Saudi Journal of Anaesthesia最新文献

Breast cancer is the most common malignancy among Saudi women, with Modified Radical Mastectomy (MRM) as a standard treatment, typically performed under general anesthesia (GA). However, GA poses significant risks to patients with multiple comorbidities. We present a 66-year-old female with invasive ductal carcinoma, complicated by scleroderma with interstitial lung disease, chemotherapy-induced heart failure, and hypertension, making GA a high-risk option. To optimize perioperative safety, thoracic epidural anesthesia (TEA) combined with a pectoralis nerve block (PECS2) was used instead. This approach provided effective surgical anesthesia, hemodynamic stability, and minimized opioid use. The patient tolerated the procedure well, with intraoperative hypotension managed by vasopressor support. She resumed oral intake within 6 hours, required minimal postoperative opioids, and was discharged on the third postoperative day without complications. This case highlights the feasibility and advantages of TEA with PECS2 block as a safe and effective alternative to GA in high-risk MRM patients. By reducing GA-related pulmonary and cardiac risks, improving postoperative pain control, and shortening hospital stays, this technique may enhance perioperative outcomes in select patients. Further studies are warranted to support the wider adoption of regional anesthesia in oncologic breast surgeries.

Background: We proposed that the L3 paravertebral block (PVB) combined with the retro-psoas compartment block (RPCB) would provide a better postoperative analgesia for total knee arthroplasty (TKA) than the femoral nerve block (FNB) alone.

Materials and methods: A total of 66 patients scheduled for TKA were randomly allocated to receive either FNB or L3 PVB-RPCB. Postoperative patient-controlled analgesia with intravenous sufentanil was administered. The primary endpoint was the total sufentanil consumption within the first 24 hour postoperative. Secondary outcomes assessed included pain intensity, sensory dermatomal coverage 20 min after administering the blocks, rescue analgesia requests, satisfaction scores, and the incidence of nausea, vomiting, itching, and posterior knee pain.

Results: Patients in the L3 PVB-RPCB group consumed significantly less sufentanil in the first 24-hour post-surgery compared to those who received an FNB, with intake measuring 30 [28 to 33] ug versus 43 [37 to 46] ug, respectively, (P < 0.01). Furthermore, the pain scores were significantly lower in patients with L3 PVB-RPCB at 6 hour and 12 hours at rest (P < 0.01), and at 12 hours on movement (P < 0.01). This group also showed a reduced need for rescue analgesia and experienced less posterior knee pain (P < 0.01). There were no significant differences in satisfaction scores or in the occurrence of opioid-related side effects.

Conclusion: The reduction of sufentanil consumption within the initial 24 hour after TKA demonstrates a beneficial effect of L3 PVB-RPCB over the FNB in providing the postoperative analgesia.

Background: Recommended prophylaxis against postspinal hypotension includes vasopressor infusions needing continuous and accurate titration preferably with infusion pumps, along with close blood pressure monitoring. In resource constrained settings with high volume obstetric care such intensive management may be difficult for every patient. Thus a dependent, simple tool without need of advanced technology to predict postspinal hypotension is desirable. Although PRAM score is such a tool it has never been validated.

Aim: To validate previously formulated bed-side PRAM score (also after adding postspinal tachycardia as a variable) for predicting postspinal hypotension.

Materials and methods: This prospective study included 371 consenting patients scheduled for elective/emergency cesarean delivery using standardized spinal block. Postspinal hypotension was defined as systolic blood pressure <80% of baseline or <90mmHg, whichever was higher (upto 15 minutes after baby delivery); and managed with boluses of phenylephrine (50 μg i.v.) till resolution. PRAM score included grade of 1 for each of: baseline heart rate >90 bpm, mean arterial pressure <90 mmHg and age >25 years minutes. Postspinal tachycardia was an increase in heart rate by >10 bpm within 5 minutes.

Results: Incidence of postspinal hypotension was 49.3%, with median onset time of 3 minutes, number of hypotensive episodes ranging from 0 to 5, and amount of phenylephrine required 50-300 μg. ROC analysis showed significant predictive value of PRAM score for postspinal hypotension, with an AUC of 0.578 [95% CI: 0.520-0.636] (P= 0.008); and sensitivity of 89% at cut-off value of PRAM score= 1. When including tachycardia within the first 5 minutes post-block, modified PRAM score had improved predictive accuracy with AUC of 0.601 [95% CI: 0.544-0.659] (P = 0.001).

