Barakat H, Al Nawwar R, Gholmieh L
… +4 more, Chahine C, Karake M, Assaf G, Al Jalbout Y
Saudi J Anaesth
· 2025 · PMID 40994505
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BACKGROUND: Mastectomy is associated with postoperative pain that can become chronic if left untreated. While opioids are commonly used, their adverse effects on recovery highlight the need for alternative methods. This...BACKGROUND: Mastectomy is associated with postoperative pain that can become chronic if left untreated. While opioids are commonly used, their adverse effects on recovery highlight the need for alternative methods. This study investigates the opioid-sparing effects of adding dexmedetomidine to ropivacaine, compared to ropivacaine without dexmedetomidine, in erector spinae plane block for patients undergoing mastectomy. METHODS: This is a prospective, randomized controlled trial conducted at a tertiary University Hospital. Forty-four patients undergoing mastectomy with axillary lymph node dissection under general anesthesia were enrolled and randomized to receive erector spinae block with dexmedetomidine added to ropivacaine (intervention) or without dexmedetomidine (control). The primary outcome was total opioid consumption in the post-anesthesia care unit (PACU) and up to 24 hours postoperatively. Secondary outcomes included intraoperative hemodynamics, vitals, medications, and complications, as well as pain medications and levels, and side effects during the first 24 hours postoperatively. RESULTS: PACU opioid consumption was significantly lower in patients who received the intervention compared to those who underwent the routine procedural protocol (3.14 ± 2.85 vs 5.86 ± 4.52, = 0.021). Median survival time to opioid provision in the PACU and total morphine consumption up to 24 hours were not statistically significantly different between the two groups. Pain levels remained statistically significantly lower in the experimental group up to 12 hours postoperatively, after which no significant difference was observed. No significant side effects were reported. CONCLUSIONS: Dexmedetomidine, in safe doses, with ropivacaine in erector spinae block reduces immediate opioid consumption and postoperative pain in mastectomy patients.
Romanò B, Luca E, Russo A
… +5 more, Candelli M, Della Polla DA, Piccioni A, Franceschi F, Aceto P
Saudi J Anaesth
· 2025 · PMID 40994504
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BACKGROUND: To evaluate the number and type of acute pathological events during each football match and analyze whether the stadium's health protocol, which includes anti-COVID-19 measures, has had an impact on reducing...BACKGROUND: To evaluate the number and type of acute pathological events during each football match and analyze whether the stadium's health protocol, which includes anti-COVID-19 measures, has had an impact on reducing admissions to nearby hospitals. The number of spectators requiring assistance was evaluated through the patient presentation rate (PPR), and the number of hospitalizations was assessed through the hospital transport rate (TTHR). METHODS: General and specific measures aimed at reducing the risk of COVID-19 transmission were implemented for spectators attending the 2020 UEFA European Football Championship matches held in Rome. For planning and risk stratification of events, the Arbon and Maurer scores were calculated to define the expected resources and the impact on healthcare systems. The primary outcome was the PPR and relative triage grouped into four categories. The secondary outcome was the need for hospitalization and the relative TTHR. The Mann-Whitney test was used to compare parametric variables, whereas categorical variables were compared using the Chi-square test. All data were analyzed using SPSS v26 (IBM, NY, USA). RESULTS: The most frequent symptoms were headache (23.9%), confusion (23.9%), syncope (11.4%), and dizziness (5.7%). The PPR ranged from 0.84 to 1.15. The most frequently assigned code was white in all events examined. The TTHR was between 0 and 0.21. CONCLUSION: The assistance service provided at EURO 2020 successfully fulfilled its primary role of minimizing referrals to nearby hospitals. Mass gathering events can be conducted safely if adequate precautionary measures against COVID-19 are implemented.
Saudi J Anaesth
· 2025 · PMID 40994503
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Lumbar epidural anesthesia is an important part of labor analgesia. Despite common complications, lumbar epidurals are considered the most effective pain management option during childbirth. Fracture of the epidural cath...Lumbar epidural anesthesia is an important part of labor analgesia. Despite common complications, lumbar epidurals are considered the most effective pain management option during childbirth. Fracture of the epidural catheter during removal is an uncommon but known complication, but fragmentation of the catheter during insertion is extremely uncommon. There are several reasons for catheter fracture during removal; however, catheter fracture during insertion can occur for two main reasons in labor epidurals. The first reason is if the anesthetist pulls the catheter while the Tuohy needle is still in place, and the second is when the catheter is removed during active labor contractions. We describe the occurrence of such an event in a primiparous patient, where the epidural catheter fractured during insertion. A brief review is provided to prevent and manage such complications.
