesia. Patients were randomized to Group A which included patients who received general anesthesia with ESPB, and Group B, or the control group, included patients who received general anesthesia with systemic analgesics and postoperative local infiltration without ESPB. Intraoperative total fentanyl consumption, VAS score at 0, 3, 6, 12, 18, and 24 hours, time to activate patient-controlled analgesia (PCA) pump, total morphine consumption, and opioid-related side effects were monitored and compared in both groups.\u0000 \u0000 \u0000 \u0000 Postoperative PCA morphine consumption was significantly lower in group A patients who received ESPB than those in the control group (17.06 ± 9.59 vs 37.82 ± 9.88 P value = <0.0001). VAS scores at rest and movement at 0, 3, 6, 9, 12, 18, and 24 hours were significantly lower (P value = 0.05) in the ESPB group compared with the control group at all time points.\u0000 \u0000 \u0000 \u0000 Bilateral ultrasound-guided Erector spinae plane block, when administered in traumatic spine patients undergoing spine fixation surgery, provides better analgesia with statistically decreased VAS scores and less postoperative opioid requirement.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nadine El Hadi, Jad Hosri, Tamam Tulimat, Usamah Hadi
The authors have conducted a retrospective analysis based on two cases of patients with intra-tracheal pathologies who received treatment from the same surgeon at a tertiary referral center. The effective management of airways in patients with intra-tracheal lesions necessitates close collaboration between surgeons and anesthesiologists. Factors such as the size, location, rigidity of the tumor, and the remaining tracheal lumen space should be carefully considered. In situations where there is near complete obstruction of the trachea and a substantial risk of worsened respiratory function, resorting to cardiopulmonary bypass or extracorporeal membrane oxygenation is advisable. This pilot study aims at devising an algorithm for the airway management of intra-tracheal lesions, although a larger case cohort is needed to assess its applicability and effectiveness.
{"title":"Algorithm for airway management in benign intra-tracheal lesions","authors":"Nadine El Hadi, Jad Hosri, Tamam Tulimat, Usamah Hadi","doi":"10.4103/sja.sja_975_23","DOIUrl":"https://doi.org/10.4103/sja.sja_975_23","url":null,"abstract":"The authors have conducted a retrospective analysis based on two cases of patients with intra-tracheal pathologies who received treatment from the same surgeon at a tertiary referral center. The effective management of airways in patients with intra-tracheal lesions necessitates close collaboration between surgeons and anesthesiologists. Factors such as the size, location, rigidity of the tumor, and the remaining tracheal lumen space should be carefully considered. In situations where there is near complete obstruction of the trachea and a substantial risk of worsened respiratory function, resorting to cardiopulmonary bypass or extracorporeal membrane oxygenation is advisable. This pilot study aims at devising an algorithm for the airway management of intra-tracheal lesions, although a larger case cohort is needed to assess its applicability and effectiveness.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Pahuja, Ravikiran Nikhade, Anjali Bhure, A. Pingley
Among congenital cyanotic heart diseases (CHDs), situs inversus totalis with transposition of great vessels with a large ventricular septal defect (VSD) has a very low incidence of around 1 in 10,000. Hereby, we present a 16-year-old man with the aforementioned cardiac anomaly with cardiac arrhythmias, septic shock, and a history of road traffic accident-causing osteomyelitis of the left thigh requiring incision and drainage. The patient was admitted to the intensive care unit with a high-grade fever, narrow pulse pressure, and atrial fibrillation. The patient was operated on under general anesthesia with endotracheal intubation after optimization. Invasive monitoring, antiarrhythmics, and vasopressors were required intraoperatively, and surgery progressed uneventfully. Furthermore, the patient had undergone a series of debridements after 8 days, which were performed under regional anesthesia uneventfully. This case report represents a plan of action for perioperative anesthetic management and anticipates the difficulties for CHD patients in the course of surgery and subsequential prudence.
{"title":"Anesthetic management of a patient with congenital cyanotic heart anomaly for emergency surgery: A case report","authors":"H. Pahuja, Ravikiran Nikhade, Anjali Bhure, A. Pingley","doi":"10.4103/sja.sja_48_24","DOIUrl":"https://doi.org/10.4103/sja.sja_48_24","url":null,"abstract":"Among congenital cyanotic heart diseases (CHDs), situs inversus totalis with transposition of great vessels with a large ventricular septal defect (VSD) has a very low incidence of around 1 in 10,000. Hereby, we present a 16-year-old man with the aforementioned cardiac anomaly with cardiac arrhythmias, septic shock, and a history of road traffic accident-causing osteomyelitis of the left thigh requiring incision and drainage. The patient was admitted to the intensive care unit with a high-grade fever, narrow pulse pressure, and atrial fibrillation. The patient was operated on under general anesthesia with endotracheal intubation after optimization. Invasive monitoring, antiarrhythmics, and vasopressors were required intraoperatively, and surgery progressed uneventfully. Furthermore, the patient had undergone a series of debridements after 8 days, which were performed under regional anesthesia uneventfully. This case report represents a plan of action for perioperative anesthetic management and anticipates the difficulties for CHD patients in the course of surgery and subsequential prudence.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rishabh Jaju, Saurabh Varshney, Pooja Bihani, Naveen Paliwal, H. M. R. Karim, Dipak Bhuyan
Anesthesiologists’ services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient’s knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services. It was a single-center, cross-sectional survey involving 550 patients aged 18–65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients’ baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant. Less than half comprehended anesthesia’s role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists’ services, which might be attributable to the survey-based interaction. A significant need for more understanding regarding anesthesia and anesthesiologists’ roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients’ knowledge, comprehension, and satisfaction.
{"title":"Enhanced perioperative communication elevates patients’ understanding, perception, and satisfaction for anesthesia services: Insights from a survey study","authors":"Rishabh Jaju, Saurabh Varshney, Pooja Bihani, Naveen Paliwal, H. M. R. Karim, Dipak Bhuyan","doi":"10.4103/sja.sja_104_24","DOIUrl":"https://doi.org/10.4103/sja.sja_104_24","url":null,"abstract":"\u0000 \u0000 Anesthesiologists’ services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient’s knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services.\u0000 \u0000 \u0000 \u0000 It was a single-center, cross-sectional survey involving 550 patients aged 18–65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients’ baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant.\u0000 \u0000 \u0000 \u0000 Less than half comprehended anesthesia’s role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists’ services, which might be attributable to the survey-based interaction.\u0000 \u0000 \u0000 \u0000 A significant need for more understanding regarding anesthesia and anesthesiologists’ roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients’ knowledge, comprehension, and satisfaction.\u0000","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Satish Kumar Mishra, Saket Davera, G. Viswanath, Shalendra Singh
Anesthetic management of extremely low-birth-weight (ELBW) neonates is always accompanied by many dilemmas and challenges. Here, we report a case in which 512 g of ELBW newborns underwent exploratory laparotomy for perforation. Anesthesia management of such ELBW infants has not been reported in the literature.
{"title":"Anesthetic management of extremely low-birth-weight neonates for laparotomy","authors":"Satish Kumar Mishra, Saket Davera, G. Viswanath, Shalendra Singh","doi":"10.4103/sja.sja_82_24","DOIUrl":"https://doi.org/10.4103/sja.sja_82_24","url":null,"abstract":"Anesthetic management of extremely low-birth-weight (ELBW) neonates is always accompanied by many dilemmas and challenges. Here, we report a case in which 512 g of ELBW newborns underwent exploratory laparotomy for perforation. Anesthesia management of such ELBW infants has not been reported in the literature.","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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