Tontu F, Akca H, Berktas CK
… +2 more, Asar S, Ozcan FG
Saudi J Anaesth
· 2025 · PMID 40642630
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BACKGROUND: Robotic-assisted laparoscopic prostatectomy (RALP) poses challenges in ventilation and oxygenation due to steep Trendelenburg positioning and pneumoperitoneum. This study aims to investigate the impact of ste...BACKGROUND: Robotic-assisted laparoscopic prostatectomy (RALP) poses challenges in ventilation and oxygenation due to steep Trendelenburg positioning and pneumoperitoneum. This study aims to investigate the impact of steep Trendelenburg and pneumoperitoneum on respiratory mechanics, novel oxygenation, and saturation indices. METHODS: Mechanical ventilator, blood gas, and hemodynamic parameters were recorded for 56 RALP patients at three periods (pre-Trendelenburg, Trendelenburg and pneumoperitoneum, post-Trendelenburg). Oxygenation and saturation indices (OIs and OSIs) were calculated and compared using one-way repeated measures ANOVA with Bonferroni tests. RESULTS: Elastance, Pplato, Ppeak, Pmean, MP, MP, DP, OI-P, OI-MP, OI-MP, OI-DP, OSI-P, OSI-MP, OSI-MP, and OSI-DP significantly increased with Trendelenburg positioning and pneumoperitoneum. Despite a reduction in the post-Trendelenburg period, these indices remained significantly elevated compared to pre-Trendelenburg levels. C, C, PaO, PaO/FiO, and PaO/FiO*PEEP significantly decreased with Trendelenburg positioning and pneumoperitoneum. CONCLUSIONS: In RALP, pneumoperitoneum and Trendelenburg positioning led to significant increases in respiratory mechanics (Pmean, DP, MP) and oxygenation and saturation indices (OI-P, OI-MP, OI-MP, OI-DP, OSI-P, OSI-MP, OSI-MP, OSI-DP). These new oxygenation indices may assist clinicians in optimizing the cost-gain balance in perioperative lung-protective ventilation strategies.
Chouhan A, Kaur S, Kamal M
… +3 more, Chauhan NK, Sharma AK, Puri GD
Saudi J Anaesth
· 2025 · PMID 40642629
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Pulmonary Alveolar Proteinosis (PAP) is a rare condition where surfactant accumulates in the lungs' alveoli, causing respiratory failure. Whole lung lavage (WLL) is the primary treatment, requiring careful perioperative...Pulmonary Alveolar Proteinosis (PAP) is a rare condition where surfactant accumulates in the lungs' alveoli, causing respiratory failure. Whole lung lavage (WLL) is the primary treatment, requiring careful perioperative management due to potential complications. We present the case of a 38-year-old man with severe PAP who underwent WLL with cardiopulmonary bypass standby. Preoperative assessment revealed severe hypoxemia and respiratory alkalosis. During surgery, he experienced desaturation and hemodynamic instability, necessitating noradrenaline support and real-time lung ultrasound monitoring. Postoperatively, significant improvements in oxygen levels and radiographic findings were observed. Diagnosis relies on Broncho alveolar lavage fluid analysis, and WLL is effective for patients with impaired gas exchange, improving symptoms and survival. This case highlights the importance of multidisciplinary care and meticulous perioperative management in achieving positive outcomes in PAP treatment with WLL.
Saudi J Anaesth
· 2025 · PMID 40642628
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The case report discusses the anesthetic management and postoperative course of a 4-month-old girl with Ellis Van Creveld syndrome. Key challenges included an abnormal chest wall, tracheal abnormalities, and complex card...The case report discusses the anesthetic management and postoperative course of a 4-month-old girl with Ellis Van Creveld syndrome. Key challenges included an abnormal chest wall, tracheal abnormalities, and complex cardiac issues, requiring tailored anesthetic planning and vigilant monitoring. The patient experienced complications such as complete heart block and persistent hypercapnia after the surgery, which required a permanent pacemaker and prolonged noninvasive ventilation, leading to an extended hospital stay.
