Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background: Marfan syndrome is an autosomal dominant connective tissue disorder that affects multiple organ systems, with cardiovascular complications posing a major risk. With advancements in medical care and the increasing lifespan of patients with Marfan syndrome, the spectrum of medical issues has evolved. This case report highlights the complex anaesthetic management of a patient with Marfan syndrome during elective ventral hernia repair. Case presentation: A 37-year-old male with Marfan syndrome was admitted for elective open ventral hernia repair. Challenges included severe arterial hypertension, prior aortic valve replacement, scoliosis, and an anticipated difficult airway, as the patient presented with restricted mouth opening due to craniofacial abnormalities consistent with difficult laryngoscopy. Preoperative assessments included routine tests, echocardiography and chest X-ray. The anaesthetic management focused on specific patient positioning with head-up tilt, maintenance of haemodynamic stability with the insertion of an arterial line before the induction of anaesthesia and neuromuscular block (NMB) monitoring, followed by titrated doses of all medications. Lung ventilation strategies were specifically adjusted to address the patient’s underlying comorbidities. The patient was extubated and transferred to the recovery unit. The intraoperative and immediate postoperative periods were relatively uneventful. Dyspnea due to external pressure on the abdominal wall caused by a specific binder was treated with the release of pressure. Later postoperative recovery was complicated by hydrothorax and pneumonia, both treated successfully. Conclusions: This case emphasises the importance of multidisciplinary approaches and vigilant monitoring in the management of a patient with Marfan syndrome perioperatively, even for seemingly low-risk operations. Appropriate anaesthetic management helped to avoid major perioperative complications....
Effective pain management following upper abdominal surgery, particularly in the area between the lower costal margin and the umbilicus, remains a clinical challenge. The sixth to eleventh intercostal nerves provide sensory innervation not only to this area but also to the area directly below the umbilicus, and various regional anaesthesia techniques have been described to block these nerves and reduce postoperative pain. Over the past decade, several approaches have emerged that target these nerves within the relatively confined anatomical space between the anterior axillary line and the midline. This review explores the various techniques employed to block the lower intercostal nerves, focusing on the anatomical, sonographic, and technical considerations of each technique. Traditional and contemporary approaches to providing analgesia to the upper abdominal wall will be discussed. An understanding of the differences and/or similarities of the sono-anatomy of the target fascial planes is crucial for success when performing these blocks. Further research to identify the most effective and reliable regional techniques for upper abdominal surgery is still needed....
Background: As more older adults undergo surgery globally, their multimorbidity and reduced physiological reserves heighten anaesthetic risk. Evidence from low-resource settings is scarce. This study compared the frequency and types of peri-operative and early postoperative anaesthetic adverse events in patients aged 65 or older versus younger adults at Gabriel Touré University Hospital, Mali. Methods: We conducted a cross-sectional, descriptive, and analytical study in the Anaesthesia-Intensive Care Department of Gabriel Touré University Hospital from 1 July to 30 September 2024. All patients ≥ 18 years scheduled for elective surgery with anaesthesia were eligible. Patients were divided into Group I (18 - 65 years) and Group II (≥65 years). Anaesthetic risk was stratified using the American Society of Anesthesiologists (ASA) physical status classification. Emergency procedures, patients < 18 years, incomplete or lost files, and pre-operative decompensation of comorbidities were excluded. Pre-operative clinical status, comorbidities, laboratory results, and ASA class were collected. Intra-operative data included types of anaesthesia, induction technique, and haemodynamic events (tachycardia, bradycardia, hypotension, hypertension). Postoperative monitoring during the first 24 h focused on blood pressure, heart rate, oxygen saturation, and destination after the post-anaesthesia care unit. Data were analysed with IBM SPSS Statistics 22.0 using Pearson’s chi-square test (p < 0.05). Results: Of 389 patients, 86 were included (69 in Group I and 17 in Group II). Hypertension was more frequent in elderly patients (47.1% vs. 10.1%), whereas absence of medical history predominated in younger adults (85.5% vs. 52.9%) (χ 2 = 13.224; p = 0.001). Other preoperative clinical, biological, and ASA characteristics were similar between groups. General anesthesia was more often used in younger patients (65.2% vs. 35.3%; χ 2 = 5.060; p = 0.024), while regional anesthesia was preferred in older adults (64.7% vs. 33.3%; χ 2 = 5.616; p = 0.018). The incidence of intraoperative hemodynamic events and postoperative instability during the first 24 h did not differ significantly between age groups, nor did postoperative destination: approximately 87% of patients in each group were transferred to standard surgical wards and 13% to intensive care. Conclusion: In this single-centre cohort, patients aged ≥ 65 years undergoing elective surgery did not experience a higher rate of peri- or early postoperative anaesthetic complications than younger adults, provided that pre-operative assessment was rigorous and anaesthetic techniques were adapted, with greater use of regional anaesthesia. These findings support the view that chronological age alone should not contraindicate elective surgery under anaesthesia and underline the potential value of incorporating systematic frailty screening to refine risk stratification in elderly patients....
