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Background: The transversus abdominis plane block (TAPB) is frequently used for postoperative analgesia in abdominal surgery. However, it remains insufficient for analgesia during upper abdominal surgeries. Therefore, we compared the efficacy of the subcostal transversus abdominis plane block (STAPB) or rectus sheath block (RSB), in addition to the posterior transversus abdominis plane block (PTAPB), for postoperative analgesia in major gynecologic cancer surgeries. Methods: This prospective randomized study included 50 patients aged > 18 years (American Society of Anesthesiologists physical status II or III), who underwent gynecologic cancer surgery through a midline incision. All patients underwent PTAPB, STAPB, or RSB according to the randomization. The following parameters were recorded and compared: demographic data; intraoperative hemodynamic parameters; numeric rating scale (NRS) pain levels at the 1st, 6th, 12th, and 24th postoperative hours; opioid consumption; number of requests and boluses; adverse effects; surgical complications within 24 h. Results: Forty-seven patients were included in this study. In the STAPB group, postoperative 1, 12 and 24 h NRS values were lower; opioid consumption, opioid demand, and bolus numbers were lower during the postoperative 24 h as compared to RSB (P < 0.05). The intraoperative opioid and hemodynamic values were similar in both groups. Conclusions: STAPB in addition to PTAPB provides more effective analgesia than RSB for postoperative pain management in open gynecologic cancer surgeries. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed to compare the efficacy of epidural catheter and paravertebral block methods for the management of postoperative pain in patients undergoing thoracotomy and pneumonectomy and to develop clinical routines for optimal pain control. Methods: Hemodynamic data, arterial blood gas values, VAS scores (at ICU admission and postoperative 8, 16, and 24 h), total amount of rescue analgesics for 24 h, and mortality rates of patients undergoing pneumonectomy treated with preoperative thoracic epidural analgesia (TEA) and paravertebral block were compared. Results: Patients’ pain scores upon admission to the ICU and 8, 16, and 24 h postoperatively and the total amount of rescue analgesia administered during the study period were compared. VAS scores 8 and 16 h postoperatively were statistically similar between the groups. Additionally, postoperative ICU admission and 24-h VAS follow-up were significantly lower in the TEA group (p<0.05). The mean total dose (mg) of additional morphine at 24 h in PVB group was found to be statistically significantly higher than that in the TEA group (p=0.0001). Conclusion: The data of 2,422 operations were analyzed, and 34 patients were included in this study. No statistically significant difference was observed between the groups in terms of mortality. In this study, we observed that postthoracotomy pain can be managed by paravertebral block with preoperative bolus bupivacaine. This study confirmed that paravertebral block is an effective method for achieving analgesia during pneumectomy, as recommended by the PROSPECT guidelines. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Anesthesia / Anestezi Dergisi (JARSS) is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Coronavirus disease-2019 pandemic has shown us that the number of intensive care beds can be severely limited for postoperative care of high-risk patients. This situation has led to the need to develop a perioperative plan without intensive care support in the management of high-risk abdominal emergencies that cannot be postponed. In this case series, we shared our experiences of awake laparotomy under combined spinal epidural anesthesia in four cases in the related patient group. The patients' age and ARISCAT score median (min-max) values were respectively 73 years (56-85) and 68 (52-74), ASA scores were III, and all were at high risk for pulmonary complications. The probabilities of mortality, serious complications and expected hospital stay were 23% (11-36%), 40% (34-48%), and 15.5 (13.5-19) days. It was planned to operate the patients under combined spinal-epidural anesthesia. Epidural catheters were placed to cover the dermatome range of the planned surgical incision. Spinal anesthesia dose and initial level target was individualized according to the age and hemodynamic status of the patients, and 0.5% heavy-bupivacaine was administered. All patients underwent gastrointestinal resection at different levels, accompanied by anastomosis