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Background: The aim of our study is to assess the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) on 28-day mortality in patients admitted to the intensive care unit with crush syndrome following the Kahramanmaraş earthquake in Türkiye., Methods: A total of 63 adult patients with crush syndrome admitted to the intensive care unit after the earthquake were enrolled in this study. The medical records of the patients were examined using follow-up forms and the hospital data system., Results: The mean age of the patients was 38.9±17.3 years, and the median time under debris was 31.5 hours. The 28-day mortality rate was 27%. In univariate generalized estimating equations (GEE) and other analyses, variables that are significant (or candidate variables) between 28-day mortality groups included age as a biological factor. These variables were included in the multivariate GEE model. The effects of continuous renal replacement therapy (CRRT), serum sodium concentration, Sequential Organ Failure Assessment (SOFA) score, and PLR on mortality were statistically significant., Conclusion: Elevated SOFA scores, the necessity for CRRT, increased serum sodium levels, and decreased PLR values are associated with increased 28-day mortality in patients with crush syndrome after an earthquake.

Objective: In this survey study, we aimed to investigate thoracic anaesthesia practices in Turkey., Methods: The survey was sent to the members of the Turkish Society of Anesthesiology and Reanimation by e-mail. Participants were asked to answer 35 questions about their thoracic anaesthesia practice., Results: A total of 148 questionnaires were completed. Most of the participants preferred double-lumen endobronchial tube for one-lung ventilation. 69.6% of auscultation method and 45.9% of fiberoptic bronchoscope method were used to confirm the tube position. The most frequently used additional monitoring method was invasive blood pressure. Generally, intravenous anaesthetic agents were preferred for anaesthesia induction, and a combination of inhalation and intravenous agents was used for anaesthesia maintenance. Most of the participants used intraoperative lung-protective mechanical ventilation strategies. For postoperative analgesia, 75% of participants preferred regional analgesic techniques and 89.9% of them used routine opioid agents. In general, moderate amount of fluid was applied (57.4%), crystalloids were the first choice in fluid therapy, and intraoperative hypotension was generally treated with controlled intravenous fluid and vasoactive agents. The haemoglobin threshold value for blood transfusion was stated as 8 g dL-1 by 35.8% of participants., Conclusions: Our data showed that the anaesthesia management of thoracic surgery in Turkey is generally compatible with the current international guidelines. However, the following conclusion was reached: training on blood transfusion, the use of fiberoptic bronchoscope, regional techniques, and intraoperative additional monitoring would be beneficial, and a national consensus should be reached on the thoracic anaesthesia practice.

Introduction: The aim of this study was to reveal the effect of the individual's lifestyle and personality traits on the disease process in patients with sepsis and to have clinical predictions about these patients., Materials and Methods: The study was planned as a multi-center, prospective, observational study after obtaining the approval of the local ethics committee. Patients were hospitalized in different intensive care units. Besides demographics and personal characteristics of patients, laboratory data, length of hospital and ICU stay, and mortality was recorded. Two hundred and fifty-nine patients were followed up in 11 different intensive care units. Mortality rates, morbidities, blood analyses, and personality traits were evaluated as primary outcomes., Result: Of the 259 patients followed up, mortality rates were significantly higher in men than in women (p= 0.008). No significant difference was found between the patients' daily activity, tea and coffee consumption, reading habits, smoking habits, blood groups, atopy histories and mortality rates. Examining the personal traits, it was seen that 90 people had A-type personality structure and 51 (56.7%) of them died with higher mortality rate compared to type B (p= 0.038). There was no difference between personalities, in concomitant ARDS occurrence, need for sedation and renal replacement therapies., Conclusions: Among individuals diagnosed with sepsis/septic shock, mortality increased significantly in patients with A-type personality trait compared to other personality traits. These results showed that personal traits may be useful in predicting the severity of disease and mortality in patients with sepsis/septic shock.

