Saudi J Anaesth
· 2026 · PMID 42022060
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A 47-year-old man was diagnosed with a tracheal mass with a narrowed airway at the level of vertebrae thoracalis 2-4 (T2 - T4). He was scheduled for sternotomy. The patient's clinical condition was considered ASA III. We...A 47-year-old man was diagnosed with a tracheal mass with a narrowed airway at the level of vertebrae thoracalis 2-4 (T2 - T4). He was scheduled for sternotomy. The patient's clinical condition was considered ASA III. We used fiberoptic bronchoscopy (FOI) to visualize the tumor's location and employed double endotracheal tubes to manage the airway difficulties. The first endotracheal tube was inserted orally into the trachea until it passed the tumor to provide primary airway control. Once the ventilator was connected, the second tube was repositioned below the tumor to maintain airway patency. After the surgery, the patient was transferred to the intensive care unit (ICU) for close monitoring of maintaining respiratory stability and preventing complications. The patient recovered well with stable vital signs and effective pain control.
Sinha D, Waindeskar V, Ahmad Z
… +5 more, Jain S, Mandal P, Yadav A, Nag S, Richhariya S
Saudi J Anaesth
· 2026 · PMID 42022059
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BACKGROUND AND AIMS: USG guidance for caudal epidural block (CEB) improves precision. However, the reliability of sonographic signs in confirming proper placement remains underexplored. This prospective study aimed to ev...BACKGROUND AND AIMS: USG guidance for caudal epidural block (CEB) improves precision. However, the reliability of sonographic signs in confirming proper placement remains underexplored. This prospective study aimed to evaluate the accuracy of trainee-performed landmark-based CEB placement, factors associated with first-pass accuracy, and reliable sonographic indicators of a successful block. MATERIALS AND METHODS: After written informed consent, 70 ASA I-II children (1-12 years) undergoing infra-umbilical surgeries were enrolled. CEB was performed using the landmark technique. Saline spread, sacral canal dilatation, pumping sign, and needle visualization were recorded in transverse and longitudinal views. First-pass CEB placement accuracy, overall success rate, and factors influencing accuracy were analyzed. Univariate binary logistic regression was performed to assess the predictive value of individual ultrasonographic signs for block success. RESULTS: The first-pass accuracy rate was 62.8%, with an overall success rate of 69%. Clear landmark palpation significantly improved first-pass accuracy ( value < 0.05). Visualization of the needle tip in either transverse (OR 3.60, 95% CI 1.32-9.79, = 0.01) or longitudinal (OR 2.66, 95% CI 1.00-7.07, = 0.05) view and visualization of sacral canal dilatation (OR 5.25, 95% CI 1.81-15.23, = 0.002) in the longitudinal orientation had a high odds ratio of a successful block. CONCLUSION: Landmark-based trainee-performed CEB has limitations, with a 62.8% first-pass accuracy and a 69% overall success rate. Reliable USG signs for block confirmation included needle visualization or sacral canal dilatation. Routine integration of USG is recommended to enhance the reliability of pediatric CEB.
