Saudi Journal Of Anaesthesia[JOURNAL]
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200 papers
A unique method for one-lung ventilation in pediatric thoracic surgery: Suction catheter and single-lumen tube approach: A case report.
Abid DS, Al Oufi H
Saudi J Anaesth · 2026 · PMID 42022080 · Full text
Effective one-lung ventilation (OLV) ensures optimal surgical exposure and isolation of the operative lung. This case describes a novel technique for achieving OLV in pediatric thoracic surgery using a suction catheter w...
Effective one-lung ventilation (OLV) ensures optimal surgical exposure and isolation of the operative lung. This case describes a novel technique for achieving OLV in pediatric thoracic surgery using a suction catheter with a single-lumen endotracheal tube (SLT). An 11-year-old girl presented with a 2-day history of hemoptysis. Chest CT showed bronchial wall thickening and multifocal nodular opacities in the right upper lobe, suggesting pulmonary hemorrhage. After standard ASA monitoring, arterial and central venous lines were placed. The patient was intubated with a size 6.0 SLT and a size 10 suction catheter, guided into the left main bronchus under fiberoptic bronchoscopy. Tube position was confirmed by auscultation and chest X-ray. Intraoperatively, adhesions indicated prior embolization. The right upper lobe bronchus and vessels were ligated with LigaSure. Postoperative recovery was uneventful, and imaging on day five showed no pneumothorax. This simple, effective method facilitates safe OLV in pediatric thoracic surgery.
Successful anesthetic management of a patient with congenital laryngomalacia undergoing left inguinal hernia repair.
Seri ZMFD, Fakioglu E, Guney LH … +1 more , Araz C
Saudi J Anaesth · 2026 · PMID 42022079 · Full text
Laryngomalacia is the most common congenital anomaly of the larynx and a leading cause of inspiratory stridor in infants. Stridor and noisy breathing are key clinical manifestations that may signify varying degrees of re...
Laryngomalacia is the most common congenital anomaly of the larynx and a leading cause of inspiratory stridor in infants. Stridor and noisy breathing are key clinical manifestations that may signify varying degrees of respiratory compromise and can provide insight into the level of airway obstruction. A comprehensive evaluation of the upper airway is essential in children suspected of having laryngomalacia to ensure accurate diagnosis and appropriate management of both the primary condition and any associated comorbidities. Laryngomalacia presents along a spectrum of severity, with mild cases often requiring only close observation, while more severe forms may necessitate surgical intervention such as supraglottoplasty. Anesthetic management in these patients presents significant challenges due to the potential for airway obstruction, particularly during induction and emergence from anesthesia. This case report details the successful perioperative anesthetic management of a two-month-old male infant with congenital laryngomalacia undergoing elective inguinal hernia repair. It highlights the critical importance of meticulous airway planning, the maintenance of spontaneous ventilation, and a collaborative, multidisciplinary approach to optimize patient safety and outcomes.
Cadaveric dissection studies in regional anesthesia - A comprehensive bibliographic analysis.
Nair AS, Navveen PM, Nath R … +1 more , Diwan S
Saudi J Anaesth · 2026 · PMID 42022078 · Full text
The anatomical basis and safety optimization of regional anesthesia techniques are supported by cadaveric studies. However, the development of this field of study has not been thoroughly documented. To map publication tr...
The anatomical basis and safety optimization of regional anesthesia techniques are supported by cadaveric studies. However, the development of this field of study has not been thoroughly documented. To map publication trends, collaborative networks, and emerging themes in cadaveric studies on regional anesthesia, we conducted a bibliometric analysis. A Scopus database search using the keywords 'cadaveric studies' and 'regional anesthesia' revealed 298 articles from inception till May 2025. The comma-separated values (CSV) file was uploaded to the VOS viewer and CiteSpace software for analyzing various bibliometric parameters like bibliographic coupling, citation, co-authorship, co-occurrence, and co-citation. The results revealed that most of the work was done and published in high-income countries (the United States, the United Kingdom, and Canada), in established universities (University of Toronto, Canada), and in high-impact journals (Regional Anesthesia and Pain Medicine). Future studies should prioritize multicenter, cross-cultural cadaveric validations, standardized anatomical nomenclature, and stronger collaboration among anatomists and anesthesiologists to translate cadaveric insights into clinical protocols and enhance patient safety.
Cauda equina syndrome in an obese parturient following cesarean section under combined spinal-epidural anesthesia.
