Saudi Journal of Anaesthesia

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly influence overall and disease-free survival in selected patients suffering from peritoneal surface malignancies (PSMs). We report here the anaesthetic management of a 52 year old patient of Ca Colon with secondary ovarian and peritoneal deposits. She underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with curative intent. The advent of CRS/HIPEC gives a promising alternative to conventional treatment modalities but comes with numerous challenges to the anesthesiologist-in view of the metabolic and hemodynamic adjustments-and demands training...

Unexpected cardiac arrest in the perioperative period is a devastating complication. Owing to immaturity of organ systems, and presence of congenital malformations, morbidity and mortality are higher in neonates. There is abundant literature about early recognition and management of perioperative adverse events in children, but similar data and guidelines for surgical neonates is lacking. The current neonatal resuscitation guidelines cater to a newborn requiring resuscitation at the time of birth in the delivery room...

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BACKGROUND: The clinical outcomes (time to ambulation, length of stay, and home discharge) after proximal femoral nail (PFN) for proximal femoral fractures (PFF) is dependent on successful pain management. Currently, the lumbar erector spinae plane block (LESPB) is in vogue and is associated with favorable outcomes in the postoperative period. Our study aimed to evaluate whether a LESPB provided equivalent analgesia and clinical outcomes as compared to LPB in PFN for PFF. MATERIAL AND METHODS: We compared LPBs [L] with LESPBs [E], with 30 patients in each group, performed from June 2020 to June 2021 for PFN in PFF's...

Tizanidine is a centrally acting α2 agonist which has been used as a premedication due to its opioid-sparing and sympatholytic properties. This systematic review assessed the safety and feasibility of oral tizanidine. After registering the protocol with PROSPERO (CRD42022368546), randomized controlled trials and non-randomized observational studies were searched in various databases. The primary outcome was intraoperative opioid use; the secondary outcomes were 24-hr opioid consumption, pain scores, time to rescue analgesia, and adverse events...

BACKGROUND AND GOAL: Laryngeal mask airway (LMA), a supraglottic device for airway management and ventilation, is used both in emergencies, out of the operating room, and in the operating room during general anesthesia. This study aims to compare the success rate and complications of the classic insertion method (with a semi-inflated cuff) and another technique using the index and middle fingers of the second hand to prevent retroversion of the mask tip (alternative method). METHODS AND MATERIALS: In total, 288 patients scheduled for short-time ophthalmologic elective surgeries under general anesthesia were randomly allocated to two groups for LMA placement; group C, classical method (with semi-inflated cuff), and group A, alternative method...

As the number of COVID-19 cases is rapidly increasing internationally, management, recommendations and guidelines of COVID-19 are rapidly evolving and changing. Formulating local clinical management policies among institutions adopting these recommendations is vital to staff as well as the patients' safety. Also, training multidisciplinary teams on these policies is an important, yet challenging, part of the process. The purpose of this paper is to present the process that has been followed to formulate COVID-19-specific response anesthesiology and operating room (OR) policies at King Abdulaziz University Hospital, by applying David A...

Achondroplasia is an autosomal dominant inherited disorder that results in premature ossification of the epiphyseal growth plates and restriction of proximal long bone movement. Herein, we report the anesthetic management of such a patient undergoing stone retrieval in the lithotomy position. He had a restricted ability to flex and abduct the hip joint and lumbar hyperlordosis. These were anticipated to be a concern for the lithotomy position and prone to positional injuries. Hence, the decision was made to position the patient before induction of anesthesia in the presence of surgeons to ensure the optimal exposure needed for the procedure while avoiding any hyperflexion or abduction of the hip and knee joints...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Positioning of patients during surgery, whether prone or head down, can lead to airway edema which, in turn, may lead to a difficult airway, and enhanced chances for reintubation. We aimed to assess and evaluate modified Mallampati class (MMC) change in patients scheduled for lumbar spine surgery in the prone position. MATERIALS AND METHODS: This prospective observational study included 80 patients scheduled for lumbar spine surgery. The MMC was assessed up to 48 h postoperatively...

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Gerbode defect is a rare left ventricle to right atrium shunt that can be acquired or congenital. The incidence of acquired defects has been growing and is caused by previous cardiac surgery, endocarditis, trauma and myocardial infarct. It can be challenging and the anesthesiologist should maintain a suspicion when there is circulatory failure after a cardiac surgery. It can be diagnosed by trans-esophageal echocardiography. In this case we presented the anesthetic management and the successful surgical correction of an acquired ventricular-atrial defect secondary to a previous mitral valve replacement...

BACKGROUND: Supraclavicular brachial plexus blocks (SCBPB) are routinely placed prior to anaesthetic induction for post-operative pain relief after prolonged orthopaedic oncosurgery, since patients are required to remain awake for sensorimotor evaluation of block. If the window period after surgery but before anesthesia-reversal is employed for administering SCBPB, it bestows the quadruple advantage of being painless, not augmenting surgical bleed, longer post-operative analgesia and reduced opioid-related side effects...

No abstract text is available yet for this article.

Anesthetic management of dystonic patients with uncontrolled involuntary movements refractory to medical management is a challenge to neuroanaesthetists. According to some studies, the prevalence of Panthothenate Kinase Associated Neurodegeneration is 1 to 9/1,000,000. Report of Deep Brain Stimulation for Hallervorden-Spatz is extremely rare in literature. "Awake" bilateral electrode placement, with microelectrode recording (MER) and stimulation with a scalp nerve block, titrated conscious sedation with Monitored Anesthesia Care (MAC) is preferable...

The radial artery is the most common choice for arterial cannulation, coronary interventions, and various interventional radiological procedures. Here, we describe a case of unilateral duplication of the radial artery detected during radial artery cannulation using point-of-care ultrasonography (POCUS). The duplication of the radial artery in the forearm can hinder trans-radial access secondary to variations in the diameter. An actual duplication also carries a high risk of accidental injury to the arterial wall during routine invasive procedures and other forearm procedures such as free flap construction...

The patient with Long QT syndrome (LQTS) presents a unique challenge to the anesthesiologist. The anesthetic management of such patients requires a good knowledge of the pathophysiology of this rare disease. General anesthesia (GA) or combined spinal epidural anesthesia (CSEA) are the most preferred anesthetic techniques among anesthesiologists for such patients posted for the lower segment cesarean section delivery. In this report, we would like to share our experience of anesthetic management of a young primigravida, a case of symptomatic LQTS with a permanent pacemaker in situ ...

Anesthesia for impacted tracheobronchial foreign body (FB) removal in pediatrics is challenging owing to shared airway, need of tubeless apneic anesthesia, and higher risk of airway complications. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) has unique applications for apneic anesthesia. The authors describe two pediatric cases of impacted lower bronchial FB that were difficult to retrieve and required long procedure time. They were done successfully under apneic anesthesia using THRIVE that provided intermittent total apnea of 58 and 62 min, respectively, with single-continuous apnea time of 13-18 min...