Low A, Bettan D, Jeffries S
… +6 more, Sinha A, Pelletier E, Cafferty O, Laferriere-Langlois P, Malo M, Hemmerling TM
Saudi J Anaesth
· 2026 · PMID 42022058
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BACKGROUND: No study has evaluated peripheral nerve block as the primary anesthetic technique in adult hip fracture surgery. This retrospective cohort study compares peri-operative outcomes between spinal anesthesia and...BACKGROUND: No study has evaluated peripheral nerve block as the primary anesthetic technique in adult hip fracture surgery. This retrospective cohort study compares peri-operative outcomes between spinal anesthesia and peripheral nerve block with sedation (block-sedation) in adult emergency hip fracture surgery. METHODS: Adult patients who underwent hip fracture repair at Fleury Hospital between 2018 and 2025 were screened ( = 503). Of these, patients receiving planned spinal anesthesia ( = 238) or block-sedation ( = 230) were identified. Primary outcome was the success rate of block-sedation in emergency hip fracture surgery, defined as the proportion of patients in whom block-sedation was used without conversion to another anesthetic technique. Secondary outcomes included peri-operative opioid requirement (MME), postoperative pain, intra-operative anesthetic requirements (i.e., ketamine, midazolam, propofol), post-anesthesia care unit (PACU) stay, hospital length of stay, and intra-operative hypotension requiring inotropes. RESULTS: Block-sedation was successful without conversion in 98.1% of patients; four patients (1.9%) required conversion to general anesthesia and were excluded from peri-operative outcomes. Median PACU stay was longer in the spinal group (54 min, IQR 42-72) compared with block-sedation (36 min, IQR 27-53; < 0.001) The incidence of hypotension requiring inotropes was higher in the spinal group (53.0%) compared with the block-sedation group (19.4%; < 0.001). Postoperative pain scores were comparable between groups ( = 0.126), and postoperative hospital length of stay was also similar ( = 0.416). CONCLUSION: In this propensity-matched cohort study, block-sedation was feasible and safe for MIS hip fracture surgeries, with a high success rate (>98%) and low conversion to general anesthesia.
Rawlani S, Karnik PP, Subramanian S
… +1 more, Narsingrao R
Saudi J Anaesth
· 2026 · PMID 42022056
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OBJECTIVE: To evaluate the feasibility and benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elective ophthalmic day-care surgeries conducted under general anesthesia at the tertiary care ophth...OBJECTIVE: To evaluate the feasibility and benefits of implementing Enhanced Recovery After Surgery (ERAS) protocols in elective ophthalmic day-care surgeries conducted under general anesthesia at the tertiary care ophthalmic center. METHODS: This prospective observational study included 70 patients aged above 1 month undergoing elective ophthalmic surgery under general anesthesia. Key ERAS elements were adapted, including structured preoperative counselling, optimized fasting, multimodal analgesia, prophylaxis for postoperative nausea and vomiting (PONV), early oral intake, and use of the Aldrete score for discharge readiness. Pain was assessed using age-appropriate scoring systems like Visual Analogue Scale (VAS), Face, Legs, Activity, Cry, Consolability (FLACC) and patient feedback was obtained using a validated questionnaire. Data were analyzed using SPSS. RESULTS: Mean fasting durations were 7.04 ± 1.2 hours for solids and 3.02 ± 1.22 hours for clear liquids. A low-dose opioid regimen combined with paracetamol ensured effective pain control; only a small number of patients required rescue analgesia. The overall incidence of PONV was low (8.6%), and early oral fluid intake was well tolerated. Most participants reported high satisfaction with their perioperative experience, with 91.4% scoring 4 or 5 on a 5-point scale. No adverse events or delayed discharges were observed. CONCLUSION: Integrating ERAS principles into ophthalmic day-care anesthesia is feasible and associated with improved recovery, reduced discomfort, and high patient satisfaction. A structured, multidisciplinary approach tailored to the ambulatory context can enhance perioperative care without compromising safety.
Saudi J Anaesth
· 2026 · PMID 41710644
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BACKGROUND: Good procedural skill is the basic requirement of being an anesthetist. Formative assessment of procedural skill (workplace-based assessment (WPBA) can significantly enhance skill attainment in postgraduate s...BACKGROUND: Good procedural skill is the basic requirement of being an anesthetist. Formative assessment of procedural skill (workplace-based assessment (WPBA) can significantly enhance skill attainment in postgraduate students. AIM: Implementation of DOPS as a formative assessment tool to enhance the procedural skills of postgraduate (PG) students of anesthesia. OBJECTIVE: 1. To assess the effect of DOPS as a formative assessment tool on procedural skills of PG students of anesthesia 2. To evaluate the perception of faculty and students about DOPS as a formative assessment tool. METHODOLOGY: After obtaining informed consent, anesthesia PG students were assessed for procedural skills by DOPS using a validated checklist for that particular skill, and structured feedback was provided by the assessor immediately after the procedure. After 1 month, a second DOPS assessment was done using the same checklist, and the scores of both DOPS were compared and analyzed. After the second DOPS feedback from the students and faculty involved in the study was taken with a preformed questionnaire on a 5-point Likert scale. RESULTS: There was a significant improvement in the DOPS scores of the students in the second DOPS assessment ( = 0.001). The majority of the students (73.8%) agreed that DOPS helps improve their skills. The majority of students and faculty are in favor of incorporating DOPS in the PG curriculum. CONCLUSION: DOPS is a great tool for WPBA. It is not only a tool for the assessment, but it also helps in improving skills, and works as a teaching learning method.
