Anaesthesia, Pain & Intensive Care

Cancer care insights: hypoxia in the tumor microenvironment, a biomarker, barrier, or breakthrough?

2026-08-09T22:58:17-06:00

A characteristic of the tumor microenvironment (TME), hypoxia has two functions in the biology of cancer. From one perspective, oxygen deprivation causes metabolic reprogramming, interferes with normal immune surveillance, and increases resistance to treatment. Conversely, hypoxia-inducible pathways have changed the way precision oncology is approached by showing promise as biomarkers and therapeutic targets. Novel approaches for taking advantage of this hostile niche are being revealed by developments in imaging technologies, nanomedicine, and hypoxia-activated prodrugs (HAP). Nevertheless, dynamic oxygen fluctuations and tumor heterogeneity continue to pose a challenge to clinical translation. This editorial discusses whether hypoxia serves primarily as a treatment barrier, a prognostic biomarker, or an intriguing novel therapeutic approach for cancer.

Abbreviations: HAP: Hypoxia-Activated Prodrugs; PKR: Protein Kinase R; TME: Tumor Microenvironment

Keywords: Hypoxia; Tumor; Microenvironment; Prognostic Biomarkers; Immunotherapy; Hypoxia-Inducible Factor 1; alpha (HIF-1α)

Citation: Asghar N. Zafar K. Cancer care insights: hypoxia in the tumor microenvironment, a biomarker, barrier, or breakthrough? Anaesth. pain intensive care 2026;30(6):659-660. DOI: 10.35975/apic.v30i6.3258

Received: May 09, 2026; Accepted: June 01, 2026

Evaluation of effect of hip-to-shoulder width ratio on sensory level of spinal anesthesia for urological surgeries: a tertiary care hospital study

2026-08-09T22:58:33-06:00

Background: The sensory level achieved with spinal anesthesia varies among patients and may be influenced by anthropometric factors. Hip-to-shoulder width ratio, as a marker of body habitus, has been hypothesized to affect cephalad spread of intrathecally administered local anesthetics. The objective of the present study was to determine the correlation between hip-to-shoulder width ratio and spinal anesthesia sensory levels in patients undergoing urological surgeries.

Methodology: This descriptive cross-sectional study was conducted at Sindh Institute of Urology and Transplantation over a period of five months from 5^th June, 2025 to 10^th October, 2025. A total of 111 patients were enrolled through non-probability consecutive sampling. Baseline demographics, anthropometric measurements, and vertebral column length were recorded. Sensory block characteristics and intraoperative complications were assessed. Pearson’s correlation coefficient and chi-square test were applied, with p < 0.05 considered significant.

Results: The mean age of participants was 54.6 ± 10.8 years, with males comprising 82.9%. The mean hip-to-shoulder width ratio was 0.83 ± 0.05. A significant positive correlation was observed between hip-to-shoulder width ratio and both pinprick (r = 0.298, p = 0.002) and temperature sensory block levels (r = 0.312, p = 0.001). BMI also showed a significant association (p = 0.018), while gender and ethnicity did not significantly influence block outcomes. Nausea was the only complication significantly associated with inadequate block (p = 0.042).

Conclusion: Hip-to-shoulder width ratio and BMI are important predictors of spinal anesthesia spread in urological surgeries. Incorporating these parameters into pre-anesthetic assessment may improve block predictability and patient safety.

Keywords: Anthropometry; Body Mass Index; Hip-to-shoulder width ratio; Sensory block; Spinal Anesthesia; Urologic Surgical Procedures

Citation: Naeem N, Abbas MQ, Ghani, Abbas AA, Uddin SW, Kumar V. Evaluation of effect of hip-to-shoulder width ratio on sensory level of spinal anesthesia for urological surgeries: a tertiary care hospital study. Anaesth. pain intensive care 2026;30(6):661-668. DOI: 10.35975/apic.v30i6.3259

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025

Right ventricular functions in sepsis and septic shock: relation to risk stratification and short-term outcomes

2026-08-09T22:58:37-06:00

Background: Sepsis-induced cardiac dysfunction (SICD) is common in sepsis and septic shock. Although traditionally focused on left ventricular dysfunction, right ventricular (RV) impairment may have important prognostic value. This study evaluated the relationship between RV performance and severity and outcome in sepsis and septic shock.