Sim SS, Lee AR
Saudi J Anaesth · 2026 · PMID 42022077 · Full text
Cauda equine syndrome (CES) is the very rare complication especially after uneventful neuraxial anesthesia. A woman underwent a combined spinal-epidural anesthesia for cesarean section. Postoperatively 24 hours, she comp...
Cauda equine syndrome (CES) is the very rare complication especially after uneventful neuraxial anesthesia. A woman underwent a combined spinal-epidural anesthesia for cesarean section. Postoperatively 24 hours, she complained of paresthesia of the left leg, urinary retention, and saddle anesthesia. After checking magnetic resonance imaging (MRI), CES was suspicious and medical treatment was initiated. During the 18-month follow-up, though perineal hypoesthesia and paresthesia of the left leg were recovered, urinary and fecal incontinence remained. This case demonstrates that CES may occur even after an uneventful combined spinal-epidural anesthesia (CSEA) in obese patients with subclinical spinal epidural lipomatosis (SEL) and disc herniation.
Comparative evaluation of artificial intelligence chatbots for real-time guidance during intraoperative anesthetic crises: A simulation-based study.
Al-Azzam AAM, Alkhateeb Z, Shahin A … +4 more , Bsisu I, Alaqtash R, Attoun E, Rababa'a H
Saudi J Anaesth · 2026 · PMID 42022076 · Full text
BACKGROUND: Artificial intelligence (AI) chatbots are increasingly used in healthcare, but their ability to interpret anesthetic monitoring data during intraoperative crises remains unclear. OBJECTIVE: To evaluate AI cha...
BACKGROUND: Artificial intelligence (AI) chatbots are increasingly used in healthcare, but their ability to interpret anesthetic monitoring data during intraoperative crises remains unclear. OBJECTIVE: To evaluate AI chatbots' responses to simulated anesthetic emergencies, with a focus on visual monitor interpretation compared to contextual case information. METHODS: This simulation-based study was conducted using a high-fidelity patient monitor. Twenty intraoperative emergencies were designed as static monitor images with minimal clinical context. Five AI platforms, ChatGPT, Claude, Gemini, Copilot, and DeepSeek, were tested. Each scenario was submitted in a separate, new conversation with no advanced reasoning tools enabled. Six blinded evaluators scored 100 responses using the validated CLEAR tool. The primary outcome was the mean total score per chatbot; secondary outcomes included domain-specific scores and differences between visual and contextual scenarios. RESULTS: ChatGPT achieved the highest mean score (4.4 ± 0.6), outperforming other platforms across all CLEAR domains ( < 0.001). Its accuracy was consistent between contextual (4.6 ± 0.3) and visual (4.1 ± 0.9) scenarios. DeepSeek scored the lowest overall score (2.7 ± 1.1), and had a mean 2.3 ± 1.1 in "lack of false information", often due to misinterpreting monitor values, reducing its visual scenario performance. Overall, contextual scenarios scores were higher than visual ones across all platforms. CONCLUSION: Among AI chatbots, ChatGPT demonstrated the most consistent and guideline-concordant responses to simulated anesthetic crises as of March 2025. This study provides a benchmark for evaluating clinical AI performance and supports the selective integration of such tools in anesthesia decision-making workflows.
Thoracic spinal anesthesia for emergency derivative colostomy in a turner syndrome patient.
Scimia P, De Cato A, Frischia M … +1 more , Gentili L
Saudi J Anaesth · 2026 · PMID 42022075 · Full text
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Comment on: Ultrasound-guided erector spinae plane block vs modified thoracolumbar interfascial plane block in lumbar spine surgeries.
Kurhekar P, Narayanan S, Rajarathinam B
Saudi J Anaesth · 2026 · PMID 42022074 · Full text
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Randomized controlled trial to compare post operative analgesia between ultrasound guided quadratus lumborum and erector spinae plane block in children undergoing pyeloplasty.
Kaur N, Pandey M, Varshney PG … +1 more , Kundal R
Saudi J Anaesth · 2026 · PMID 42022073 · Full text
BACKGROUND: Erector spinae plane block (ESPB) and quadratus lumborum block (QLB) have demonstrated efficacy in providing postoperative analgesia following abdominal surgeries. However, evidence regarding their effectiven...
