Saudi Journal of Anaesthesia最新文献

Non-Islet Cell Tumor Hypoglycemia (NICTH) associated with solitary fibrous tumor is referred to as Doege-potter syndrome (DPS). Non-Islet Cell Tumor Hypoglycemia (NICTH) is a paraneoplastic syndrome characterized by hypoglycemia from secretion of insulin-like growth factor type 2 (IGF-2). Surgical resection of massive Solitary Fibrous Tumor of Pleura (SFTP) can be complicated by airway collapse, vascular compression, hemodynamic instability and hemorrhage. SFTP patients present with metabolic derangements secondary to paraneoplastic processes. We present a case of successful removal of massive right-sided SFTP via posterolateral thoracotomy and discuss the perioperative considerations for which providers should be familiar.

Background: This study aimed to investigate the protective effects of intravenous lipid emulsion (ILE) against bupivacaine-induced cardiac toxicity, using histopathological analyses.

Methods: Twenty-eight adult male Wistar-Albino rats were divided into four groups: Sham (Group A), ILE (Group B), Bupivacaine (Group C), and Bupivacaine + ILE (Group D). Neurotoxicity was induced in Groups C and D with continuous bupivacaine infusion. ILE was administered to Groups B and D. Histological examination of brain tissues, and apoptotic index were evaluated.

Results: The apoptotic index was significantly higher in Group C, but ILE administration in Group D markedly decreased these parameters (P < 0.05). Histopathological analysis revealed that ILE reduced edema and neuronal degeneration in Group D.

Conclusion: ILE demonstrated a neuroprotective effect against bupivacaine-induced cardiac toxicity by improving hemodynamic stability and reducing cellular damage. This suggests a potential therapeutic role of ILE in managing local anesthetic systemic toxicity.

Fospropofol is a water-soluble prodrug of propofol that has gained increasing attention in the field of anesthesia due to its gentle modulation of cerebral blood flow and metabolism. This review summarizes the pharmacological mechanisms by which fospropofol regulates cerebral hemodynamics, including direct effects on vascular smooth muscle and indirect modulation via suppression of neural metabolic activity. The article also discusses its ability to reduce cerebral metabolic rate, inhibit neuronal excitability, and modulate energy balance, all of which contribute to its potential neuroprotective properties, particularly in ischemia-reperfusion injury. Preclinical and clinical studies suggest that fospropofol exerts antioxidant and anti-inflammatory effects that may further support neural preservation. Clinically, fospropofol has shown value in various scenarios requiring precise neuromanagement, including neurosurgery, anesthesia in elderly patients, intensive care sedation, and perioperative neuroprotection. Despite promising results, further high-quality, large-scale studies are needed to clarify its neuroprotective efficacy across diverse patient populations and surgical contexts. With its favorable pharmacokinetics, controllable depth of sedation, and multitargeted neural effects, fospropofol is poised to become an important tool in individualized neuroanesthesia and brain-protective strategies.

Acute compartment syndrome (ACS) arises from increased pressure within a confined osteofascial compartment, leading to tissue ischemia, metabolic deficits, and potential irreversible damage if untreated. Although trauma is the most common cause, obesity-especially when combined with immobility-can increase the risk of ACS, presenting significant challenges in anesthetic management. This case report details the anesthesiological management of a 42-year-old man with severe obesity (BMI 78 kg/m²), classified as super-super obese, who presented with ACS in his right lower limb. Given his complex airway and the limitations of performing general anesthesia (GA), a regional anesthetic approach was selected. Due to anatomical challenges posed by the patient's obesity, an adductor canal block was performed using ultrasound and Doppler guidance to identify key structures and achieve a successful block. The patient was sedated, remained hemodynamically stable during surgery, and required minimal analgesics postoperatively. This case highlights the critical role of regional anesthesia in super obese patients, overcoming challenges like difficult anatomical landmarks and limited equipment, and underscores the importance of personalized, adaptive approaches to achieve optimal outcomes. Despite the technical difficulties, this successful use of regional anesthesia provides valuable insights into the management of high-risk super obese patients with ACS and reinforces the need for anesthesiologists to employ creative and flexible techniques, including advanced imaging tools, to ensure safe anesthesia care.