Methods: This prospective cohort study included 50 adults admitted to the Critical Care Medicine Unit, Mansoura University Hospitals, between June 2024 and June 2025 with sepsis or septic shock. Transthoracic echocardiography was performed within 12 hours of admission and repeated during follow-up for up to 7 days. RV assessment included tissue Doppler-derived tricuspid annular systolic velocity (TV S′), tricuspid E/e′ ratio, RV myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and TAPSE/PASP ratio. Patients were classified by sepsis severity and survival status. The primary outcome was in-hospital mortality; the secondary outcome was intensive care unit length of stay.

Results: Septic shock was associated with lower TAPSE (P = 0.015), TAPSE/PASP ratio (P = 0.003), and TV S′ (P = 0.009), and higher RV MPI (P = 0.001) and TV E/e′ (P = 0.007). Baseline TV S′, TAPSE, and TAPSE/PASP were comparable between survivors and non-survivors, but decreased significantly during follow-up in non-survivors (P = 0.001 for each). Non-survivors also showed increasing RV filling pressures, lactate, neutrophil-to-lymphocyte ratio, and troponin (P ≤ 0.005).

Conclusions: RV dysfunction, particularly reduced TAPSE/PASP ratio, lower TV S′, and higher RV MPI, provides clinically relevant prognostic information for septic shock progression and short-term mortality.

Keywords: Echocardiography; Myocardial performance index; Sepsis-induced cardiac dysfunction; Sepsis; Septic shock; Right ventricular dysfunction; Tissue Doppler imaging

Abbreviations: MPI: myocardial performance index, RV: right ventricular, SICD: Sepsis-induced cardiac dysfunction. TAPSE: tricuspid annular plane systolic excursion

Citation: El-Shimy AA, Hafez AA, Gouda TES, Mousa SA. Right ventricular functions in sepsis and septic shock: relation to risk stratification and short-term outcomes. Anaesth. pain intensive care 2026;30(3):669-683. DOI: 10.35975/apic.v30i6.3262

Received: May 14, 2026; Revised: June 10, 2026; Accepted: June 10, 2026

Antenatal depression as an emerging multidisciplinary challenge in obstetric, peri-operative, and critical care medicine

2026-08-09T22:58:40-06:00

Background & Objective: Antenatal depression is increasingly recognized as a significant contributor to adverse maternal, fetal, peri-operative, and critical care outcomes during pregnancy. The objective of this study was to determine the prevalence of antenatal depression and evaluate its clinicodemographic determinants among pregnant women attending a tertiary care hospital, with emphasis on its implications for obstetric, peri-operative, and critical care practice.

Methodology: The cross-sectional study was carried out at Department of Obstetrics and Gynecology, Unit IV, Fatima Memorial Hospital, Lahore. Patients who were pregnant with gestational age values 12-38 weeks and aged 18-40 years were enrolled using non-probability consecutive sampling, however patients with neurological or psychiatric symptoms and those who were already taking medications for depression were excluded. Information regarding demographic and obstetric variables were recorded. The Beck depression inventory (BDI) was used to measure antenatal depression, and a score above 11 was regarded as a sign of depression. Data were computed with SPSS version 20. Statistical tests Chi-square test, p ≤0.05 was taken as significant.

Results: The overall mean age of participants was 26.24 ± 4.46 years old, and the gestational age mean of 24.81 ± 6.50 weeks. The mean BDI score was 8.86 ± 2.65. It was found that 11.2% of participants were experiencing antenatal depression. Statistically significant correlations between parity, educational status and BDI score with antenatal depression and age were found (P < 0.05), however no statistically significant existed between gestational age and antenatal depression (P > 0.05).

Conclusion: Antenatal depression is widespread among pregnant women, and it is affected by various demographic and obstetric factors. Frequent screening of mothers and early intervention are the keys to improve maternal mental health and pregnancy outcomes.

