Saudi J Anaesth
· 2026 · PMID 41710609
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BACKGROUND: Subarachnoid block (SAB) is a preferred anesthetic technique for infraumbilical surgeries. However, in obese patients, landmark identification for SAB can be difficult, increasing the risk of procedural failu...BACKGROUND: Subarachnoid block (SAB) is a preferred anesthetic technique for infraumbilical surgeries. However, in obese patients, landmark identification for SAB can be difficult, increasing the risk of procedural failure and complications. This study is determined to compare the efficacy of ultrasound (USG)-guided, C-arm fluoroscopy-guided, and anatomical landmark-guided SAB in obese patients. METHODS: Sixty patients of 18-80 years with BMI ≥30 kg/m² of American Society of Anaesthesiologist Physical Status (ASA PS) II-III scheduled for infraumbilical surgeries were randomized into three equal groups: Group A, Group B, and Group C for USG-guided, C-arm-guided, and Landmark-guided SAB, respectively. Each received 0.5% hyperbaric bupivacaine intrathecally using a 25-G Quincke's needle. Total time taken for the procedure, number of spinal needle insertion attempts, patient satisfaction score, success rate, and complications in each group were recorded. RESULTS: All groups were comparable demographically. Group B had the significantly highest total time taken for the procedure, 380.4 ± 46.2 seconds, compared to Group A, 273.6 ± 7.5 seconds, and Group C, 165.7 ± 23.2 seconds. The number of spinal needle insertion attempts was lowest in Groups A and B, with higher patient satisfaction scores. Complications occurred only in Group C. CONCLUSION: Imaging modalities-guided SAB in obese patients took a prolonged procedure time but had fewer spinal needle insertion attempts and better patient satisfaction than the landmark-guided SAB. Between the imaging modalities, USG-guided SAB was faster, required fewer needle insertions, and gave better patient satisfaction than C-arm guided SAB.
Punzo G, Favitta SF, Nachira D
… +2 more, Congedo MT, Aceto P
Saudi J Anaesth
· 2026 · PMID 41710608
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The ultrasound-guided serratus posterior superior intercostal plane (SPSIP) block is a newly introduced regional anesthesia technique that has shown promising results in adult patients undergoing uniportal video-assisted...The ultrasound-guided serratus posterior superior intercostal plane (SPSIP) block is a newly introduced regional anesthesia technique that has shown promising results in adult patients undergoing uniportal video-assisted thoracoscopic lung resections and other thoracic procedures. However, its use in dorsal mass excisions has not yet been reported. In the reported case, a 66-year-old female patient received an SPSIP block for the surgical removal of a 7 cm lesion located in the upper scapular region. The surgery and postoperative period proceeded without complications, and the patient remained pain-free until discharge. This case underscores the SPSIP block's safety and effectiveness in providing postoperative analgesia for dorsal mass excision.
Bapu SD, Tan SJ, Musuku SR
… +2 more, Cherukupalli D, Shapeton AD
Saudi J Anaesth
· 2026 · PMID 41710607
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Uvular injury, although rare, is a clinically significant complication of airway and pharyngeal manipulation and procedural intervention across multiple specialties including anesthesiology, otolaryngology, gastroenterol...Uvular injury, although rare, is a clinically significant complication of airway and pharyngeal manipulation and procedural intervention across multiple specialties including anesthesiology, otolaryngology, gastroenterology, obstetrics and gynecology, pediatrics, emergency medicine, and infectious disease. This narrative review comprises case reports and series from MEDLINE and Embase databases and Google Scholar from 1978 to 2025 outlining the embryological origin and anatomy of the uvula, the pathophysiology and management of uvular injury, and preventative measures. Common etiologies can be classified into mechanical injury from airway instrumentation, nonmechanical injury from isolated uvular edema, infection and drug reactions, pediatric uvular injury, and idiopathic uvular injury resulting in an array of injuries from uvular edema to necrosis, paralysis, and hematoma. Typically, uvular injuries present with sore throat, odynophagia, dysphagia, foreign body sensation, and, in more severe cases, airway obstruction. On physical exam, the uvula may appear erythematous, edematous, and necrotic or avulsed in severe cases. Uvular injuries commonly resolve with conservative management such as analgesics and anti-inflammatory medications. Antibiotics and surgical intervention are rarely indicated as most injuries resolve within 2 weeks. Recommendations for prevention of mechanical injury include device placement lateral to the midline, gentle and controlled suctioning, and careful patient positioning. Currently, there is a lack of standardized management guidelines for uvular injury. One proposed grading system categorizes uvular injury by Grade I-IV ranging from mild edema and uvulitis to uvular necrosis and autoamputation. However, future large-scale studies are warranted to standardize management protocols and guidelines.
