Saudi Journal of Anaesthesia最新文献

Background: Mastectomy is associated with postoperative pain that can become chronic if left untreated. While opioids are commonly used, their adverse effects on recovery highlight the need for alternative methods. This study investigates the opioid-sparing effects of adding dexmedetomidine to ropivacaine, compared to ropivacaine without dexmedetomidine, in erector spinae plane block for patients undergoing mastectomy.

Methods: This is a prospective, randomized controlled trial conducted at a tertiary University Hospital. Forty-four patients undergoing mastectomy with axillary lymph node dissection under general anesthesia were enrolled and randomized to receive erector spinae block with dexmedetomidine added to ropivacaine (intervention) or without dexmedetomidine (control). The primary outcome was total opioid consumption in the post-anesthesia care unit (PACU) and up to 24 hours postoperatively. Secondary outcomes included intraoperative hemodynamics, vitals, medications, and complications, as well as pain medications and levels, and side effects during the first 24 hours postoperatively.

Results: PACU opioid consumption was significantly lower in patients who received the intervention compared to those who underwent the routine procedural protocol (3.14 ± 2.85 vs 5.86 ± 4.52, P = 0.021). Median survival time to opioid provision in the PACU and total morphine consumption up to 24 hours were not statistically significantly different between the two groups. Pain levels remained statistically significantly lower in the experimental group up to 12 hours postoperatively, after which no significant difference was observed. No significant side effects were reported.

Conclusions: Dexmedetomidine, in safe doses, with ropivacaine in erector spinae block reduces immediate opioid consumption and postoperative pain in mastectomy patients.

Background: To evaluate the number and type of acute pathological events during each football match and analyze whether the stadium's health protocol, which includes anti-COVID-19 measures, has had an impact on reducing admissions to nearby hospitals. The number of spectators requiring assistance was evaluated through the patient presentation rate (PPR), and the number of hospitalizations was assessed through the hospital transport rate (TTHR).

Methods: General and specific measures aimed at reducing the risk of COVID-19 transmission were implemented for spectators attending the 2020 UEFA European Football Championship matches held in Rome. For planning and risk stratification of events, the Arbon and Maurer scores were calculated to define the expected resources and the impact on healthcare systems. The primary outcome was the PPR and relative triage grouped into four categories. The secondary outcome was the need for hospitalization and the relative TTHR. The Mann-Whitney U test was used to compare parametric variables, whereas categorical variables were compared using the Chi-square test. All data were analyzed using SPSS v26 (IBM, NY, USA).

Results: The most frequent symptoms were headache (23.9%), confusion (23.9%), syncope (11.4%), and dizziness (5.7%). The PPR ranged from 0.84 to 1.15. The most frequently assigned code was white in all events examined. The TTHR was between 0 and 0.21.

Conclusion: The assistance service provided at EURO 2020 successfully fulfilled its primary role of minimizing referrals to nearby hospitals. Mass gathering events can be conducted safely if adequate precautionary measures against COVID-19 are implemented.

Background: Nurse anesthetists (NAs) face several challenges in their work, one of which is dealing with patients who experience anxiety and fear before surgery. The increased patient turnover and a shortage of healthcare professionals lead to a heavier focus on physical care, thus leaving limited time to address the psychological needs of patients.

Objectives: This study aimed to critically evaluate and compile research that describes the things NAs use in reducing patients' fear and anxiety before surgery.

Materials and methods: A systematic search was conducted on PubMed, Medline, CHINAL, Embase, and the Cochrane Library database for qualitative and quantitative literature regarding factors influencing patients' wellbeing before surgery. An inductive thematic analysis generated categories and subcategories. Twenty-one studies were included.

Results: The thematic analysis of the articles included revealed two main categories and six subcategories. Some strategies identified to help reduce fear and anxiety in patients before surgery included providing various types of information, offering psychological support, using different relaxation techniques, and ensuring that each patient is allocated sufficient time.

Conclusion: The results of the presented study showed that strategies such as providing different forms of information, psychological support, and different relaxation therapies gave good results. However, there is a need for further research in health care to identify which nonpharmacological nursing interventions are most effective in alleviating preoperative anxiety. More research is also needed to determine how preoperative care should be structured to help patients feel safe and comfortable before surgery.

Background: Liver transplantation is frequently associated with massive blood loss and utilization of blood products to optimize coagulation; this study aimed to evaluate their possible correlation with etiological and perioperative factors.

Methods: A retrospective analysis of adult liver transplant (LT) recipients (excluding re-do transplants) operated upon at our center between 2011 and 2021 was conducted using R package with rBiostatistics.com graphical user interface.

Results: Of the 947 cases, 70.70% had cirrhosis, and 28.6% hepatocellular carcinoma, as secondary diagnoses; the most common primary diagnosis was viral hepatitis (B = 20.9% and C = 20.0%). The mean blood loss volume was 3393.2 ml. Living donor liver transplantation (LDLT) recipients (n = 740, 78.2%) had lesser blood loss (mean difference 738 mL, P = 0.037) and reduced requirement for fresh frozen plasma (FFP, OR = 0.734, P = 0.001) and platelets (OR = 0.809, P < 0.001). Presence of hepatocellular carcinoma (n = 273, 28.6%) was significantly protective for blood loss (mean difference 717 ml, P = 0.037) and the need for FFP (OR = 0.991, P < 0.001), cryoprecipitate (OR = 0.568, P = 0.001), and platelets (OR = 0.602, P < 0.001). Schistosomiasis (n = 23, 2.4%) was accompanied by increased blood loss (mean difference 2328 ml (P = 0.012)). A body mass index (BMI) >35 kg/m² increased the hazard of cryoprecipitate requirement (OR = 1.203, P = 0.008).