Keywords: Antenatal Depression, Prenatal Care, Beck Depression Inventory, Maternal Health, Risk Factors

Citation: Javaid M, Hanif S, Ghaffar S, Shaheen M, Khalid I. Antenatal depression as an emerging multidisciplinary challenge in obstetric, peri-operative, and critical care medicine. Anaesth. pain intensive care 2026;30(6):684-689. DOI: 10.35975/apic.v30i6.3261

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025

Impact of dihydropyrimidine dehydrogenase deficiency on oxidative stress index induced by 5-fluorouracil therapy in patients with stage-III colorectal cancer patients

2026-08-09T22:58:44-06:00

Background & objective: To the best of our knowledge, no previous studies have examined the valuation of oxidative stress levels in colorectal cancer patients with dehydropyrimidine dehydrogenase (DPD) deficiency who are receiving 5-fluorouracil chemotherapy. The aim of this study is to determine the oxidative stress index (OSI) in stage III colorectal cancer patients with DPD deficiency who are receiving 5-fluorouracil (5-FU) chemotherapy.

Methods: This study comprised 164 male patients with stage III colorectal cancer, all of whom got adjuvant treatment containing of a single cycle of 5-fluorouracil (5-FU). Participants were categorized according to their DPD levels into two groups: 82 males with DPD deficiency and 82 males without DPD deficiency. Multiple regression analyses were carried out to evaluate the OSI and its related elements after adjusting for potential confounders, and receiver operating characteristic (ROC) curve analysis was conduct to evaluate the diagnostic performance of OSI.

Results: The OSI was expressively higher in DPD-deficient patients in comparison with non-DPD-deficient patients (P < 0.001). OSI exhibited a significant negative correlation with DPD levels (r = –0.674, P < 0.001) and white blood cell (WBC) count (r = –0.570, P < 0.001). In multiple regression analysis, DPD level was independently related with OSI (P < 0.001). Additionally, receiver operating characteristic (ROC) curve analysis revealed excellent diagnostic performance of OSI, with an area under the curve (AUC) of 0.989 (95% CI: 0.979–0.999, P < 0.001).

Conclusions: A strong relationship was observed between DPD deficiency and severe systemic oxidative stress in colorectal cancer patients receiving 5-FU chemotherapy.

Videolaryngoscopy versus direct laryngoscopy for pediatric endotracheal intubation in tonsillectomy

2026-08-09T22:58:51-06:00

Background: Video laryngoscopes (VL) enhance glottic visualization and facilitate endotracheal intubation. While VL have demonstrated superiority over direct laryngoscopy (DL) in adults, evidence in pediatric populations remains limited. This study compared the performance and safety of the video laryngoscopy (VL) and direct laryngoscopy (DL) in pediatric endotracheal intubation.

Methods: In this randomized controlled trial, 180 children (aged 2–16 years) undergoing tonsillectomy under general anesthesia were assigned to intubation with either a McGRATH MAC VL or a MacIntosh DL. Primary outcome was the first-attempt intubation success rate. Secondary outcomes included intubation time, Cormack-Lehane grade, Intubation Difficulty Scale (IDS), external laryngeal manipulation (ELM) use, and complications.

Results: The VL group showed a higher first-attempt success rate than the DL group (95.6% vs. 84.4%; p=0.027). Time to intubation was similar (VL: 30.6 ± 5.7 s vs. DL: 28.4 ± 8.5 s; p=0.076). Grade I–II glottic views were more frequent with VL (97.8% vs. 85.6%; P = 0.003). The VL group had lower IDS scores, fewer ELMs, and fewer minor complications. Hemodynamic stability was maintained in both groups.

Conclusion: VL using McGRATH MAC improved intubation success and reduced airway-related complications compared to DL in pediatric tonsillectomy.

Keywords: Direct laryngoscopy; Endotracheal intubation; Pediatric; Tonsillectomy, Video laryngoscope

Citation: Van MN, Phan T, Xuan TT, Cong PM, Diemunsch P. Videolaryngoscopy versus direct laryngoscopy for pediatric endotracheal intubation in tonsillectomy. Anaesth. pain intensive care 2026;30(6):697-703. DOI: 10.35975/apic.v30i6.2794

Received: September 17, 2025; Revised: March 04; March 11, 2026; Accepted: March 11, 2026

Assessment of patient satisfaction regarding nursing care in hemodialysis units: a cross-sectional study

2026-08-09T22:59:02-06:00

Background & objective: The increasing number of patients requiring long-term dialysis is driving a growing demand for nursing care in hemodialysis units. This necessitates ongoing evaluation of the quality of nursing care provided by measuring patient satisfaction with this care in these units, as this plays a crucial role in promoting adherence to treatment plans and ultimately contributing to improved health outcomes. To assess patient satisfaction with the quality of nursing care in hemodialysis units.