Background: Post-sternotomy pain is a significant challenge in cardiac surgeries. Effective pain management can reduce opioid reliance and lower pain scores, contributing to shorter hospital stays. The erector spinae plane block (ESPB) has shown promise as an analgesic for various surgical procedures. Given the frequency of sternotomies in our center and the associated prolonged pain that delays intensive care unit (ICU) discharge, we aimed to assess the impact of ESPB on postoperative opioid (fentanyl) use and pain levels up to 48 h after extubation.

Methods: This study was a prospective, double-blind, randomized controlled trial involving 80 adult patients (ASA III) scheduled for cardiac surgery. Participants were randomized into two groups: the ESPB group (n = 40; bilateral 0.25% bupivacaine, 20 mL) and a control group (n = 40; no ESPB). The main outcomes measured were fentanyl use post-surgery and pain scores using the visual analog scale (VAS). Secondary outcomes included intraoperative fentanyl use, time to first analgesic dose, extubation timing, and ICU stay duration. SPSS v.26 was used for statistical analysis.

Results: The ESPB group had significantly reduced fentanyl consumption during intubation (150 [0-800] vs. 950 [30-5260], P < 0.0001), at 3 h post-extubation (25 [0-50] vs. 0 [0-200], P = 0.034), 12 h post-extubation (0 [0-80] vs. 0 [0-200], P = 0.002), over 12 h total (0 [0-100] vs. 30 [0-600], P = 0.01), at 24 h (0 [0-100] vs. 30 [0-900], P = 0.003), and at 48 h (0 [0-100] vs. 50 [0-1200], P = 0.001). VAS scores were consistently lower for the ESPB group at rest at multiple points up to 48 h (P < 0.0001). Additionally, the ESPB group required less intraoperative fentanyl (P = 0.001), had shorter ICU stays (P = 0.009), and faster extubation times (P = 0.013). The time to first analgesic and paracetamol use did not differ significantly (P = 0.97 and 0.255, respectively).

Conclusions: The findings suggest that ESPB is an effective addition to multimodal anesthesia for cardiac surgery, significantly reducing pain and opioid use, and improving postoperative outcomes.

Traumatic epidural hematoma is a common pathological condition following traumatic brain injury (TBI). Neurogenic pulmonary edema (NPE) is a rare but life-threatening complication, typically occurring in association with acute severe intracranial pathologies. Cases of pediatric traumatic epidural hematoma complicated by NPE are exceedingly rare. This case report describes a 1.5-year-old boy who suffered a large acute temporoparietal-occipital epidural hematoma with brain herniation after falling from a bed. Following an emergency epidural hematoma evacuation, the child developed high fever, respiratory distress, and copious pink frothy sputum, with chest CT showing large areas of high-density shadows in both lungs, leading to a diagnosis of NPE. Through aggressive supportive care, including mechanical ventilation, pharmacological treatment, and other supportive measures, the patient's respiratory function gradually improved, and pulmonary imaging abnormalities resolved rapidly within 48 hours, resulting in a favorable outcome. This case underscores the critical role of early recognition and timely intervention in managing acute traumatic epidural hematoma complicated by NPE, providing valuable insights for the clinical management of similar cases.

Purpose: Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspiration following successful esophagectomy has not been systematically investigated, and there are no guidelines for the anesthetic management of postesophagectomy patients who require elective surgeries involving general anesthesia (GA).

Methods: PubMed/MEDLINE, Embase, and Web of Science were systematically searched from inception through January 1, 2024 to identify studies involving patients ≥90 days postesophagectomy and undergoing elective surgery unrelated to their esophagectomy status, where GA was required. Data on perioperative anesthetic management were extracted. The primary outcomes assessed were perioperative gastrointestinal and pulmonary complications. Secondary outcomes included the approach to induction of GA and author recommendations.

Results: Of the 4097 studies, ten studies involving 131 patients met inclusion criteria. Intraoperatively, adverse events during induction occurred in 13.0% of 131 cases, including regurgitation of gastric contents in 5.3% and pulmonary aspiration in 9.9%. The airway was managed with an endotracheal tube in 95.6%. Induction was performed in the semi-Fowler position in 92.9% and performed using the rapid sequence and standard induction techniques in 58.7% and 41.3%, respectively.

Conclusions: Patients who have undergone esophagectomy may remain at high risk for aspiration during GA even in the long term, necessitating enhanced vigilance in anesthetic management. We offer evidence-informed suggestions for elective induction of GA in patients with a history of successful esophagectomy to enhance safe practice for these patients.