Krupic F, Krupic M, Dervisevic E
… +2 more, Kovacevic M, Bujakovic T
Saudi J Anaesth
· 2025 · PMID 40994485
·
Full text
BACKGROUND: Between 10% and 80% of surgical patients experience some form of fear and anxiety before surgery. This is often attributed to inadequate or incorrect preoperative information. OBJECTIVES: This study aimed to...BACKGROUND: Between 10% and 80% of surgical patients experience some form of fear and anxiety before surgery. This is often attributed to inadequate or incorrect preoperative information. OBJECTIVES: This study aimed to critically evaluate and compile research that describes the impact of preoperative information on the patient's well-being before surgery. 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' well-being before surgery. An inductive thematic analysis generated categories and subcategories. Nineteen studies were included. RESULTS: Two main categories emerged from the thematic analysis of the included articles. These were the direct impact of information on fear and anxiety and the indirect impact of information on fear and anxiety. Information from healthcare professionals, alternative sources of information, shortage of healthcare professionals, music, and inability to receive information were some of the factors that can influence the well-being of patients before surgery. There are different reasons for the patient's fear and anxiety preoperatively, as well as the importance of direct and indirect information and other methods. For some patients, however, too much information could cause more fear and anxiety. CONCLUSION: The importance of the patient's discomfort being highlighted by the healthcare professionals emerges clearly and shows negative experiences in those cases where the patient feels his fears and concerns are not being addressed. More qualitative and quantitative research in the same theme, education and using person-centred care, and the right amount of information based on the patient's wishes are needed to improve the patient's well-being.
Buyuk D, Sonmez EA, Bingol DA
… +2 more, Seyhan TO, Sungur MO
Saudi J Anaesth
· 2025 · PMID 40994484
·
Full text
BACKGROUND: In this prospective observational study, we aimed to determine the perioperative incidence and the risk factors of acute kidney injury after elective major abdominal surgery. METHODS: Adult patients who had u...BACKGROUND: In this prospective observational study, we aimed to determine the perioperative incidence and the risk factors of acute kidney injury after elective major abdominal surgery. METHODS: Adult patients who had undergone major elective abdominal surgery were included in the study. The patients were divided into Group AKI + and Group AKI, according to KDIGO criteria at 48 hours. Patients' demographic data, preoperative status, and laboratory data, operation-related data, and postoperative laboratory and follow-up data were noted. The patients were followed up for complications and mortality within three months after the operation date. RESULTS: In 425 patients included in the statistical analysis, the incidence of acute kidney injury after elective major abdominal surgery in our hospital was found to be 11.52% (49/425). In the multivariate analysis, postoperative continuation of vasopressor, mean arterial pressure <50 mmHg for at least 5 minutes, intraoperative 6% hydroxy-ethyl starch use, and high body mass index were found to be independent risk factors, in order of importance in increasing risk (OR 5.1, CI [1.4-18.9], = 0,016; OR 3.9, CI [1.3-11.6], = 0,014; OR 2.7, CI [1.1-6.8], = 0,029; OR 1.2, CI [1.1-1.2], < 0,001, respectively). 30- and 90-day mortality was found more frequently in patients who developed acute kidney injury. CONCLUSIONS: In this study, we recommend modifying risk factors if possible, including avoiding 6% HES use and close blood pressure monitoring to reduce the incidence of postoperative acute kidney injury.
Leblebici F, Kayhan Z, Çekmen N
… +2 more, Seri ZMFD, Güneş E
Saudi J Anaesth
· 2025 · PMID 40994482
·
Full text
Sturge-Weber Syndrome (SWS) is a non-familial neurocutaneous disease related to capillary-venous malformations affecting many parts, such as the brain, skin, eyes, face, and respiratory tract and characterized by facial...Sturge-Weber Syndrome (SWS) is a non-familial neurocutaneous disease related to capillary-venous malformations affecting many parts, such as the brain, skin, eyes, face, and respiratory tract and characterized by facial capillary malformation (port wine stain), which is a highly complex and significant challenge for anaesthesiologists. Difficult ventilation and intubation are expected in patients with airway, mouth, lip, and facial involvement of angiomas. Soft induction intubation and extubation are required to prevent increased intracranial (ICP) and intraocular pressure (IOP). We aimed to present the case of a 36-year-old female patient with a hemangioma covering three-quarters of the oral cavity, pharynx, larynx, floor of the mouth, face, neck, and both arms, and her lower lip was significantly swollen and protruding due to the angioma, and she had macroglossia. Therefore, a comprehensive preoperative multidisciplinary approach to examining, evaluating, and closely monitoring these patients is crucial for successful anesthesia management.