Saudi J Anaesth
· 2026 · PMID 41710606
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Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce perioperative bleeding. Although generally safe, TXA has been associated with rare, but potentially life-threatening anaphylactic reactions. We repor...Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce perioperative bleeding. Although generally safe, TXA has been associated with rare, but potentially life-threatening anaphylactic reactions. We report a case of severe anaphylaxis following intravenous TXA. A 33-year-old male with no known allergies developed severe bronchospasm, hypotension, ventricular arrhythmias, and lip swelling within min of TXA administration. Initial treatment included oxygen, intratracheal salbutamol, and intravenous pheniramine with delayed epinephrine due to the transient arrhythmias. Serum tryptase measured two hours later was within normal range. Six weeks postoperatively, skin prick test (SPT) showed trace positivity to TXA and a stepwise intravenous drug provocation test (DPT) reproduced clinical symptoms at 100 mg, confirming IgE-mediated hypersensitivity. This case highlights the diagnostic challenges of perioperative anaphylaxis under general anaesthesia and emphasizes the importance of early recognition, prompt epinephrine use, and confirmatory testing for safe perioperative management.
Nagy M, Mustafa SN, Muawad R
… +2 more, Mahmoud AH, AlDhuwaihy A
Saudi J Anaesth
· 2026 · PMID 41710605
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Malignant hyperthermia (MH) remains the monster every anesthesiologist can meet suddenly in the OR. It is a rare but life-threatening hypermetabolic reaction triggered by certain anesthetic agents. Here we present a case...Malignant hyperthermia (MH) remains the monster every anesthesiologist can meet suddenly in the OR. It is a rare but life-threatening hypermetabolic reaction triggered by certain anesthetic agents. Here we present a case of a 40-year-old male, who developed MH 45 min after induction of anesthesia for functional endoscopic sinus surgery (FESS) in King Abdulaziz Medical City in KSA. It was not the first time the patient was exposed to general anesthesia, with no relevant family history. Early recognition, prompt administration of dantrolene, and aggressive supportive measures resulted in full recovery. Despite the full recovery from metabolic derangements, he developed upper extremity DVT in the same limb dantrolene was administered.
Saudi J Anaesth
· 2026 · PMID 41710600
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The intersection of vaccination strategies, infection prevention protocols, and perioperative care represents a critical nexus in modern anesthetic practice and public health. This comprehensive review examines the evolv...The intersection of vaccination strategies, infection prevention protocols, and perioperative care represents a critical nexus in modern anesthetic practice and public health. This comprehensive review examines the evolving role of immunization and infection control measures in reducing perioperative complications, with particular emphasis on the Saudi Arabian healthcare context. The coronavirus disease 2019 pandemic has highlighted the importance of vaccination timing in relation to elective surgery, while established infection prevention practices continue to form the cornerstone of safe perioperative care. In Saudi Arabia, national initiatives have demonstrated significant improvements in healthcare-associated infection rates, with central line-associated bloodstream infections decreasing from 2.5 per 1000 catheter-days in 2021 to 1.28 per 1000 catheter-days by 2024. The implementation of evidence-based vaccination protocols and comprehensive infection prevention strategies has shown measurable benefits in reducing surgical site infections, respiratory complications, and overall perioperative morbidity. Anesthesiologists play a pivotal role in this public health framework, serving as key stakeholders in perioperative optimization through vaccination status assessment, infection control adherence, and risk stratification. The Saudi healthcare system's commitment to infection prevention excellence, aligned with Vision 2030 objectives, provides a unique model for integrating public health principles into anesthetic practice. Current evidence supports the strategic timing of vaccinations relative to elective procedures, with recommendations for postponing elective surgery 3-7 days after inactivated vaccines and 14-21 days following live vaccines. This review synthesizes current evidence, identifies best practices, and proposes future directions for optimizing the vaccination-infection prevention-anesthesia nexus to improve patient outcomes and advance public health goals within the Saudi healthcare landscape.