or stoma opening. The median (min-max) of the surgical times was 155 (120-210) minutes. No new clinical condition requiring intensive care or not in the preoperative period was observed in the service care of any patient. The hospital stay was observed as 7.5 (5-13) days. Koronavirüs hastalığı-2019 pandemisi bize yoğun bakım yatak sayısının yüksek riskli hastaların postoperatif takibi için ciddi şekilde kısıtlanabileceğini göstermiştir. Bu durum, ertelenemeyecek yüksek riskli abdominal acillerin yönetiminde yoğun bakım desteği olmaksızın bir perioperatif plan geliştirme ihtiyacı doğurmuştur. Bu olgu serisinde, ilgili hasta grubunda olan dört olguda kombine spinal epidural anestezi altında uyanık laparotomi deneyimlerimizi paylaştık. Hastaların yaş ve ARISCAT skor medyan (min-maks) değerleri sırasıyla 73 yıl (56-85) ve 68 (52-74), ASA skorları III ve hepsi pulmoner komplikasyonlar yönünden yüksek risklilerdi. Mortalite ve ciddi komplikasyon olasılıkları ile beklenen hastane yatış süreleri sırasıyla %23 (%11-36), %40 (%34-48), 15,5 (13,5-19) gün şeklindeydi. Hastaların kombine spinal-epidural anestezi altında opere edilmesi planlandı. Epidural kateterler planlanan cerrahi kesinin dermatom aralığını kapsayacak şekilde yerleştirildi. Spinal anestezi doz ve ilk seviye hedefi hastaların yaş ve hemodinamik durumuna göre bireyselleştirilerek %0,5 heavy-bupivakain ile yapıldı. Tüm hastalara farklı seviyelerden gastrointestinal rezeksiyon ve beraberinde anastomoz veya stoma açılması uygulaması yapıldı. Cerrahi süreler medyanı (min-maks) 155 (120-210) dakikaydı. Hiçbir hastanın servis takibinde yoğun bakım ihtiyacı gerektirecek veya preoperatif dönemde olmayan yeni bir klinik durum izlenmedi. Hastane yatış süreleri 7,5 (5-13) gün olarak izlendi. [ABSTRACT FROM AUTHOR]

Objective: Bispectral index (BIS) is a processed electroencephalogram that is extensively used to monitor intraoperative anesthetic depth. There have been studies on the effects of BIS monitoring during cardiac surgery on operative and postoperative results. However, these studies have reported different results. This study evaluated the effects of BIS monitoring on opioid use and postoperative recovery in patients undergoing on-pump coronary artery bypass surgery. Methods: A total of 114 patients who underwent elective on-pump coronary bypass graft surgery were ultimately included in the study and were prospectively randomized into BIS (-) and BIS (+) groups (51 and 63 patients respectively). In BIS (-) group, fentanyl doses were given according to clinical parameters such as hemodynamic changes and follow up pupils. In BIS (+) group, fentanyl doses were adjusted to keep BIS levels between 40 and 50. Results: There were no differences between the two groups with respect to age, sex, body mass index, smoking history and severity of comorbidities. Intraoperative fentanyl use was significantly lower in BIS (+) group; 2676±527.4 and 1632.5±325.5 in BIS (-) and BIS (+) groups respectively (p<0.001). The durations of postoperative intubation (10.5±2.7 vs. 8.05±2.9 h; p<0.001), intensive care unit (ICU) (2.8±0.9 vs. 2.4±0.7 days; p=0.02) and hospital (5.6±3.7 vs. 4.3±1.7 days; p=0.03) stays were also significantly shorter in BIS (+) group. Conclusion: BIS monitoring during on-pump coronary bypass surgery decreases the need for opioid use during surgery. It is also associated with decreased time to extubation and shorter durations of ICU and hospital stays. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study aimed to assess the specificity and sensitivity of three predictors of mortality in patients with sepsis: the presence of infection-causing microorganisms, the severity of disease classifications, and biomarkers. Materials and Methods: We retrospectively analyzed the records of 76 patients. All the patients were aged above 18 years, and were diagnosed with sepsis, admitted, treated, and followed-up in our hospital’s reanimation unit between 01/01/2017 to 01/01/2018. Patients’ demographic data, treatments in the intensive care unit, causes and durations, biochemical analyses, 24-hour Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scores, Sequential Organ Failure Assessment (SOFA) scores, and microorganisms detected through culture analysis were analyzed in terms of their specificity and sensitivity in predicting mortality and morbidity. Results: Of the patients analyzed, 46.05% were women and 53.95% were men. The average age was 62.67±18.1 years, and the mortality rate was 51.31%. While sepsis developed postoperatively in 60.53% of patients, 39.47% of patients developed sepsis due to an internal medical pathology. The average duration of treatment was 35±43.7 days. The most common infection-causing pathogen was Klebsiella pneumoniae, followed by Staphylococcus aureus. In terms of fungal infections, Candida spp. was found to be the most common. In the first 24 hours of treatment, high SOFA, APACHE-II, procalcitonin values, and infection with Enterococcus faecalis were all found to be independent risk factors for mortality (p<0.05). Conclusion: In patients with sepsis, severity of disease classifications and E. faecalis infection are independent risk factors of high mortality rates, and should be considered in the evaluation of patients. [ABSTRACT FROM AUTHOR]