Guillarducci VT, Japolino KL, Seiberlich E
… +1 more, Delgado MA
Saudi J Anaesth
· 2025 · PMID 40994481
·
Full text
Noonan syndrome (NS) is an autosomal dominant multisystem disorder characterized by congenital cardiac defects, craniofacial anomalies, and hematological abnormalities. With an incidence of 1 in 1000 to 2500 live births,...Noonan syndrome (NS) is an autosomal dominant multisystem disorder characterized by congenital cardiac defects, craniofacial anomalies, and hematological abnormalities. With an incidence of 1 in 1000 to 2500 live births, NS is one of the most common syndromes associated with congenital heart disease, second only to trisomy 21. Pregnant patients with NS present unique anesthetic challenges due to the syndrome's diverse manifestations and the physiological changes of pregnancy. This report describes a 28-year-old woman with NS who underwent elective cesarean delivery at 36 weeks of gestation. Her medical history included repaired congenital heart defects, pulmonary stenosis, severe scoliosis, and asthma. Spinal anesthesia was successfully employed using a low-dose combination of local anesthetics and opioids to achieve effective sensory block while maintaining hemodynamic stability. The patient's normal coagulation profile allowed neuraxial anesthesia to be a feasible option despite potential technical difficulties associated with spinal abnormalities. This case underscores the importance of a multidisciplinary approach to pregnant patients with NS, including comprehensive preoperative evaluation and individualized anesthetic planning. Neuraxial anesthesia can be a safe and effective option when tailored to the patient's specific physiology, ensuring optimal maternal and fetal outcomes while minimizing risks.
Girombelli A, Pekrun J, Vetrone F
… +6 more, Marelli S, Ledingham N, Rana NK, Speciale D, Ingrassia PL, Maino P
Saudi J Anaesth
· 2025 · PMID 40994480
·
Full text
BACKGROUND: Emergency Front Of Neck Access techniques are an essential skill for anesthesiologists, enabling them to effectively manage the critical "can't intubate, can't oxygenate" scenarios. Current literature suggest...BACKGROUND: Emergency Front Of Neck Access techniques are an essential skill for anesthesiologists, enabling them to effectively manage the critical "can't intubate, can't oxygenate" scenarios. Current literature suggests minimal improvement in mortality associated with these scenarios due to their rarity and difficulty in providing adequate training. This study aims to evaluate whether high-fidelity training can outperform low-fidelity training in teaching Emergency Front Of Neck Access. METHODS: We designed a prospective, single-blinded observational trial to assess the presumed superiority of high-fidelity training compared to low-fidelity training in teaching Emergency Front Of Neck Access to our anesthesiology department. The Performance Rating Scale (PRS) was the tool we employed to assess the participants' performance during both scenarios. The primary outcome was the difference in PRS between the high- and low-fidelity training groups. The secondary outcomes were the correlation between PRS scores and the participants' past clinical experience with Emergency Front Of Neck Access, the number of tracheostomies performed, and years of clinical service. RESULTS: A total of 30 participants from our anesthesia department were enrolled. There was a statistically significant difference in Performance Rating Scale scores between high-fidelity and low-fidelity training. The low-fidelity group had a median score of 7 (range -7 to 9), while the high-fidelity group had a median score of -3 (range -11 to 11). None of the secondary outcomes reached statistical significance. CONCLUSIONS: Our findings suggest that the benefits of high-fidelity training may justify the additional costs associated with incorporating it into conventional airway management training.