Saudi J Anaesth
· 2026 · PMID 41710643
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BACKGROUND AND AIMS: Ketofol, a combination of ketamine and propofol, is widely used for procedural sedation in monitored anesthesia care (MAC). While it provides analgesia and hemodynamic stability, it may be insufficie...BACKGROUND AND AIMS: Ketofol, a combination of ketamine and propofol, is widely used for procedural sedation in monitored anesthesia care (MAC). While it provides analgesia and hemodynamic stability, it may be insufficient for painful procedures. Sufentanil, a potent opioid with rapid onset and moderate duration, may enhance analgesia in ketofol-based MAC. This study aimed to evaluate the efficacy and safety of adding single-dose sufentanil to ketofol in patients undergoing brief ambulatory gynecologic procedures under MAC. MATERIALS AND METHODS: We retrospectively reviewed patients who received ketofol-based MAC with or without a single dose of sufentanil. Primary outcomes included postoperative pain scores at 0-1 and 1-6 h. Secondary outcomes included surgical condition scores, need for assisted ventilation, and incidence of postoperative nausea and vomiting (PONV). RESULTS: Eighty patients were included (n = 40 per group). The sufentanil group had significantly lower pain scores in the first postoperative hour than did those of the ketofol-only group, with no difference in pain scores at 1-6 h. Surgical conditions were significantly better in the sufentanil group than in the ketofol-only group. However, assisted ventilation was more frequently required in the sufentanil group than in the ketofol-only group. PONV incidence was similar between groups. CONCLUSION: Adding a single dose of sufentanil to ketofol-based MAC improves early postoperative analgesia and enhances surgical conditions without prolonging the emergence time or increasing the incidence of PONV. However, it significantly increases the need for assisted ventilation, highlighting the importance of respiratory monitoring.
Silva JT, Abrantes CS, Mendes Â
… +1 more, Machado H
Saudi J Anaesth
· 2026 · PMID 41710642
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Congenital complete atrioventricular block (CCAVB) is a rare but high-risk condition with significant maternal and fetal morbidity and mortality. Management often involves pacemaker implantation, yet anesthetic guideline...Congenital complete atrioventricular block (CCAVB) is a rare but high-risk condition with significant maternal and fetal morbidity and mortality. Management often involves pacemaker implantation, yet anesthetic guidelines for pregnant women with CCAVB remain unclear. We describe the anesthetic care of a 29-year-old primigravida with asymptomatic CCAVB (no pacemaker) and well-controlled Crohn's disease, who underwent urgent cesarean delivery at 34+5 weeks for severe preeclampsia. A multidisciplinary team developed a detailed perioperative plan. On the day of surgery, defibrillator pads were applied, an arterial line was placed, and a cardiologist was present with electrophysiology backup. Pre-anesthetic fluid status was assessed with transthoracic echocardiography. Epidural anesthesia was cautiously titrated using 0.75% ropivacaine (16 mL) and sufentanil 10 µg over 20 minutes. The procedure was uneventful, with no need for pacing or vasopressors. A healthy newborn was delivered. The patient recovered in level 2 care and was discharged on postoperative day 3. This case underscores the importance of multidisciplinary planning and cautious epidural anesthesia in CCAVB pregnancies without pacing.