Methods: A descriptive cross-sectional study was conducted with 230 patients undergoing hemodialysis in three units. Non-probability convenience sampling was used. Data were collected between November 24, 2025, and December 29, 2025. Patients were interviewed using the Patient Satisfaction with Quality of Nursing Care Questionnaire (PSNCQQ-Ar), Arabic version. The questionnaire consists of 17 items, and responses are measured on a five-point Likert scale, covering various aspects of patient satisfaction with nursing care. This tool was used to objectively measure patient satisfaction, enhancing the validity and reliability of the study.

Results: The results indicated high overall satisfaction with the quality of nursing care, with a mean of 3.68 and a standard deviation of 0.46. 52.6% of patients expressed complete satisfaction, while moderate levels of satisfaction were observed in the areas of information provision and family involvement.

Conclusion: More than half of the patients expressed complete satisfaction with the quality of care provided, while some aspects of care require improvement. Adopting a patient-centered and more patient-centered approach may contribute to enhancing the quality of nursing care and increasing patient satisfaction levels.

Keywords: patient satisfaction, nursing care, hemodialysis units

Citation: Kareem ZA, Al-Amarei HM. Assessment of patient satisfaction regarding nursing care in hemodialysis units: a cross-sectional study. Anaesth. pain intensive care 2026;30(6):704-709. DOI: 10.35975/apic.v30i6.3264

Received: April 14, 2026; Revised: May 26, 2026; Accepted: June 01, 2026

Effect of vitamin D₃ supplementation on Sinonasal Outcome Test-22 (SNOT-22) and visual analogue scale scores in patients with chronic rhinosinusitis

2026-08-09T22:59:06-06:00

Background & objective: Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the nasal and paranasal sinus mucosa lasting more than 12 weeks. Symptoms such as nasal obstruction, facial pain, and olfactory dysfunction can substantially impair patients’ quality of life. Vitamin D₃ has been proposed as a supportive therapy due to its anti-inflammatory and immunomodulatory properties. This study aimed to evaluate the effect of vitamin D₃ supplementation on CRS symptom severity using the Sinonasal Outcome Test-22 (SNOT-22) and the Visual Analog Scale (VAS).

Methods: This study employed a quasi-experimental design with a one-group pretest–posttest approach without a control group. A total of 17 patients with chronic rhinosinusitis were included. Participants received oral vitamin D₃ at a dose of 1,000 IU per day for 30 days. SNOT-22 and VAS scores were assessed before and after the intervention. Statistical analysis was performed using the Wilcoxon signed-rank test.

Results: Vitamin D₃ supplementation resulted in a significant reduction in symptom severity. The mean SNOT-22 score significantly decreased after the intervention (P = 0.004). Similarly, VAS scores showed a significant reduction following supplementation (P = 0.005), indicating improvement in pain and overall symptom burden.

Conclusion: Vitamin D supplementation was associated with significant improvement in symptoms and pain among patients with chronic rhinosinusitis. These findings suggest that vitamin D supplementation may serve as an effective adjuvant therapy for the management of chronic rhinosinusitis.

Keywords: Chronic rhinosinusitis; Pain; SNOT-22; Supplementation; Vitamin D₃

Citation: Siregar SM, Soetjipto, Romdhoni AC, Hakim MSA. effect of vitamin D₃ supplementation on Sinonasal Outcome Test-22 (SNOT-22) and visual analog scale scores in patients with chronic rhinosinusitis. Anaesth. pain intensive care 2026;30(6):710-715. DOI: 10.35975/apic.v30i6.3265

Received: January 29, 2026; Received: March 12, 2026; Accepted: April 17, 2026

A BIS guided comparison of propofol-fentanyl and propofol-dexmedetomidine combinations for intravenous sedation in endoscopic retrograde cholangiopancreatography (ERCP)

2026-08-09T22:59:14-06:00

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex endoscopic procedure which is sometimes quite challenging. Appropriate sedation and analgesia guarantee adequate patient participation.

Aim: To compare and evaluate the combinations of propofol-fentanyl and propofol-dexmedetomidine for intravenous sedation during ERCP using Bispectral Index (BIS).

Methods: Eighty-two patients undergoing ERCP under IV sedation were studied in two groups. Group A received fentanyl 1 mcg/kg IV, while Group B received dexmedetomidine 1 mcg/kg over 10 minutes. Both groups received an initial propofol bolus (1-2 mg/kg) followed by infusion (1-5 mg/kg/h) targeting a BIS value < 60. Additional Propofol doses were administered for BIS > 70.