BACKGROUND: Erector spinae plane block (ESPB) and quadratus lumborum block (QLB) have demonstrated efficacy in providing postoperative analgesia following abdominal surgeries. However, evidence regarding their effectiveness in pediatric renal surgeries remain limited. The present study aimed to compare the duration of postoperative analgesia between ultrasound-guided quadratus lumborum and erector spinae plane blocks in children undergoing open pyeloplasty. METHODS: Sixty children undergoing pyeloplasty, aged between 6 months and 7 years were randomized to receive ultrasound guided ESPB or QLB after induction of general anesthesia. Time to first rescue analgesia, total analgesic requirement, and time to perform the block were observed. RESULTS: The time to first rescue analgesia was 1040 ± 99 min in QLB group as compared to 889 ± 67 min in ESPB group ( < 0.001). Mean total analgesic requirement (fentanyl) in 24 hours was lower in QLB group as compared to ESPB group (1.77 ± 1.36 μg/kg and 3.9 ± 0.80 μg/kg, respectively) ( < 0.001). The mean total time to perform block was 246 ± 107 sec in QLB group and 140 ± 80 sec in ESPB group ( < 0.001). CONCLUSION: Ultrasound guided quadratus lumborum block provides longer duration of postoperative analgesia with lesser total analgesic requirement as compared to erector spinae plane block in children undergoing pyeloplasty, with marginally longer time to administer quadratus lumborum block.
Anesthesia considerations in pediatric pancreatectomy for congenital hyperinsulinemic hypoglycemia: A retrospective case series.
Arafah O, Nassef M, Akhtar AB … +2 more , Alshammari H, Norris A
Saudi J Anaesth · 2026 · PMID 42022072 · Full text
BACKGROUND: Congenital hyperinsulinemic hypoglycemia (CHI) is a rare but serious condition resulting from genetic abnormalities that cause excessive insulin secretion and recurrent hypoglycemia. It poses significant neur...
BACKGROUND: Congenital hyperinsulinemic hypoglycemia (CHI) is a rare but serious condition resulting from genetic abnormalities that cause excessive insulin secretion and recurrent hypoglycemia. It poses significant neurological risks in infancy. When medical therapy fails, pancreatectomy becomes necessary; however, the procedure presents major anesthetic challenges due to unstable glucose levels during surgery. METHODOLOGY: We performed a retrospective study of electronic records of 34 patients <5 years who underwent laparoscopic pancreatectomy at King Faisal Specialist Hospital and Research Center (KFSHRC Riyadh, Saudi Arabia) between 2015 and 2023. RESULTS: Of the 34 patients, 64.7% (n = 22) were male; most (67.6%, n = 23) were aged 4-8 weeks. Nesidioblastosis was the most common pathology (55.9%, n = 19). The mean surgery duration was 177.2 ± 51.7 minutes. Nearly all patients (94.1%, n = 32) were referred to the intensive care unit (ICU), and 85.3% (n = 29) remained intubated postoperatively. All patients received dextrose-containing fluids (5-50% concentration). Intraoperative blood glucose levels ranged from 2.5-33.4 mmol/L, with significant variation between preoperative, intraoperative, and postoperative values ( = 0.005). Blood transfusion was required in 35.3% (n = 12) of patients, with no critically low glucose levels recorded perioperatively. CONCLUSION: Pediatric pancreatectomy for CHI is associated with significant intraoperative glucose fluctuations, necessitating meticulous glucose and fluid management. Nesidioblastosis remains the leading pathology. Most patients require postoperative ICU care with elective ventilation. Early diagnosis, vigilant anesthetic management, and structured postoperative protocols are essential to minimize morbidity.
Enhanced recovery after surgery from 1990 to 2024: A bibliometric and visual analysis.
Seyrekli H, Karabörk M, Gündoğdu O
Saudi J Anaesth · 2026 · PMID 42022071 · Full text
BACKGROUND: This study aimed to analyze publications from 1990 to 2024 to examine the relationship of Enhanced Recovery After Surgery (ERAS) with countries, institutions, authors, journals, references, and keywords. METH...
