Muawad R, AlDhuwaihy A, AlGhamdi A
… +1 more, Abdurazaq A
Saudi J Anaesth
· 2025 · PMID 40642650
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This report discusses the anesthetic management of a 7-year-old child with aromatic L-amino acid decarboxylase (AADC) deficiency, a rare neurometabolic disorder. The patient underwent ventilation tube insertion and adeno...This report discusses the anesthetic management of a 7-year-old child with aromatic L-amino acid decarboxylase (AADC) deficiency, a rare neurometabolic disorder. The patient underwent ventilation tube insertion and adenotonsillectomy. Similar to other adenotonsillectomy procedures, this surgery carries a higher risk of postoperative nausea and vomiting, necessitating a careful management strategy. We opted for dexamethasone as the primary antiemetic agent and limited opioid use to a single dose of fentanyl, while also incorporating dexmedetomidine for enhanced pain management alongside ketorolac and paracetamol. This case highlights the need for specialized anesthesia protocols for AADC deficiency patients to enhance safety and outcomes, particularly addressing the challenges of nausea and vomiting.
Saudi J Anaesth
· 2025 · PMID 40642649
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Traumatic epidural hematoma is a common pathological condition following traumatic brain injury (TBI). Neurogenic pulmonary edema (NPE) is a rare but life-threatening complication, typically occurring in association with...Traumatic epidural hematoma is a common pathological condition following traumatic brain injury (TBI). Neurogenic pulmonary edema (NPE) is a rare but life-threatening complication, typically occurring in association with acute severe intracranial pathologies. Cases of pediatric traumatic epidural hematoma complicated by NPE are exceedingly rare. This case report describes a 1.5-year-old boy who suffered a large acute temporoparietal-occipital epidural hematoma with brain herniation after falling from a bed. Following an emergency epidural hematoma evacuation, the child developed high fever, respiratory distress, and copious pink frothy sputum, with chest CT showing large areas of high-density shadows in both lungs, leading to a diagnosis of NPE. Through aggressive supportive care, including mechanical ventilation, pharmacological treatment, and other supportive measures, the patient's respiratory function gradually improved, and pulmonary imaging abnormalities resolved rapidly within 48 hours, resulting in a favorable outcome. This case underscores the critical role of early recognition and timely intervention in managing acute traumatic epidural hematoma complicated by NPE, providing valuable insights for the clinical management of similar cases.
Chittoria K, Sharma A, Kothari N
… +1 more, Kumari K
Saudi J Anaesth
· 2025 · PMID 40642648
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Suzetrigine is the first and only FDA-approved non-opioid oral medication designed to be used for the treatment of moderate-to-severe acute pain. It represents a significant step forward in pain treatment by providing ex...Suzetrigine is the first and only FDA-approved non-opioid oral medication designed to be used for the treatment of moderate-to-severe acute pain. It represents a significant step forward in pain treatment by providing excellent relief without the hazards associated with opiate usage. Its approval transforms postoperative pain care, meeting a key public health need while lowering addiction concerns. While the adverse effect profile requires additional investigation, its distinctive mechanism and safety feature represent a game-changing potential in the area of analgesia.
Favitta SF, Santolamazza D, Luca E
… +2 more, De Cicco R, Aceto P
Saudi J Anaesth
· 2025 · PMID 40642647
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Bariatric surgery is a rapidly developing field and presents a challenge for anesthesia management, especially in the treatment of acute postoperative pain. Severely obese patients have a greater risk of intra and postop...Bariatric surgery is a rapidly developing field and presents a challenge for anesthesia management, especially in the treatment of acute postoperative pain. Severely obese patients have a greater risk of intra and postoperative complications due to their cardiovascular and respiratory pathophysiological alterations. Excessive fat also alters the normal metabolism of analgesic drugs, in particular opioids, thus reducing their therapeutic range and increasing the risk of reaching toxic doses with accumulation and overdose effects. Nociception, in contrast to pain, is not a subjective experience but a physiological response to a nociceptive stimulus, which manifests as objective modifications in vital parameters. An increasing number of monitoring methods have been approved in recent years, especially developed for the detection of intraoperative nociception to enable better control of opioid titration. This review aimed to provide an overview of the main monitoring systems commercially available devices, which could be used to monitor nociception during bariatric surgery. Eighteen studies evaluating the most widespread nociception monitoring systems were analyzed. These studies were mostly conducted on patients undergoing abdominal laparoscopic surgery, which is comparable to bariatric surgery in terms of pain stimulation. Intraoperative and postoperative opioid consumption were compared between patients subject to nociceptive monitoring and those in whom analgesia was guided by their changes in vital parameters. Although the devices seem able to optimize the anesthetic management of these patients, studies on bariatric populations are scarce and do not allow us to state whether the routine use of these tools can modify the patient's clinical outcome.