Result: The onset of sedation was significantly faster in Group B (1.96 ± 0.43 min vs. 2.33 ± 0.47 min; p < 0.001). The total propofol dose required was significantly lower in Group B (initial dose: 40 ± 5.48 mg vs. 52.20 ± 4.19 mg; P < 0.001; additional dose: 83.17 ± 17.53 mg vs. 118.05 ± 18.87 mg; P < 0.001). Recovery time was shorter in Group B (9.08 ± 1.50 min vs. 11.14 ± 1.50 min; P < 0.001). Patient satisfaction was comparable between groups, but physician satisfaction was significantly higher for Group B (P < 0.05).

Conclusion: In this study, the Dexmedetomidine-propofol combination was associated with faster onset and recovery, reduced propofol requirements, and higher physician satisfaction during ERCP compared to Fentanyl-propofol.

Keywords: Endoscopic Retrograde Cholangiopancreatography; ERCP; Bispectral Index; Dexmedetomidine; Fentanyl; Sedation; Physician Satisfaction

Citation: Kunju SG, Bhat G, Bhat MG, Sorake CJ. A BIS guided comparison of propofol-fentanyl and propofol-dexmedetomidine combinations for intravenous sedation in endoscopic retrograde cholangiopancreatography (ERCP). Anaesth. pain intensive care 2026;30(6):716-723. DOI: 10.35975/apic.v30i6.3266

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025

The relationship between spiritual awareness and quality of life among families of children with epilepsy

2026-08-09T22:59:16-06:00

Background: Epilepsy is a common chronic neurological disorder among children, significantly impacting the lives of their families. Parental spiritual awareness plays an important role in enhancing their quality of life and their ability to cope with the challenges of caring for children with epilepsy. The objective of this study is to assess the level of spiritual awareness among parents of children with epilepsy and explore its relationship to their quality of life.

Methods: A cross-sectional study was conducted on a sample of 200 parents who had children affected with epilepsy. The sample distributed throughout three hospitals includes (Nasiriyah Teaching Hospital, Bint Al-Huda Teaching Hospital and Martyr Muhammad Al-Moussawi Children's Hospital). The reliability of the questionnaire was achieved through a pilot study and then presented to experts to prove its validity. The total number of items included in the questionnaire to measure spiritual awareness was 13-items and was 15-items to measure quality of life. The data was collected by using the interview technique.

Results: : The study showed that 60% of parents had a high level of spiritual awareness, while 75% of families had a moderate quality of life. The results also revealed a weak positive correlation between spiritual awareness and quality of life (r = 0.147). Statistically significant differences in spiritual awareness were found according to the father's age, family type, number of children, mother's education, father's occupation, and monthly income (p<0.05).

Conclusions: Spiritual awareness among parents enhances their ability to cope with their child's illness, thus improving their quality of daily life. The findings indicate the importance of educational programs to enhance and support spiritual awareness to improve parents' quality of life.

Keywords: Children, epilepsy, spiritual awareness, quality of life

Citation: Mohammed ZB, Hussain AMA. The relationship between spiritual awareness and quality of life among families of children with epilepsy. Anaesth. pain intensive care 2026;30(3):724-731. DOI: 10.35975/apic.v30i6.3268

Received: xxxx; Revised: xxxx; Accepted: xxxx

A randomized double-blind trial comparing lidocaine and dexmedetomidine infusions for intraoperative bleeding in patients undergoing functional endoscopic sinus surgery

2026-08-09T22:59:24-06:00

Objectives: To evaluate the efficacy of lidocaine and dexmedetomidine infusions in controlling intraoperative bleeding during FESS.

Methods: Sixty subjects undergoing FESS were involved in a randomized, double-blind investigation and allocated into two distinct treatment arms. Group L was treated with an initial lidocaine bolus of 1.5 mg/kg, subsequently maintained with a continuous infusion at a rate of 1 mg/kg/h. Conversely, Group D received a 1 µg/kg loading dose of dexmedetomidine, followed by a maintenance infusion adjusted to a rate between 0.4 and 0.7 µg/kg/h.