BACKGROUND: This study aimed to analyze publications from 1990 to 2024 to examine the relationship of Enhanced Recovery After Surgery (ERAS) with countries, institutions, authors, journals, references, and keywords. METHODS: We searched for ERAS-related publications between 1990 and 2024 in the Web of Science Core Collection (WOSCC) database. The strategy included the following search terms: "TS=ERAS" OR "enhanced recovery" OR "enhanced recovery after surgery" OR "enhanced recovery after surgery eras" OR "enhanced recovery program" OR "enhanced recovery protocol" OR "eras protocol" OR "eras r" OR "fast track" OR "fast track surgery" OR "fast-track" OR "fast-track surgery." The search was restricted to articles and reviews in all languages. All results were filtered using these criteria on WOSCC and exported as a plain text file. Visual analyses were performed using Microsoft Word and VOS viewer 1.6.20. RESULTS: A total of 4,275 publications and 111,922 citations were identified. Overall, 101 countries contributed to ERAS research, with the United States ranking first. The institution with the highest number of publications was Harvard University. Nicolas Demartines ranked first with 51 publications, while H. Kehlet was the most frequently cited author. Among the journals publishing on ERAS, Transplantation had the highest number of publications. The most cited source was Enhanced Recovery After Surgery: A Review. Keyword analysis revealed that "enhanced recovery after surgery" was the primary research focus within the existing literature. CONCLUSIONS: The findings of this study demonstrate that, particularly since 2008, there has been a steadily growing interest in ERAS worldwide.
Impact of the Raqeeb narcotic controlling system on tramadol prescriptions in surgical patients: A pre-post implementation study.
Almarhabi Y
Saudi J Anaesth · 2026 · PMID 42022070 · Full text
BACKGROUND: Tramadol hydrochloride, a Schedule III opioid, is the primary take-home narcotic for postoperative pain in Saudi Arabia, with a misuse prevalence of 11.4%-20%. On February 1, 2024, the Saudi Food and Drug Aut...
BACKGROUND: Tramadol hydrochloride, a Schedule III opioid, is the primary take-home narcotic for postoperative pain in Saudi Arabia, with a misuse prevalence of 11.4%-20%. On February 1, 2024, the Saudi Food and Drug Authority implemented the Raqeeb electronic monitoring system for real-time prescription tracking to curb abuse while maintaining legitimate access. OBJECTIVES: To evaluate Raqeeb's impact on tramadol prescribing in surgical patients and compare outcomes with international prescription drug monitoring programs (PDMPs). METHODS: Retrospective cohort study of all adult patients (≥18 years) receiving tramadol prescriptions at a tertiary hospital in Saudi Arabia (April 2023 to June 2025), divided into pre-Raqeeb and post-Raqeeb periods. All tramadol prescriptions (acute postoperative and chronic/non-surgical indications) were included. Monthly rates were normalized; comparisons used -tests and chi-square tests. RESULTS: Monthly tramadol prescription rates in surgical patients decreased 43% (from 10.6 to 6.1 prescriptions/month). Mean dispensed quantity increased from 17.0 ± 7.6 to 21.5 ± 12.9 tablets ( = 0.003). Prescriptions issued by the surgical team fell from 86% to 48% ( < 0.001); prescriptions linked to a recent surgical procedure declined from 67% to 51% ( = 0.033). Anorectal procedures dropped 81%, while breast surgery increased 117%. Mean patient age rose from 50 ± 16 to 56 ± 15 years ( = 0.012). Repeat prescriptions remained stable (33% vs. 29%). CONCLUSION: Raqeeb achieved a 43% reduction in tramadol prescriptions among surgical patients-exceeding typical PDMP postoperative reductions (5%-30%)-with a shift toward older patients and chronic indications, without apparent barriers to legitimate access.
Rectus sheath block as the sole anesthesia technique for open surgical repair of umbilical hernias: A retrospective cohort study.
Rispler EL, Bettan DL, Valerio A … +3 more , Jeffries SD, Sinha A, Hemmerling TM
Saudi J Anaesth · 2026 · PMID 42022069 · Full text
BACKGROUND: The rectus sheath block is a regional anesthetic technique that provides effective analgesia for midline abdominal surgeries. This study evaluated the feasibility of the rectus sheath block as the sole anesth...