Saudi J Anaesth
· 2026 · PMID 41710641
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Virtual health hospitals have been on the rise significantly since COVID-19 globally. The Kingdom of Saudi Arabia has established several initiatives as part of Vision 2030, where Tele/Virtual Health is key part of this...Virtual health hospitals have been on the rise significantly since COVID-19 globally. The Kingdom of Saudi Arabia has established several initiatives as part of Vision 2030, where Tele/Virtual Health is key part of this vision. The purpose of this review is to evaluate and establish the expected challenges and the potential value in virtual hospitals in Saudi Arabia. It also aims to identify and analyze gaps in existing knowledge to ideally aid the planning and commissioning of future research on this subject. Results of this review highlight several themes from the literature evolved as follow: 1) need for improvement in Saudi healthcare, 2) emergence of virtual healthcare due to COVID-19, 3) Virtual healthcare has many pros and cons to consider, and, 4) Virtual healthcare has many challenges.
Mohamed AI, Bashir MS, Al Zhranei RM
… +4 more, Alsalmi M, Alghamdi AA, Meer AA, Bajabaa SK
Saudi J Anaesth
· 2026 · PMID 41710640
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BACKGROUND: Postoperative pulmonary complications (PPCs) are a major cause of morbidity in orthopedic surgery, yet the Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) score remains under-validated in...BACKGROUND: Postoperative pulmonary complications (PPCs) are a major cause of morbidity in orthopedic surgery, yet the Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) score remains under-validated in Saudi populations with unique metabolic and environmental risk profiles. METHODS: We conducted a prospective cohort study (2024-2025) of 600 adults undergoing elective/urgent orthopedic surgery at King Abdulaziz Medical City. Using a prespecified +5-point adjustment for cemented arthroplasty (accounting for bone cement implantation syndrome), we calculated ARISCAT scores preoperatively and assessed PPCs within 7 days using European Society of Anesthesiology and Intensive Care criteria. Secondary outcomes included intensive care unit admissions, length of stay (LOS), and hospitalization costs. RESULTS: The overall PPC incidence was 19.2%, with stepwise increases by risk category: 4.1% (low risk, ≤25 points), 17.3% (intermediate), and 44.8% (high-risk, ≥45; < 0.001). The model demonstrated excellent discrimination (area under the curve [AUC] = 0.83, 95% confidence interval [CI] 0.78-0.88) and calibration ( = 0.27). High-risk patients had 5.2× greater PPC odds (adjusted odds ratio [OR] 5.2, 95% CI: 3.1-8.7), 3.1-day longer LOS, and $2350 higher costs versus low-risk patients (all < 0.001). Cemented arthroplasty independently predicted PPCs (OR 1.8, 95% CI: 1.1-3.0). CONCLUSION: This prospective Saudi validation demonstrates ARISCAT's strong predictive performance in orthopedic surgery, with notable enhancement when applying the cemented procedure modification. The substantial clinical burden observed in high-risk patients (44.8% PPC rate) and the associated economic impact highlight an urgent need for targeted preoperative optimization and resource-stratified care pathways. These findings reinforce ARISCAT's utility in guiding surgical planning and underscore the value of tailoring risk assessment tools to the unique metabolic and environmental risk profile of Saudi orthopedic populations.