Conclusion: The PRAM score effectively predicts postspinal hypotension during cesarean delivery.

Sublingual dexmedetomidine under the tradename of IgalmiTM is the first and only FDA-approved sedative agent for treating agitation in schizophrenia and bipolar I or II patients. This article highlights the benefits and adverse effects associated with this novel route of administration of dexmedetomidine and its potential to emerge as a promising sedative agent.

To examine the role of Transcutaneous Electrical Nerve Stimulation (TENS) in pain management post-laparoscopic cholecystectomy (LC). An in-depth search was conducted on Google Scholar, PubMed, and Ovid MEDLINE from their inception until November 2024. We included randomized controlled trials and prospective studies that compared TENS for postoperative pain relief as determined by the Visual Analog Scale (VAS). The quality assessment using the GRADE and Cochrane risk of bias methods. Six trials, comprising a total of 423 patients, were included in the study. The meta-analysis of the VAS at different times yielded no significant reduction in pain observed postoperatively at 4 hours (MD: -0.70, CI: -1.97 to 0.57, P = 0.28); at 8 hours (MD: -0.75, CI: -2.15 to 0.65, P = 0.29); and at discharge (MD: -0.88, CI: -2.02 to 0.26, P = 0.13). While the included studies showed minimal risk of bias, the certainty of evidence by the GRADE assessment was deemed low. While some studies suggest a potential benefit of TENS in reducing postoperative pain, the current evidence remains inconclusive due to the variability in study design, TENS parameters, and outcome reporting. Additional high-quality RCTs are required.

Background: Neuraxial anesthesia (NA), specifically thoracic spinal anesthesia (TSA), offers several theoretical advantages when compared to the General Anesthesia (GA). This retrospective study compares TSA with the gold standard GA in elective colorectal laparoscopic surgery and evaluates the impact on respiratory functions.

Material and methods: The data used in this study were extracted from the medical records of 34 consecutive patients, who had undergone laparoscopic colon resection surgery in Melegnano Hospital-ASST Melegnano Martesana-Italy and had been administered NA or GA. Postoperative lung function was assessed via lung ultrasound [Lung Ultrasound Score(LUS)], and PaO₂/FiO₂ (P/F) ratio.

Results: The average duration of the surgical procedure was 201.9 ± 50.4 min (NA 191.1 ± 44.1 vs. GA 212 ± 55.3 min, P = 0.21). Arterial blood gas parameters showed a reduction in the postoperative values of P/F ratio (P/F: NA 387 ± 70 vs GA 342 ± 52, P = 0.049). LUS reveals a higher prevalence of atelectasis in the poster-inferior lung regions. After surgery, the pre- and post-operative LUS scores (Delta LUS) showed differences in the GA group (NA 1.8 ± 1.8 vs GA 3.8 ± 1.9, P = 0.003). The receiver operating characteristic (ROC) curve proved to be very accurate (area under the curve (AUC) = 0.898, P < 0.001) in predicting postoperative oxygen support, even more so in the GA group (2 in the NA group vs 7 in the GA).

Conclusions: In the context of a progressively aging population and an increase in the fragility of patients, NA with spontaneous ventilation appears to exert a minor impact on respiratory function compared to GA.

Noonan syndrome (NS) is an autosomal dominant multisystem disorder characterized by congenital cardiac defects, craniofacial anomalies, and hematological abnormalities. With an incidence of 1 in 1000 to 2500 live births, NS is one of the most common syndromes associated with congenital heart disease, second only to trisomy 21. Pregnant patients with NS present unique anesthetic challenges due to the syndrome's diverse manifestations and the physiological changes of pregnancy. This report describes a 28-year-old woman with NS who underwent elective cesarean delivery at 36 weeks of gestation. Her medical history included repaired congenital heart defects, pulmonary stenosis, severe scoliosis, and asthma. Spinal anesthesia was successfully employed using a low-dose combination of local anesthetics and opioids to achieve effective sensory block while maintaining hemodynamic stability. The patient's normal coagulation profile allowed neuraxial anesthesia to be a feasible option despite potential technical difficulties associated with spinal abnormalities. This case underscores the importance of a multidisciplinary approach to pregnant patients with NS, including comprehensive preoperative evaluation and individualized anesthetic planning. Neuraxial anesthesia can be a safe and effective option when tailored to the patient's specific physiology, ensuring optimal maternal and fetal outcomes while minimizing risks.