Chittoria K, Sharma A, Kothari N
… +1 more, Goyal S
Saudi J Anaesth
· 2025 · PMID 40994515
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Sublingual dexmedetomidine under the tradename of IgalmiTM is the first and only FDA-approved sedative agent for treating agitation in schizophrenia and bipolar I or II patients. This article highlights the benefits and...Sublingual dexmedetomidine under the tradename of IgalmiTM is the first and only FDA-approved sedative agent for treating agitation in schizophrenia and bipolar I or II patients. This article highlights the benefits and adverse effects associated with this novel route of administration of dexmedetomidine and its potential to emerge as a promising sedative agent.
Saudi J Anaesth
· 2025 · PMID 40994514
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BACKGROUND: Existing studies on anesthesiologists' attitudes toward artificial intelligence (AI) leave a global understanding underexplored. This cross-sectional study aims to investigate Turkish anesthesiologists' attit...BACKGROUND: Existing studies on anesthesiologists' attitudes toward artificial intelligence (AI) leave a global understanding underexplored. This cross-sectional study aims to investigate Turkish anesthesiologists' attitudes toward AI, examining its perceived benefits, limitations, and associated ethical concerns. Insights from this study aim to enhance understanding of AI's role in anesthesiology within a cultural and ethical context. METHODS: This nationwide study surveyed Turkish anesthesiologists. Descriptive statistics summarized categorical variables, Pearson's Chi-square test compared variables between groups. Binary logistic regression analyzed associations between demographic factors and positive attitudes toward AI. RESULTS: Among 293 valid responses, 69.6% of participants expressed positive attitudes toward AI. Gender ( = 0.01), employment setting ( < 0.001), and prior AI experience ( < 0.001) were significant predictors of positive attitudes. AI applications most frequently endorsed included preoperative assessments (93.1%), academic support (95.2%), and medical education (91.2%). Ethical concerns were prominent, with liability ambiguity (87.3%) and privacy issues (62.8%) being the most cited. Logistic regression revealed that participants aged 46-55 were significantly more likely to exhibit positive attitudes (OR = 3.744, = 0.03), while those with over 15 years of experience were less likely to do so (OR = 0.105, = 0.04). CONCLUSIONS: Turkish anesthesiologists exhibited predominantly positive attitudes toward AI, with prior experience playing a significant role in shaping perceptions. While AI was embraced for academic, educational, and noninvasive tasks, skepticism was present toward its application in invasive procedures. These findings highlight AI's potential to enhance efficiency and patient safety while underscoring the need for comprehensive legal and ethical frameworks.
Elsayed HMA, Al-Metwalli RR, Abdelraheem M
… +1 more, Badawy F
Saudi J Anaesth
· 2025 · PMID 40994513
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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: Thir...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).
Hom B, McIntee D, Zhang YP
… +3 more, Hershenhouse JS, Nash A, Richeimer S
Saudi J Anaesth
· 2025 · PMID 40994511
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BACKGROUND: Ketamine has been shown to be an effective treatment at sub-anesthetic doses for various chronic pain conditions. This study assesses the relationship between oral ketamine and the incidence of adverse side e...BACKGROUND: Ketamine has been shown to be an effective treatment at sub-anesthetic doses for various chronic pain conditions. This study assesses the relationship between oral ketamine and the incidence of adverse side effects in patients receiving long-term, moderate to high-dose tablets for chronic pain. MATERIALS AND METHODS: All adult patients given prescriptions for oral ketamine from November 2019 to October 2023 were identified for our initial cohort. Patients were excluded if they failed to reach at least 80 mg per day during their treatment period or if their treatment periods lasted less than 90 days. Demographic variables, comorbidities, prescription information, and patient-reported side effects were recorded. RESULTS: This study identified 193 patients who received oral ketamine prescriptions at our institution. One hundred forty-nine patients received 80 mg-159 mg per day, 24 patients received 160 mg-199 mg per day, and 20 patients received 200 mg-240 mg per day. In Group 1, 9 of the 149 patients (6.0%) reported 12 instances of side effects; in Group 2, 2 of the 24 patients (8.3%) reported 6 instances of side effects; in Group 3, 2 of the 20 patients (10%) reported 2 instances of side effects. The maximum average daily dosage was not associated with the number of reported side effects ( = 0.10). Age was the only covariate associated with the number of adverse side effects ( = 0.04). CONCLUSION: Our results suggest that at daily doses above 80 mg and up to 240 mg, oral ketamine does not show a dose-dependent relationship in predicting the number of patient-reported side effects.
