Saudi Journal of Anaesthesia最新文献

Background: Suzetrigine, a novel nonopioid analgesic, selectively inhibits voltage-gated sodium channel 1.8 (NaV1.8) and has recently been approved for the management of moderate to severe acute pain. This meta-analysis aimed to evaluate the efficacy and safety of suzetrigine by cumulating data from available evidence.

Methods: A literature search was conducted using ClinicalTrials.gov, PubMed, and Cochrane Central Register of Controlled Trials. Five randomized controlled trials (RCTs) were included in the systematic review, with four RCTs in the meta-analysis. The primary efficacy outcomes were time-weighted sum of pain intensity difference over 48 h (SPID 48) and 24 h (SPID 24) between suzetrigine and placebo. Secondary outcomes included proportion of participants achieving ≥30%, ≥50%, and ≥70% reduction in numeric pain rating scale (NPRS) scores at 48 h and safety analysis.

Results: Suzetrigine showed significantly better efficacy versus placebo in reducing pain, with a standard mean difference of 5.55 (95% CI 2.97-8.13, P < 0.00001) for SPID 48 and 5.33 (95% CI 2.50-8.16, P < 0.00001) for SPID 24. Odds of achieving ≥30%, ≥50%, and ≥70% reduction in NPRS scores at 48 h were significantly higher in the suzetrigine group (OR 1.95, 1.74, and 1.81, respectively; all P < 0.00001). Suzetrigine showed comparable efficacy to hydrocodone bitartrate-acetaminophen (HB/APAP) with a better safety profile, showing lower incidence of adverse events and gastrointestinal side effects.

Conclusion: Suzetrigine appears to be an effective, well-tolerated option for acute pain management, showing superiority to placebo and comparable efficacy to HB/APAP, with a better safety profile. However, future long-term studies are needed to assess its efficacy and safety in various acute pain settings.

Uvular injury, although rare, is a clinically significant complication of airway and pharyngeal manipulation and procedural intervention across multiple specialties including anesthesiology, otolaryngology, gastroenterology, obstetrics and gynecology, pediatrics, emergency medicine, and infectious disease. This narrative review comprises case reports and series from MEDLINE and Embase databases and Google Scholar from 1978 to 2025 outlining the embryological origin and anatomy of the uvula, the pathophysiology and management of uvular injury, and preventative measures. Common etiologies can be classified into mechanical injury from airway instrumentation, nonmechanical injury from isolated uvular edema, infection and drug reactions, pediatric uvular injury, and idiopathic uvular injury resulting in an array of injuries from uvular edema to necrosis, paralysis, and hematoma. Typically, uvular injuries present with sore throat, odynophagia, dysphagia, foreign body sensation, and, in more severe cases, airway obstruction. On physical exam, the uvula may appear erythematous, edematous, and necrotic or avulsed in severe cases. Uvular injuries commonly resolve with conservative management such as analgesics and anti-inflammatory medications. Antibiotics and surgical intervention are rarely indicated as most injuries resolve within 2 weeks. Recommendations for prevention of mechanical injury include device placement lateral to the midline, gentle and controlled suctioning, and careful patient positioning. Currently, there is a lack of standardized management guidelines for uvular injury. One proposed grading system categorizes uvular injury by Grade I-IV ranging from mild edema and uvulitis to uvular necrosis and autoamputation. However, future large-scale studies are warranted to standardize management protocols and guidelines.

Introduction: Spinal anesthesia (SA) may mitigate some of the risks associated with general anesthesia (GA). As an alternative to GA, SA can be used in a variety of surgical procedures and may be particularly beneficial in patients with significant comorbid conditions. We retrospectively review our experience with SA in the American Society of Anesthesiology (ASA) physical classification III and IV patients.

Methods: Retrospective chart review of ASA III/IV pediatric-aged patients who received SA for surgical procedures from 2016-2023. Data included patient demographics, procedure and anesthetic characteristics, surgical procedure, additional intraoperative sedation, reasons for conversion to GA, intraoperative adverse events, and reasons for emergency department return.

Results: The initial study cohort included 69 patients (median age eight months) with ASA physical status III or IV who presented for SA. SA failed in eight patients. This left a cohort of 61 patients in whom SA was successful (88%). Congenital cardiac, respiratory, genetic, and renal disorders were among the most common comorbid conditions. Thirty-six of the 61 patients (59%) received no additional sedative or analgesic medications following lumbar puncture for SA. The most common intraoperative adverse event was systolic blood pressure (sBP) less than 60 mmHg (n = 15; 25%), but no case required the administration of a vasoactive or anticholinergic agent. Phase I recovery was bypassed in 44% (n = 27) of cases. Six patients (9.8%) returned to the emergency department following hospital discharge, but no return was due to an anesthetic concern.

Conclusion: SA offers a safe and effective alternative to GA for ASA physical class III/IV patients. The low rate of intraoperative complications highlights the safety profile of the technique even in high-risk surgical candidates.