Pulitanò R, Bracci F, La Verde F
… +1 more, Giudice M
Saudi J Anaesth
· 2025 · PMID 40642645
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Ports are totally implanted intravenous devices used to administer intravenous therapies that require the central venous pathway. Traditionally, ports are implanted mostly on the chest wall or on the arms (PICC PORTs). I...Ports are totally implanted intravenous devices used to administer intravenous therapies that require the central venous pathway. Traditionally, ports are implanted mostly on the chest wall or on the arms (PICC PORTs). In some patients, CHEST PORTs and PICC PORTs are contraindicated, and ports are implanted by inserting the catheter into the femoral vein (FEMORAL PORT or FICC PORT). In this report, we want to describe an unusual case of placement of a FICC-PORT using the most recent techniques of implantation and tip location.
Zabani IA, Alamoudi D, Alhroub K
… +9 more, Alhassoun A, Tawfik G, Alzanbagi A, Alzahrani F, Zia F, Almuqati R, Tayeb A, Alsayouri Z, Saad H
Saudi J Anaesth
· 2025 · PMID 40642642
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BACKGROUND: Post-sternotomy pain is a significant challenge in cardiac surgeries. Effective pain management can reduce opioid reliance and lower pain scores, contributing to shorter hospital stays. The erector spinae pla...BACKGROUND: Post-sternotomy pain is a significant challenge in cardiac surgeries. Effective pain management can reduce opioid reliance and lower pain scores, contributing to shorter hospital stays. The erector spinae plane block (ESPB) has shown promise as an analgesic for various surgical procedures. Given the frequency of sternotomies in our center and the associated prolonged pain that delays intensive care unit (ICU) discharge, we aimed to assess the impact of ESPB on postoperative opioid (fentanyl) use and pain levels up to 48 h after extubation. METHODS: This study was a prospective, double-blind, randomized controlled trial involving 80 adult patients (ASA III) scheduled for cardiac surgery. Participants were randomized into two groups: the ESPB group ( = 40; bilateral 0.25% bupivacaine, 20 mL) and a control group ( = 40; no ESPB). The main outcomes measured were fentanyl use post-surgery and pain scores using the visual analog scale (VAS). Secondary outcomes included intraoperative fentanyl use, time to first analgesic dose, extubation timing, and ICU stay duration. SPSS v.26 was used for statistical analysis. RESULTS: The ESPB group had significantly reduced fentanyl consumption during intubation (150 [0-800] vs. 950 [30-5260], < 0.0001), at 3 h post-extubation (25 [0-50] vs. 0 [0-200], = 0.034), 12 h post-extubation (0 [0-80] vs. 0 [0-200], = 0.002), over 12 h total (0 [0-100] vs. 30 [0-600], = 0.01), at 24 h (0 [0-100] vs. 30 [0-900], = 0.003), and at 48 h (0 [0-100] vs. 50 [0-1200], = 0.001). VAS scores were consistently lower for the ESPB group at rest at multiple points up to 48 h ( < 0.0001). Additionally, the ESPB group required less intraoperative fentanyl ( = 0.001), had shorter ICU stays ( = 0.009), and faster extubation times ( = 0.013). The time to first analgesic and paracetamol use did not differ significantly ( = 0.97 and 0.255, respectively). CONCLUSIONS: The findings suggest that ESPB is an effective addition to multimodal anesthesia for cardiac surgery, significantly reducing pain and opioid use, and improving postoperative outcomes.