BACKGROUND: The rectus sheath block is a regional anesthetic technique that provides effective analgesia for midline abdominal surgeries. This study evaluated the feasibility of the rectus sheath block as the sole anesthetic technique for open umbilical hernia repair. METHODS: A retrospective observational cohort study was conducted at a single secondary care hospital between 2017 and 2024. A total of 201 adult patients who had an elective open umbilical hernia repair with a pre-operative rectus sheath block were included. Patients were stratified into two groups with respect to their anesthetic plan: rectus sheath block only and rectus sheath block with general anesthesia. Primary outcomes were conversion rate to general anesthesia in the rectus sheath block group, post-anesthesia care unit recovery times, and postoperative pain scores. Data were analyzed using non-parametric tests under the intention-to-treat principle, and a two-sided < 0.05 was considered statistically significant. RESULTS: The conversion rate to general anesthesia was 1.19%. The rectus sheath block group had significantly shorter post-anesthesia care unit recovery times (26.67 ± 13.57 min vs. 49.64 ± 23.91 min; < 0.001) and lower postoperative morphine milligram equivalent consumption (0.321 ± 1.513 mg vs. 2.955 ± 4.381 mg; < 0.001) compared with the rectus sheath block with general anesthesia group. Postoperative pain scores were comparable between groups ( = 0.170). CONCLUSION: The rectus sheath block is an effective sole anesthetic technique for open umbilical hernia repair, with a low conversion rate to general anesthesia.
Opioid stewardship program implementation in pediatric surgeries: A systematic review.
Mahmoud AH, Muawad R, Ruiz PS … +9 more , Alkharisi MM, Aljedani HZ, Alhifzi MA, Alobaidy SO, Abdelhamid MA, Aloubili RS, Almutairi NN, Alshalahi SS, AlDhuwaihy A
Saudi J Anaesth · 2026 · PMID 42022068 · Full text
BACKGROUND: Postoperative opioid use in pediatric surgeries presents significant challenges due to associated risks such as dependence, oversedation, and misuse. Opioid stewardship programs (OSPs) aim to mitigate these r...
BACKGROUND: Postoperative opioid use in pediatric surgeries presents significant challenges due to associated risks such as dependence, oversedation, and misuse. Opioid stewardship programs (OSPs) aim to mitigate these risks by promoting appropriate opioid prescribing and multimodal pain strategies. OBJECTIVES: To evaluate the effectiveness of current OSPs and their impact on opioid prescribing practices in pediatric surgeries. METHODS: We systematically searched PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, and Web of Science for English language studies (2011-2024) that described opioid stewardship initiatives in pediatric surgery. Eighteen studies were included. We included randomized controlled trials, observational studies, and systematic reviews, excluding studies without a formal OSP, studies exclusively focusing on adults, and those without any specific outcomes. Data extraction and quality assessment were performed independently by multiple reviewers. Risk of bias was evaluated using Cochrane and ROBINS-I tools. RESULTS: Eighteen studies were included with sample sizes ranging from 81 to more than 83,000 patients. The key interventions included opioid prescribing protocols, and guidelines, provider education about opioid use, and alternative pain management options to limit opioid dependence. All the studies reported reduction in opioid prescribing rates. There was reduction in discharge prescriptions from 68.4% to 10.7% after introducing consent ( < 0.001). There were no significant increases in emergency department visits related to reduced opioid prescribing. Pain scores remained stable, and oversedation events were reduced in some settings. CONCLUSION: Structured opioid stewardship interventions including protocols and guidelines, combined with targeted education and improved pain management techniques, effectively reduce opioid use while preserving adequate pain control. Future multicenter trials and studies will be required to further optimize opioid stewardship interventions and maximize patient outcomes.
Anesthetic considerations in smokers: A scoping review.
Yamani AN, Almazrooa A
Saudi J Anaesth · 2026 · PMID 42022067 · Full text
Tobacco smoking is a well-established modifiable risk factor that significantly influences perioperative outcomes through complex physiological and pharmacological mechanisms. Despite widespread awareness of its long-ter...
Tobacco smoking is a well-established modifiable risk factor that significantly influences perioperative outcomes through complex physiological and pharmacological mechanisms. Despite widespread awareness of its long-term health consequences, a considerable proportion of surgical patients continue to smoke at the time of their procedures. The objective of this review is to synthesize current evidence regarding the impact of smoking on anesthetic management. Smoking induces chronic inflammation and structural changes in the respiratory tract, which may increase the risk of intraoperative hypoxemia, bronchospasm, and postoperative pulmonary complications. Cardiovascular risks are similarly elevated due to smoking-related endothelial dysfunction, increased sympathetic activity, and impaired myocardial oxygen balance. Moreover, nicotine and other components of tobacco smoke alter drug metabolism, particularly via hepatic enzyme induction, affecting the pharmacokinetics of commonly used anesthetics and analgesics. Smokers also exhibit altered pain perception and increased opioid requirements postoperatively, complicating analgesic strategies. In conclusion, an in-depth understanding of the multifaceted effects of smoking on anesthetic care is essential for optimizing outcomes and reducing perioperative morbidity in this high-risk group.