Conclusion: The blood loss and the blood products transfusion requirements in LT are influenced by the etiology, graft type, and other perioperative factors such as BMI.

Eisenmenger syndrome (ES) represents the extreme phenotype of pulmonary hypertension. We present the anesthetic management of an ES case undergoing transurethral resection of bladder tumor (TURBT). A 56-year-old lady who is known to suffer from ES diagnosed with a urinary bladder multifocal tumor was scheduled for TURBT. We describe here the successful management of the ES case undergoing TURBT using continuous spinal anesthesia.

This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An 81-year-old female patient who had severe mitral valve regurgitation, severe tricuspid valve regurgitation, and pulmonary hypertension was scheduled for Mitral Valve Replacement and DeVega Tricuspidoplasty. The patient had many comorbidities, so she was on antihypertensive (nebivolol), antithrombotic (rivaroxaban), and antidiabetic (insulin) medications. After anesthesia induction, the patient was positioned for CVC. Ultasound guidance showed that the anteroposterior diameter of the right IJV was small and the degree of overlapping of carotid artery (CA) was high. Left side was evaluated before starting the procedure. Marked enlargement of the left IJV and less overlapping of CA was observed. Left IJV catheterization was decided and performed without any complication. The surgery lasted for 3 hours and was completed uneventfully. Although right IJV is usually preferred for CVC where central intravenous access is required, it is advisable to evaluate the left IJV when the right one has a small diameter and there is a significant overlapping of right CA. In these cases, the choice for CVC side should be based on the data which is obtained from both sides.

Etomidate is the agent of choice for the induction of anesthesia in patients with cardiovascular illness, hypotension, or shock. Notwithstanding its numerous attributes, etomidate's most notable adverse impact is adrenocortical suppression. Due to these concerns, the creation of an etomidate alternative that maintains its beneficial effects while mitigating adverse outcomes became essential. This article will focus on the new etomidate analog, methoxyethyl etomidate hydrochloride, referred to as ET-26.

Objective: To determine the median effective dose (ED50) of 2% lidocaine mixed with propofol for preventing pain during the induction of anesthesia using a modified Dixon's up-and-down method.

Materials and methods: Thirty ASA (American Society of Anesthesiologists) grade I and II patients, aged 18-60 years, undergoing elective surgery were enrolled. Using the modified Dixon's up-and-down method, patients received varying doses of lidocaine mixed with 20 mL of propofol MCT/LCT (Medium Chain Triglyceride/Long Chain Triglyceride) emulsion. The primary outcome was the calculation of the ED50 of 2% lidocaine, defined as the midpoint dose at which 50% of patients experienced painless injection. Secondary outcomes included pain scores during injection, heart rate changes, and withdrawal movements.

Results: Thirty patients completed the study. The ED50 of lidocaine premixed with 20 mL of propofol MCT/LCT emulsion to prevent pain during the induction of anesthesia was 32.14 mg (95% CI = 32.09 mg-32.18 mg), equivalent to 1.46 mg/mL (95% CI: 1.02 mg/mL-1.91 mg/mL). Demographic and clinical characteristics of patients who experienced pain and those who did not were not statistically significant.

Conclusion: Our study concluded that the ED50 of lidocaine premixed with 20 mL of propofol to prevent pain during the induction of anesthesia was 32.14 mg (95% CI = 32.09 mg-32.18 mg), equivalent to 1.46 mg/mL (95% CI: 1.02-1.91 mg/mL).

Background: Between 10% and 80% of surgical patients experience some form of fear and anxiety before surgery. This is often attributed to inadequate or incorrect preoperative information.

Objectives: This study aimed to critically evaluate and compile research that describes the impact of preoperative information on the patient's well-being before surgery.

Methods: A systematic search was conducted on PubMed, Medline, CHINAL, Embase, and the Cochrane Library database for qualitative and quantitative literature regarding factors influencing patients' well-being before surgery. An inductive thematic analysis generated categories and subcategories. Nineteen studies were included.

Results: Two main categories emerged from the thematic analysis of the included articles. These were the direct impact of information on fear and anxiety and the indirect impact of information on fear and anxiety. Information from healthcare professionals, alternative sources of information, shortage of healthcare professionals, music, and inability to receive information were some of the factors that can influence the well-being of patients before surgery. There are different reasons for the patient's fear and anxiety preoperatively, as well as the importance of direct and indirect information and other methods. For some patients, however, too much information could cause more fear and anxiety.

Conclusion: The importance of the patient's discomfort being highlighted by the healthcare professionals emerges clearly and shows negative experiences in those cases where the patient feels his fears and concerns are not being addressed. More qualitative and quantitative research in the same theme, education and using person-centred care, and the right amount of information based on the patient's wishes are needed to improve the patient's well-being.