Saudi J Anaesth
· 2025 · PMID 40642641
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There is an emerging body of evidence to suggest that the peripheral administration of vasopressors is safe and effective in many clinical contexts and often superior to central administration. Vasopressors are a class o...There is an emerging body of evidence to suggest that the peripheral administration of vasopressors is safe and effective in many clinical contexts and often superior to central administration. Vasopressors are a class of medications used to create vasoconstriction in patients with shock to increase systemic arterial blood pressure and tissue perfusion. Certain clinical circumstances require the use of these vasoactive drugs immediately for which the need to administer these drugs peripherally becomes paramount, although controversial. The authors present a narrative review dedicated to describing the current practice of the route of administration of vasopressors, comparing peripheral versus central administration, and explaining the advantages and drawbacks of each route as well as potential complications associated with them.
Saudi J Anaesth
· 2025 · PMID 40642640
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Breast cancer surgery often results in significant postoperative pain, which can have psychological, physiological, and socio-economic consequences, and increase the risk of chronic pain. While locoregional anesthesia, i...Breast cancer surgery often results in significant postoperative pain, which can have psychological, physiological, and socio-economic consequences, and increase the risk of chronic pain. While locoregional anesthesia, including fascial blocks, has become essential in perioperative pain management, achieving adequate coverage in complex breast surgeries, especially with axillary dissection, remains challenging. This report presents a case of a 55-year-old woman undergoing left mastectomy with axillary lymph node dissection. A combination of a unilateral Erector Spinae Plane (ESP) block at the T2-T3 level and a Serratus Posterior Superior Intercostal Plane (SPSIP) block was performed preoperatively. The patient experienced minimal postoperative pain, with low pain scores (0/2) at 3, 12, and 48 hours post-surgery, requiring only one dose of paracetamol. The blocks provided effective analgesia, and the patient had no complications. The combined use of these two fascial blocks enhances coverage by targeting both intercostal and brachial plexus branches, offering a synergistic effect and the proximity of the block sites allows for efficient performance without repositioning the patient, reducing execution time. We believe the synergic combination of SPSIP and ESP blocks offers a promising strategy for pain management in breast cancer surgeries involving axillary dissection.
Saudi J Anaesth
· 2025 · PMID 40642638
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Fospropofol is a water-soluble prodrug of propofol that has gained increasing attention in the field of anesthesia due to its gentle modulation of cerebral blood flow and metabolism. This review summarizes the pharmacolo...Fospropofol is a water-soluble prodrug of propofol that has gained increasing attention in the field of anesthesia due to its gentle modulation of cerebral blood flow and metabolism. This review summarizes the pharmacological mechanisms by which fospropofol regulates cerebral hemodynamics, including direct effects on vascular smooth muscle and indirect modulation via suppression of neural metabolic activity. The article also discusses its ability to reduce cerebral metabolic rate, inhibit neuronal excitability, and modulate energy balance, all of which contribute to its potential neuroprotective properties, particularly in ischemia-reperfusion injury. Preclinical and clinical studies suggest that fospropofol exerts antioxidant and anti-inflammatory effects that may further support neural preservation. Clinically, fospropofol has shown value in various scenarios requiring precise neuromanagement, including neurosurgery, anesthesia in elderly patients, intensive care sedation, and perioperative neuroprotection. Despite promising results, further high-quality, large-scale studies are needed to clarify its neuroprotective efficacy across diverse patient populations and surgical contexts. With its favorable pharmacokinetics, controllable depth of sedation, and multitargeted neural effects, fospropofol is poised to become an important tool in individualized neuroanesthesia and brain-protective strategies.
Saudi J Anaesth
· 2025 · PMID 40642635
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Continuous epidural catheter technique is generally a safe modality. A rare occurrence of development of subarachnoid-cutaneous fistula (SACF), postremoval of epidural catheter, is described. It can be potentially challe...Continuous epidural catheter technique is generally a safe modality. A rare occurrence of development of subarachnoid-cutaneous fistula (SACF), postremoval of epidural catheter, is described. It can be potentially challenging to diagnose and treat. A watchful and patient conservative approach is highly recommended for successful outcomes.
