survey of the practice of regional anesthesia in Saudi Arabia

This survey aimed to assess both the extent of practice and need for training in regional anesthesia among anesthesiologists in Saudi Arabia in 2012. We distributed an electronic survey among 382 anesthesiologists attending the bi-annual meetings of the Saudi Anesthetic Association, enquiring about their practice in regional anesthesia. Questions concerned the practice of regional anesthesia, use of ultrasound guidance, and the need for training workshops. The response rate of anesthetists was 55.2% with most of them were males and had mean age of 25-50 years. Most anesthesiologists [88.2%] were practicing regional anesthesia frequently in the operating rooms [75.3%] rather than designated block room. From the respondents, only 14.2% did fellowship in regional anesthesia, 21.8% and 18.5% were using ultrasound and nerve stimulation guidance, respectively, 11.4% received formal training, and 86.3% were willing to attend training workshops on regional anesthesia. There was a significant negative correlation between the ultrasound users and their institutional positions [r=-0.191] [P=0.026]. We believe that more could be done to improve the practice of regional anesthesia in the Kingdom of Saudi Arabia, including the implementation of formal training and conduction of more frequent specialized courses/workshops in the field of regional anesthesia with special reference to ultrasound regional anesthesia blockade techniques

survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents [NMB] in 2012. We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine "first choice" use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring [NMT], type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium. A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation [39% and 35%, respectively]. From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB. We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC [>20%] and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines

the bispectral index a sensitive monitor for survival after living donor liver transplantation?

Bispectral index [BIS] monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation [LDLT]. We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival. After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane-fentanyl-rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome. The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase [P<0.05]. The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane-fentanyl anesthesia

Does nitric oxide improve left ventricular dysfunction complicated with refractory hypoxemia after CABG surgery?

Nitric oxide [NO] may improve left ventrcular dysfunction after cardiac surgery. We have reported a case of severe left ventricular dysfunction and refractory hypoxemia after a two-vessel coronary artery grafting surgery. Different protective ventilation strategies and circulatory support with infusions of epinephrine and dopamine and intra-aortic balloon pumping failed to induce improvements in the cardiopulmonary function. In light of the worsening myocardial function and refractory hypoxemia, inhaled NO 20 ppm was initiated. This was followed by a progressive rapid improvement in the left ventricular function and oxygenation index, and gradual resolution of radiological lung infiltrates. The use of NO inhalation can be a safe and effective treatment modality for the refractory left ventricular dysfunction and worsening hypoxemia after coronary artery bypass grafting [CABG] surgery