Neffy: A latest needle-free epinephrine.
Chittoria K, Mukesh A, Sharma A
Saudi J Anaesth · 2026 · PMID 42022066 · Full text
Anaphylaxis is a rapid-onset, potentially fatal allergic reaction requiring prompt administration of epinephrine. Until recently, epinephrine autoinjectors have dominated emergency treatment, but challenges, such as need...
Anaphylaxis is a rapid-onset, potentially fatal allergic reaction requiring prompt administration of epinephrine. Until recently, epinephrine autoinjectors have dominated emergency treatment, but challenges, such as needle phobia, improper use, and poor carriage rates, reduce their real-world efficacy. Neffy (ARS-1; epinephrine nasal spray) introduces a needle-free, intranasal route for epinephrine delivery. This review examines the clinical evidence, pharmacological profile, indications, and safety data for Neffy and discusses implications for clinical practice.
Rising focus on neuropsychiatric risks: A half-century bibliometric analysis of sevoflurane literature.
Dai JC, Shui M, Song C … +3 more , Guo Y, Xu M, Zhan J
Saudi J Anaesth · 2026 · PMID 42022065 · Full text
BACKGROUND: An increasing number of articles have been published on sevoflurane. However, a quantitative evaluation of sevoflurane-related publications that are frequently cited has not been performed. This study aimed t...
BACKGROUND: An increasing number of articles have been published on sevoflurane. However, a quantitative evaluation of sevoflurane-related publications that are frequently cited has not been performed. This study aimed to determine how interest in sevoflurane has changed among the authors of academic journals over the past 50 years. METHODS: Sevoflurane-related studies were retrieved from the Web of Science Core Collection. The 100 most frequently cited original studies were identified via manual screening and analyzed. Document metrology software programs were used to perform visual analysis. RESULTS: The citation frequency of the 10 most frequently cited articles ranged from 293 to 576, with an average citation frequency of 379.2. Five of the 10 most cited articles involved studies of sevoflurane-related neuropsychiatric complications. Among the 10 articles, the first three were related to neuropsychiatric complications. Only two articles on the effects of general anesthesia with sevoflurane were included. These articles originated from 17 countries, with more than half being from the United States and Japan. Harvard University was the most cited university. The three core journals were Anesthesiology, Anaesthesia and Analgesia, and the British Journal of Anaesthesia. Anesthesiology is the academic journal that publishes the most sevoflurane-related research. Fifteen of the 55 articles focused on neuropsychiatric complications, and 10 focused on the mechanisms of sevoflurane anesthesia. CONCLUSION: This study shows that the research focus has shifted from the anesthetic mechanisms of sevoflurane to its neuropsychiatric complications, highlighting the need for clinicians to carefully weigh its benefits against potential neurological risks, particularly in pediatric and elderly populations.
Pulse pressure variation versus central venous pressure guided fluid management therapy in kidney transplant recipients: A single-blinded prospective randomized control study.
Gupta S, Arora D
Saudi J Anaesth · 2026 · PMID 42022064 · Full text
BACKGROUND: End-stage renal disease (ESRD) necessitates renal transplantation, where precise fluid management is essential for graft perfusion and function. Central venous pressure (CVP) is traditionally used, but the op...
BACKGROUND: End-stage renal disease (ESRD) necessitates renal transplantation, where precise fluid management is essential for graft perfusion and function. Central venous pressure (CVP) is traditionally used, but the optimal strategy is uncertain. Pulse pressure variation (PPV), a dynamic index, may better predict fluid responsiveness. This randomized trial compared PPV- versus CVP-guided fluid therapy in kidney transplant recipients. METHODS: Fifty ESRD patients undergoing renal transplantation were randomly divided into two groups (n = 25 each). Group A received intraoperative fluid therapy guided by PPV, while Group B followed CVP-guided fluid therapy. The primary outcome was total intraoperative fluid administered. Secondary outcomes included total urine output, time to onset of diuresis, incidence of hypotensive episodes, and post-reperfusion lactate levels. Data were analyzed with independent t-tests or Mann-Whitney tests for continuous variables and Fisher's exact test for categorical variables; < 0.05 denoted significance. RESULTS: Total fluid administration was significantly lower in the PPV group (1862 ± 327 mL) than in the CVP group (2480 ± 355 mL; < 0.0001). Intraoperative urine output was higher with PPV guidance (996 ± 348 mL vs. 820 ± 141 mL; = 0.026). The time to diuresis was shorter in the PPV group (median 1 min [IQR 1-2] vs. 2 min [IQR 1-3]; = 0.0008). Incidence of hypotension and lactate levels post clamp release did not differ between groups. CONCLUSION: PPV-guided therapy reduced fluid requirements and accelerated diuresis without increasing hypotension or lactate levels, supporting dynamic over static preload indices for optimizing graft perfusion.