Saudi J Anaesth
· 2025 · PMID 40994479
·
Full text
Breast cancer is the most common malignancy among Saudi women, with Modified Radical Mastectomy (MRM) as a standard treatment, typically performed under general anesthesia (GA). However, GA poses significant risks to pat...Breast cancer is the most common malignancy among Saudi women, with Modified Radical Mastectomy (MRM) as a standard treatment, typically performed under general anesthesia (GA). However, GA poses significant risks to patients with multiple comorbidities. We present a 66-year-old female with invasive ductal carcinoma, complicated by scleroderma with interstitial lung disease, chemotherapy-induced heart failure, and hypertension, making GA a high-risk option. To optimize perioperative safety, thoracic epidural anesthesia (TEA) combined with a pectoralis nerve block (PECS2) was used instead. This approach provided effective surgical anesthesia, hemodynamic stability, and minimized opioid use. The patient tolerated the procedure well, with intraoperative hypotension managed by vasopressor support. She resumed oral intake within 6 hours, required minimal postoperative opioids, and was discharged on the third postoperative day without complications. This case highlights the feasibility and advantages of TEA with PECS2 block as a safe and effective alternative to GA in high-risk MRM patients. By reducing GA-related pulmonary and cardiac risks, improving postoperative pain control, and shortening hospital stays, this technique may enhance perioperative outcomes in select patients. Further studies are warranted to support the wider adoption of regional anesthesia in oncologic breast surgeries.
Saudi J Anaesth
· 2025 · PMID 40994477
·
Full text
Etomidate is the agent of choice for the induction of anesthesia in patients with cardiovascular illness, hypotension, or shock. Notwithstanding its numerous attributes, etomidate's most notable adverse impact is adrenoc...Etomidate is the agent of choice for the induction of anesthesia in patients with cardiovascular illness, hypotension, or shock. Notwithstanding its numerous attributes, etomidate's most notable adverse impact is adrenocortical suppression. Due to these concerns, the creation of an etomidate alternative that maintains its beneficial effects while mitigating adverse outcomes became essential. This article will focus on the new etomidate analog, methoxyethyl etomidate hydrochloride, referred to as ET-26.
Secco G, Vailati D, Basta B
… +5 more, Bonvecchio E, Fusco T, Mori L, Magistro C, Marino G
Saudi J Anaesth
· 2025 · PMID 40994475
·
Full text
BACKGROUND: Neuraxial anesthesia (NA), specifically thoracic spinal anesthesia (TSA), offers several theoretical advantages when compared to the General Anesthesia (GA). This retrospective study compares TSA with the gol...BACKGROUND: Neuraxial anesthesia (NA), specifically thoracic spinal anesthesia (TSA), offers several theoretical advantages when compared to the General Anesthesia (GA). This retrospective study compares TSA with the gold standard GA in elective colorectal laparoscopic surgery and evaluates the impact on respiratory functions. MATERIAL AND METHODS: The data used in this study were extracted from the medical records of 34 consecutive patients, who had undergone laparoscopic colon resection surgery in Melegnano Hospital-ASST Melegnano Martesana-Italy and had been administered NA or GA. Postoperative lung function was assessed via lung ultrasound [Lung Ultrasound Score(LUS)], and PaO/FiO (P/F) ratio. RESULTS: The average duration of the surgical procedure was 201.9 ± 50.4 min (NA 191.1 ± 44.1 vs. GA 212 ± 55.3 min, = 0.21). Arterial blood gas parameters showed a reduction in the postoperative values of P/F ratio (P/F: NA 387 ± 70 vs GA 342 ± 52, = 0.049). LUS reveals a higher prevalence of atelectasis in the poster-inferior lung regions. After surgery, the pre- and post-operative LUS scores (Delta LUS) showed differences in the GA group (NA 1.8 ± 1.8 vs GA 3.8 ± 1.9, = 0.003). The receiver operating characteristic (ROC) curve proved to be very accurate (area under the curve (AUC) = 0.898, < 0.001) in predicting postoperative oxygen support, even more so in the GA group (2 in the NA group vs 7 in the GA). CONCLUSIONS: In the context of a progressively aging population and an increase in the fragility of patients, NA with spontaneous ventilation appears to exert a minor impact on respiratory function compared to GA.