Majeed A, Chaiah Y, Hammad A
… +3 more, Alkhani S, Amer MA, Broering DC
Saudi J Anaesth
· 2025 · PMID 40642627
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Medication errors carry the potential for serious patient harm and even death. Prescription and medication administration errors are common, while the incidence of dispensing errors is less consistent due to difficulties...Medication errors carry the potential for serious patient harm and even death. Prescription and medication administration errors are common, while the incidence of dispensing errors is less consistent due to difficulties in detection and under-reporting. This case report describes an incident in which a busy pharmacy in a quaternary care hospital dispensed a norepinephrine infusion that actually contained epinephrine. The error became apparent only after the patient, undergoing living donor liver transplantation surgery, developed unexpected, dramatic, and potentially fatal instability, which worsened with progressively higher doses of norepinephrine. The differentials of the presentation were sequentially excluded, leading to the realisation that the contents of the dispensed medicine might have been inaccurate. When a freshly prepared infusion of norepinephrine replaced the pharmacy-supplied bag, the adverse parameters reversed, and the patient stabilised. This case underscores the importance of maintaining a high index of suspicion for medication dispensing errors, as doing so helped identify the cause and ultimately saved the patient's life.
Ma T, Feng L, Li GH
… +6 more, Sun XY, Chu Y, Zhao WH, Feng S, Zhang H, Wang W
Saudi J Anaesth
· 2025 · PMID 40642625
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INTRODUCTION: The effects of acute sleep deprivation on cognitive function and inflammatory responses remain inadequately defined. This study aimed to evaluate changes in cognitive function and inflammatory responses amo...INTRODUCTION: The effects of acute sleep deprivation on cognitive function and inflammatory responses remain inadequately defined. This study aimed to evaluate changes in cognitive function and inflammatory responses among anesthesiologists and nurses in the operating room following 24-hour shift work-induced sleep deprivation. MATERIAL AND METHODS: Forty anesthesiologists and nurses were assigned to either the sleep deprivation group (n = 20, working from 8:00 AM to 8:00 AM the following day) or the rest control group (n = 20, working regular hours from 8:00 AM to 5:00 PM). All participants underwent assessments of cognitive functions and peripheral blood sample collections for brain-derived neurotrophic factor (BDNF), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) at 8:00 AM, 4:00 PM, 0:00, and 8:00 AM the following day. Cognitive functions were assessed using the Trail Making Test and the Stroop Color-Word Test. RESULTS: Cognitive assessments revealed no significant effect on reaction time following one night of sleep deprivation ( > 0.05 for all). However, the learning effect from repeated administrations of the Trail Making Test and the Stroop Color-Word Test did not result in decreased reaction times in the sleep deprivation group ( > 0.05 for all). Increased fluctuations in serum levels of TNF-α and BDNF were observed after 24-hour shift work at 8:00 AM ( < 0.05 for all). CONCLUSION: Sleep deprivation induced by 24-hour shifts did not impair cognitive performance but did affect learning ability in anesthesiologists and nurses. Additionally, sleep deprivation caused increased fluctuations in serum levels of TNF-α and BDNF at 8:00 AM.
Saudi J Anaesth
· 2025 · PMID 40642624
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BACKGROUND: Team-based learning (TBL) as a student-centered approach can be encouraged and supported by transforming the conventional lecture format into an engaging and active process of learning. The objective of this...BACKGROUND: Team-based learning (TBL) as a student-centered approach can be encouraged and supported by transforming the conventional lecture format into an engaging and active process of learning. The objective of this study was to explore students' perception of team-based learning and compare their performance after TBL sessions and traditional lectures in the local anesthesia course. MATERIALS AND METHODS: Eight topics of local anesthesia during the academic years 2022-2023 and 2023-2024 were divided into team-based learning sessions and traditional lectures. Teaching activities in TBL included tests and group discussions. A cross-sectional descriptive questionnaire comprising 10 written questions targeting students' perception of TBL and traditional lectures was handed to students at the end of the course. RESULTS: The mean average scores of responses agreed with the related questions' statements. The results of Pearson's correlation test revealed that there was a significant relationship ( = 0.780, < 0.05) between the statements of teaching methods and student's responses in both academic years. CONCLUSION: Students performed better and had positive opinions of TBL as their preferred learning technique when team-based learning substituted some didactic lectures.
Saudi J Anaesth
· 2025 · PMID 40642622
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Birt-Hogg-Dubé (BHD) syndrome is a rare syndrome which is usually inherited but may occur . It usually presents with cutaneous manifestations, pneumothorax, and, most importantly, renal tumors. Spinal anesthesia was used...Birt-Hogg-Dubé (BHD) syndrome is a rare syndrome which is usually inherited but may occur . It usually presents with cutaneous manifestations, pneumothorax, and, most importantly, renal tumors. Spinal anesthesia was used in this case to avoid respiratory complications such as pneumothorax.