Aim: Clinical application of insulin infusion therapy is usually accomplished with regular human insulin. It is known that the regular insulin adsorbed to the hydrophobic surfaces and different approaches were implemented into the clinical practices. It was aimed to evaluate the rate of adsorption of insulin to polypropylene (PP) bags and polyvinyl chloride (PVC) infusion sets and stability of insulin during the infusion., Methods: A 100 IU insulin was added to PP bags containing 100 mL of 0.9% NaCl solution (n = 6). The infusion was started at a rate of 2 mL/h using infusion sets in the PVC structure. Insulin quantification was performed in the samples taken both from the bag and from the end tip of the infusion set during infusion. The stability of insulin solutions stored at room (+25°C) and refrigerator (+4°C) temperatures were compared. Samples were analysed using reverse-phase high-performance liquid chromatography., Results: No statistically significant difference was found between the concentrations of the samples taken from the bags stored at room and refrigerator temperatures at the 4th, 12th, and 24th hours (P > .05). It was seen that the adsorption rate of insulin to PVC set was 57% and PP bags is at most 5% at the 24th hour., Conclusion: When PP bags are used for insulin infusion, it is predicted that 24-hour change can be made instead of frequent change. In addition, losses caused by the high rate of insulin adsorption to PVC infusion sets should be considered and PP infusion sets would be the better option to use if available., (© 2020 John Wiley & Sons Ltd.)

Objective: To compare the effects of ultrasound-guided thoracic paravertebral block (PVB) and intravenous paracetamol on postoperative pain control in paediatric patients undergoing percutaneous nephrolithotomy (PNL)., Methods: Forty patients aged 1-5 years, with an American Society of Anesthesiologists physical status I-II, scheduled for PNL were enrolled into this prospective randomised controlled trial. After arrival in the operating room, all patients were administered standardised general anaesthesia. Patients in Group PVB received ultrasound-guided PVB using bupivacaine 0.5% at a total volume of 0.5 mL kg -1 at the vertebral levels T11, T12 and L1. Patients in Group P were administered paracetamol intravenously (15 mg kg -1 ) before the beginning of surgery. Patients in both groups were given tramadol (1 mg kg -1 ) for supplemental analgesia. Patient demographics, haemodynamic parameters, peripheral oxygen saturation and sevoflurane concentration were recorded. The Face, Legs, Activity, Cry and Consolability pain scores; satisfaction of parents; the number of patients requiring supplemental analgesia; and complications were evaluated during the postoperative period., Results: Pain scores were significantly lower in Group PVB compared with Group P (p=0.001). There were no analgesic requirements in Group PVB; however, all patients needed a supplemental analgesic in Group P. Parental satisfaction was higher in Group PVB than in Group P., Conclusion: This study demonstrated that ultrasound-guided PVB provides more effective postoperative analgesia with no side effects compared to intravenous paracetamol in children undergoing PNL., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