Machado F, Gouveia H, Freitas S
… +1 more, Rodrigues F
Saudi J Anaesth
· 2025 · PMID 40642634
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Von Hippel-Lindau disease (VHLD) is a rare autosomal dominant genetic disorder characterized by the development of highly vascularized tumors, including central nervous system (CNS) hemangioblastomas, pheochromocytomas,...Von Hippel-Lindau disease (VHLD) is a rare autosomal dominant genetic disorder characterized by the development of highly vascularized tumors, including central nervous system (CNS) hemangioblastomas, pheochromocytomas, and renal cell carcinomas. Pregnancy in patients with VHLD presents unique anesthetic challenges due to tumor-associated risks and physiological changes. This report describes the anesthetic management of a 31-year-old woman with VHLD and twin gestation during active labor at 35 weeks of pregnancy. Despite the advantages of neuraxial anesthesia for cesarean delivery, general anesthesia was selected due to the unavailability of recent imaging and the potential risks of neuraxial techniques in such cases. The case emphasizes the importance of individualized planning, hemodynamic stability, and multidisciplinary collaboration to optimize outcomes for both mother and neonates.
Saudi J Anaesth
· 2025 · PMID 40642632
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BACKGROUND: Myasthenia gravis (MG) patients undergoing surgery may opt for general anesthesia without neuromuscular blocking agents (NMBAs). The univent tube, featuring a single lumen with bronchial blockers, is known fo...BACKGROUND: Myasthenia gravis (MG) patients undergoing surgery may opt for general anesthesia without neuromuscular blocking agents (NMBAs). The univent tube, featuring a single lumen with bronchial blockers, is known for its flexibility and preference in challenging intubations, reducing airway damage during one-lung ventilation. This study assesses the safety and feasibility of utilizing the univent tube for thoracoscopic thymectomy in MG patients under general anesthesia without NMBAs, complemented by airway topical anesthesia. METHODS: In this single-center, prospective observational study, 83 consecutive MG patients underwent thoracoscopic thymectomy with univent tube intubation. General anesthesia without NMBAs and airway topical anesthesia were administered. Emphasis was placed on intubation conditions, surgical aspects, intraoperative respiratory, and airway complications. RESULTS: Clinically acceptable intubation conditions were achieved in 99% of patients, with 80% rated as 'excellent' and 19% as 'good.' No cases experienced intubation failure, and 2% exhibited reactions to tracheal tube insertion. Higher MG stages correlated with more favorable intubation conditions, particularly during laryngoscopy. Surgical conditions were excellent in 89%, and blocking the right lung increased total lung collapse, enhancing surgical conditions. Intraoperative ventilation was sufficient for all cases. Incidences of bronchial and vocal cord injuries were 6% and 10%, respectively, with no hematoma cases. Postoperative sore throat (12%) and hoarseness (6%) resolved within three days. CONCLUSIONS: Despite the potential benefits of NMBAs, the univent tube proved safe and effective for thoracoscopic thymectomy in MG patients without NMBAs, with higher MG stages associated with improved intubation conditions and enhanced surgical conditions with right-side bronchial blockage.
Saudi J Anaesth
· 2025 · PMID 40642631
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BACKGROUND: Periodontal bone defects pose a significant challenge in stomatology, affecting dental stability and function. OBJECTIVE: This study aimed to explore the clinical efficacy of concentrated growth factor (CGF)...BACKGROUND: Periodontal bone defects pose a significant challenge in stomatology, affecting dental stability and function. OBJECTIVE: This study aimed to explore the clinical efficacy of concentrated growth factor (CGF) combined with artificial or autologous bone powder in the treatment of periodontal bone defects. METHODS: A total of 106 patients with bone defects requiring surgical intervention were divided into two groups: the control group and the observation group. Preoperative data were analyzed, and postoperative periodontal indicators, bone resorption markers, and masticatory function were assessed at baseline and 2 weeks, 1 month, 3 months, and 6 months post surgery. RESULTS: There were no significant differences in baseline characteristics between the two groups. The observation group showed improvements in periodontal probing depth, mucosal recession, plaque index, gingival index, gingival retreat index, and bone gla protein after 6 months. The masticatory function of the observation group was significantly better at 1 to 6 months post operation, and there were significant differences in postoperative pain levels at 6 months. CONCLUSION: CGF combined with artificial bone powder demonstrates superior performance in masticatory function recovery and periodontal clinical parameter restoration, indicating potential benefits for periodontal bone defect treatment.