Saudi Journal of Anaesthesia最新文献

The incidence of tracheocele is rare, but whenever encountered, Tracheoceles must be meticulously managed owing to the grave complications associated with them. Here, we report the successful management of a case of orbital tumor who underwent orbital exenteration and was incidentally preoperatively diagnosed with having a large tracheocele in the lower neck region.

Objective: Residual neuromuscular blockade (RNMB), defined as a train-of-four ratio (TOFR) <0.90, is a complication of neuromuscular blocking agents (NMBA). Data about RNMB in children are rare. This single-center observational trial evaluated the rate of neuromuscular monitoring (NMM), the incidence, and consequences of RNMB in pediatrics.

Methods: Children over 1 month undergoing elective and urgent surgery during core work hours receiving NMBA were included in an 84-day observation period. When the anesthesiologist decided to extubate, a blinded investigator measured the TOFR by acceleromyography. Data on demographics, surgery, anesthesia, and outcome were recorded. Comparison of qualitative variables was done using the chi-square test. The Mann-Whitney U test was used to compare quantitative variables between patients with or without TOFR <0.90. P <0.05 was considered significant.

Results: Eighty-nine children were included in the analysis. Rate of quantitative and qualitative NMM was 65.2% and 5.6%, respectively. Incidence of RNMB was 10.1% with TOFRs between 0.78 and 0.89 in 8 children and a TOFR of 0.48 in one child. Median time from the last NMBA administration to the TOFR before extubation was significantly shorter in patients with a TOFR <0.90 in comparison with a TOFR ≥0.90 (88 vs. 110 min). In the RNMB group, qualitative NMM was significantly more often used compared with the no RNMB group (22.2% vs. 3.8%). Adverse events were rare with no significant differences between the two groups.

Conclusion: RNMB in children is a relevant hazard. Qualitative NMM is not reliable to exclude RNMB. Institutional training programs on neuromuscular management in children may be helpful to improve the rate of quantitative NMM.

Chronic myofascial pain is a very common pathological condition, but the diagnosis can be complex. Elastosonography can be a valuable aid to diagnosis by demonstrating increased stifness of the myofascial unit. In addition, it can demonstrate the reduction in stifness after performing a fascial plane block by allowing the effectiveness of the block to be evaluated. In this case series we present cases of patients evaluated with elastosonography before and after fascial plane block and demonstrate the differences.

Lumbar epidural anesthesia is an important part of labor analgesia. Despite common complications, lumbar epidurals are considered the most effective pain management option during childbirth. Fracture of the epidural catheter during removal is an uncommon but known complication, but fragmentation of the catheter during insertion is extremely uncommon. There are several reasons for catheter fracture during removal; however, catheter fracture during insertion can occur for two main reasons in labor epidurals. The first reason is if the anesthetist pulls the catheter while the Tuohy needle is still in place, and the second is when the catheter is removed during active labor contractions. We describe the occurrence of such an event in a primiparous patient, where the epidural catheter fractured during insertion. A brief review is provided to prevent and manage such complications.

Combined spinal-epidural is a widespread technique used not only for lower limb, pelvic, and lower abdominal surgeries but also used to provide postoperative and labor analgesia. The accidental breakage or shearing of an epidural catheter is a known but rare complication. The real dilemma lies in its management, whether to leave it in situ or surgically remove it. We are presenting a case of accidental breakage of an epidural catheter and the consensus of its management.

[This corrects the article on p. 318 in vol. 19, PMID: 40642619.].

Background: The purpose of this survey was to delineate and compare patient blood management (PBM) approaches in cardiac surgery across nine Middle Eastern countries while identifying the main challenges against the implementation of the PBM program in cardiac surgery as reported by the surveyed centers.

Design: An online survey was established to assess current PBM practices in surveyed countries, including risk factors for bleeding or transfusion, management of preoperative anemia in elective cases, and antifibrinolytic use.

Setting: This questionnaire was conducted among cardiac anesthesiologists in Middle Eastern countries in 2024.

Participants: Only doctors participated voluntarily in this survey.

Interventions: No intervention.

Measurements: We assessed the extent of adoption of PBM practices in surveyed countries for patients who underwent cardiac surgery with cardiopulmonary bypass.

Main results: Of 40 survey responses, 26 (60%) were eligible for analysis. Most respondents were cardiac anesthesiologists. Key risk factors of bleeding or transfusion identified by over 70% of respondents included redo cardiac surgery, preoperative anemia, recent clopidogrel use, thrombocytopenia <100 × 10⁹/L, and oral anticoagulants. More than half of the centers would correct preoperative anemia using iron. Tranexamic acid was universally used, though administration regimens varied. Autologous priming and normothermia were the most common bypass strategies that would be used by more than 50% of respondents. Viscoelastic testing was available in more than 70% of centers and used by more than half of respondents in case of clinical bleeding.

Conclusion: PBM practices in Middle Eastern cardiac centers are heterogeneous, reflecting inconsistent adoption of guidelines. Enhanced training, institutional support, and homogenized national protocols are needed to standardize PBM in the region.