Saudi Journal of Anaesthesia最新文献

Eisenmenger syndrome (ES) represents the extreme phenotype of pulmonary hypertension. We present the anesthetic management of an ES case undergoing transurethral resection of bladder tumor (TURBT). A 56-year-old lady who is known to suffer from ES diagnosed with a urinary bladder multifocal tumor was scheduled for TURBT. We describe here the successful management of the ES case undergoing TURBT using continuous spinal anesthesia.

This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An 81-year-old female patient who had severe mitral valve regurgitation, severe tricuspid valve regurgitation, and pulmonary hypertension was scheduled for Mitral Valve Replacement and DeVega Tricuspidoplasty. The patient had many comorbidities, so she was on antihypertensive (nebivolol), antithrombotic (rivaroxaban), and antidiabetic (insulin) medications. After anesthesia induction, the patient was positioned for CVC. Ultasound guidance showed that the anteroposterior diameter of the right IJV was small and the degree of overlapping of carotid artery (CA) was high. Left side was evaluated before starting the procedure. Marked enlargement of the left IJV and less overlapping of CA was observed. Left IJV catheterization was decided and performed without any complication. The surgery lasted for 3 hours and was completed uneventfully. Although right IJV is usually preferred for CVC where central intravenous access is required, it is advisable to evaluate the left IJV when the right one has a small diameter and there is a significant overlapping of right CA. In these cases, the choice for CVC side should be based on the data which is obtained from both sides.

Etomidate is the agent of choice for the induction of anesthesia in patients with cardiovascular illness, hypotension, or shock. Notwithstanding its numerous attributes, etomidate's most notable adverse impact is adrenocortical suppression. Due to these concerns, the creation of an etomidate alternative that maintains its beneficial effects while mitigating adverse outcomes became essential. This article will focus on the new etomidate analog, methoxyethyl etomidate hydrochloride, referred to as ET-26.

Objective: To determine the median effective dose (ED50) of 2% lidocaine mixed with propofol for preventing pain during the induction of anesthesia using a modified Dixon's up-and-down method.

Materials and methods: Thirty ASA (American Society of Anesthesiologists) grade I and II patients, aged 18-60 years, undergoing elective surgery were enrolled. Using the modified Dixon's up-and-down method, patients received varying doses of lidocaine mixed with 20 mL of propofol MCT/LCT (Medium Chain Triglyceride/Long Chain Triglyceride) emulsion. The primary outcome was the calculation of the ED50 of 2% lidocaine, defined as the midpoint dose at which 50% of patients experienced painless injection. Secondary outcomes included pain scores during injection, heart rate changes, and withdrawal movements.

Results: Thirty patients completed the study. The ED50 of lidocaine premixed with 20 mL of propofol MCT/LCT emulsion to prevent pain during the induction of anesthesia was 32.14 mg (95% CI = 32.09 mg-32.18 mg), equivalent to 1.46 mg/mL (95% CI: 1.02 mg/mL-1.91 mg/mL). Demographic and clinical characteristics of patients who experienced pain and those who did not were not statistically significant.

Conclusion: Our study concluded that the ED50 of lidocaine premixed with 20 mL of propofol to prevent pain during the induction of anesthesia was 32.14 mg (95% CI = 32.09 mg-32.18 mg), equivalent to 1.46 mg/mL (95% CI: 1.02-1.91 mg/mL).

Background: Between 10% and 80% of surgical patients experience some form of fear and anxiety before surgery. This is often attributed to inadequate or incorrect preoperative information.

Objectives: This study aimed to critically evaluate and compile research that describes the impact of preoperative information on the patient's well-being before surgery.

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' well-being before surgery. An inductive thematic analysis generated categories and subcategories. Nineteen studies were included.

Results: Two main categories emerged from the thematic analysis of the included articles. These were the direct impact of information on fear and anxiety and the indirect impact of information on fear and anxiety. Information from healthcare professionals, alternative sources of information, shortage of healthcare professionals, music, and inability to receive information were some of the factors that can influence the well-being of patients before surgery. There are different reasons for the patient's fear and anxiety preoperatively, as well as the importance of direct and indirect information and other methods. For some patients, however, too much information could cause more fear and anxiety.

Conclusion: The importance of the patient's discomfort being highlighted by the healthcare professionals emerges clearly and shows negative experiences in those cases where the patient feels his fears and concerns are not being addressed. More qualitative and quantitative research in the same theme, education and using person-centred care, and the right amount of information based on the patient's wishes are needed to improve the patient's well-being.

The incidence of tracheocele is rare, but whenever encountered, Tracheoceles must be meticulously managed owing to the grave complications associated with them. Here, we report the successful management of a case of orbital tumor who underwent orbital exenteration and was incidentally preoperatively diagnosed with having a large tracheocele in the lower neck region.

Objective: Residual neuromuscular blockade (RNMB), defined as a train-of-four ratio (TOFR) <0.90, is a complication of neuromuscular blocking agents (NMBA). Data about RNMB in children are rare. This single-center observational trial evaluated the rate of neuromuscular monitoring (NMM), the incidence, and consequences of RNMB in pediatrics.

Methods: Children over 1 month undergoing elective and urgent surgery during core work hours receiving NMBA were included in an 84-day observation period. When the anesthesiologist decided to extubate, a blinded investigator measured the TOFR by acceleromyography. Data on demographics, surgery, anesthesia, and outcome were recorded. Comparison of qualitative variables was done using the chi-square test. The Mann-Whitney U test was used to compare quantitative variables between patients with or without TOFR <0.90. P <0.05 was considered significant.

Results: Eighty-nine children were included in the analysis. Rate of quantitative and qualitative NMM was 65.2% and 5.6%, respectively. Incidence of RNMB was 10.1% with TOFRs between 0.78 and 0.89 in 8 children and a TOFR of 0.48 in one child. Median time from the last NMBA administration to the TOFR before extubation was significantly shorter in patients with a TOFR <0.90 in comparison with a TOFR ≥0.90 (88 vs. 110 min). In the RNMB group, qualitative NMM was significantly more often used compared with the no RNMB group (22.2% vs. 3.8%). Adverse events were rare with no significant differences between the two groups.

Conclusion: RNMB in children is a relevant hazard. Qualitative NMM is not reliable to exclude RNMB. Institutional training programs on neuromuscular management in children may be helpful to improve the rate of quantitative NMM.

Chronic myofascial pain is a very common pathological condition, but the diagnosis can be complex. Elastosonography can be a valuable aid to diagnosis by demonstrating increased stifness of the myofascial unit. In addition, it can demonstrate the reduction in stifness after performing a fascial plane block by allowing the effectiveness of the block to be evaluated. In this case series we present cases of patients evaluated with elastosonography before and after fascial plane block and demonstrate the differences.

Lumbar epidural anesthesia is an important part of labor analgesia. Despite common complications, lumbar epidurals are considered the most effective pain management option during childbirth. Fracture of the epidural catheter during removal is an uncommon but known complication, but fragmentation of the catheter during insertion is extremely uncommon. There are several reasons for catheter fracture during removal; however, catheter fracture during insertion can occur for two main reasons in labor epidurals. The first reason is if the anesthetist pulls the catheter while the Tuohy needle is still in place, and the second is when the catheter is removed during active labor contractions. We describe the occurrence of such an event in a primiparous patient, where the epidural catheter fractured during insertion. A brief review is provided to prevent and manage such complications.