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In thoracic surgery practice, bronchial closure and anastomosis are relatively easy in technical terms; however, it is also the procedure that is most open to the development of complications with high morbidity. This study aimed to investigate the effect of simultaneous evaluation of bronchial closure under fiberoptic bronchoscopy guidance during lung resection on the development of complications.Patients aged over 18 years who underwent elective lung resection in our clinic between 2017 and 2021 were included in the study. Postoperative complications were recorded and statistically analyzed.The mean age of the patients was 61.4±10.4 years, and 267 patients were male (75.4%) and 87 (24.6%) were female. Thoracotomy was performed in 258 (72.9%) patients and lung resection with the video-assisted thoracoscopic surgery technique in 96 (27.1%) patients. During the follow-up, complications were observed during the first 30 days in 78 (22.0%) of the patients and later in 9 (2.5%). Surgical mortality occurred in 11 patients (3.1%), and the rate of readmission to the intensive care unit was 5.6% (n=20).We consider that the control of the resection line with the active use of fiberoptic bronchoscopy during surgery is important for the prevention of the development of bronchial morbidity. Complications in the early period can be reduced by ensuring that the remaining bronchus is not narrowed, there are no residual stump structures that may disrupt the bronchial line, such as cartilage, and bronchial washing is frequently undertaken.

Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. Methods: We conducted a web-based survey (March– July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting pol icies and communication modes including use of virtual visiting (videoconferencing). Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/ 525) had unrestricted visiting hours ; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19 ; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates ; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. Conclusions: Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.

Objectives We aimed to investigate the effect of sugammadex on the motor, sensory and deep sensory block in the sciatic nerve created by bupivacaine in rats. Materials and methods 18 Sprague-Dawley adult male rats treated with unilateral sciatic nerve block by bupivacaine (0.2 ml) were randomly divided into three groups. Control group (Group C, n = 6, 1.5 mL saline) perineural sugammadex group (Group PNS, n = 6, 16 mg/kg) and intraperitoneal sugammadex group (Group IPS, n = 6, 16 mg/kg) Motor, sensory, and deep sensory functions were evaluated every 10 minutes by a blind researcher. 6 tissue samples each belonging to the sciatic nerve, 1.5 cm in length and 0.2 cm in diameter, were taken from paraffin blocks. Sections of 3-4 micrometers were stained with Hematoxylin + Eosin, Masson Trichrome dyes and examined under a light microscope. Results There was no statistically significant difference between 3 groups in terms of the time to return to normal motor, sensory and deep sensory function. There was also no significant difference in edema, extracellular matrix, and myelin. Inflammatory cells were seen in all groups, mainly epineurium, epineurium, and perineurium. Conclusion There are findings of no histological effects or effects on local block of sugammadex in rats undergoing sciatic nerve block.

Purpose The standard procedure for low-flow anesthesia usually incorporates a high fresh gas flow (FGF) of 4-6 L/minute during the wash-in phase. However, the administration of a high FGF (4-6 L/min) increases the inhaled anesthetic agent consumption. This study was designed to compare the sevoflurane consumption at 2 rates of flow and vaporizer concentration during the wash-in period. Methods Patients were randomly enrolled into high FGF (HFGF) (n = 30) and low FGF (LFGF) (n = 30) groups. During the wash-in, the HFGF group received 4 L/minute FGF with a sevoflurane vaporizer setting of 2.5%, and the LFGF group received 1 L/minute FGF with a vaporizer setting of 8%. Once the wash-in was complete, anesthesia maintenance was performed with 0.5 L/min FGF with a vaporizer setting of 2.5-4.5% in both groups. The patient demographic data, bispectral index values, hemodynamic variables, wash-in time, sevoflurane consumption during the wash-in phase, and total sevoflurane consumption were analyzed. Results The median sevoflurane consumption in the wash-in phase was 8.2 mL (7.1-9.3) in the HFGF group and 2.7 mL (2.2-3.1) in the LFGF group (p = 0.001). The mean total sevoflurane consumption was 17.41 +/- 3.58 mL in the patients who received HFGF and 14.93 +/- 3.57 mL in the LFGF group (p = 0.001). The mean wash-in completion time was 12.49 +/- 2.79 min in the HFGF group and 3.35 +/- 0.67 min in the LFGF group (p = 0.001). Conclusions The anesthetic agent consumption during the wash-in phase was approximately 3 times lower with the administration of sevoflurane at 1 L/minute FGF than the use of 4 L/minute FGF.