Yadava D, Tripathi M, Rai S
… +4 more, Malviya D, Kumar S, Rao N, Mishra S
Saudi J Anaesth
· 2026 · PMID 41710639
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BACKGROUND: During continuous renal replacement therapy (CRRT), regional citrate anticoagulation (RCA) and bivalirudin are appealing alternatives since they provide excellent anticoagulation within the circuit without in...BACKGROUND: During continuous renal replacement therapy (CRRT), regional citrate anticoagulation (RCA) and bivalirudin are appealing alternatives since they provide excellent anticoagulation within the circuit without increasing the risk of bleeding. This study has been done to assess the hemofilter survival time, length of intensive care unit (ICU) stays, bleeding, thrombosis, and kidney function in bivalirudin and RCA. METHODS: A total of 40 patients who needed CRRT were enrolled in the study with acute kidney injury (AKI). The patients were divided into two groups of 20 each. RCA was used in the CRRT in the first group and bivalirudin in the second group according to protocol. We have monitored serum urea, serum creatinine, last 24 h urine output, hemoglobin (Hb), platelet count, prothrombin time (PT), international normalized ratio (INR), serum albumin, any bleeding complication, or any transfusion requirement pre-CRRT, during CRRT, and after CRRT. RESULTS: Hemofilter life span was found significantly longer in the citrate group than the bivalirudin group (67.75 ± 16.64 vs 50.65 ± 7.98, < 0.001). Length of ICU stay is found to be non-significant between the groups ( > 0.05). Significant difference was found in S. Creatinine level and urine output from pre-CRRT to post-CRRT in both the groups ( < 0.05), but no significant difference was found in pre-CRRT, during CRRT, and post-CRRT between both the groups ( > 0.05). No significant difference was found in terms of mortality, bleeding, and transfusion between the groups ( > 0.05). CONCLUSION: After observing the data and statistical evaluation, we found that RCA has a better hemofilter life span than bivalirudin without a significant difference in mortality, bleeding, or transfusion.
De Cassai A, Potenza F, Vallesi V
… +8 more, Zarantonello F, Mormando G, Sella N, Boscolo A, Pettenuzzo T, Dost B, Tulgar S, Navalesi P
Saudi J Anaesth
· 2026 · PMID 41710637
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BACKGROUND: Peer review has been the cornerstone of academic publishing for nearly 400 years, serving as a critical gatekeeping mechanism for new knowledge. However, it faces significant criticisms, including reviewer fa...BACKGROUND: Peer review has been the cornerstone of academic publishing for nearly 400 years, serving as a critical gatekeeping mechanism for new knowledge. However, it faces significant criticisms, including reviewer fatigue, superficial evaluations, and potential biases. This study aims to explore the peer review process within anesthesiology and pain medicine journals from the editors' perspectives, focusing on criteria for selecting reviewers and managing divergences between peer reviewers and authors. METHODS: We conducted an online survey targeting editors in anesthesiology and pain medicine journals listed in the Scopus database. A total of 2083 unique editors were identified, and invitations to participate were sent via email, supplemented by reminders. The survey consisted of 27 questions regarding editorial roles, reviewer selection, and challenges in the peer review process. RESULTS: A total of 207 editors entered the final analysis (9.9% of the sample). The survey revealed that most editors prioritize familiarity with reviewers' expertise over diversity of perspectives. A notable 61.8% of editors reported moderate workloads, yet challenges such as securing qualified reviewers and managing reviewer burnout were prevalent. While 55.8% expressed satisfaction with the current system, 69.9% identified a need for better reviewer training, and 8.3% suggested compensating reviewers as a potential enhancement to the process. CONCLUSIONS: Our findings highlight significant strengths and weaknesses in the peer review process for anesthesiology and pain medicine journals. There is an urgent need for improved strategies to diversify the reviewer pool and provide adequate training and support for reviewers.
Mogahed MM, Abdalraheem TMA, Elkahwagy MS
… +1 more, Easa WSH
Saudi J Anaesth
· 2026 · PMID 41710636
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BACKGROUND: Lumbar spine surgery is often associated with intense postoperative pain. We compared ultrasound guided erector spinae plane block (ESPB) and modified thoracolumbar interfascial plane block (mTLIP) in patient...BACKGROUND: Lumbar spine surgery is often associated with intense postoperative pain. We compared ultrasound guided erector spinae plane block (ESPB) and modified thoracolumbar interfascial plane block (mTLIP) in patients undergoing lumbar spine surgeries under general anesthesia. The primary outcome was total postoperative fentanyl requirements. The secondary outcomes included pain score at rest and during movement, time of first postoperative analgesic request, and opioid side effects. METHODS: One hundred eighty patients scheduled for spine surgeries under general anesthesia were enrolled in this randomized trial. They were randomized to receive ESPB, mTLIP, or not receive any block (control group). Blocks were done by injecting 20 mL of 0.5% ropivacaine mixed with 2 mcg/ml adrenaline. RESULTS: Postoperative fentanyl (mcg) was significantly higher in the group C in comparison with the ESPB and the mTLIP groups < 0.001; however, it was comparable between the ESPB and the mTLIP groups ( = 0.08). Also, Numerical Rating Scale (NRS) scores either during rest or during movement was higher in the early postoperative hours in the group C; however, both the block groups provide comparable NRS scores either during rest or during movement with > 0.05 at all time intervals during the first 24 h. CONCLUSION: Both ultrasound guided ESPB and mTLIP decrease the perioperative amount of fentanyl consumption and provide comparable pain scores at rest and during movement during the first postoperative 24 h in lumbar spine surgeries.