Results: Subjects in Group D demonstrated a notably improved surgical field quality, as indicated by a median Fromme score of 1 (range 0-2), in contrast to a median score of 2 (range 1-2) in Group L (P = 0.004). Furthermore, beginning 10 minutes post-induction and persisting until the end of surgery, Group D displayed notably minor heart rate and mean arterial pressure values. A significant prolongation in the time to first rescue analgesic requirement was observed in Group D compared to Group L (P < 0.001), accompanied by reduced total morphine consumption (P = 0.004). Postoperative pain, assessed using the visual analog scale, was notably lower in Group D at the 2-, 4-, and 6-hour time points. Surgeon satisfaction was notably superior for the surgical conditions provided by Group D (P = 0.028).

Conclusions: Dexmedetomidine infusion provides superior surgical field quality and postoperative analgesia compared to lidocaine during FESS, with a comparable safety profile.

Keywords: Dexmedetomidine, Functional Endoscopic Sinus Surgery, Intraoperative Bleeding, Lidocaine, Surgical Field Quality

Citation: Eldemerdash AM, Afifi SA, Afifi S. A Randomized Double-Blind Trial Comparing Lidocaine and Dexmedetomidine Infusions for Intraoperative Bleeding in Patients Undergoing Functional Endoscopic Sinus Surgery. Anaesth. pain intensive care 2026;30(6):732-741. DOI: 10.35975/apic.v30i6.3267

Received: xx; Revised: xx; Accepted: xx

Adherence to treatment in patients with cystic fibrosis in Jordan: a cross-sectional study on the effect of quality of life and patients’ beliefs

2026-08-09T22:59:30-06:00

Background: Although patients with cystic fibrosis (CF) may be prescribed the most appropriate treatment, non-adherence to treatment recommendations was reported to be common. However, the extent of adherence to different treatment regimens in patients with CF and whether the patient’s quality of life and patient’s and parents’ beliefs influence adherence to treatment in Jordan were not previously investigated.

Objective: The study aimed to measure the adherence rate to treatment in patients with CF and determine the effect of health-related quality of patient's life as well as patient and parent beliefs about CF treatment.

Method: At the outpatient clinics of Princess Rahma Hospital and the Medical Royal Services Hospital, 58 children (≤18 years) with cystic fibrosis (31 males; median [range] 9.0 [1.3-18.0] years) and their parents were selected. The Medication Adherence Report Scale (MARS) was used to measure medication adherence to CF treatment. Refined versions of the Beliefs about Medicines Questionnaire-specific (BMQ-S) were used to measure the treatment beliefs of patients and their parents. The Cystic Fibrosis Questionnaire-Revised (CFQ-R) was used to measure the health-related quality of life of the patients.

Results: Comparable adherence rate to cystic fibrosis treatment between patients (57.6%) and parents (61.2%) was found. Parental BMQ differential score (necessity–concern value) was associated with a child adherent (P = 0.005), but the patient quality of life was not found to be predictive of adherence (P > 0.05).

Conclusion: Low adherence to CF treatment regimens was revealed. Parental beliefs about CF treatments should be considered when addressing child adherence. Children with CF must be supported to ensure and maintain a satisfactory quality of life throughout their life span.

Keywords: Adherence; Beliefs; Children; Cystic fibrosis; HRQOL; Jordan; Medication Adherence Report Scale; Medicines Questionnaire-specific (BMQ-S)

Citation: Alshraiedeh N, Taybeh EO, Naser AY, Jalil B, El-Qasem A. Adherence to treatment in patients with cystic fibrosis in Jordan: a cross-sectional study on the effect of quality of life and patients’ beliefs. Anaesth. pain intensive care 2026;30(6):742-748. DOI: 10.35975/apic.v30i6.3270

Received: April 28, 2025; Revised: March 26, 2026; Accepted: April 11, 2026

The relationship between chronic musculoskeletal pain and depression

2026-08-09T22:59:35-06:00

One of the main causes of disability in the world, chronic musculoskeletal pain (CMP) is frequently linked to psychiatric conditions, especially depression. A growing body of research suggests that there is a complex and reciprocal link between CMP and depression. Persistent pain, diminished functional ability, and a lower quality of life are all ways that CMP can lead to the emergence of depressive symptoms. On the other hand, depression can worsen pain perception through psychological and neurological processes. According to recent epidemiological research, 20–40% of people with chronic pain also have depression. This emphasizes how crucial it is to use integrated management techniques that deal with the condition's psychological and physical components. This study addresses musculoskeletal pain and depression because it is crucial to comprehend this relationship in order to improve therapeutic outcomes and lessen the burden of chronic musculoskeletal illnesses.