Objective: The developing brain is vulnerable to the negative effects of anaesthetics. We aimed to investigate the effect of isoflurane and polyunsaturated fatty acids (PUFAs) on cognition. Methods: A total of 64, ten days old rats were randomly divided into 4 groups: group O2 (oxygen group), group Iso (isoflurane group), group Iso-S (isoflurane+saline) and group Iso-PUFAs (isoflurane+intraperitoneal [IP] PUFAs emulsion). Rats in groups Iso, Iso-S and Iso-PUFAs were exposed to 1.5% isoflurane in 50% oxygen for 6 hours. Rats in group O2 breathed only 50% oxygen. Before anaesthesia, rats in group Iso-S were administered 0.5 mL isotonic and rats in group Iso-PUFAs were administered 5 mL kg-1 PUFAs emulsion by IP injection. The Morris water maze (MWM) test was performed on postnatal 28-33 days. Histological evaluation and immune histochemical staining (Bcl-2 antibody) were performed on postnatal day 11 on rat brains. Results: As demonstrated by the reduction in the escape latency on days 3, 4 and 5 compared with day 1, all rats learned the task during the acquisition period. In contrast to others, rats in group Iso spent significantly lower time to find the platform on day 2 than on day 1 (p=0.034). No significant difference was found among the groups in terms of time spent in finding the platform. There were no significant differences in probe trials, histological features and Bcl-2 immunoreactivity among the groups. Conclusion: Isoflurane did not cause cognitive dysfunction and neuronal death, and a single dose of PUFAs emulsion had no effect on cognition either. [ABSTRACT FROM AUTHOR]

Objective: In this study, we evaluated the effects of body mass index on mortality and morbidity after cardiac surgery. Method: The record of 813 patients who performed open-heart surgery in our clinic were retrospectively analyzed. 505 patients with complete records were included in the study. Postoperative mortality and morbidity developments were compared in patients with a body mass index of (BMI) ≥30 kg/m2 and BMI ≤30 kg/m2 from the records. Results: 389 (%70) of patients were BMI < 30 kg/m2, non-obese (Group N), 166 of them were BMI ≥30 kg/m2, obese (Group OB). The mean age of groups (59.2±12.5, 59.6±9.6 years, respectively, p=0.65) was similar. Female gender, Diabetes Mellitus (DM), hypertension, hyperlipidemia were more common in Group OB (p<0.05). Intraoperative cardiopulmonary bypass (101±43, 98±42 p=0.26) and the duration of aortic cross clamp (64±32.7, 61.6±32.5 p=0.21) were similar. Post-operative complications of pulmonary (%19, %10) and renal (%13, %9) were significantly higher in Group OB (p<0.05), tamponade (%3.1, %0.6) and bleeding revision (%5.7, %1.8) were higher in Group N (p<0.05). Mortality occurred in 27 (5%) patients after surgery. There was no significant difference between mortality rates, ICU and hospital stay (p<0.05). Conclusion: High BMI (≥30 kg/m2) is associated with respiratory system and renal complications after cardiac surgery, and low BMI (< 30 kg/m2) is associated with morbidities such as tamponade and bleeding revision. [ABSTRACT FROM AUTHOR]

Objective: Transcatheter Aortic Valve Implantation (TAVI) procedure is a minimally invasive technique that have been applied in aortic stenosis pathologies which carry high-risk for conventional surgery. Although there is no definitive consensus on anesthesic applications, general, local anesthesic and sedation techniques are being used. In this study, we aimed to evaluate our anesthesia methods used in TAVI procedures, and their effects on results. Method: The archive records of patients who underwent TAVI procedure due to the severe aortic stenosis between 2013 and 2017 were analyzed. Anesthesic approaches, features of the procedure, and patient outcomes were evaluated. Results: Of the 100 (50 women/50 men) patients who underwent TAVI, 15 had general anesthesia (GA) (15%), and 49 had local anesthesia with sedation (LS) (49%), and 36 had