Saudi Journal of Anaesthesia最新文献

Mepolizumab, a comprehensible monoclonal antibody that inhibits interleukin-5 (IL-5), offers a new therapeutic option for a subset of patients with chronic obstructive pulmonary disease (COPD) marked by eosinophilic inflammation. Despite the success of conventional inhaled therapies, a significant proportion of COPD patients continue to experience exacerbations. This review discusses the mechanism, clinical trials, safety profile, and future potential of mepolizumab, the first and only FDA-approved biologic for COPD.

Background: Emergency Front Of Neck Access techniques are an essential skill for anesthesiologists, enabling them to effectively manage the critical "can't intubate, can't oxygenate" scenarios. Current literature suggests minimal improvement in mortality associated with these scenarios due to their rarity and difficulty in providing adequate training. This study aims to evaluate whether high-fidelity training can outperform low-fidelity training in teaching Emergency Front Of Neck Access.

Methods: We designed a prospective, single-blinded observational trial to assess the presumed superiority of high-fidelity training compared to low-fidelity training in teaching Emergency Front Of Neck Access to our anesthesiology department. The Performance Rating Scale (PRS) was the tool we employed to assess the participants' performance during both scenarios. The primary outcome was the difference in PRS between the high- and low-fidelity training groups. The secondary outcomes were the correlation between PRS scores and the participants' past clinical experience with Emergency Front Of Neck Access, the number of tracheostomies performed, and years of clinical service.

Results: A total of 30 participants from our anesthesia department were enrolled. There was a statistically significant difference in Performance Rating Scale scores between high-fidelity and low-fidelity training. The low-fidelity group had a median score of 7 (range -7 to 9), while the high-fidelity group had a median score of -3 (range -11 to 11). None of the secondary outcomes reached statistical significance.

Conclusions: Our findings suggest that the benefits of high-fidelity training may justify the additional costs associated with incorporating it into conventional airway management training.

Robotic-assisted surgery offers significant advantages in pediatric procedures due to its precision and minimally invasive nature. This case report examines the anesthetic management of a 9-year-old male diagnosed with pheochromocytoma who underwent robotic-assisted adrenalectomy. The report highlights the intraoperative challenges of managing hemodynamic fluctuations, including hypertension and hypotension, and addresses the measures taken to monitor and manage hypoglycemia.

Background: Healthcare providers use smartphones for various beneficial purposes, including education, communication, and remote patient monitoring. However, concerns have arisen about their potential to distract anesthesiologists in the operating room, potentially leading to catastrophic consequences. This study aimed to assess smartphone habits and attitudes among anesthesiologists at a tertiary care hospital in Riyadh, Saudi Arabia.

Materials and methods: A cross-sectional survey was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Anesthesiologists were surveyed using a questionnaire distributed via email and phone numbers. Hard copies of the questionnaire were also distributed in the operating rooms. Data are cleaned in Excel and analyzed using IBM SPSS 29.0.

Results: Our study included 123 participants, mostly male (n = 102, 82.9%), with a significant portion aged 31-40 years (n = 34, 27.6%). Most were consultants (n = 51, 41.5%), and 64.2% (n = 79) spent less than 25% of their working hours on smartphones. Despite 52.8% (n = 65) reporting distractions from smartphone use, only 29.3% (n = 36) supported restrictions in operating theaters. A significant association was found between age and perceptions of smartphone impact on patient care (P = 0.012), with younger anesthetists more likely to see a positive effect. Moreover, frequent smartphone users were more likely to perceive benefits in patient care (P = 0.038), and those not distracted by phones believed that smartphone usage improved care (P < 0.001). Finally, those not irritated by colleagues' phone use were more likely to report positive impacts on patient care (P < 0.001).

Conclusion: Our study highlights the pervasive use of smartphones among anesthesiologists, with many acknowledging both benefits and distractions. While a significant number perceive positive impacts on patient care, concerns about distraction remain, indicating the need for balanced guidelines in operating theaters.

This report discusses the anesthetic management of a 7-year-old child with aromatic L-amino acid decarboxylase (AADC) deficiency, a rare neurometabolic disorder. The patient underwent ventilation tube insertion and adenotonsillectomy. Similar to other adenotonsillectomy procedures, this surgery carries a higher risk of postoperative nausea and vomiting, necessitating a careful management strategy. We opted for dexamethasone as the primary antiemetic agent and limited opioid use to a single dose of fentanyl, while also incorporating dexmedetomidine for enhanced pain management alongside ketorolac and paracetamol. This case highlights the need for specialized anesthesia protocols for AADC deficiency patients to enhance safety and outcomes, particularly addressing the challenges of nausea and vomiting.

Background: In recent years, the use of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) for the treatment of pediatric hydrocephalus has gained increasing attention, particularly in North America and Africa. It has shown potential to enhance the efficacy of ETV alone and reduce the need for ventriculoperitoneal shunt placement. However, research on the potential side effects of CPC, particularly concerning postoperative sympathetic nervous system responses, remains limited. In our clinical practice, we observed that ETV + CPC may induce transient sympathetic storms, a phenomenon not yet reported in the literature, posing new challenges for postoperative anesthetic management and monitoring.

Objective: This study aims to report the phenomenon of transient sympathetic storm following ETV + CPC, analyze its potential mechanisms, and raise awareness among anesthesiologists and neurosurgeons to enhance recognition and management of this condition.

Methods: A retrospective analysis was performed on three pediatric patients with communicating hydrocephalus who underwent ETV + CPC at our hospital between January 2016 and December 2016 and subsequently developed transient sympathetic storm. The clinical features, intraoperative and postoperative conditions, and patient outcomes were analyzed to explore the relationship between the extent of CPC and the severity of sympathetic hyperactivity.

Results: All three patients developed varying degrees of sympathetic hyperactivity after surgery, including tachycardia, rapid breathing, increased muscle tone, tension, and limb tremors. The first case (6-month-old boy) underwent right-sided CPC and had the mildest response. The second case (6-month-old girl) underwent right-sided and partial left-sided CPC, exhibiting moderate response. The third case (21-month-old girl) underwent extensive bilateral CPC and had the most severe response with the longest duration. Sympathetic hyperactivity was positively correlated with the extent and intensity of CPC.

Conclusion: Transient sympathetic storm may occur after ETV + CPC, presenting challenges for postoperative anesthetic and neurosurgical care. The severity of sympathetic hyperactivity appears to correlate with the extent and intensity of CPC. Its mechanism is hypothesized to involve thermal injury to the bilateral thalamus and associated vasculature. Further research is required to better understand the side effects and complications of CPC. This study also supports the hypothesis that bilateral thalamic injury may trigger sympathetic hyperactivity, providing new evidence and insights into the mechanisms underlying paroxysmal sympathetic hyperactivity.