Saudi J Anaesth
· 2025 · PMID 40642621
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Bombay blood group is a rare blood phenotype, frequently misinterpreted as "O" blood group, and sometime causes severe hemolytic transfusion reactions. We are reporting a 4-year-old cardiac patient with congenital heart...Bombay blood group is a rare blood phenotype, frequently misinterpreted as "O" blood group, and sometime causes severe hemolytic transfusion reactions. We are reporting a 4-year-old cardiac patient with congenital heart disease. During routine intraoperative evaluation, the patient was confirmed as having Bombay blood group and leukocyte adhesion deficiency type II. As this condition is extremely rare in Saudi Arabia, matched blood donors were secured from outside the country. The patient underwent bilateral peripheral artery stenosis reconstruction. Successful intraoperative management was done using one unit of matched blood transfusion, acute normovolemic hemodilution strategy, intravenous injection of antifibrinolytic agents, and regular antimicrobial surgical prophylaxis. The postoperative period was uneventful, and the patient was discharged from the hospital 1 week later. Correct and preoperative identification of Bombay phenotype, patient labeling and flagging, maintaining records for rare blood groups, and collaborations with other blood banks are necessary strategies for safe management of patients with Bombay blood group.
Saudi J Anaesth
· 2025 · PMID 40642620
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The wide spread of the serratus posterior superior intercostal plane (SPSIP) block in the hemithorax and axilla suggests it can provide sufficient postoperative analgesia for breast cancer surgery. This case series aims...The wide spread of the serratus posterior superior intercostal plane (SPSIP) block in the hemithorax and axilla suggests it can provide sufficient postoperative analgesia for breast cancer surgery. This case series aims to present the data of five patients who underwent SPSIP block. Patients received preoperative SPSIP block as part of a multimodal analgesia protocol. Our findings indicate that Numeric Rating Scale pain scores remained below 3/10 in all patients, the time to mobilization was shortened, and postoperative opioid requirements were minimal. These data indicate that the SPSIP block might be an efficient choice for pain control in breast cancer surgeries.
Liu Y, Du J, Li Y
… +5 more, Zhang Q, Li P, Li S, Ma X, Xu F
Saudi J Anaesth
· 2025 · PMID 40642619
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BACKGROUND: This study aims to investigate the efficacy and safety of dexmedetomidine in treating postoperative acute pain through a clinical randomized controlled trial. METHODS: This study selected 165 patients who und...BACKGROUND: This study aims to investigate the efficacy and safety of dexmedetomidine in treating postoperative acute pain through a clinical randomized controlled trial. METHODS: This study selected 165 patients who underwent general anesthesia surgeries at our hospital from October 2022 to May 2023 as research subjects. They were enrolled and randomly allocated to a control group ( = 73) and an experimental group ( = 74) based on a computer-generated random numbers table. Firstly, we compared the general clinical data before surgery. Secondly, we compared the pain degree, sedative degree, and vital signs at 6 time points (before surgery [T0], 1 h postoperatively [T1], 6 h postoperatively [T2], 12 h postoperatively [T3], 24 h postoperatively [T4], and 48 h postoperatively [T5]). Lastly, we compared the incidence of adverse reactions and comprehensive satisfaction degree for the two groups of patients after surgery. RESULTS: The results showed that compared to the control group, the experimental group had lower VAS score, Ramsay score, mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) ( < 0.05), whereas blood oxygen saturation (SpO) showed no change ( > 0.05). No difference was observed in the incidence of adverse reactions between the experimental and control groups ( > 0.05). The comprehensive satisfaction degree of patients in the experimental group was higher compared to the control group ( < 0.05). CONCLUSIONS: Dexmedetomidine could effectively manage the vital signs of patients with postoperative acute pain, improve treatment outcomes, alleviate pain, enhance sedation, ensure safety, and enhance comprehensive satisfaction.
Saudi J Anaesth
· 2025 · PMID 40642617
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Reports on intraoperative coagulation monitoring using viscoelastic testing methods are scarce in oncosurgical patients. Evidence-based clinical reports with the use of Sonoclot and subsequent corrections of coagulation...Reports on intraoperative coagulation monitoring using viscoelastic testing methods are scarce in oncosurgical patients. Evidence-based clinical reports with the use of Sonoclot and subsequent corrections of coagulation abnormalities in above population are not available in the literature. We report here records of altered coagulation in 10 subjects with massive hemorrhage. Detection of intraoperative coagulation abnormalities was done using activated clotting time, clot rate, and platelet function. The most common Sonoclot signature abnormality found in our series was a poorly formed, dull, and rounded "peak," indicative of irregularities of fibrin formation. Dilutional coagulopathy and hyper-fibrinolysis events too were recorded in few subjects. Appropriate transfusions with blood products were considered based on Sonoclot curve assessment. All subjects had adequate recovery. We conclude that the Sonoclot analysis demonstrates potential for optimizing blood product use in oncosurgical patients with massive hemorrhage, warranting further research to establish standardized protocols and quantify its impact.