Saudi J Anaesth
· 2025 · PMID 40994501
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BACKGROUND: We proposed that the L3 paravertebral block (PVB) combined with the retro-psoas compartment block (RPCB) would provide a better postoperative analgesia for total knee arthroplasty (TKA) than the femoral nerve...BACKGROUND: We proposed that the L3 paravertebral block (PVB) combined with the retro-psoas compartment block (RPCB) would provide a better postoperative analgesia for total knee arthroplasty (TKA) than the femoral nerve block (FNB) alone. MATERIALS AND METHODS: A total of 66 patients scheduled for TKA were randomly allocated to receive either FNB or L3 PVB-RPCB. Postoperative patient-controlled analgesia with intravenous sufentanil was administered. The primary endpoint was the total sufentanil consumption within the first 24 hour postoperative. Secondary outcomes assessed included pain intensity, sensory dermatomal coverage 20 min after administering the blocks, rescue analgesia requests, satisfaction scores, and the incidence of nausea, vomiting, itching, and posterior knee pain. RESULTS: Patients in the L3 PVB-RPCB group consumed significantly less sufentanil in the first 24-hour post-surgery compared to those who received an FNB, with intake measuring 30 [28 to 33] ug versus 43 [37 to 46] ug, respectively, ( < 0.01). Furthermore, the pain scores were significantly lower in patients with L3 PVB-RPCB at 6 hour and 12 hours at rest ( < 0.01), and at 12 hours on movement ( < 0.01). This group also showed a reduced need for rescue analgesia and experienced less posterior knee pain ( < 0.01). There were no significant differences in satisfaction scores or in the occurrence of opioid-related side effects. CONCLUSION: The reduction of sufentanil consumption within the initial 24 hour after TKA demonstrates a beneficial effect of L3 PVB-RPCB over the FNB in providing the postoperative analgesia.
Saudi J Anaesth
· 2025 · PMID 40994500
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Eisenmenger syndrome (ES) represents the extreme phenotype of pulmonary hypertension. We present the anesthetic management of an ES case undergoing transurethral resection of bladder tumor (TURBT). A 56-year-old lady who...Eisenmenger syndrome (ES) represents the extreme phenotype of pulmonary hypertension. We present the anesthetic management of an ES case undergoing transurethral resection of bladder tumor (TURBT). A 56-year-old lady who is known to suffer from ES diagnosed with a urinary bladder multifocal tumor was scheduled for TURBT. We describe here the successful management of the ES case undergoing TURBT using continuous spinal anesthesia.
Chittoria K, Surendran A, Kamal M
… +3 more, Sharma A, Sethi P, Chawla S
Saudi J Anaesth
· 2025 · PMID 40994499
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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...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 or surgically remove it. We are presenting a case of accidental breakage of an epidural catheter and the consensus of its management.
Saudi J Anaesth
· 2025 · PMID 40994498
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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 infl...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.
Unterbuchner C, Kögel J, Ehehalt K
… +1 more, Metterlein T
Saudi J Anaesth
· 2025 · PMID 40994496
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OBJECTIVE: Residual neuromuscular blockade (RNMB), defined as a train-of-four ratio (TOFR) <0.90, is a complication of neuromuscular blocking agents (NMBA). Data about RNMB in children are rare. This single-center observ...OBJECTIVE: Residual neuromuscular blockade (RNMB), defined as a train-of-four ratio (TOFR) <0.90, is a complication of neuromuscular blocking agents (NMBA). Data about RNMB in children are rare. This single-center observational trial evaluated the rate of neuromuscular monitoring (NMM), the incidence, and consequences of RNMB in pediatrics. METHODS: Children over 1 month undergoing elective and urgent surgery during core work hours receiving NMBA were included in an 84-day observation period. When the anesthesiologist decided to extubate, a blinded investigator measured the TOFR by acceleromyography. Data on demographics, surgery, anesthesia, and outcome were recorded. Comparison of qualitative variables was done using the chi-square test. The Mann-Whitney U test was used to compare quantitative variables between patients with or without TOFR <0.90. <0.05 was considered significant. RESULTS: Eighty-nine children were included in the analysis. Rate of quantitative and qualitative NMM was 65.2% and 5.6%, respectively. Incidence of RNMB was 10.1% with TOFRs between 0.78 and 0.89 in 8 children and a TOFR of 0.48 in one child. Median time from the last NMBA administration to the TOFR before extubation was significantly shorter in patients with a TOFR <0.90 in comparison with a TOFR ≥0.90 (88 vs. 110 min). In the RNMB group, qualitative NMM was significantly more often used compared with the no RNMB group (22.2% vs. 3.8%). Adverse events were rare with no significant differences between the two groups. CONCLUSION: RNMB in children is a relevant hazard. Qualitative NMM is not reliable to exclude RNMB. Institutional training programs on neuromuscular management in children may be helpful to improve the rate of quantitative NMM.
