Saudi Journal of Anaesthesia最新文献

Bariatric surgery is a rapidly developing field and presents a challenge for anesthesia management, especially in the treatment of acute postoperative pain. Severely obese patients have a greater risk of intra and postoperative complications due to their cardiovascular and respiratory pathophysiological alterations. Excessive fat also alters the normal metabolism of analgesic drugs, in particular opioids, thus reducing their therapeutic range and increasing the risk of reaching toxic doses with accumulation and overdose effects. Nociception, in contrast to pain, is not a subjective experience but a physiological response to a nociceptive stimulus, which manifests as objective modifications in vital parameters. An increasing number of monitoring methods have been approved in recent years, especially developed for the detection of intraoperative nociception to enable better control of opioid titration. This review aimed to provide an overview of the main monitoring systems commercially available devices, which could be used to monitor nociception during bariatric surgery. Eighteen studies evaluating the most widespread nociception monitoring systems were analyzed. These studies were mostly conducted on patients undergoing abdominal laparoscopic surgery, which is comparable to bariatric surgery in terms of pain stimulation. Intraoperative and postoperative opioid consumption were compared between patients subject to nociceptive monitoring and those in whom analgesia was guided by their changes in vital parameters. Although the devices seem able to optimize the anesthetic management of these patients, studies on bariatric populations are scarce and do not allow us to state whether the routine use of these tools can modify the patient's clinical outcome.

Von Hippel-Lindau disease (VHLD) is a rare autosomal dominant genetic disorder characterized by the development of highly vascularized tumors, including central nervous system (CNS) hemangioblastomas, pheochromocytomas, and renal cell carcinomas. Pregnancy in patients with VHLD presents unique anesthetic challenges due to tumor-associated risks and physiological changes. This report describes the anesthetic management of a 31-year-old woman with VHLD and twin gestation during active labor at 35 weeks of pregnancy. Despite the advantages of neuraxial anesthesia for cesarean delivery, general anesthesia was selected due to the unavailability of recent imaging and the potential risks of neuraxial techniques in such cases. The case emphasizes the importance of individualized planning, hemodynamic stability, and multidisciplinary collaboration to optimize outcomes for both mother and neonates.

Pulmonary Alveolar Proteinosis (PAP) is a rare condition where surfactant accumulates in the lungs' alveoli, causing respiratory failure. Whole lung lavage (WLL) is the primary treatment, requiring careful perioperative management due to potential complications. We present the case of a 38-year-old man with severe PAP who underwent WLL with cardiopulmonary bypass standby. Preoperative assessment revealed severe hypoxemia and respiratory alkalosis. During surgery, he experienced desaturation and hemodynamic instability, necessitating noradrenaline support and real-time lung ultrasound monitoring. Postoperatively, significant improvements in oxygen levels and radiographic findings were observed. Diagnosis relies on Broncho alveolar lavage fluid analysis, and WLL is effective for patients with impaired gas exchange, improving symptoms and survival. This case highlights the importance of multidisciplinary care and meticulous perioperative management in achieving positive outcomes in PAP treatment with WLL.

Background: This study aims to investigate the efficacy and safety of dexmedetomidine in treating postoperative acute pain through a clinical randomized controlled trial.

Methods: This study selected 165 patients who underwent general anesthesia surgeries at our hospital from October 2022 to May 2023 as research subjects. They were enrolled and randomly allocated to a control group (n = 73) and an experimental group (n = 74) based on a computer-generated random numbers table. Firstly, we compared the general clinical data before surgery. Secondly, we compared the pain degree, sedative degree, and vital signs at 6 time points (before surgery [T0], 1 h postoperatively [T1], 6 h postoperatively [T2], 12 h postoperatively [T3], 24 h postoperatively [T4], and 48 h postoperatively [T5]). Lastly, we compared the incidence of adverse reactions and comprehensive satisfaction degree for the two groups of patients after surgery.

Results: The results showed that compared to the control group, the experimental group had lower VAS score, Ramsay score, mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) (P < 0.05), whereas blood oxygen saturation (SpO₂) showed no change (P > 0.05). No difference was observed in the incidence of adverse reactions between the experimental and control groups (P > 0.05). The comprehensive satisfaction degree of patients in the experimental group was higher compared to the control group (P < 0.05).

Conclusions: Dexmedetomidine could effectively manage the vital signs of patients with postoperative acute pain, improve treatment outcomes, alleviate pain, enhance sedation, ensure safety, and enhance comprehensive satisfaction.

The case report discusses the anesthetic management and postoperative course of a 4-month-old girl with Ellis Van Creveld syndrome. Key challenges included an abnormal chest wall, tracheal abnormalities, and complex cardiac issues, requiring tailored anesthetic planning and vigilant monitoring. The patient experienced complications such as complete heart block and persistent hypercapnia after the surgery, which required a permanent pacemaker and prolonged noninvasive ventilation, leading to an extended hospital stay.

Background: Team-based learning (TBL) as a student-centered approach can be encouraged and supported by transforming the conventional lecture format into an engaging and active process of learning. The objective of this study was to explore students' perception of team-based learning and compare their performance after TBL sessions and traditional lectures in the local anesthesia course.

Materials and methods: Eight topics of local anesthesia during the academic years 2022-2023 and 2023-2024 were divided into team-based learning sessions and traditional lectures. Teaching activities in TBL included tests and group discussions. A cross-sectional descriptive questionnaire comprising 10 written questions targeting students' perception of TBL and traditional lectures was handed to students at the end of the course.

Results: The mean average scores of responses agreed with the related questions' statements. The results of Pearson's correlation test revealed that there was a significant relationship (r = 0.780, P < 0.05) between the statements of teaching methods and student's responses in both academic years.

Conclusion: Students performed better and had positive opinions of TBL as their preferred learning technique when team-based learning substituted some didactic lectures.