Background: This randomised, single-centre study and original research manuscript aimed to evaluate whether perioperative hypnosis and acupuncture can reduce postoperative nausea and vomiting (PONV), opioid use, and other complications in spinal surgery compared to standard pharmacological management. Methods: In total, 60 patients undergoing spinal surgery were divided into three groups regarding antiemetic prevention: Hypnosis and acupuncture (HG), hypnosis, acupuncture, and antiemetic (HAG), and standard control with antiemetic (CG). Hypnosis was performed one day before surgery, or patients received premedication with midazolam on the day of surgery. Anaesthesia was induced and maintained with propofol and remifentanil. Acupuncture was performed bilaterally at points LI4 and PC6 after induction of anaesthesia. Postoperatively, the consumption of opioids and antiemetics, satisfaction and well-being, length of stay and complications were recorded. Results: In all groups, additional opioids were administered in the first hour after surgery (p = 0.4). In the ICU, only one patient in the HAG and two patients in the CG and HG required additional analgesics (p = 0.8). Overall satisfaction (9/9/0 vs. 10/6/4 vs. 9/7/3; p = 0.4) and well-being scores (10/8/0 vs. 13/5/2 vs. 13/5/1; p = 0.5) were high across all groups, with no significant differences. Two patients in CG experienced mild complications. The length of hospitalisation was similar (3 days in CG vs. 4 days in HAG and HG (p = 0.7). Only one patient in the HG required antiemetics; none were needed in CG or HAG (p = 0.4). Conclusions: Within the constraints of this exploratory single-centre trial, hypnosis appeared to provide anxiolytic benefits comparable to benzodiazepines, and intraoperative acupuncture did not increase PONV despite reduced pharmacological prophylaxis. No significant differences were detected in opioid and antiemetic consumption. Larger, adequately powered studies are needed to confirm these findings and optimise the timing and modality of non-pharmacological interventions....
Background/Objectives: Postoperative nausea and vomiting (PONV) remains a frequent and clinically relevant complication following open lumbar discectomy (OLD) under general anesthesia. The present study represents a secondary, post hoc analysis of a randomized controlled trial originally designed to investigate the effects of infiltration anesthesia (IA) on postoperative pain perception and opioid consumption. The objective of this analysis was to explore the incidence of PONV in patients undergoing OLD under adequacy of anesthesia (AoA)-guided general anesthesia, with or without IA. Methods: This secondary analysis included 94 patients undergoing OLD under AoA-guided general anesthesia with fentanyl titration based on the surgical pleth index (SPI). Patients were randomized to receive IA with 0.2% ropivacaine (RF) or bupivacaine (BF) plus 50 μg fentanyl, or no IA (control). PONV was assessed as early (in the post-anesthesia care unit), late (in the neurosurgical ward), and overall (within 48 h postoperatively). Opioid consumption and Apfel risk scores were also analyzed. All analyses related to PONV were exploratory. Results: PONV occurred in 12.8% of patients, with no significant differences between study groups. Postoperative morphine consumption was significantly lower in the RF group than in the control group (2.7 ± 5.3 mg vs. 7.1 ± 5.9 mg; p < 0.05). Higher preinduction SPI values were observed in patients who experienced early PONV (73.1 ± 9.7 vs. 59.5 ± 17.2; p < 0.05); however, this exploratory finding requires confirmation in larger studies. Conclusions: In this secondary, post hoc analysis, no significant differences in PONV incidence were observed between anesthetic groups in patients undergoing OLD under AoA-guided general anesthesia. The observed association between pre-induction SPI values and early PONV should be interpreted cautiously and requires confirmation in adequately powered prospective studies....
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