Pancreatic volume is enlarged in acute pancreatitis.This study aimed to evaluate whether there was a difference in pancreatic volume between survivors and non-survivors with acute pancreatitis using computer-generated 3D imaging.This single-center retrospective observational cohort study was conducted between January 2015 and December 2020. The hospital automation system was used to get the patients diagnosed with acute pancreatitis by using International Classification of Diseases (ICD) (ninth edition, code 577.0 or 10th version, code K 85.0) codes. The patients' pancreatic volumes, computed tomography severity index (CTSI), and modified computed tomography severity index (mCTSI) scores were calculated using the data obtained from the hospital automation system. The pancreatic volumes of the patients were measured using the computer-generated 3D imaging method. Pancreatic volume, CTSI, and mCTSI were then statistically compared in terms of mortality prediction by using the receiver operating characteristic (ROC) analysis.Of the 143 patients, 57.34% were female and 42.66% were male. The cut-off value of pancreatic volume in determining mortality was81.5 cmAlthough CTSI scores pancreatic enlargement and mCTSI scores pancreatic necrosis and inflammation, the pancreatic volume value is not clearly scored in both. In this study population, pancreatic volume above 81.5 cm was associated with increased mortality. Both CTSI and mCTSI scores outperformed pancreatic volume in predicting mortality.

Background: Both the Miller and Macintosh blades are commonly used during laryngoscopy in infants and children, although the glottic views have not been compared in neonates. This study compared the glottic views with the Miller and Macintosh size 0 blades in neonates when the blades were placed above and below the epiglottis. Methods: Forty anaesthetized and paralyzed neonates undergoing elective surgery were enrolled and randomized to either the Miller or Macintosh size 0 blade. Two glottic views were obtained in random order in each neonate and were photographed using the same blade: lifting the epiglottis first then the tongue base or vice versa. The percentage of glottic opening (POGO) scores were evaluated with each view. The POGO scores and cardiorespiratory variables were then analysed. Results: The POGO scores using the Miller blade to lift both the epiglottis and the tongue base were similar, whereas the scores using the Macintosh blade to lift the epiglottis were greater than those to lift the tongue base. The POGO scores using the Miller blade in both positions were significantly greater than those using the Macintosh blade in the corresponding positions (P = 0.0001). The heart rate using the Miller blade was greater than that using the Macintosh blade (P = 0.0001). Conclusions: In neonates, the glottic views using the Miller size 0 blade to lift both the epiglottis and the tongue base were deemed to be excellent and superior to those using the Macintosh blade in both positions.

