Saudi Journal of Anaesthesia最新文献

Combined spinal-epidural is a widespread technique used not only for lower limb, pelvic, and lower abdominal surgeries but also used to provide postoperative and labor analgesia. The accidental breakage or shearing of an epidural catheter is a known but rare complication. The real dilemma lies in its management, whether to leave it in situ or surgically remove it. We are presenting a case of accidental breakage of an epidural catheter and the consensus of its management.

[This corrects the article on p. 318 in vol. 19, PMID: 40642619.].

Background: The purpose of this survey was to delineate and compare patient blood management (PBM) approaches in cardiac surgery across nine Middle Eastern countries while identifying the main challenges against the implementation of the PBM program in cardiac surgery as reported by the surveyed centers.

Design: An online survey was established to assess current PBM practices in surveyed countries, including risk factors for bleeding or transfusion, management of preoperative anemia in elective cases, and antifibrinolytic use.

Setting: This questionnaire was conducted among cardiac anesthesiologists in Middle Eastern countries in 2024.

Participants: Only doctors participated voluntarily in this survey.

Interventions: No intervention.

Measurements: We assessed the extent of adoption of PBM practices in surveyed countries for patients who underwent cardiac surgery with cardiopulmonary bypass.

Main results: Of 40 survey responses, 26 (60%) were eligible for analysis. Most respondents were cardiac anesthesiologists. Key risk factors of bleeding or transfusion identified by over 70% of respondents included redo cardiac surgery, preoperative anemia, recent clopidogrel use, thrombocytopenia <100 × 10⁹/L, and oral anticoagulants. More than half of the centers would correct preoperative anemia using iron. Tranexamic acid was universally used, though administration regimens varied. Autologous priming and normothermia were the most common bypass strategies that would be used by more than 50% of respondents. Viscoelastic testing was available in more than 70% of centers and used by more than half of respondents in case of clinical bleeding.

Conclusion: PBM practices in Middle Eastern cardiac centers are heterogeneous, reflecting inconsistent adoption of guidelines. Enhanced training, institutional support, and homogenized national protocols are needed to standardize PBM in the region.

Mepolizumab, a comprehensible monoclonal antibody that inhibits interleukin-5 (IL-5), offers a new therapeutic option for a subset of patients with chronic obstructive pulmonary disease (COPD) marked by eosinophilic inflammation. Despite the success of conventional inhaled therapies, a significant proportion of COPD patients continue to experience exacerbations. This review discusses the mechanism, clinical trials, safety profile, and future potential of mepolizumab, the first and only FDA-approved biologic for COPD.

Background: Emergency Front Of Neck Access techniques are an essential skill for anesthesiologists, enabling them to effectively manage the critical "can't intubate, can't oxygenate" scenarios. Current literature suggests minimal improvement in mortality associated with these scenarios due to their rarity and difficulty in providing adequate training. This study aims to evaluate whether high-fidelity training can outperform low-fidelity training in teaching Emergency Front Of Neck Access.

Methods: We designed a prospective, single-blinded observational trial to assess the presumed superiority of high-fidelity training compared to low-fidelity training in teaching Emergency Front Of Neck Access to our anesthesiology department. The Performance Rating Scale (PRS) was the tool we employed to assess the participants' performance during both scenarios. The primary outcome was the difference in PRS between the high- and low-fidelity training groups. The secondary outcomes were the correlation between PRS scores and the participants' past clinical experience with Emergency Front Of Neck Access, the number of tracheostomies performed, and years of clinical service.

Results: A total of 30 participants from our anesthesia department were enrolled. There was a statistically significant difference in Performance Rating Scale scores between high-fidelity and low-fidelity training. The low-fidelity group had a median score of 7 (range -7 to 9), while the high-fidelity group had a median score of -3 (range -11 to 11). None of the secondary outcomes reached statistical significance.

Conclusions: Our findings suggest that the benefits of high-fidelity training may justify the additional costs associated with incorporating it into conventional airway management training.

Robotic-assisted surgery offers significant advantages in pediatric procedures due to its precision and minimally invasive nature. This case report examines the anesthetic management of a 9-year-old male diagnosed with pheochromocytoma who underwent robotic-assisted adrenalectomy. The report highlights the intraoperative challenges of managing hemodynamic fluctuations, including hypertension and hypotension, and addresses the measures taken to monitor and manage hypoglycemia.