Background/aim: The modifiedYa l ePreoperative Anxiety Scale (m-YPAS) is widely used to measure children’s anxiety levels. The aim of this study was to translate the m-YPAS into Turkish and test its validity and reliability in Turkish children., Materials and Methods: The English version of the m-YPAS was translated into Turkish using the forward-back-forward translation technique. This study enrolled 120 children. The m-YPAS was administered to 120 children who were recorded on video. The State-Trait Anxiety Inventory for Children (STAIC) was used for only 30 of 120 children. The videotapes were evaluated by two experienced observers [an anesthesiologist, ObA(an), and a psychologist, ObB(ps)]. The interrater reliability, concurrent validity, sensitivity, specificity, and positive and negative predictive values were analyzed., Results: The mean age of the children was 7.8 ± 2.2 years.The weighted kappa values of the m-YPAS between observers were in substantial agreement (κw = 0.74–0.80) and almost perfect agreement (κw = 0.84–0.85). The Cronbach alpha values were high [α = 0.85 for ObA(an) and α = 0.86 for ObB(ps)]. The correlation between m-YPAS and STAIC showed good agreement (P < 0.05). The sensitivity and specificity were high, and the predictive value was 92.86%., Conclusion: The Turkish version of the m-YPAS can be applied as a reliable and valid observational questionnaire for Turkish children., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: In intensive care unit (ICU) patients, intravenous (iv) and volatile agents are used for sedation. The aim of the present study was to investigate the effects of dexmedetomidine and sevoflurane on pulmonary mechanics in ICU patients with pulmonary disorders., Methods: After approval of the ethical committee and informed consent between the ages of 18-65 years were obtained, 30 patients with an American Society of Anesthesiologist status I-III, who were mechanically ventilated, who had pulmonary disorders and who needed sedation were included in the study. Exclusion criteria were severe hepatic, pulmonary and renal failures; pregnancy; convulsion and/or seizure history; haemodynamic instability and no indication for sedation. Patients were divided into two groups by randomised numbers generated by a computer. For sedation, 0.5% -1 % sevoflurane (4-10 mL h -1 ) was used by an Anaesthetic Conserving Device in Group S (n=15), and iv dexmedetomidine infusion (1 μg -1 kg -1 10 min -1 loading and 0.2-0.7 μg -1 kg -1 h -1 maintenance) was performed in Group D (n=15). Arterial blood gas analysis, airway resistance, positive end-expiratory pressure (PEEP), frequency, tidal volume (TV), peak airway pressure (Ppeak), static pulmonary compliance and end-tidal CO 2 values were recorded at baseline, 1, 3, 6, 9, 12 and 24 h., Results: Demographic data, airway resistance, PEEP, frequency, TV, Ppeak and static pulmonary compliance values were similar between the groups. PaCO 2 and end-tidal CO 2 values were higher in Group S than in Group D. Sedation and patient comfort scores were similar between the two groups., Conclusion: Both sevoflurane and dexmedetomidine are suitable sedative agents in ICU patients with pulmonary diseases., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