local anesthesia with monitorized anesthesia care (LM) (36%). In the LM group, the anesthesia and procedure times were significantly shorter compared to the GA and LS groups (p<0.05). Vasoactive agenst, and fluid infusions were used more frequently and intensive care (ICU) stay were prolonged in the GA (p<0.05). While the 30-day mortality was 14% in all groups, the mortality rate in the GA was significantly higher than the LS and LM (p=0.007). Conclusion: With an increase in technological advances and experience, the need GA for TAVI has decreased and the anesthesia technique has shifted sharply to applications of LS and LM with the advantages they provided. However, regardless of the anesthesia technique, all patients should be followed up closely in the intraoperative period for good patient outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The care of pediatric patients with mental retardation (MR) who will undergo surgery for families may become complex and stressful. This study aimed to investigate the effect of MR grade on the anxiety of parents of pediatric patients who will undergo surgery under general anesthesia. Methods: The parents of 40 pediatric patients with group MR and 60 pediatric patients with normal mental state (group NMS) who underwent surgery under general anesthesia were subjected to preoperative State-Trait Anxiety Inventory (STAI) test. In addition to parents’ demographic data, such as age, sex, educational status, occupational status, and consanguineous marriages, the effect of sex and MR grade of children on anxiety was examined. Results: The patient’s demographics showed nonsignificant differences. No significant difference was found between the parents of the two groups in terms of SAI and TAI scores. Similarly, parental occupation, education level, and sex of the child had no effect on the SAI and TAI scores. The presence of consanguineous marriages was significantly higher in group MR. In group NMS, a significant positive correlation was found between SAI and TAI scores of the parents. Conclusion: No correlation was found between the presence and MR grade of the child and parents’ SAI and TAI scores. Therefore, no relationship was found between MR in children and parental anxiety levels. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the early extubation rate and the factors affecting early extubation in pediatric patients undergoing cardiac surgery., Methods: Between August 1st, 2020 and December 1st, 2021, a total of 528 pediatric patients (264 males, 264 females; median age: 4 months; range, 2 days to 24 months) who were followed in the pediatric cardiac intensive care unit after congenital heart surgery were retrospectively analyzed. Demographic and clinical characteristics of the patients including operation and intensive care data were obtained from the medical records. Patients included in the study were categorized into three groups as the group of patients who were extubated in the operating room (fast-track extubation), the group of patients who were extubated in the first 6 h of the operation (early extubation), the group of patients who were extubated after the postoperative 6 h or the group of patients who were not extubated or died (delayed extubation)., Results: Sixty-eight (12.9%) cases had fast-tract extubation, 124 (23.6%) cases had early extubation, and 335 (63.6%) cases had delayed extubation. The median age of the patients in the delayed extubation group was three months, which was significantly lower than those of the other groups (p<0.05). Reintubation rates were 1.5% in the fast-tract extubation group, 2.5% in early extubation group, and 9% in delayed extubation group (p<0.05). The median intensive care unit stay was 3, 5, and 10 days, respectively (p<0.05). Length of hospitalization was significantly higher in the delayed extubation group compared to the other groups (p<0.05). Neonatal age group, Risk Adjustment for Congenital Heart Surgery 1 score >4, Society of Thoracic Surgeons- European Association for Cardio-Thoracic Surgery mortality category >3, cardiopulmonary bypass time >100/min, vasoactive inotrope score >8, acute kidney injury >2, and low weight were found to be independent risk factors for delayed extubation., Conclusion: Fast-track and early extubation can be successfully applied with low reintubation rates in selected cases with congenital heart surgery. Age, body weight, presence of genetic syndrome, operational risk category, and procedure time may affect the extubation time., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2023, Turkish Society of Cardiovascular Surgery.)