Saudi J Anaesth
· 2025 · PMID 40994473
·
Full text
BACKGROUND: Pneumatic tourniquets are used in orthopedic surgeries to provide a bloodless surgical area and reduce blood loss. Tourniquet inflation causes metabolic changes, leading to cerebral vasodilatation and increas...BACKGROUND: Pneumatic tourniquets are used in orthopedic surgeries to provide a bloodless surgical area and reduce blood loss. Tourniquet inflation causes metabolic changes, leading to cerebral vasodilatation and increased intracranial pressure (ICP). A new noninvasive method to measure optic nerve sheath diameter (ONSD) via ultrasonography to detect the raised ICP is reliable, inexpensive, and can be repeated many times. MATERIALS AND METHODS: In this prospective observational study, 23 patients aged between 16 and 60 years, undergoing elective lower limb orthopedic surgeries under spinal anesthesia were included. After pre-anesthetic evaluation and obtaining informed written consent, an ocular ultrasound was performed to measure baseline ONSD in both eyes. Spinal anesthesia was administered and A pneumatic thigh tourniquet was applied as close as possible to the limb root and inflated to 150 mmHg-250 mmHg above the systolic blood pressure. A total of 5 measurements of ONSD were taken by the investigator (anesthetist): before giving spinal anesthesia, after giving spinal anesthesia, before tourniquet deflation, within 5 min, and after 10 min of tourniquet deflation. RESULTS: In our study, the mean age of subjects was 34.57 ± 13.5 years. The majority were males (83%). The subjects showed an increase in ONSD after pneumatic tourniquet deflation in comparison with the baseline values, in the left eye [0.543 cm ± 0.021, < 0.001] and the right eye [0.549 cm ± 0.021, < 0.001], which were statistically significant. CONCLUSION: The impact of pneumatic tourniquet deflation on ONSD measurements recorded by ultrasound in lower limb orthopedic surgeries was significant and this change occurred with a simultaneous increase in end-tidal carbon dioxide (EtCO).
Pfokreni L, Bhatia PK, Rathod D
… +3 more, Kumari K, Meshram T, Goyal S
Saudi J Anaesth
· 2025 · PMID 40994471
·
Full text
BACKGROUND: Postoperative pain after laparoscopic surgery can include referred shoulder pain, visceral pain, and incisional pain, often due to CO₂ insufflation and peritoneal irritation. Although opioids are widely used...BACKGROUND: Postoperative pain after laparoscopic surgery can include referred shoulder pain, visceral pain, and incisional pain, often due to CO₂ insufflation and peritoneal irritation. Although opioids are widely used for pain management, their side effects, such as sedation, nausea, and constipation, can delay recovery and increase costs. Opioid-free anesthesia (OFA) is an emerging alternative that aims to relieve pain using non-opioid medications, reducing these risks and potentially enhancing recovery. METHODS: This single-center, prospective, randomized controlled trial included neonates and infants (ASA 1 and 2) undergoing laparoscopic or endoscopic surgeries. Participants randomly received either opioid-based anesthesia (OA) with intravenous fentanyl at induction, followed by continuous infusion or OFA with ketamine at induction, followed by infusion. The primary outcome was postoperative pain, assessed using the Neonatal Infant Pain Scale (NIPS) on admission to the post-anesthesia care unit (PACU). Secondary outcomes included pain scores at intervals up to 12 h postoperatively. RESULTS: NIPS scores were significantly higher in the OFA group in the PACU, with more patients experiencing moderate pain (NIPS >4) in the first hour (41.7%, n = 20 vs. 16.6%, n = 8, respectively; < 0.001). Both approaches demonstrated similar intraoperative stability, recovery, and safety, suggesting that either method can be chosen based on clinical requirements. CONCLUSIONS: OA with fentanyl offered superior immediate postoperative analgesia compared to OFA with ketamine, while both approaches demonstrated comparable intraoperative stability, recovery profiles, and safety, supporting their use based on clinical needs and patient-specific factors.
