Saudi Journal of Anaesthesia最新文献

Electrical storm (ES) is a rare and life-threatening cardiac emergency characterized by recurrent ventricular arrhythmias, posing unique challenges when it occurs during pregnancy. We report the case of a 28-year-old woman presenting with refractory ES in the late stages of a dichorionic-diamniotic twin pregnancy. Initial management included emergent cesarean delivery under general anesthesia due to maternal hemodynamic instability and fetal bradycardia. Despite pharmacological stabilization and multiple synchronized cardioversions, the arrhythmia persisted, necessitating catheter ablation to restore sinus rhythm. Multidisciplinary collaboration involving anesthesiology, obstetrics, cardiology, and electrophysiology ensured a favorable outcome for both mother and neonates, with no long-term complications. This case highlights the critical importance of tailored, interdisciplinary approaches in managing ES during pregnancy and underscores the need for resource optimization and rapid decision-making to balance maternal and fetal safety. Future investigations should focus on identifying potential triggers and improving protocols for the management of ES in high-risk pregnancies.

Background: Postoperative pain after laparoscopic surgery can include referred shoulder pain, visceral pain, and incisional pain, often due to CO₂ insufflation and peritoneal irritation. Although opioids are widely used for pain management, their side effects, such as sedation, nausea, and constipation, can delay recovery and increase costs. Opioid-free anesthesia (OFA) is an emerging alternative that aims to relieve pain using non-opioid medications, reducing these risks and potentially enhancing recovery.

Methods: This single-center, prospective, randomized controlled trial included neonates and infants (ASA 1 and 2) undergoing laparoscopic or endoscopic surgeries. Participants randomly received either opioid-based anesthesia (OA) with intravenous fentanyl at induction, followed by continuous infusion or OFA with ketamine at induction, followed by infusion. The primary outcome was postoperative pain, assessed using the Neonatal Infant Pain Scale (NIPS) on admission to the post-anesthesia care unit (PACU). Secondary outcomes included pain scores at intervals up to 12 h postoperatively.

Results: NIPS scores were significantly higher in the OFA group in the PACU, with more patients experiencing moderate pain (NIPS >4) in the first hour (41.7%, n = 20 vs. 16.6%, n = 8, respectively; P < 0.001). Both approaches demonstrated similar intraoperative stability, recovery, and safety, suggesting that either method can be chosen based on clinical requirements.

Conclusions: OA with fentanyl offered superior immediate postoperative analgesia compared to OFA with ketamine, while both approaches demonstrated comparable intraoperative stability, recovery profiles, and safety, supporting their use based on clinical needs and patient-specific factors.

Background: Existing studies on anesthesiologists' attitudes toward artificial intelligence (AI) leave a global understanding underexplored. This cross-sectional study aims to investigate Turkish anesthesiologists' attitudes toward AI, examining its perceived benefits, limitations, and associated ethical concerns. Insights from this study aim to enhance understanding of AI's role in anesthesiology within a cultural and ethical context.

Methods: This nationwide study surveyed Turkish anesthesiologists. Descriptive statistics summarized categorical variables, Pearson's Chi-square test compared variables between groups. Binary logistic regression analyzed associations between demographic factors and positive attitudes toward AI.

Results: Among 293 valid responses, 69.6% of participants expressed positive attitudes toward AI. Gender (P = 0.01), employment setting (P < 0.001), and prior AI experience (P < 0.001) were significant predictors of positive attitudes. AI applications most frequently endorsed included preoperative assessments (93.1%), academic support (95.2%), and medical education (91.2%). Ethical concerns were prominent, with liability ambiguity (87.3%) and privacy issues (62.8%) being the most cited. Logistic regression revealed that participants aged 46-55 were significantly more likely to exhibit positive attitudes (OR = 3.744, P = 0.03), while those with over 15 years of experience were less likely to do so (OR = 0.105, P = 0.04).

Conclusions: Turkish anesthesiologists exhibited predominantly positive attitudes toward AI, with prior experience playing a significant role in shaping perceptions. While AI was embraced for academic, educational, and noninvasive tasks, skepticism was present toward its application in invasive procedures. These findings highlight AI's potential to enhance efficiency and patient safety while underscoring the need for comprehensive legal and ethical frameworks.

Background: Caudal block is a widely practiced regional anesthetic technique in pediatric patients undergoing infraumbilical and lower limb surgeries. However, assessing its effectiveness intraoperatively remains a challenge due to limitations in conventional clinical evaluation methods, especially under general anesthesia. The perfusion index (PI), a noninvasive indicator of peripheral perfusion, has emerged as a potential early marker of successful neuraxial block.

Aim: To evaluate the perfusion index as a primary predictor of successful caudal block in children undergoing elective infraumbilical and lower limb surgeries, and to compare it with traditional hemodynamic parameters.

Methods: This prospective observational study was conducted over two years at a tertiary care center. A total of 80 pediatric patients (ASA I-II, aged 1-8 years) undergoing elective surgeries under general anesthesia with caudal block were enrolled. PI, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at multiple time intervals post-block. The primary outcome was the change in PI; secondary outcomes included changes in hemodynamic parameters.

Results: A significant increase in PI was observed as early as 3 minutes after caudal block, rising from a baseline of 1.55 ± 1.08 to 3.96 ± 1.94 (P < 0.001), with a peak at 30 minutes (5.23 ± 1.42). In contrast, SBP, DBP, and MAP showed significant reductions only after 15 minutes. SpO₂ remained stable throughout. The early rise in PI correlated with successful block onset and duration, making it a reliable early predictor compared to delayed hemodynamic changes.