Keywords: depression, mental health, biopsychosocial model, chronic pain, musculoskeletal pain

Citation: Abror ANF, Hidayati HB. The relationship between chronic musculoskeletal pain and depression. Anaesth. Pain intensive care 2026; 30(6):762-768. DOI: 10.35975/apic.v30i6.10.35975/apic.v30i6.3272

Received: April 15, 2026; Revised: April 26, 2026; Accepted: May 15, 2026

Individualized anesthetic strategy for day-case hemorrhoidectomy in a patient with muscular dystrophy: a case report

2026-08-09T22:59:40-06:00

Patients with muscular dystrophy face significant anesthetic challenges due to the increased risks of respiratory compromise, cardiac involvement, rhabdomyolysis, and adverse reactions to anesthetic agents. Careful planning of anesthetic techniques is particularly important in ambulatory surgery settings where rapid postoperative recovery and discharge are required. We report a case of a 31-year-old woman with muscular dystrophy who presented with symptomatic third-degree hemorrhoids. The patient had a history of extensive spinal fusion for thoracolumbar scoliosis, which made regional anesthesia technically difficult and potentially unsafe. Additionally, general anesthesia was considered a high-risk procedure because of the underlying neuromuscular disease. After preoperative evaluation, hemorrhoidectomy was successfully performed under local anesthesia. The patient was discharged without complications on the day of surgery. This case report highlights the importance of individualized anesthetic strategies in patients with muscular dystrophy undergoing anorectal surgery at a day-surgery clinic. When conventional anesthetic options are limited, local anesthesia is a safe and effective alternative. In day-case surgery, individualized anesthetic planning based on patient-specific factors, along with a meticulous and limited hemorrhoidectomy, is essential rather than rigid adherence to a single anesthetic technique.

Keywords: Ambulatory surgical procedure; Hemorrhoidectomy; Local anesthesia; Muscular dystrophy

Citation: Lee H, Lee KH. Individualized anesthetic strategy for day-case hemorrhoidectomy in a patient with muscular dystrophy: a case report. Anaesth. pain intensive care 2026;30(6):769-772. DOI: 10.35975/apic.v30i6.3273

Received: March 05, 2026; Revised: April 07, 2026; Accepted: April 26, 2026

Ultrasound-guided stem cell therapy for hip and knee osteoarthritis: a case report

2026-08-09T22:59:42-06:00

Introduction: Osteoarthritis (OA) is a progressive degenerative joint disease commonly affecting weight-bearing joints such as the knee and hip, leading to pain, stiffness, and functional impairment. Conventional treatments often provide only temporary symptom relief, prompting increasing interest in regenerative approaches such as mesenchymal stem cell therapy.

Case Report: We report a 60-year-old woman with a one-year history of left hip and knee pain refractory to conservative management. Clinical and imaging findings were consistent with osteoarthritis and suspected avascular necrosis of the left femoral head. Initial ultrasound examination demonstrated intra-articular effusion in both joints. The patient first underwent ultrasound-guided intra-articular corticosteroid injection followed by viscosupplementation. Due to persistent symptoms, regenerative therapy using umbilical cord–derived mesenchymal stem cells (UC-MSCs) was performed under ultrasound guidance. A total of 70 × 10⁶ cells were injected intra-articularly, including 20 × 10⁶ cells into each knee and 30 × 10⁶ cells into the left hip. Progressive improvement in pain and function was observed without significant adverse events.

Conclusion: Ultrasound-guided intra-articular UC-MSC therapy may represent a promising minimally invasive treatment option for patients with osteoarthritis who do not respond adequately to conventional therapy.

Keywords: hip osteoarthritis; knee osteoarthritis; mesenchymal stem cells; regenerative therapy; ultrasound-guided injection

Citation: Novy TCT, Lampah C, Putra DGS, Hadimartana D, Yaputri MJ. Ultrasound-guided stem cell therapy for hip and knee osteoarthritis: a case report. Anaesth. pain intensive care 2026;30(6):773-779.
DOI: 10.35975/apic.v30i6.3274

Received: xxxxxxxxx; Revised: xxxxxxxxxxx; Accepted: xxxxxxxxxx

Anesthetic management of a patient with difficult intubation and ventilation due to a congenital cervical teratoma

2026-08-09T22:59:47-06:00

Background: Congenital cervical teratoma is a rare tumor in neonates that can cause life-threatening airway obstruction. Early diagnosis and airway planning are essential to improve outcomes. Anesthetic management poses significant challenges due to airway deviation and limited visualization during intubation.