Akhter N, Villalobos EE, Kitio SAY
… +5 more, Heydinger GJ, Veneziano G, Roth C, Thung A, Tobias JD
Saudi J Anaesth
· 2026 · PMID 41710635
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INTRODUCTION: Spinal anesthesia (SA) may mitigate some of the risks associated with general anesthesia (GA). As an alternative to GA, SA can be used in a variety of surgical procedures and may be particularly beneficial...INTRODUCTION: Spinal anesthesia (SA) may mitigate some of the risks associated with general anesthesia (GA). As an alternative to GA, SA can be used in a variety of surgical procedures and may be particularly beneficial in patients with significant comorbid conditions. We retrospectively review our experience with SA in the American Society of Anesthesiology (ASA) physical classification III and IV patients. METHODS: Retrospective chart review of ASA III/IV pediatric-aged patients who received SA for surgical procedures from 2016-2023. Data included patient demographics, procedure and anesthetic characteristics, surgical procedure, additional intraoperative sedation, reasons for conversion to GA, intraoperative adverse events, and reasons for emergency department return. RESULTS: The initial study cohort included 69 patients (median age eight months) with ASA physical status III or IV who presented for SA. SA failed in eight patients. This left a cohort of 61 patients in whom SA was successful (88%). Congenital cardiac, respiratory, genetic, and renal disorders were among the most common comorbid conditions. Thirty-six of the 61 patients (59%) received no additional sedative or analgesic medications following lumbar puncture for SA. The most common intraoperative adverse event was systolic blood pressure (sBP) less than 60 mmHg ( = 15; 25%), but no case required the administration of a vasoactive or anticholinergic agent. Phase I recovery was bypassed in 44% ( = 27) of cases. Six patients (9.8%) returned to the emergency department following hospital discharge, but no return was due to an anesthetic concern. CONCLUSION: SA offers a safe and effective alternative to GA for ASA physical class III/IV patients. The low rate of intraoperative complications highlights the safety profile of the technique even in high-risk surgical candidates.
Saudi J Anaesth
· 2026 · PMID 41710634
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BACKGROUND: Managing dental pain in medically compromised patients poses clinical challenges due to altered drug metabolism, systemic contraindications, and increased risk of adverse effects. Existing guidelines often la...BACKGROUND: Managing dental pain in medically compromised patients poses clinical challenges due to altered drug metabolism, systemic contraindications, and increased risk of adverse effects. Existing guidelines often lack specificity for this group, highlighting the need for a tailored approach to analgesic prescribing. This review aimed to survey the literature and propose an evidence-informed analgesic ladder for dental care in medically vulnerable patients. METHODS: A comprehensive review was conducted using structured searches of PubMed, Scopus, Web of Science, and the Cochrane Library for studies published from January 2000 to May 2025. Eligible studies included randomized controlled trials (RCTs), systematic and narrative reviews, and clinical guidelines addressing dental analgesia in patients with conditions such as cardiovascular disease, renal or hepatic impairment, asthma, diabetes, and cancer. Forty-nine studies met the inclusion criteria. Findings were thematically analyzed by pain severity and patient-specific risk factors, forming the basis of a five-step analgesic ladder. RESULTS: The proposed ladder offers a structured framework to guide dental clinicians in selecting analgesics based on pain intensity and patient medical conditions. It incorporates stepwise recommendations accounting for common comorbidities and contraindications, with emphasis on dose adjustment, combination therapy, and selective use of adjunctive analgesics. CONCLUSION: This review presents a practical, patient-centered analgesic ladder to support safer dental pain management in medically compromised individuals. Despite the limited availability of RCTs, this framework offers an evidence-informed tool for personalized dental pain care. Further research is needed to validate the model and explore the role of adjunctive analgesia.