Doğukan M, Yılmaz N, Türk A
… +3 more, Tosun F, Duran M, Bozkurt Z
Saudi J Anaesth
· 2025 · PMID 40642616
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BACKGROUND: This study aimed to investigate the protective effects of intravenous lipid emulsion (ILE) against bupivacaine-induced cardiac toxicity, using histopathological analyses. METHODS: Twenty-eight adult male Wist...BACKGROUND: This study aimed to investigate the protective effects of intravenous lipid emulsion (ILE) against bupivacaine-induced cardiac toxicity, using histopathological analyses. METHODS: Twenty-eight adult male Wistar-Albino rats were divided into four groups: Sham (Group A), ILE (Group B), Bupivacaine (Group C), and Bupivacaine + ILE (Group D). Neurotoxicity was induced in Groups C and D with continuous bupivacaine infusion. ILE was administered to Groups B and D. Histological examination of brain tissues, and apoptotic index were evaluated. RESULTS: The apoptotic index was significantly higher in Group C, but ILE administration in Group D markedly decreased these parameters ( < 0.05). Histopathological analysis revealed that ILE reduced edema and neuronal degeneration in Group D. CONCLUSION: ILE demonstrated a neuroprotective effect against bupivacaine-induced cardiac toxicity by improving hemodynamic stability and reducing cellular damage. This suggests a potential therapeutic role of ILE in managing local anesthetic systemic toxicity.
Hazarika A, Kumar M, Ahluwalia J
… +5 more, Khurana BJK, Mahajan V, Bhatia N, Naik N, Kumar D
Saudi J Anaesth
· 2025 · PMID 40642615
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BACKGROUND: Trauma causes a state of hypercoagulability, and its presence is common early in the injury course. D-dimer (DD), considered a good screening tool for coagulation activation and higher plasma levels, has been...BACKGROUND: Trauma causes a state of hypercoagulability, and its presence is common early in the injury course. D-dimer (DD), considered a good screening tool for coagulation activation and higher plasma levels, has been associated with unfavorable outcomes. Hence, in trauma, measuring DD levels may help provide useful prognostic information. The aim of the study was to find whether DD levels at the time of admission can predict the outcome of patients. METHODS: This prospective observational studied 205 adult patients of age group 18-60 years, presenting to trauma emergency within 24 h of injury and blood samples collected within this period. The primary outcome was to assess whether DD levels at admission predicted outcome. Association of DD levels with injury severity score, with blunt or penetrating trauma, time from injury to admission, and to hospital stay were secondary outcomes. A value of DD >250 ng/ml was considered elevated. RESULTS: The DD levels were significantly higher in patients who died than those who were discharged [2316.28 (384.5,3331.18) vs 498.03 (140,693), = 0.001]. On receiver operating characteristic analysis, a cutoff value of 1793.35 ng/ml for serum DD was obtained with sensitivity and specificity values of 72.7% and 60.8%, respectively. The odds of death in patients were 5.87 [95% CI 1.67 to 20.51] times more when DD >1793.35 ng/ml ( = 0.002). CONCLUSION: Our study demonstrates that DD levels at admission were high among nonsurvivors compared to survivors. A cutoff value of more than 1793.35 ng/ml is associated with an unfavorable outcome.
Saudi J Anaesth
· 2025 · PMID 40642613
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BACKGROUND: The optimal procedural sedation and analgesic regime for gastrointestinal endoscopy is uncertain. Ketamine and fentanyl are commonly used analgesic agents alongside propofol but both have significant side eff...BACKGROUND: The optimal procedural sedation and analgesic regime for gastrointestinal endoscopy is uncertain. Ketamine and fentanyl are commonly used analgesic agents alongside propofol but both have significant side effect profiles. OBJECTIVES: This systematic review and meta-analysis compares the efficacy and safety of propofol-ketamine (PK) to propofol-fentanyl (PF) sedation for patients undergoing gastrointestinal endoscopy. METHODS: Medline, EMBASE, and CENTRAL were searched to identify all comparative studies comparing PF to PK sedation. Nine randomized control trials (RCTs) met inclusion criteria. The primary outcomes were procedure time and recovery time. Secondary outcomes included adverse effects. All outcome data analyses were conducted using random-effects modeling. FINDINGS: Nine RCTs with a total of 1006 patients were analyzed (508 (50.5%) PF, 498 PK). Sedation-analgesia regimes with PF were associated with both shorter procedure times (mean difference (MD) = -1.670 minutes (95% CI, -2.890, -0.450); < 0.01) and recovery times (MD = -1.215 minutes (95% CI,-2.131, -0.300)) compared with PK. In the PF group, there was a higher incidence of desaturation (PF: 18.03% vs PK: 7.84%, OR = 3.163 (95% CI, 1.552, 6.444); < 0.01) and hypotension (PF: 17.20% vs PK: 8.33%, OR = 2.501 (95% CI, 1.296, 4.824); < 0.01). CONCLUSIONS: There is moderate certainty evidence that PF reduces procedure time and low certainty that it improves recovery time compared to PK for gastrointestinal endoscopy. The risk of potentially life-threatening hypotension and desaturation was significantly greater in the PF group.
