Motor and somatosensory evoked potential spinal cord monitoring during intubation and neck extension for thyroidectomy in a Down syndrome boy with atlantoaxial instability.

Intubation or neck extension can compress the spinal cord in patients with craniocervical instability. Protective motor evoked potential (MEP) and somatosensory evoked potential (SEP) monitoring of these maneuvers is an obvious consideration when these patients undergo already-monitored spinal surgery, but might be overlooked when they undergo other normally unmonitored procedures. Here we report monitoring intubation and neck extension for the unusual indication of thyroidectomy in a Down syndrome boy with atlantoaxial instability. Transcranial electric stimulation thenar MEPs and optimized median nerve SEPs were acquired about every minute throughout intubation and neck extension under propofol and remifentanil anesthesia without neuromuscular blockade. Potentials were stable and there was no neurologic deficit. This approach could protect craniocervical instability patients against cord compression when they undergo intubation and neck extension for surgical procedures that would not otherwise indicate spinal cord monitoring.

Neuraxial Analgesia for Scoliosis Correction: A Case Series in a Specialised Children's Centre.

BACKGROUND: Surgical correction of spinal deformities in children presents a challenge to the anaesthetist due to the extensive nature of the surgery, the co-morbidities of the patients and the constraints on aesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Patients undergoing scoliosis surgery are considered to suffer severe pain, which may lead to a negative impact on patient psychology and physical well-being. By using effective postoperative pain regimens to enhance recovery after surgery, pain can be significantly reduced, leading to patient satisfaction, facilitating early mobilisation, promoting oral intake, lowering postoperative pain and shortening the length of hospital stay. Thus, the primary objectives of this study were to assess the postoperative pain management and first rescue analgesic medications, by using preservative-free morphine 50 mcg/kg and dexmedetomidine 4 mcg along with normal saline 0.5 ml kg caudally, as well as to look for the secondary objectives side effects, including respiratory depression, nausea, vomiting and pruritis, timing of postoperative ambulation and length of hospital stay.  Methods: In this study, we retrospectively included children under 14 years of age and above three years who underwent scoliosis surgery under a caudal epidural-general anaesthesia using caudal morphine and the dexmedetomidine technique in the period from January to May 2023 at the National Guard Health Affairs Hospital (NGHA), Riyadh. We collected the data of seven cases using the electronic chart system of the Best Care database to extract the specific cases that meet the inclusion criteria for the study, which are idiopathic scoliosis patients, aged 3-14 years, and primary correction procedures.  Results: The pain-free duration was between seven hours and 48 hours (about two days). There were four female cases (57.14%), and three cases were male (42.85%). The patients' American Society of Anesthesiologists (ASA) status were II to III. In all the cases, there was no documentation of any episodes of postoperative nausea and vomiting (PONV), respiratory distress or pruritus, except for one case where the patient had an episode of PONV.  Conclusion: In this study, our aim was to present our experience with dexmedetomidine as an efficient medication when coadministered with morphine to be used in the operating room. We found a high level of reliability in prolonging analgesia time and delaying the usage of rescue medication. We encourage more studies on caudal dexmedetomidine for patients undergoing scoliosis surgery.

Comparison of Postoperative Outcome in Children Undergoing Inguinal Hernia Repair Using Regional With General Versus General Anesthesia Alone: A Single Center Study.

BACKGROUND: Inguinal hernia repair is one of the most common general surgical procedures. It has been performed under local, regional, or general anesthesia. We hypothesized that using regional plus general anesthesia rather than general anesthesia alone would improve outcomes in neonates and pediatric patients undergoing hernia repair. METHODS: This is a retrospective cohort study, including all pediatric patients who underwent inguinal hernia repair from 2015-2021. We divided patients into two groups. The first group was labeled "general anesthesia" (GA), while the second group was labeled "combined general and regional anesthesia" (GA+RA). We compared both groups in terms of demographic data, intraoperative outcome variables, and postoperative outcome variables. RESULTS:  212 children fulfilled the study criteria, with 57 in the GA group and 155 in the GA+RA group. Demographic and preoperative data were comparable between both groups except for age, which was 60.3±49.4 months in the GA group versus 26.7±33.13 months in the GA+RA group (p<.0001). Outcome variables demonstrated statistically significant improvement in postoperative pain occurrence, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation in the GA+RA group in comparison to the GA group with P values of 0.031, 0.02, 0.005, and 0.02, respectively. CONCLUSION: Using regional and general anesthesia techniques rather than general anesthesia alone is associated with a decrease in postoperative pain, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation. Further studies are still warranted to validate our conclusions.