Osmotic demyelination syndrome (ODS) is a rare condition marked by demyelination of brain tissue due to degeneration and loss of oligodendrocytes. It is classified into central pontine myelinolysis and extrapontine myelinolysis based on the lesion sites. Diagnosis and treatment are often delayed due to inadequate clinical recognition. This study aims to examine the causes, diagnosis, and treatment experiences of ODS post liver transplantation (LT). The case of a 67-year-old female patient who underwent LT for chronic acute liver failure and primary biliary cirrhosis is retrospectively analyzed. Following her transfer to the intensive care unit, the development of ODS was monitored. Symptoms appeared on the second day after LT, beginning with muscle loss in the limbs. This was followed by localized twitching in the left upper limb and bilateral lower limb twitching, along with tremors in the head and face, lethargy, binocular fixation, facial paralysis, aphasia, and coma. ODS was confirmed through head magnetic resonance imaging, and the patient died 40 days post operation. LT and electrolyte disturbances are significant risk factors for ODS. Various pathophysiological factors influence its onset and progression during the perioperative period, necessitating prioritized prevention. Its clinical presentations are diverse, and enhancing clinical vigilance and timely diagnostic evaluations are crucial for early diagnosis of ODS.

Background: Effective pain control following tonsillectomy in children remains challenging. Traditionally, opioids such as fentanyl have been used for pain control, but its adverse effect profile makes it a less ideal option for children, particularly those with obstructive sleep apnea. The curent study investigates the perioperative effects of ketamine on postoperative pain and delirium in children.

Methods: In this prospective trials, patients 3-8 years of age were randomized to receive either fentanyl or ketamine for pain management. Pain was assessed using the face, legs, activity, crying, consolability (FLACC) scale, and emergence delirium was evaluated with the pediatric anesthesia emergence delirium (PAED) scale. Postoperative outcomes, including recovery time and analgesic requirements, were also recorded.

Results: The study cohort include 59 pediatric patients. The ketamine group exhibited higher pain scores in the first 15 min post-surgery compared to the fentanyl group. However, pain scores between the two groups were comparable by 30 min. The incidence of emergence delirium was higher with ketamine than fentanul (19.35% versus 3.57%). The groups had similar recovery and post-anesthesia care unit (PACU) times, as well as supplemental analgesia requirements.

Conclusion: Although ketamine demonstrated delayed pain relief and a higher incidence of emergence delirium, it showed potential as part of a multimodal analgesic approach. The combination of fentanyl and ketamine may optimize pain management in pediatric tonsillectomy, reducing opioid use while minimizing adverse effects. Further studies are needed to refine dosing strategies and assess long-term outcomes.

Background: Good procedural skill is the basic requirement of being an anesthetist. Formative assessment of procedural skill (workplace-based assessment (WPBA) can significantly enhance skill attainment in postgraduate students.

Aim: Implementation of DOPS as a formative assessment tool to enhance the procedural skills of postgraduate (PG) students of anesthesia.

Objective: 1. To assess the effect of DOPS as a formative assessment tool on procedural skills of PG students of anesthesia 2. To evaluate the perception of faculty and students about DOPS as a formative assessment tool.

Methodology: After obtaining informed consent, anesthesia PG students were assessed for procedural skills by DOPS using a validated checklist for that particular skill, and structured feedback was provided by the assessor immediately after the procedure. After 1 month, a second DOPS assessment was done using the same checklist, and the scores of both DOPS were compared and analyzed. After the second DOPS feedback from the students and faculty involved in the study was taken with a preformed questionnaire on a 5-point Likert scale.

Results: There was a significant improvement in the DOPS scores of the students in the second DOPS assessment (P = 0.001). The majority of the students (73.8%) agreed that DOPS helps improve their skills. The majority of students and faculty are in favor of incorporating DOPS in the PG curriculum.

Conclusion: DOPS is a great tool for WPBA. It is not only a tool for the assessment, but it also helps in improving skills, and works as a teaching learning method.

Congenital complete atrioventricular block (CCAVB) is a rare but high-risk condition with significant maternal and fetal morbidity and mortality. Management often involves pacemaker implantation, yet anesthetic guidelines for pregnant women with CCAVB remain unclear. We describe the anesthetic care of a 29-year-old primigravida with asymptomatic CCAVB (no pacemaker) and well-controlled Crohn's disease, who underwent urgent cesarean delivery at 34+5 weeks for severe preeclampsia. A multidisciplinary team developed a detailed perioperative plan. On the day of surgery, defibrillator pads were applied, an arterial line was placed, and a cardiologist was present with electrophysiology backup. Pre-anesthetic fluid status was assessed with transthoracic echocardiography. Epidural anesthesia was cautiously titrated using 0.75% ropivacaine (16 mL) and sufentanil 10 µg over 20 minutes. The procedure was uneventful, with no need for pacing or vasopressors. A healthy newborn was delivered. The patient recovered in level 2 care and was discharged on postoperative day 3. This case underscores the importance of multidisciplinary planning and cautious epidural anesthesia in CCAVB pregnancies without pacing.