Case: We report a case of a 7-month-old male infant with a large cervical teratoma (10.5 × 10.8 × 10.7 cm). Anesthesia was induced using sevoflurane with spontaneous ventilation. Direct laryngoscopy was performed using a Magill laryngoscope while an assistant repositioned the mass to expose the trachea. Intubation was successful on the first attempt using a 4.5 mm ETT. Backup airway tools, including a fiberoptic laryngoscope and LMA, were prepared but not required. Surgery lasted 360 minutes, with minimal blood loss and stable intraoperative hemodynamics. The patient was transferred to the PICU postoperatively.

Discussion: This case highlights the importance of early planning, maintaining spontaneous ventilation, and preparing for difficult airway scenarios in pediatric cervical teratoma. Compared to previous reports, the success of first-attempt intubation and minimal complications highlight the value of manual mass manipulation and adequate preparation.

Conclusion: Airway management in congenital cervical teratoma requires careful preoperative evaluation, availability of advanced airway tools, and multidisciplinary coordination. Successful outcomes depend on preserving airway patency, ensuring optimal ventilation, and anticipating complications with thorough preparation.

Keywords: anesthesia; intubation; ventilation; management; congenital cervical teratoma;pediatric

Citation: Ahmad B, Santoso KH, Utarani A, Hanindito E. Semedi BP. Anesthetic management of a patient with difficult intubation and ventilation due to a congenital cervical teratoma. Anaesth. pain intensive care 2026;30(6):780-783. DOI: 10.35975/apic.v30i6.3275

Received: September 14, 2025; Revised: October 26, 2025; Accepted: June 02, 2026

Comparative efficacy of medications in preventing postoperative nausea and vomiting following general anesthesia in adults: a systematic review and meta-analysis

2026-08-09T22:58:29-06:00

Background: A prevalent adverse effect of general anesthesia is postoperative nausea and vomiting (PONV), resulting in considerable suffering for many surgical patients. Several medicines have been used to prevent PONV. Although these medications are commonly used, it remains unclear which ones are most effective—whether used alone or in combination—due to the absence of thorough head‒to-head trials.

Methods: This research was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A thorough literature review was performed utilizing databases such as PubMed and Google Scholar. Keywords such as "general anesthesia" OR "anesthesia," "postoperative nausea" OR "postoperative vomiting" OR "PONV," "drug" OR "medication" OR "prophylaxis," were used to locate pertinent studies.

Results: There was a substantial decrease in the incidence of PONV risk with interventions, particularly 1 mg intravenous haloperidol, which demonstrated superior efficacy compared with 5 mg dexamethasone and other interventions (RR=0.27, 95% CI: 0.13–0.55). The overall heterogeneity among studies assessing PONV prevention efficacy was high (I² = 74%, P = 0.00001). Adverse events associated with interventions were minimal, with little heterogeneity for severe adverse events (I² = 0%, P = 0.23) or adverse events overall (I² = 40%, P = 0.10). The risk of bias assessment indicated that most studies were of good quality, with 18 studies having a low or unclear risk of bias and one study being classified as high risk.

Conclusions: This study revealed a statistically significant difference between pharmacological medicines used for preventing PONV in adults. Specifically, 1 mg intravenous haloperidol was found to be more effective than 5 mg intravenous dexamethasone and other interventions used in other studies. However, generally, it can be concluded that all the interventions used in general anesthesia were successful in lowering PONV among adults.

Keywords: PONV, Haloperidol, General Anesthesia, Adverse Events

Citation: AlJahdali M, AlSaeed R, Alanazi A, Alghamdi R, Al-Nawab E. Comparative efficacy of medications in preventing postoperative nausea and vomiting following general anesthesia in adults: a systematic review and meta-analysis Anaesth. pain intensive care 2026;30(6):748-761. DOI: 10.35975/apic.v30i6.3271

Received: February 05, 2016; Revised: April 08, 2026; Accepted: April 08, 2026