Development of a Cardiac Anesthesia Tool (CAT) to Predict Intensive Care Unit (ICU) Admission for Pediatric Cardiac Patients Undergoing Non-cardiac Surgery: A Retrospective Cohort Study.

Background and aim: of the work: Pediatric cardiac patients often undergo non-cardiac surgical procedures and many of these patients would require intensive care unit admission, but can we predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Numerous preoperative and intraoperative variables were strongly associated with ICU admission. Given the variations in the underlying cardiac physiology and the diversity of noncardiac surgical procedures along with the scarce predictive clinical tools, we aimed to develop a simple and practical tool to predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Material and methods: This is a retrospective study, where all files of pediatric cardiac patients who underwent noncardiac surgical procedures from January 1, 2015, to December 31, 2019, were reviewed. We retrieved details of the preoperative and intraoperative variables including age, weight, comorbid conditions, and underlying cardiac physiology. The primary outcome was the need for ICU admission. We performed multiple logistic regression analyses and analyses of the area under receiver operating characteristics (ROC) curves to develop a predictive tool. Results: In total, 519 patients were included. The mean age and weight were 4.6 ± 3.4 year and 16 ± 13 Kg respectively. A small proportion (n = 90, 17%) required ICU admission. Statistically, there was strong association between each of American society of anesthesiologist's physical status (ASA-PS) class III and IV, difficult intubation, operative time more than 2 hours, requirement of transfusion and the failure of a deliberately planned extubation and ICU admission. Additional analysis was done to develop a Cardiac Anesthesia Tool (CAT) based on the weight of each variable derived from the regression coefficient. The CAT list is composed of the ASA-PS, operative time, and requirement of transfusion, difficult intubation and the failure of deliberately planned extubation. The minimum score is zero and the maximum is eight. The probability of ICU admission is proportional to the score. Conclusion: CAT is a practical and simple clinical tool to predict the need for ICU admission based on simple additive score. We propose using this tool for pediatric cardiac patients undergoing non-cardiac procedure.

Factors impacting anesthesiology residents in Saudi Arabia when they are planning their future.

PURPOSE: This study is undertaken to examine the factors that influence Saudi Board anesthesia residents' preferences in terms of future practice location, fellowship training, and research. METHODS: A cross-sectional study was conducted. Data on fellowship training, research, and future practice location preferences, as well as demographics, were collected using surveys distributed to all anesthesia residents enrolled at Saudi anesthesiology residency program (N = 302). RESULTS: A total of 117 residents (38.7%) responded to the survey. Of those 88.5% of residents planned on further subspecializing. The most highly sought fellowships were acute and chronic pain, regional anesthesia, simulation, and pediatric anesthesia. Residents pursuing fellowship training were mostly affected by personal interest, improving employment prospects, and future income. Only 11.5% of residents intended to incorporate research into their next practice-personal interest, employability, and lifestyle were the most influential in their decision. CONCLUSION: Most anesthesia residents training in Saudi Arabia choose to pursue fellowship training. However, less than one-fifth have an interest in incorporating research into their future careers.

Hospital preparedness and management of pediatric population during COVID-19 outbreak.

With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.

A case series of different anesthesia approaches for single ventricular physiology patients in various stages of palliation underwent noncardiac procedures.

Patients with single ventricle physiology (SVP) are a particularly challenging population with congenital heart disease (CHD); they will go for staged, palliation ending in the Fontan circulation. Nowadays, with improvement in surgical procedures for CHD, these patients become growing population, and noncardiac surgeries become not uncommon. The authors report different anesthesia approaches for four pediatric patients with SVP underwent ten noncardiac procedures done under general anesthesia following the different stages of palliation at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, between 2009 and 2015 and do a brief review of the literature on this topic. The aim of this study is to highlight that anesthesia approach for patients with SVP varies according to the patient physical situation at the time of the procedure, stage of palliation, and type of surgery. Therefore, every anesthesiologist should have thorough knowledge about SVP, different stages of palliative surgery, anesthesia concern in each one and risk factors associated with perioperative morbidity before anesthetizing patients for a noncardiac procedure to keep patient safety as well as avoiding unnecessary cancellation, rescheduling, and admissions to the ward or the Intensive Care Unit.