Background The aim of this study was to investigate the reliability of COVID-19 Reporting and Data System (CO-RADS) scale on chest computerized tomography (CT) in addition to the reverse transcriptase-polymerase chain reaction (RT-PCR) test in diagnosis of COVID-19 on patients who will undergo elective surgery to protect patients and healthcare professionals during the intense pandemic period and the correlation between CO-RADS scale and Total Severity Score (TSS). During the intensive pandemic until normalization, 253 patients aged ≥ 18 years who underwent elective surgery with two negative RT-PCR results within the last 5 days and CO-RADS scale ≤ 3 on chest CT were included in the study. Demographic characteristics, American Society of Anesthesiologists classification, type of anesthesia and surgery, department of clinic, chest CT findings, scale of CO-RADS and TSS on CT, patients’ postoperative hospital stay, follow-up time, and vital status (whether or not COVID-19 disease) at the hospital and discharge information were collected for each patient. Results The most frequently calculated CO-RADS score was found to be 1 (73.1%). It was followed by scale of CO-RADS 2 (20.9%). Regarding TSS, the most common TSS for the right and left lungs was 0 (91.7% and 92.5%, respectively). COVID-19 was not detected in any of the patients who were hospitalized for an average of 4.9 ± 6.4 days and followed-up for an average of 14.3 ± 8.2 days. It was observed that the CO-RADS score and TSS were positively and moderately correlated with each other (p < 0.001). Conclusion It was concluded that in early diagnostic of COVID-19, chest CT scans serve like a complementary diagnostic method in addition to RT-PCR testing to keep safe both the patients and health professionals and the scale of CO-RADS and TSS on CT are valuable in correlation with each other.

Toxic epidermal necrolysis (TEN) is a serious cutaneous adverse reaction with high mortality rate. The severe acute respiratory syndrome-coronavirus-2 virus disease represented a global pandemic known as coronavirus disease-2019 (COVID-19), without exact cure up to date. The usage of immunosuppressive drugs during COVID-19 infection is a major clinical challenge; however, it seems inevitable in rare cases. Here we aimed to report a patient, who was treated concomitantly for TEN and COVID-19 with a good clinical outcome by reviewing the existing literature.

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (pConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Resumo A Distrofia Miotonica (DM) tipo‐1 (Doenca de Steinert) e uma doenca multissistemica progressiva autossomica dominante em que a crise miotonica pode ser desencadeada por varios fatores, incluindo dor, estresse emocional, hipotermia, tremores e estimulo mecânico ou eletrico. O presente relato descreve anestesia geral realizada com dexmedetomidina em combinacao com peridural toracica para colecistectomia laparoscopica em paciente com Doenca de Steinert. Para evitar laringoscopia, a intubacao traqueal foi realizada utilizando cateter de intubacao Aintree guiado por broncofibroscopia optica. Os efeitos anestesicos prolongados do propofol foram revertidos e a recuperacao anestesica foi acelerada pelo uso de infusao intravenosa de teofilina.

OBJECTIVE: : Fear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital METHODS: Anesthesiologists, nurses and nurse anesthetists were invited to fill out the survey The survey was consist of questions from ''The Fear of COVID-19 Scale'', ''Patient Health Questionnaire'' and ''Pittsburgh Sleep Quality Index'' (PSQI) Each question was worth a point RESULTS: The data of 208 participants were analyzed Mean age was 29 ± 7 748 years, 72 1% were male, 67 3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone Moderate depression was the most frequently detected outcome (n = 90, 43 3%) Mean The Fear of COVID-19 Scale for all participants was 18 56 ± 7 731 The mean PSQI of patients was 6 18 ± 4 356 with a 45 7% rate of poor sleep quality PSQI was found significantly higher in nurses (7 1 ± 4 7, p = 0 000) Nurses were the group with the highest deterioration in sleep quality (53 6%, p = 0 003) The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0 018) PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7 02 ± 4 59 vs 4 81 ± 3 57 respectively, p = 0 001) A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0 005) CONCLUSION: Depression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak Intensive care unit nurses were at highest risk

Living donor and cadaveric donor renal transplantation have received a significant interest. During the procedure, both volatile agents and total intravenous anesthesia are used.