Background: Mastectomy is associated with postoperative pain that can become chronic if left untreated. While opioids are commonly used, their adverse effects on recovery highlight the need for alternative methods. This study investigates the opioid-sparing effects of adding dexmedetomidine to ropivacaine, compared to ropivacaine without dexmedetomidine, in erector spinae plane block for patients undergoing mastectomy.

Methods: This is a prospective, randomized controlled trial conducted at a tertiary University Hospital. Forty-four patients undergoing mastectomy with axillary lymph node dissection under general anesthesia were enrolled and randomized to receive erector spinae block with dexmedetomidine added to ropivacaine (intervention) or without dexmedetomidine (control). The primary outcome was total opioid consumption in the post-anesthesia care unit (PACU) and up to 24 hours postoperatively. Secondary outcomes included intraoperative hemodynamics, vitals, medications, and complications, as well as pain medications and levels, and side effects during the first 24 hours postoperatively.

Results: PACU opioid consumption was significantly lower in patients who received the intervention compared to those who underwent the routine procedural protocol (3.14 ± 2.85 vs 5.86 ± 4.52, P = 0.021). Median survival time to opioid provision in the PACU and total morphine consumption up to 24 hours were not statistically significantly different between the two groups. Pain levels remained statistically significantly lower in the experimental group up to 12 hours postoperatively, after which no significant difference was observed. No significant side effects were reported.

Conclusions: Dexmedetomidine, in safe doses, with ropivacaine in erector spinae block reduces immediate opioid consumption and postoperative pain in mastectomy patients.

Background: To evaluate the number and type of acute pathological events during each football match and analyze whether the stadium's health protocol, which includes anti-COVID-19 measures, has had an impact on reducing admissions to nearby hospitals. The number of spectators requiring assistance was evaluated through the patient presentation rate (PPR), and the number of hospitalizations was assessed through the hospital transport rate (TTHR).

Methods: General and specific measures aimed at reducing the risk of COVID-19 transmission were implemented for spectators attending the 2020 UEFA European Football Championship matches held in Rome. For planning and risk stratification of events, the Arbon and Maurer scores were calculated to define the expected resources and the impact on healthcare systems. The primary outcome was the PPR and relative triage grouped into four categories. The secondary outcome was the need for hospitalization and the relative TTHR. The Mann-Whitney U test was used to compare parametric variables, whereas categorical variables were compared using the Chi-square test. All data were analyzed using SPSS v26 (IBM, NY, USA).

Results: The most frequent symptoms were headache (23.9%), confusion (23.9%), syncope (11.4%), and dizziness (5.7%). The PPR ranged from 0.84 to 1.15. The most frequently assigned code was white in all events examined. The TTHR was between 0 and 0.21.

Conclusion: The assistance service provided at EURO 2020 successfully fulfilled its primary role of minimizing referrals to nearby hospitals. Mass gathering events can be conducted safely if adequate precautionary measures against COVID-19 are implemented.

Background: Nurse anesthetists (NAs) face several challenges in their work, one of which is dealing with patients who experience anxiety and fear before surgery. The increased patient turnover and a shortage of healthcare professionals lead to a heavier focus on physical care, thus leaving limited time to address the psychological needs of patients.

Objectives: This study aimed to critically evaluate and compile research that describes the things NAs use in reducing patients' fear and anxiety before surgery.

Materials and methods: A systematic search was conducted on PubMed, Medline, CHINAL, Embase, and the Cochrane Library database for qualitative and quantitative literature regarding factors influencing patients' wellbeing before surgery. An inductive thematic analysis generated categories and subcategories. Twenty-one studies were included.

Results: The thematic analysis of the articles included revealed two main categories and six subcategories. Some strategies identified to help reduce fear and anxiety in patients before surgery included providing various types of information, offering psychological support, using different relaxation techniques, and ensuring that each patient is allocated sufficient time.

Conclusion: The results of the presented study showed that strategies such as providing different forms of information, psychological support, and different relaxation therapies gave good results. However, there is a need for further research in health care to identify which nonpharmacological nursing interventions are most effective in alleviating preoperative anxiety. More research is also needed to determine how preoperative care should be structured to help patients feel safe and comfortable before surgery.

Background: Liver transplantation is frequently associated with massive blood loss and utilization of blood products to optimize coagulation; this study aimed to evaluate their possible correlation with etiological and perioperative factors.

Methods: A retrospective analysis of adult liver transplant (LT) recipients (excluding re-do transplants) operated upon at our center between 2011 and 2021 was conducted using R package with rBiostatistics.com graphical user interface.

Results: Of the 947 cases, 70.70% had cirrhosis, and 28.6% hepatocellular carcinoma, as secondary diagnoses; the most common primary diagnosis was viral hepatitis (B = 20.9% and C = 20.0%). The mean blood loss volume was 3393.2 ml. Living donor liver transplantation (LDLT) recipients (n = 740, 78.2%) had lesser blood loss (mean difference 738 mL, P = 0.037) and reduced requirement for fresh frozen plasma (FFP, OR = 0.734, P = 0.001) and platelets (OR = 0.809, P < 0.001). Presence of hepatocellular carcinoma (n = 273, 28.6%) was significantly protective for blood loss (mean difference 717 ml, P = 0.037) and the need for FFP (OR = 0.991, P < 0.001), cryoprecipitate (OR = 0.568, P = 0.001), and platelets (OR = 0.602, P < 0.001). Schistosomiasis (n = 23, 2.4%) was accompanied by increased blood loss (mean difference 2328 ml (P = 0.012)). A body mass index (BMI) >35 kg/m² increased the hazard of cryoprecipitate requirement (OR = 1.203, P = 0.008).

Conclusion: The blood loss and the blood products transfusion requirements in LT are influenced by the etiology, graft type, and other perioperative factors such as BMI.