Gentili L, Guerriero G, Nania F
… +1 more, Angeletti C
Saudi J Anaesth
· 2025 · PMID 40642612
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Acute compartment syndrome (ACS) arises from increased pressure within a confined osteofascial compartment, leading to tissue ischemia, metabolic deficits, and potential irreversible damage if untreated. Although trauma...Acute compartment syndrome (ACS) arises from increased pressure within a confined osteofascial compartment, leading to tissue ischemia, metabolic deficits, and potential irreversible damage if untreated. Although trauma is the most common cause, obesity-especially when combined with immobility-can increase the risk of ACS, presenting significant challenges in anesthetic management. This case report details the anesthesiological management of a 42-year-old man with severe obesity (BMI 78 kg/m²), classified as super-super obese, who presented with ACS in his right lower limb. Given his complex airway and the limitations of performing general anesthesia (GA), a regional anesthetic approach was selected. Due to anatomical challenges posed by the patient's obesity, an adductor canal block was performed using ultrasound and Doppler guidance to identify key structures and achieve a successful block. The patient was sedated, remained hemodynamically stable during surgery, and required minimal analgesics postoperatively. This case highlights the critical role of regional anesthesia in super obese patients, overcoming challenges like difficult anatomical landmarks and limited equipment, and underscores the importance of personalized, adaptive approaches to achieve optimal outcomes. Despite the technical difficulties, this successful use of regional anesthesia provides valuable insights into the management of high-risk super obese patients with ACS and reinforces the need for anesthesiologists to employ creative and flexible techniques, including advanced imaging tools, to ensure safe anesthesia care.
Yemele Kitio SA, Olakunle IC, Tay S
… +2 more, Tobias JD, Nafiu OO
Saudi J Anaesth
· 2025 · PMID 40642611
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INTRODUCTION: Addressing childhood obesity remains a significant public health concern due to the lack of effective intervention programs and policies. While efforts are ongoing to evaluate perioperative complications re...INTRODUCTION: Addressing childhood obesity remains a significant public health concern due to the lack of effective intervention programs and policies. While efforts are ongoing to evaluate perioperative complications related to childhood obesity, there has been limited exploration of parents' and caregivers' knowledge and attitudes toward the perioperative risks associated with their children's obesity. This prospective survey evaluated parents' beliefs and practices related to childhood obesity and determined if these influenced their knowledge of obesity-related perioperative complications. METHODS: We performed a prospective survey of parents of children aged 2-17 years scheduled for elective operations at a US quaternary academic medical center. The survey instrument was pretested. The frequency of obesity-related perceptions, beliefs, and practices were assessed, stratified by child weight status. Group comparisons were made with appropriate statistical tests. RESULTS: The study included 129 parents, of whom 87 (67.4%) were married, and 102 (79.1%) were women. Most parents, regardless of perceived child weight, agreed that child overweight/obesity can cause serious illness (95%) and that they should be concerned (90%). Notably, 40% of parents failed to recognize obesity in their own children. About 40% of parents were unsure about the impact of childhood obesity on postoperative pain control, and 29% were uncertain about its effect on anesthesia risks. Additionally, 20% of parents were uncertain about the potential for serious surgical complications related to obesity, and 5% believed that being overweight or obese does not lead to significant surgical risks. CONCLUSIONS: While awareness of child overweight/obesity as a modifiable health risk is high, many parents failed to recognize it in their own children and were unaware of its potential contribution to anesthesia-related complications. Additional efforts to help parents understand their role in facilitating behavior change and to assist them in identifying at-risk children as well as the perioperative implications of childhood obesity are required.