Background: The study is presenting our long-term clinical results after freestyle stentless aortic root bioprosthesis replacement in patients with severe aortic insufficiency with ascending aortic aneurysm. Methods: Seventy-seven patients with ascending aortic aneurysms and aortic valve insufficiency underwent a total root replacement procedure using a stentless “Freestyle” valve (Medtronic Inc., Minneapolis, Minnesota). There were 50 (64.9%) men and 27 (35.1%) women. Mean age was 68.7 ± 11.1 years. The surgical procedure used a complete root replacement. Concomitant procedures included coronary artery bypass grafting in 15 (19.5%) patients. Results: The mean cardiopulmonary bypass time was 130.3 ± 26.4 minutes and total aortic cross clamp time was 99.5 ± 23.6 minutes. Hospital mortality was 2.6%. The median follow-up time was 11.2 years. The 5- and 10-years freedom from aortic valve reoperation were 97.4 ± 1.2% and 93.4 ± 4.9%, respectively. During 10 years follow up, there were 14 late deaths; 4 deaths were cardiac, and 10 deaths were noncardiac. Valve-related deaths were attributable to thromboembolism in 1 patient, endocarditis in 2 patients, and congestive heart failure in 1 patient. Conclusion: The freestyle stentless aortic root bioprosthesis offered good clinical outcomes, in terms of survival and structural valve deterioration. The Freestyle valve is a viable option for use in patients undergoing bioprosthetic aortic valve replacement and expected desire for long-term durability.

Objective: The objective of this study was to ascertain whether the addition of part-task training as a step in Pecha Kucha for fiberoptic tracheal intubation increases the success rate and reduces the complication rate. Subjects and Methods: The residents of the Department of Anesthesiology were initially included in an orientation program. We used the Pecha Kucha method for the presentation of teaching fiberoptic intubation skills. Afterwards the participants were trained in Laerdal® airway management and each participant performed tracheal intubation using the Aintree catheter. The participants were divided into two groups. Group 1 (n = 9) received part-task training and group 2 (n = 9) received whole-task training. The tracheal intubation performances of participants were evaluated on fresh frozen cadavers. The number of interventions, incidence of complications, success rate, and optimization maneuver requirements were recorded. Results: Eighteen residents aged between 27 and 33 years were included. All were junior residents with less than 2 years of experience. There was no significant difference in terms of duration of tracheal intubation, complication rates, and optimization maneuvers between the study groups. Six participants could not place the tracheal tube in the last section. The success rates for the part-task group during Aintree and tracheal tube placement were 100 and 66.7%, respectively, whereas the rates were 55.6 and 44.4%, respectively, in whole-task group (p < 0.05). Conclusion: In addition to the Pecha Kucha method in fiberoptic intubation training, simulation-based part-task training appears to increase the success rate and to reduce the complication rate on fresh frozen cadavers.

Background Although postoperative early airway complications are rarely observed, when they do develop, fatal results such as brain damage and cardiac arrest may occur. The Royal College of Anaesthetists and Difficult Airway Society investigated airway complications developing during anaesthesia over a period of 12 months within the context of the Fourth National Audit Project (NAP4) study. Inspired by that multicentre research project, this study aims to identify early airway complications that can develop in relation to anaesthesia induction in our hospital. Methods After our proposed study received approval from the Ethical Council, adult patients undergoing general anaesthesia at our operating theatres within the period of January-July 2018 were included in it. Demographic data, ventilation, American Society of Anesthesiologists (ASA) grade, Cormack-Lehane scores, tools that are used in airway management, and complications were recorded. Results Out of 909 patients in total, 752 were intubated; a laryngeal mask was placed on 157 of these patients. The complication rate was 5%, and the 3 most frequently observed complications were desaturation, bronchospasm and pharyngeal injuries. In the group having complications, the body mass index value, Cormack-Lehane, Mallampati, and ventilation scores were significantly higher than those with no complications. Conclusions During routine general anaesthesia induction at our clinic, major or minor airway complications have developed with a frequency of 5%, and it was determined that desaturation was the most frequent reversible cause.

IntroductionChildhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); pConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.