Dayal P, Tyagi A, Kumar A
… +3 more, Tyagi S, Thamburu S, Salhotra R
Saudi J Anaesth
· 2025 · PMID 40994510
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BACKGROUND: Recommended prophylaxis against postspinal hypotension includes vasopressor infusions needing continuous and accurate titration preferably with infusion pumps, along with close blood pressure monitoring. In r...BACKGROUND: Recommended prophylaxis against postspinal hypotension includes vasopressor infusions needing continuous and accurate titration preferably with infusion pumps, along with close blood pressure monitoring. In resource constrained settings with high volume obstetric care such intensive management may be difficult for every patient. Thus a dependent, simple tool without need of advanced technology to predict postspinal hypotension is desirable. Although PRAM score is such a tool it has never been validated. AIM: To validate previously formulated bed-side PRAM score (also after adding postspinal tachycardia as a variable) for predicting postspinal hypotension. MATERIALS AND METHODS: This prospective study included 371 consenting patients scheduled for elective/emergency cesarean delivery using standardized spinal block. Postspinal hypotension was defined as systolic blood pressure <80% of baseline or <90mmHg, whichever was higher (upto 15 minutes after baby delivery); and managed with boluses of phenylephrine (50 μg i.v.) till resolution. PRAM score included grade of 1 for each of: baseline heart rate >90 bpm, mean arterial pressure <90 mmHg and age >25 years minutes. Postspinal tachycardia was an increase in heart rate by >10 bpm within 5 minutes. RESULTS: Incidence of postspinal hypotension was 49.3%, with median onset time of 3 minutes, number of hypotensive episodes ranging from 0 to 5, and amount of phenylephrine required 50-300 μg. ROC analysis showed significant predictive value of PRAM score for postspinal hypotension, with an AUC of 0.578 [95% CI: 0.520-0.636] (= 0.008); and sensitivity of 89% at cut-off value of PRAM score= 1. When including tachycardia within the first 5 minutes post-block, modified PRAM score had improved predictive accuracy with AUC of 0.601 [95% CI: 0.544-0.659] ( = 0.001). CONCLUSION: The PRAM score effectively predicts postspinal hypotension during cesarean delivery.
Saudi J Anaesth
· 2025 · PMID 40994509
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BACKGROUND: Caudal block is a widely practiced regional anesthetic technique in pediatric patients undergoing infraumbilical and lower limb surgeries. However, assessing its effectiveness intraoperatively remains a chall...BACKGROUND: Caudal block is a widely practiced regional anesthetic technique in pediatric patients undergoing infraumbilical and lower limb surgeries. However, assessing its effectiveness intraoperatively remains a challenge due to limitations in conventional clinical evaluation methods, especially under general anesthesia. The perfusion index (PI), a noninvasive indicator of peripheral perfusion, has emerged as a potential early marker of successful neuraxial block. AIM: To evaluate the perfusion index as a primary predictor of successful caudal block in children undergoing elective infraumbilical and lower limb surgeries, and to compare it with traditional hemodynamic parameters. METHODS: This prospective observational study was conducted over two years at a tertiary care center. A total of 80 pediatric patients (ASA I-II, aged 1-8 years) undergoing elective surgeries under general anesthesia with caudal block were enrolled. PI, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at multiple time intervals post-block. The primary outcome was the change in PI; secondary outcomes included changes in hemodynamic parameters. RESULTS: A significant increase in PI was observed as early as 3 minutes after caudal block, rising from a baseline of 1.55 ± 1.08 to 3.96 ± 1.94 ( < 0.001), with a peak at 30 minutes (5.23 ± 1.42). In contrast, SBP, DBP, and MAP showed significant reductions only after 15 minutes. SpO remained stable throughout. The early rise in PI correlated with successful block onset and duration, making it a reliable early predictor compared to delayed hemodynamic changes.