Objective: To determine the blood sevoflurane and desflurane concentrations during one-lung ventilation (OLV)., Design: Randomized, single-blind study., Setting: Single university hospital., Participants: The study comprised 24 patients, 35 to 70 years old who were scheduled for either a major abdominal surgery or thoracotomy., Interventions: The patients were divided into the following 4 groups: sevoflurane two-lung ventilation (TLV), sevoflurane OLV, desflurane TLV, and desflurane OLV. Vaporizers were set at 1.5% sevoflurane or 6% desflurane., Measurements and Main Results: In the TLV groups, blood samples were taken in 10-minute intervals starting 40 minutes after the start of TLV (T 1 -T 9 ) for blood gas analysis and gas chromatography. In the OLV groups, the first sample was collected at 40 minutes of TLV (T 1 ), and other samples were collected in 10-minute intervals from the start of OLV (T 2 -T 9 ). Saturation of peripheral oxygen (SpO 2 ), hemodynamic variables, and inspired and end-tidal volatiles were recorded. The fraction uptake of the volatile agents (F) was calculated for each patient at the same time points. The mean arterial sevoflurane concentration in the sevoflurane OLV group at T 1 decreased from 40.7 ± 4.4 to 30.2 ± 2.5 µg/mL at T 3 (p = 0.014, 26% decrease). In the OLV desflurane group, the mean arterial desflurane concentration at T 1 declined from 224.6 ± 44.8 to 159.8 ± 32 µg/mL at T 3 (p=0.018, 29% decrease). However, the reduction of sevoflurane concentration compared with that of desflurane at T 3 was not statistically significant (p = 0.31). In addition, the fraction uptake of the volatile agents values significantly increased at the start of OLV (p = 0.001)., Conclusion: An OLV procedure causes a decrease in the both arterial and venous blood concentrations of sevoflurane and desflurane. This reduction is believed to be due to ventilation-perfusion mismatch., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Objectives: Pediatric patients frequently require deep sedation or general anesthesia for colonoscopy. This study was designed to compare the sedative efficacy of remifentanil-ketamine combination with propofol-ketamine combination in children undergoing colonoscopy., Methods: Seventy patients, between 2 and 16 years of age, scheduled for diagnostic colonoscopy were randomly allocated into two groups. Remifentanil-ketamine group received intravenous ketamine 2mg.kg -1 and remifentanil 0.25μg.kg -1 combination, followed by 0.1μg.kg -1 .min -1 remifentanil infusion. Propofol-ketamine group received intravenous propofol 1 and 2mg.kg -1 ketamine combination, followed by 1mg.kg -1 .h -1 propofol infusion. In the case of children discomfort (cry, movement, and cough), remifentanil 0.1μg.kg -1 in the remifentanil-ketamine group or propofol 0.5mg.kg -1 in the propofol-ketamine group were administered to improve children discomfort. Despite the therapy given above, if children still experience discomfort, 1mg.kg -1 of ketamine was administered as a rescue drug, regardless of the group. Ramsay sedation score, hemodynamic variables, drug requirements, gastroenterologists' satisfaction, colonoscopy duration, recovery time, and side effects were recorded throughout the procedure and the recovery period., Results: The percentage of patients with a Ramsay sedation score of 4 or higher during the procedure was 73.5 and 37.1% in remifentanil-ketamine and propofol-ketamine groups, respectively (p=0.02). Systolic and diastolic blood pressure variables were significantly higher only after induction in the remifentanil-ketamine group than in the propofol-ketamine group (p=0.015)., Conclusion: Coadministration of ketamine with either remifentanil or propofol effectively and safely provides sedation and analgesia in children undergoing colonoscopy. Sedation scores were significantly better in remifentanil-ketamine group than in propofol-ketamine group., (Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background/aim: We aimed to investigate the effect of long-term use of dexamethasone and prednisolone on the reversal effect of sugammadex. Materials and methods: TTwenty-four male Wistar albino rats were divided into three groups. Dexamethasone (600 µg/kg) was given to group D, prednisolone (10 mg/kg) was given to group P, and an equivalent volume of saline per day was administered intraperitoneally to group S for 14 days, respectively. The left hemidiaphragm with attached phrenic nerve was maintained in Krebs solution. Sugammadex (30 µmol/L) was applied while rocuronium (10 µmol/L) was present in an organ bath and a single twitch was obtained. The right hemidiaphragm was used for both adult ( ε-subunit) and fetal nicotinic acetylcholine receptor (AChR) ( ε-subunit) determination using polymerase chain reaction. Results: All animals lost weight, except group S. The mean baseline single-twitch tension was lower in both group D (14.4 ± 1.7 g) and group P (12.68 ± 0.05 g) than group S (16.8 ± 0.5 g) (P < 0.001). When sugammadex was added to the organ bath while rocuronium was present, the single twitch was measured to be lower in both group D (11.7 ± 0.7 g) and group P (11.5 ± 0.78 g) than group S (16.5 ± 0.24 g) (P < 0.001). Ɣ-AChR expression was higher in both dexamethasone and prednisolone than in saline. Conclusion: Long-term medication with dexamethasone and prednisolone caused muscle weakness, resistance to neuromuscular blockers, and upregulation of immature Ɣ-AChR and reduced the neuromuscular reversal effect of sugammadex., (CC-BY 4.0)

