Liver transplantation is a complex surgical procedure in which various forms of coagulation dysfunction can occur, including perioperative hypercoagulability. The hemostasis balance in liver graft recipients with end-stage liver disease can shift to thrombosis or haemorrhage, depending on the associated risk factors and clinical conditions. Hypercoagulability can result in serious complications such as thromboembolism, which can affect the vessels of the newly transplanted liver graft. Standard coagulation tests (SCTs), such as prothrombin time and activated partial thromboplastin time (aPTT), have a poor ability to diagnose and monitor an early stage of hypercoagulability. Recent studies demonstrated that viscoelastic hemostatic elastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are promising alternative tools for diagnosing hypercoagulability disorders. VETs measure clotting and clot formation time, clot strength (maximum clot firmness), fibrin and platelet contribution to clot firmness, and fibrinolysis, which makes them more sensitive in identifying liver graft recipients at risk for thrombosis as compared with SCTs. However, developing evidence-based guidelines for the prophylaxis and treatment of hypercoagulability based on VET results is still needed.

Trauma-induced coagulopathy (TIC) at admission to the emergency department is associated with severe bleeding, massive transfusion, increased morbidity, and mortality. There are significant regional variations in the accessibility and acceptance of point-of-care technology, such as viscoelastic hemostatic testing (VET), for coagulation monitoring and bleeding management in the Arabian Gulf council countries (GCC). Notable regional differences among these countries are mainly due to variation in the awareness of the benefits of VET-guided bleeding management using rotational thromboelastometry (ROTEM) or thromboelastography (TEG), compared with a transfusion ratio-based approach using shock packs, rather than for economic reasons. This review highlights the superiority of VET-guided bleeding management in severe trauma over conventional coagulation tests (CCTs) for early TIC detection and the importance of monitoring hemostatic disorders, whether hypocoagulability or hypercoagulability. VET consistently outperforms traditional coagulation tests in detecting early coagulation abnormalities and predicting massive transfusion and mortality in major trauma. Besides hyperfibrinolysis, fibrinogen deficiency often represents the first issue in TIC. Recent meta-analyses consistently demonstrated a reduction in mortality by implementing VET-guided bleeding management algorithms in severe trauma. Several studies demonstrated that VETs are valuable tools for massive transfusion and mortality prediction in bleeding patients with severe trauma. There is a notable variation in VET adoption and practice across trauma settings in the Arab Gulf. GCC-specific primary evidence is limited, with the Qatar cohort representing the largest directly identified regional study.

Background & objective: Little is known about Malignant Hyperthermia (MH); as serious hypermetabolic response to anesthetic-related agents regarding its existence inside Saudi Arabia (KSA). Few MH incidents have been reported in periodic medical journals. To our knowledge, this nineteen-questionnaire survey is the first to be performed in KSA regarding MH. The main objective was to report suspected MH patients and the secondary objectives were to assess the availability of dantrolene vials, the management and outcome of the suspected patients. Methodology: Google Forms were sent to the anesthesiologists working in Ministry of Health hospitals at three geographical districts in KSA (Eastern Province, Riyadh, and Western Province) through anesthesiologists’ social platforms. The electronic link was accessible from October 10, 2022, to April 02, 2024. Results: Most of the 174 anesthesiologists, who replied, were consultants (65.5%), and 70.7% had more than 10 years of experience. 32 (18.4%) anesthesiologists reported having dealt with suspected MH patients during their careers, of which 21 were inside KSA hospitals. Anesthesiologists reporting having six or more vials of dantrolene were 113/174 (64.9%), whereas 23 (13.2%) reported having 3 to 6 vials and 13 (7.5%) 1 to 3 vials. Only 25 (14.4%) reported no vials. Of the anesthesiologists, 66 (37.9%) were aware of the locations of dantrolene in their city. According to 51.7% of respondents, 120 mg of dantrolene may be prepared in 30 min. Conclusion: Our survey sheds light on susceptible MH cases in Saudi Arabia that remain unpublished or inadequately reported. Establishing a dedicated MH management and database center is a pressing need. The current low number of reported MH cases should not be used as a justification to delay such an initiative, particularly given the absence of accurate statistics. Moreover, the study demonstrates variability in hospital preparedness for MH emergencies, which needs to be addressed urgently. Hospitals with inadequate monitoring systems or insufficient dantrolene supplies need to meet the required standards for optimal patient safety. Keywords: Anesthesia; Dantrolene; Malignant Hyperthermia; Perioperative Complications Citation: Yassen KA, Al Herz PM, Alnami MS, ALmana AA, Osama AMK, Dur I Shahwar, AlSubaie RS, Saleh S, Khan I. Query malignant hyperthermia patients in Saudi Arabia; A questionnaire-based mini-survey. Anaesth. pain intensive care 2025;29(5):328-337. DOI: 10.35975/apic.v29i5.2637 Received: December 27, 2024; Revised: January 23, 2025; Accepted: May 17, 2025