Objective: The ultrasound-guided interventions have gained widespread popularity in several aspects of anesthesia practice. In this study, we aimed to compare the preoperative evaluation tests and sonographic measurements of the upper airway for the prediction of a potentially difficult airway. Material and Methods: In this prospective observational study, we enrolled 136 adult patients undergoing elective surgery under general anesthesia. The Modified Mallampati classification, thyromental distance, sternomental distance, and Cormack-Lehane scores were recorded. Sonographic measurements included pre-epiglottic space (PES), the distance between the midpoints of vocal cords and epiglottis (EVC). The ratio was interpreted. Main outcome is to determine the sensitivity and specificity of the upper airway ultrasound for the prediction of a potentially difficult airway. Results: There was no statistically significant relationship between body mass index value and thyromental distance, Thyromental/Sternomental Ratio and PES/EVC ratio, Cormack-Lehane, Mallampati classification and thyromental/sternomental distance ratio (p>0.05). The sonographic measurements of airway have no significance to predict the difficult intubation and the comparison between PES, EVC and the PES/EVC ratio and assessment tests (Cormack-Lehane, Mallampati classification, thyromental and sternomental distances) was insignificant. The sternomental distance measurement was predictive for the difficult airway only in patients having body mass index more than 31.6 kg m-2. Conclusion: Ultrasound is a useful tool for identifying the upper airway prior to anesthesia but the validity for the prediction of difficult airway is not clear. By increasing the clinical experiences and further investigations, a greater insight into its use will be gained.

Introduction For pain relief after thoracotomy, opioids and thoracic paravertebral and epidural interventions are frequently used. In recent years, interfascial blocks such as the erector spinae plane block (ESPB) and rhomboid intercostal block (RIB) have started to be used for analgesia. We aimed to compare the postoperative analgesic effect of ESPB, RIB, and a control group in pain management after open thoracotomy. Material and methods This is a randomized controlled trial. A total of 75 patients were included in three groups as the ESPB, RIB, and control (C) groups. In block groups, the blockage was performed with 20 ml 0.25% bupivacaine. In Group C, no procedures other than the standard postoperative analgesia protocol were performed. The postoperative analgesic consumptions of the patients, time of first analgesic need, and visual analog scale (VAS) values were recorded. Results The mean 24-hour tramadol consumption was 124±29.08 mg in group ESPB and 116±28.65 mg in group RIB, and the results were statistically similar (p>0.05). In Group C, the consumption is 204±44.06 mg; significantly higher than group ESPB and group RIB (p=0.004). Time to the first analgesic requirement was 355±55.69 min in group ESPB and 339.12±54.39 min in group RIB. There was no difference between groups (p>0.05). In Group C, this time was 218.91±56.73 minutes. We observed that group ESPB and group RIB needed analgesics later (p=0.006). VAS scores and the number of patients requiring analgesics were similar in group ESPB and group RIB (p>0.05). In Group C, on the other hand, VAS scores and the number of patients requiring analgesics were higher than both groups in which block was applied (p

Aims: In this study, we aimed to investigate the anti-inflammatory and antioxidant effects of intravenous ibuprofen by using the C-reactive protein level and thiol/disulfide homeostasis as the oxidative stress marker. Materials and Methods: This study was conducted on 70 patients aged between 30and65 who were scheduled for elective laparoscopic hysterectomy. The patients were divided into two groups to receive either preemptive 800mg of intravenous ibuprofen plus 1000 mg of intravenous paracetamol (Group IP) or only 1000 mg of intravenous paracetamol as a control group (Group P).The blood samples for thiol/disulfide homeostasis were collected as follows; before induction of anesthesia (T0),before pneumoperitoneum (T1),following post-deflation and discontinuation of anesthesia (T2) and postoperative 24th hour (T3).Simultaneous blood samples for C-reactive protein were also collected. The pre and postoperative urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were measured. Results: A total of 69 patients were included in the study. The patient’s characteristics and intraoperative variables were comparable between groups (p>0.05). The number of patients requiring rescue analgesia, the total amount of analgesic used, VAS scores, and postoperative side effects were significantly lower in Group IP (p0.05).The simultaneous CRP levels indicated a significant increase at the postoperative 24.hour in both groups (p0.05). There was a significant increase in urea and creatinine levels in patients of Group IP (p