Saudi J Anaesth
· 2026 · PMID 41710633
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Osmotic demyelination syndrome (ODS) is a rare condition marked by demyelination of brain tissue due to degeneration and loss of oligodendrocytes. It is classified into central pontine myelinolysis and extrapontine myeli...Osmotic demyelination syndrome (ODS) is a rare condition marked by demyelination of brain tissue due to degeneration and loss of oligodendrocytes. It is classified into central pontine myelinolysis and extrapontine myelinolysis based on the lesion sites. Diagnosis and treatment are often delayed due to inadequate clinical recognition. This study aims to examine the causes, diagnosis, and treatment experiences of ODS post liver transplantation (LT). The case of a 67-year-old female patient who underwent LT for chronic acute liver failure and primary biliary cirrhosis is retrospectively analyzed. Following her transfer to the intensive care unit, the development of ODS was monitored. Symptoms appeared on the second day after LT, beginning with muscle loss in the limbs. This was followed by localized twitching in the left upper limb and bilateral lower limb twitching, along with tremors in the head and face, lethargy, binocular fixation, facial paralysis, aphasia, and coma. ODS was confirmed through head magnetic resonance imaging, and the patient died 40 days post operation. LT and electrolyte disturbances are significant risk factors for ODS. Various pathophysiological factors influence its onset and progression during the perioperative period, necessitating prioritized prevention. Its clinical presentations are diverse, and enhancing clinical vigilance and timely diagnostic evaluations are crucial for early diagnosis of ODS.
Atalay YO, Ince A, Koc EK
… +5 more, Gungor H, Gul YG, Toklu T, Kocak M, Tobias JD
Saudi J Anaesth
· 2026 · PMID 41710632
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BACKGROUND: Effective pain control following tonsillectomy in children remains challenging. Traditionally, opioids such as fentanyl have been used for pain control, but its adverse effect profile makes it a less ideal op...BACKGROUND: Effective pain control following tonsillectomy in children remains challenging. Traditionally, opioids such as fentanyl have been used for pain control, but its adverse effect profile makes it a less ideal option for children, particularly those with obstructive sleep apnea. The curent study investigates the perioperative effects of ketamine on postoperative pain and delirium in children. METHODS: In this prospective trials, patients 3-8 years of age were randomized to receive either fentanyl or ketamine for pain management. Pain was assessed using the face, legs, activity, crying, consolability (FLACC) scale, and emergence delirium was evaluated with the pediatric anesthesia emergence delirium (PAED) scale. Postoperative outcomes, including recovery time and analgesic requirements, were also recorded. RESULTS: The study cohort include 59 pediatric patients. The ketamine group exhibited higher pain scores in the first 15 min post-surgery compared to the fentanyl group. However, pain scores between the two groups were comparable by 30 min. The incidence of emergence delirium was higher with ketamine than fentanul (19.35% versus 3.57%). The groups had similar recovery and post-anesthesia care unit (PACU) times, as well as supplemental analgesia requirements. CONCLUSION: Although ketamine demonstrated delayed pain relief and a higher incidence of emergence delirium, it showed potential as part of a multimodal analgesic approach. The combination of fentanyl and ketamine may optimize pain management in pediatric tonsillectomy, reducing opioid use while minimizing adverse effects. Further studies are needed to refine dosing strategies and assess long-term outcomes.