Saudi J Anaesth
· 2025 · PMID 40642654
·
Full text
BACKGROUND: In recent years, the use of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) for the treatment of pediatric hydrocephalus has gained increasing attention, particularly i...BACKGROUND: In recent years, the use of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) for the treatment of pediatric hydrocephalus has gained increasing attention, particularly in North America and Africa. It has shown potential to enhance the efficacy of ETV alone and reduce the need for ventriculoperitoneal shunt placement. However, research on the potential side effects of CPC, particularly concerning postoperative sympathetic nervous system responses, remains limited. In our clinical practice, we observed that ETV + CPC may induce transient sympathetic storms, a phenomenon not yet reported in the literature, posing new challenges for postoperative anesthetic management and monitoring. OBJECTIVE: This study aims to report the phenomenon of transient sympathetic storm following ETV + CPC, analyze its potential mechanisms, and raise awareness among anesthesiologists and neurosurgeons to enhance recognition and management of this condition. METHODS: A retrospective analysis was performed on three pediatric patients with communicating hydrocephalus who underwent ETV + CPC at our hospital between January 2016 and December 2016 and subsequently developed transient sympathetic storm. The clinical features, intraoperative and postoperative conditions, and patient outcomes were analyzed to explore the relationship between the extent of CPC and the severity of sympathetic hyperactivity. RESULTS: All three patients developed varying degrees of sympathetic hyperactivity after surgery, including tachycardia, rapid breathing, increased muscle tone, tension, and limb tremors. The first case (6-month-old boy) underwent right-sided CPC and had the mildest response. The second case (6-month-old girl) underwent right-sided and partial left-sided CPC, exhibiting moderate response. The third case (21-month-old girl) underwent extensive bilateral CPC and had the most severe response with the longest duration. Sympathetic hyperactivity was positively correlated with the extent and intensity of CPC. CONCLUSION: Transient sympathetic storm may occur after ETV + CPC, presenting challenges for postoperative anesthetic and neurosurgical care. The severity of sympathetic hyperactivity appears to correlate with the extent and intensity of CPC. Its mechanism is hypothesized to involve thermal injury to the bilateral thalamus and associated vasculature. Further research is required to better understand the side effects and complications of CPC. This study also supports the hypothesis that bilateral thalamic injury may trigger sympathetic hyperactivity, providing new evidence and insights into the mechanisms underlying paroxysmal sympathetic hyperactivity.
Saudi J Anaesth
· 2025 · PMID 40642653
·
Full text
Non-Islet Cell Tumor Hypoglycemia (NICTH) associated with solitary fibrous tumor is referred to as Doege-potter syndrome (DPS). Non-Islet Cell Tumor Hypoglycemia (NICTH) is a paraneoplastic syndrome characterized by hypo...Non-Islet Cell Tumor Hypoglycemia (NICTH) associated with solitary fibrous tumor is referred to as Doege-potter syndrome (DPS). Non-Islet Cell Tumor Hypoglycemia (NICTH) is a paraneoplastic syndrome characterized by hypoglycemia from secretion of insulin-like growth factor type 2 (IGF-2). Surgical resection of massive Solitary Fibrous Tumor of Pleura (SFTP) can be complicated by airway collapse, vascular compression, hemodynamic instability and hemorrhage. SFTP patients present with metabolic derangements secondary to paraneoplastic processes. We present a case of successful removal of massive right-sided SFTP via posterolateral thoracotomy and discuss the perioperative considerations for which providers should be familiar.
Tabrizi NS, Shapeton AD, Ortoleva J
… +4 more, Burmistova M, Demos RA, Musuku SR, Schumann R
Saudi J Anaesth
· 2025 · PMID 40642651
·
Full text
PURPOSE: Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspirat...PURPOSE: Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspiration following successful esophagectomy has not been systematically investigated, and there are no guidelines for the anesthetic management of postesophagectomy patients who require elective surgeries involving general anesthesia (GA). METHODS: PubMed/MEDLINE, Embase, and Web of Science were systematically searched from inception through January 1, 2024 to identify studies involving patients ≥90 days postesophagectomy and undergoing elective surgery unrelated to their esophagectomy status, where GA was required. Data on perioperative anesthetic management were extracted. The primary outcomes assessed were perioperative gastrointestinal and pulmonary complications. Secondary outcomes included the approach to induction of GA and author recommendations. RESULTS: Of the 4097 studies, ten studies involving 131 patients met inclusion criteria. Intraoperatively, adverse events during induction occurred in 13.0% of 131 cases, including regurgitation of gastric contents in 5.3% and pulmonary aspiration in 9.9%. The airway was managed with an endotracheal tube in 95.6%. Induction was performed in the semi-Fowler position in 92.9% and performed using the rapid sequence and standard induction techniques in 58.7% and 41.3%, respectively. CONCLUSIONS: Patients who have undergone esophagectomy may remain at high risk for aspiration during GA even in the long term, necessitating enhanced vigilance in anesthetic management. We offer evidence-informed suggestions for elective induction of GA in patients with a history of successful esophagectomy to enhance safe practice for these patients.