Saudi J Anaesth
· 2025 · PMID 40994495
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This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An...This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An 81-year-old female patient who had severe mitral valve regurgitation, severe tricuspid valve regurgitation, and pulmonary hypertension was scheduled for Mitral Valve Replacement and DeVega Tricuspidoplasty. The patient had many comorbidities, so she was on antihypertensive (nebivolol), antithrombotic (rivaroxaban), and antidiabetic (insulin) medications. After anesthesia induction, the patient was positioned for CVC. Ultasound guidance showed that the anteroposterior diameter of the right IJV was small and the degree of overlapping of carotid artery (CA) was high. Left side was evaluated before starting the procedure. Marked enlargement of the left IJV and less overlapping of CA was observed. Left IJV catheterization was decided and performed without any complication. The surgery lasted for 3 hours and was completed uneventfully. Although right IJV is usually preferred for CVC where central intravenous access is required, it is advisable to evaluate the left IJV when the right one has a small diameter and there is a significant overlapping of right CA. In these cases, the choice for CVC side should be based on the data which is obtained from both sides.
Gouveia H, Machado F, Freitas S
… +2 more, Ferreira T, Sousa A
Saudi J Anaesth
· 2025 · PMID 40994494
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Electrical storm (ES) is a rare and life-threatening cardiac emergency characterized by recurrent ventricular arrhythmias, posing unique challenges when it occurs during pregnancy. We report the case of a 28-year-old wom...Electrical storm (ES) is a rare and life-threatening cardiac emergency characterized by recurrent ventricular arrhythmias, posing unique challenges when it occurs during pregnancy. We report the case of a 28-year-old woman presenting with refractory ES in the late stages of a dichorionic-diamniotic twin pregnancy. Initial management included emergent cesarean delivery under general anesthesia due to maternal hemodynamic instability and fetal bradycardia. Despite pharmacological stabilization and multiple synchronized cardioversions, the arrhythmia persisted, necessitating catheter ablation to restore sinus rhythm. Multidisciplinary collaboration involving anesthesiology, obstetrics, cardiology, and electrophysiology ensured a favorable outcome for both mother and neonates, with no long-term complications. This case highlights the critical importance of tailored, interdisciplinary approaches in managing ES during pregnancy and underscores the need for resource optimization and rapid decision-making to balance maternal and fetal safety. Future investigations should focus on identifying potential triggers and improving protocols for the management of ES in high-risk pregnancies.
Alshaya RA, Alharbi MK, Albabtain B
… +1 more, Almalik A
Saudi J Anaesth
· 2025 · PMID 40994493
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BACKGROUND: Healthcare providers use smartphones for various beneficial purposes, including education, communication, and remote patient monitoring. However, concerns have arisen about their potential to distract anesthe...BACKGROUND: Healthcare providers use smartphones for various beneficial purposes, including education, communication, and remote patient monitoring. However, concerns have arisen about their potential to distract anesthesiologists in the operating room, potentially leading to catastrophic consequences. This study aimed to assess smartphone habits and attitudes among anesthesiologists at a tertiary care hospital in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Anesthesiologists were surveyed using a questionnaire distributed via email and phone numbers. Hard copies of the questionnaire were also distributed in the operating rooms. Data are cleaned in Excel and analyzed using IBM SPSS 29.0. RESULTS: Our study included 123 participants, mostly male (n = 102, 82.9%), with a significant portion aged 31-40 years (n = 34, 27.6%). Most were consultants (n = 51, 41.5%), and 64.2% (n = 79) spent less than 25% of their working hours on smartphones. Despite 52.8% (n = 65) reporting distractions from smartphone use, only 29.3% (n = 36) supported restrictions in operating theaters. A significant association was found between age and perceptions of smartphone impact on patient care ( = 0.012), with younger anesthetists more likely to see a positive effect. Moreover, frequent smartphone users were more likely to perceive benefits in patient care ( = 0.038), and those not distracted by phones believed that smartphone usage improved care ( < 0.001). Finally, those not irritated by colleagues' phone use were more likely to report positive impacts on patient care ( < 0.001). CONCLUSION: Our study highlights the pervasive use of smartphones among anesthesiologists, with many acknowledging both benefits and distractions. While a significant number perceive positive impacts on patient care, concerns about distraction remain, indicating the need for balanced guidelines in operating theaters.