Saudi J Anaesth
· 2025 · PMID 40994508
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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 additi...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.
Khubzan W, Alharbi L, Alharbi L
… +5 more, Almayof T, Alrashidi A, Alharbi A, Alshaikh R, Alotaibi A
Saudi J Anaesth
· 2025 · PMID 40994507
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To examine the role of Transcutaneous Electrical Nerve Stimulation (TENS) in pain management post-laparoscopic cholecystectomy (LC). An in-depth search was conducted on Google Scholar, PubMed, and Ovid MEDLINE from their...To examine the role of Transcutaneous Electrical Nerve Stimulation (TENS) in pain management post-laparoscopic cholecystectomy (LC). An in-depth search was conducted on Google Scholar, PubMed, and Ovid MEDLINE from their inception until November 2024. We included randomized controlled trials and prospective studies that compared TENS for postoperative pain relief as determined by the Visual Analog Scale (VAS). The quality assessment using the GRADE and Cochrane risk of bias methods. Six trials, comprising a total of 423 patients, were included in the study. The meta-analysis of the VAS at different times yielded no significant reduction in pain observed postoperatively at 4 hours (MD: -0.70, CI: -1.97 to 0.57, = 0.28); at 8 hours (MD: -0.75, CI: -2.15 to 0.65, = 0.29); and at discharge (MD: -0.88, CI: -2.02 to 0.26, = 0.13). While the included studies showed minimal risk of bias, the certainty of evidence by the GRADE assessment was deemed low. While some studies suggest a potential benefit of TENS in reducing postoperative pain, the current evidence remains inconclusive due to the variability in study design, TENS parameters, and outcome reporting. Additional high-quality RCTs are required.
Saudi J Anaesth
· 2025 · PMID 40994506
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OBJECTIVE: Postoperative airway complications pose significant risks in pediatric patients and are often multifactorial. Anatomical and physiological differences in children make predicting these complications challengin...OBJECTIVE: Postoperative airway complications pose significant risks in pediatric patients and are often multifactorial. Anatomical and physiological differences in children make predicting these complications challenging. This study examines the association between ultrasonographic (USG) measurements and postoperative airway complications, primarily focusing on the subglottic diameter-to-wall thickness difference ratio. METHODS: This prospective, double-blind study included pediatric patients aged 1-11 undergoing elective surgery between January and July 2024. Demographic and perioperative data, USG-measured airway diameters, wall thicknesses, and endotracheal tube (ETT) positions were recorded. The subglottic diameter-to-wall thickness difference ratio was the primary ultrasonographic measurement. Airway complications were assessed within the first postoperative hour, including cough, dysphonia, and laryngospasm. The relationship between USG measurements and complications was analyzed. RESULTS: Eighty patients were included, and airway complications were observed in 37.5% ( = 30). Patients with complications had lower height, subglottic diameter, and subglottic diameter-to-wall thickness difference ratio but higher subglottic wall and vocal cord thickness differences. In 70% ( = 20) of these cases, ETT had shifted superiorly from the second tracheal ring. The subglottic diameter-to-wall thickness difference ratio was significantly associated with complications (AUC 0.896, cutoff 32, sensitivity 80%, specificity 92%). ETT positioned above the second tracheal ring was also associated with increased complication risk (OR = 107.747, 95% CI: 5.305-2188.504, = 0.002). CONCLUSION: USG appears to be a valuable tool for assessing the association between the subglottic diameter-to-wall thickness difference ratio and postoperative airway complications in pediatric patients. Accurate evaluation of subglottic edema and proper ETT placement using USG may enhance patient safety.