Purpose: Adding ketamine to propofol has been suggested to be useful for sedation and general anesthesia. This study aimed to determine the effect of TIVA with different ratios of ketofol on recovery in children., Methods: Seventy-five children aged 3-12 years and undergoing adenoidectomy and/or tonsillectomy surgery were randomized into three groups. Ratios of 1:5, 1:6.7 and 1:10 ketamine-propofol mixture (ketofol) were prepared in the same syringe for groups I, II and III, respectively. Induction and maintenance of anesthesia were performed with 1:5, 1:6.7 and 1:10 ratios of ketofol in groups I, II and III, respectively. A McFarlan infusion dose regimen was used (15 mg/kg/h for 15 min, 13 mg/kg/h for 15 min, 11 mg/kg/h for 30 min) and infusion rates were decreased for the different ratios. Infusion rates were reduced to 67, 80 and 90% of the McFarlan dose regimen for groups I, II and III, respectively. Extubating time, length of stay in PACU, postoperative PAED and FLACC scores were recorded., Results: Extubating time was significantly lower [mean 254.3 ± 92.7 s (95% CI 216.6-292.6, p = 0.001)] in group III than in groups I and II [371.3 ± 153 s (308.1-434.48) and 343.2 ± 123.7 s (292.2-394.3), respectively]. Length of stay in the PACU was lower in group III [median 15 min (interquartile range 15-20, p = 0.001)] than in groups I and II: 20 (15-27.5) and 20 min (20-27.5), respectively., Conclusion: TIVA with a 1:10 ratio of ketofol admixture with a 90% reduction of McFarlan regimen can provide improved recovery conditions., Trial Registration: ClinicalTrials.gov identifier: NCT02848963.

Probiotics have been used for centuries in making fermented dairy products. The health benefits related to probiotics consumption are well recognized and they are generally regarded as safe (GRAS). Their therapeutic effects are due to the production of a variety of antimicrobial compounds, such as short-chain fatty acids, organic acids (such as lactic, acetic, formic, propionic and butyric acids), ethanol, hydrogen peroxide and bacteriocins. Ventilator-associated pneumonia (VAP) is a nosocomial infection associated with high mortality in intensive care units. VAP can result from endotracheal intubation and mechanical ventilation. These interventions increase the risk of infection as patients lose the natural barrier between the oropharynx and the trachea, which in turn facilitates the entry of pathogens through the aspiration of oropharyngeal secretions containing bacteria into the lung. In order to prevent this, probiotics have been used extensively against VAP. This review is an update containing information extracted from recent studies on the use of probiotics to treat VAP. In addition, probiotic safety, the therapeutic properties of probiotics, the probiotic strains used and the action of the probiotics mechanism are reviewed. Furthermore, the therapeutic effects of probiotic treatment procedures for VAP are compared to those of antibiotics. Finally, the influences of bacteriocin on the growth of human pathogens, and the side-effects and limitations of using probiotics for the treatment of VAP are addressed.

Objective: We compared the effects of the laryngeal mask airway (LMA), face mask and Cobra perilaryngeal airway (PLA) in the airway management of spontaneously breathing paediatric patients undergoing elective inguinal surgery., Methods: In this study, 90 cases of 1-14-year-old children undergoing elective inguinal surgery were scheduled. The patients were randomly divided into three groups. Anaesthesia was provided with sevoflurane and 50%-50% nitrous oxide and oxygen. After providing an adequate depth of anaesthesia, supraglottic airway devices were inserted in the group I and II patients. The duration and number of insertion, haemodynamic parameters, plateau and peak inspiratory pressure and positive end-expiratory pressure of the patients were recorded preoperatively, after induction and at 5, 10, 15 and 30 min peroperatively., Results: There were no statistical differences between the groups in terms of haemodynamic parameters (p>0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (p<0.05)., Conclusion: We concluded that for airway safety and to avoid possible complications, LMA and Cobra PLA could be alternatives to face mask and that the Cobra PLA provided lower airway pressure and had a faster and more easy placement than LMA.

Objective: This study aimed to evaluate the effects of ultrasound-guided rectus sheath block in gynaecological surgery with Pfannenstiel incision., Methods: After the approval of the ethics committee and the patients' consent, 75 ASA I-II patients who were aged between 20 and 70 years and scheduled for a gynaecological surgery with Pfannenstiel incision were included in this study. After induction of general anaesthesia, patients were randomly divided into three groups. In Group UR patients (n=25), ultrasound-guided rectus sheath block with 0.25% levobupivacaine (0.2 mL kg(-1)) was performed. In Group SR patients (n=25), surgical rectus sheath block with 0.25% levobupivacaine (0.2 mL kg(-1)) was applied. In Group T (n=25) patients, tramadol (2 mg kg(-1)) was intravenously administered 30 min before the end of surgery. Patient-controlled analgesia device was established for postoperative pain relief in all groups. Haemodynamic data and inspired sevoflurane concentration were recorded during the operation. Pain scores, total tramadol consumption, supplemental analgesic requirement and side effects were postoperatively evaluated., Results: Demographic characteristics, duration of surgery and haemodynamic parameters were similar between the groups. Inspired sevoflurane concentration (%) and VAS scores were significantly lower in Group UR than those in Groups SR and T. Total tramadol consumption was significantly lower in Groups UR and SR than that in Group T. There was no significant difference in the incidence of side effects., Conclusion: This study demonstrates that ultrasound-guided rectus sheath block helps to provide the effective analgesia without any side effects compared with surgical rectus sheath block and intravenous tramadol for gynaecological surgery with Pfannenstiel incision.

Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed.

Objectives: The present study was aimed at determining the effective doses of Dexmedetomidine (Dex) involved in amplitude of contraction-force and frequency of uterine rings in pregnancy terms of rats. All experiments involving animal subjects were carried out with the approval of animal care and use Ethical Committee of Cukurova University. Experiments were performed on female Albino-Wistar rats (200-260 g; n = 40)., Materials and Methods: Uterine rings from pregnant rats were placed in organ bath with Krebs and calcium ion (Ca(2+))-free solutions to record and exposed to serially increasing log10 concentrations of Dex., Results: In Krebs solution, while Dex caused an increase in the spontaneous contraction-forces in all pregnancy terms of rats in a significant dose-dependent manner, it led to a decrease in contraction-frequency in late-pregnancy term of rats. In Ca(2+)-free, the spontaneous contraction-force decreased in late-pregnancy term and increased in early and middle-pregnancy terms. In addition, while Dex increased the contraction-frequency in early and middle-pregnancy terms, it decreased in late-pregnancy term in a dose-dependent manner., Statistical Analysis Used: The data were subjected to one-way analysis of variance. Repeated measures were employed for comparison of several group means through the Tukey post-hoc test (SPSS 10.00 Inc., Chicago, Ill, USA). P < 0.05 was considered statistically significant., Conclusions: This study suggested that Dex might differently alter the spontaneous contraction-forces and contraction-frequencies of uterine rings in all pregnancy terms of rats in Krebs and Ca(2+)-free solutions.

Purpose: Several studies have reported that sevoflurane was associated with a relatively high incidence of emergence agitation in children even in the absence of any surgical intervention. The aim of this study was to compare early agitation characteristics of oral melatonin, dexmedetomidine, and midazolam premedication in children who were given sevoflurane anesthesia for esophageal dilatation., Methods: Following Internal Review Board approval and parental informed consent, 100 ASA physical status I-II children (3-9 years old) who were scheduled to undergo general anesthesia for esophageal dilatation procedures were enrolled. The patients were randomly assigned to four groups (n = 25 in each). The premedications in the groups were saline (group P), dexmedetomidine 2.5 μg/kg (group D), 0.5 mg/kg midazolam (group MD), and melatonin 0.1 mg/kg (group ML), given orally. All premedication drugs were given with paracetamol 2-2.5 mg/kg to be easily drinkable 40-45 min before anesthesia induction. Anesthesia was maintained with sevoflurane 2-4%, N(2)O 50% in oxygen. No supplemental analgesic agent was given, and an emergence agitation scale (EAS) was measured on admission to the PACU, then every 5 min, and recorded during the postoperative period: 1, awake and calm, cooperative; 2, crying, requires consoling; 3, irritable/restless, screaming, inconsolable; 4, combative, disoriented, thrashing. Children with an agitation score of 3 or 4 were classified as agitated., Results: There were no significant differences among the four groups demographically. The emergence agitation scale was higher in the placebo group than in the others at 5, 10, and 15 min postoperatively (P < 0.001). EA was similar among group D, group MD, and group ML., Conclusion: We found that oral melatonin, dexmedetomidine, and midazolam reduced the incidence of emergence agitation in children after sevoflurane anesthesia.