Saudi J Anaesth
· 2025 · PMID 40994490
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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 p...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.
Saudi J Anaesth
· 2025 · PMID 40994489
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The incidence of tracheocele is rare, but whenever encountered, Tracheoceles must be meticulously managed owing to the grave complications associated with them. Here, we report the successful management of a case of orbi...The incidence of tracheocele is rare, but whenever encountered, Tracheoceles must be meticulously managed owing to the grave complications associated with them. Here, we report the successful management of a case of orbital tumor who underwent orbital exenteration and was incidentally preoperatively diagnosed with having a large tracheocele in the lower neck region.
Ferid K, Tarik B, Svemir C
… +5 more, Mirza K, Emina D, Jelena KP, Jasmin A, Melissa K
Saudi J Anaesth
· 2025 · PMID 40994488
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BACKGROUND: Nurse anesthetists (NAs) face several challenges in their work, one of which is dealing with patients who experience anxiety and fear before surgery. The increased patient turnover and a shortage of healthcar...BACKGROUND: Nurse anesthetists (NAs) face several challenges in their work, one of which is dealing with patients who experience anxiety and fear before surgery. The increased patient turnover and a shortage of healthcare professionals lead to a heavier focus on physical care, thus leaving limited time to address the psychological needs of patients. OBJECTIVES: This study aimed to critically evaluate and compile research that describes the things NAs use in reducing patients' fear and anxiety before surgery. MATERIALS AND METHODS: A systematic search was conducted on PubMed, Medline, CHINAL, Embase, and the Cochrane Library database for qualitative and quantitative literature regarding factors influencing patients' wellbeing before surgery. An inductive thematic analysis generated categories and subcategories. Twenty-one studies were included. RESULTS: The thematic analysis of the articles included revealed two main categories and six subcategories. Some strategies identified to help reduce fear and anxiety in patients before surgery included providing various types of information, offering psychological support, using different relaxation techniques, and ensuring that each patient is allocated sufficient time. CONCLUSION: The results of the presented study showed that strategies such as providing different forms of information, psychological support, and different relaxation therapies gave good results. However, there is a need for further research in health care to identify which nonpharmacological nursing interventions are most effective in alleviating preoperative anxiety. More research is also needed to determine how preoperative care should be structured to help patients feel safe and comfortable before surgery.
Abdalwahab A, Abuzaid A, Walley H
… +3 more, Abdelfattah DF, Elmetwally SA, Elsherbeny A
Saudi J Anaesth
· 2025 · PMID 40994487
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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 impl...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 × 10/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.
Majeed A, Jobeir BA, Shabbir M
… +6 more, Ibrahim M, Nagy MS, Tufail B, Raptis DA, Altukhaifi L, AlFattani AAG
Saudi J Anaesth
· 2025 · PMID 40994486
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BACKGROUND: Liver transplantation is frequently associated with massive blood loss and utilization of blood products to optimize coagulation; this study aimed to evaluate their possible correlation with etiological and p...BACKGROUND: Liver transplantation is frequently associated with massive blood loss and utilization of blood products to optimize coagulation; this study aimed to evaluate their possible correlation with etiological and perioperative factors. METHODS: A retrospective analysis of adult liver transplant (LT) recipients (excluding re-do transplants) operated upon at our center between 2011 and 2021 was conducted using R package with rBiostatistics.com graphical user interface. RESULTS: Of the 947 cases, 70.70% had cirrhosis, and 28.6% hepatocellular carcinoma, as secondary diagnoses; the most common primary diagnosis was viral hepatitis (B = 20.9% and C = 20.0%). The mean blood loss volume was 3393.2 ml. Living donor liver transplantation (LDLT) recipients (n = 740, 78.2%) had lesser blood loss (mean difference 738 mL, = 0.037) and reduced requirement for fresh frozen plasma (FFP, OR = 0.734, = 0.001) and platelets (OR = 0.809, < 0.001). Presence of hepatocellular carcinoma (n = 273, 28.6%) was significantly protective for blood loss (mean difference 717 ml, = 0.037) and the need for FFP (OR = 0.991, < 0.001), cryoprecipitate (OR = 0.568, = 0.001), and platelets (OR = 0.602, < 0.001). Schistosomiasis ( = 23, 2.4%) was accompanied by increased blood loss (mean difference 2328 ml ( = 0.012)). A body mass index (BMI) >35 kg/m increased the hazard of cryoprecipitate requirement (OR = 1.203, = 0.008). CONCLUSION: The blood loss and the blood products transfusion requirements in LT are influenced by the etiology, graft type, and other perioperative factors such as BMI.