Comment on: "A comparative study of stroke volume variation and plethysmography variability index as goal-directed fluid therapy in major abdominal oncosurgeries".
Narayanan V
Saudi J Anaesth · 2026 · PMID 42022063 · Full text
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Clinical impact of acupuncture on post-operative nausea and vomiting (PONV) in enhanced recovery after surgery (ERAS) protocols for patients undergoing colorectal surgery: A case control study.
Ciatti L, Ballo P, Berti B … +5 more , Fricelli C, Ferri G, Martinelli M, Manetti V, Conti D
Saudi J Anaesth · 2026 · PMID 42022062 · Full text
BACKGROUND: Acupuncture therapy is gaining prevalence in the perioperative treatment of postoperative nausea and vomiting (PONV). Furthermore, PONV prophylaxis is recommended by enhanced recovery after surgery (ERAS) gui...
BACKGROUND: Acupuncture therapy is gaining prevalence in the perioperative treatment of postoperative nausea and vomiting (PONV). Furthermore, PONV prophylaxis is recommended by enhanced recovery after surgery (ERAS) guidelines. The study investigated the efficacy of acupuncture in reducing PONV in patients undergoing colorectal surgery with the ERAS program. METHODS: We conducted a case-control study in patients, who underwent colorectal surgery between January 2022 and March 2024. All of them were enrolled in the ERAS program and they were divided into two study groups: Group 1, was composed of patients who received acupuncture as additional PONV prophylaxis. Group 2, were patients who received only pharmacologic PONV prophylaxis. Patients were matched based on gender, American Society of Anesthesia Physical Status (ASA-PS) score, surgical approach, and age (±5 years). RESULTS: Forty-four patients in each study group were enrolled. No differences in terms of surgical approach and duration of surgery were observed (respectively, = 0.53, 0.96). Furthermore, no significant differences between the groups regarding postoperative pain (post-anesthesia care unit admission and at 24 hours after surgery, respectively, = 0.67, 0,82), opioid consumption as rescue ( = 0.80), and length of stay ( = 0.33) were observed. Group 1 experienced a lower incidence of vomiting ( < 0.03). DISCUSSION: Current literature reports very low quality and inconclusive results on the efficacy of acupoint stimulation in addition to antiemetic drugs. The study shows that acupuncture as an additional prophylaxis therapy effectively reduces vomiting incidence in patients undergoing colorectal surgery with the ERAS program. This result may implement the use of acupuncture therapy into perioperative care practice.
Intraoperative cardiac complications in liver transplantation: A comprehensive review of management strategies.
Çekmen N, Uslu A
Saudi J Anaesth · 2026 · PMID 42022061 · Full text
Liver transplantation (LT) stands as the definitive treatment for end-stage liver disease (ESLD), but its perioperative management poses formidable challenges for anesthesiologists. Among the myriad complexities, cardiac...
Liver transplantation (LT) stands as the definitive treatment for end-stage liver disease (ESLD), but its perioperative management poses formidable challenges for anesthesiologists. Among the myriad complexities, cardiac actions emerge as pivotal determinants of mortality and overall outcomes. Understanding the multifaceted pathogenesis of ESLD and its profound impact on the circulatory system is paramount for effective anesthesia administration during LT. LT represents a dynamic process and constitutes one of the most taxing cardiovascular events for ESLD patients. The intricate nature of anesthesia management demands a precise multidisciplinary approach, requiring anesthesiologists to remain attuned to the swiftly evolving physiological, metabolic, hemodynamic, and bleeding-coagulation dynamics. Central to successful outcomes is a thorough preoperative evaluation and optimization of the cardiovascular system to mitigate potential intraoperative cardiac complications (ICCs). Through a meticulous review of the literatüre, our focus is to illuminate key ICCs encountered during the intraoperative phase of LT, offering insights into effective anesthesia management strategies.
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