Aims: In our study,we aimed to investigate whether end-expiratory vena cava inferior (expVCI) diameter and vena cava inferior collapsibility index predicted post-spinal hypotension in geriatric patients undergoing spinal anesthesia, the correlation between them and other parameters. Material and methods: Our prospective study included ASA I-4,73 patients over 65 years of age, who were scheduled for operation using spinal anesthesia. According to the expVCI diameter displayed with USG before spinal anesthesia, patients; those with an expVCI diameter less than 1.8 cm previously determined as the threshold value are grouped as 1.(Small-VCI) Group,those greater than 1.8cm as 2.(Large-VCI) Group. Demographic characteristics of the patients, comorbidities, duration and type of operation, basal (preoperative) heart rate, systolic, diastolic, mean blood pressure, peripheral oxygen saturation values before spinal anesthesia and after spinal anesthesia in supine position (0 min) and 5th, 10th, 15th, 20th, 25th, 30th min and preoperative arterial blood gas parameters, amount of peroperative urine and bleeding, inotropic and fluid requirement, complications were recorded. Results: Hypotension developed in 28(38.4%) patients and bradycardia in 14 (19.2%) of patients. The patients who developed hypotension had more ASA 2 and ASA 3 (p=0.01), shorter height (p=0.02), and smaller expVCI diameter (p=0.004).It was observed that they had higher lactate (p=0.03), lower pH (p=0.006) values, and more inotropic agents were administered (p

Objective To evaluate the effects of 2 different dose regimens of propofol (low dose: < 1 mg/kg, high dose: ≥ 1 mg/kg) on the duration of the seizures, the required energy for the seizures, and the seizure threshold over the course of electroconvulsive therapy (ECT). Methods The electronic medical records of 165 patients receiving 971 sessions of ECT were analyzed retrospectively. Patients were evaluated in two groups according to the according to propofol doses that they had received for ECT. Group LP (n = 91): patients who received low dose propofol (< 1 mg/kg). Group HP (n = 74): patients who received high dose propofol (≥1 mg/kg). Results The required energy for seizures in Group HP were significantly higher than the Group LP in the 3rd, 4th, 5th, 6th, 7th, 8th, and 9th sessions (p < 0.05). The duration of seizures in the Group HP were significantly lower than the Group LP in the 1st, 2nd, 4th, 5th, 7th, and 8th sessions (p < 0.05). Higher electrical stimulus was needed to acquire a minimum length of seizure (> 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group. Conclusion Higher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.

Background: In this study, we aimed to evaluate the long-term outcomes of monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery in patients with atrial fibrillation. Methods: We retrospectively evaluated a total of 167 patients (67 males, 100 females; mean age 56.8 +/- 6.9 years; range, 48 to 65 years) with atrial fibrillation who underwent monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery between September 2001 and January 2015. The patients were divided into two groups according to the procedure applied as those undergoing monopolar ablation (group 1, n=68) and those undergoing bipolar ablation (group 2, n=99). All patients were followed by electrocardiogram and 24-h Holter monitoring. Echocardiography was performed before discharge, at three and 12 months postoperatively, and annually thereafter. Left atrial volume index, left atrial diameter, and left ventricular ejection fraction were recorded. Results: There was no significant correlation between the procedure applied and hypertension, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, history of the cerebrovascular events (p>0.05). The mean preoperative left atrial diameter decreased from 5.3 +/- 0.5 cm to 4.9 +/- 0.5 cm postoperatively in all patients (p=0.0001). The mean preoperative left atrial volume index decreased from 53.8 +/- 0.4 mL/m(2) t o 43.7 +/- 6.2 mL/m(2) in t he postoperative period (p=0.0001). During follow-up, 61.8% (n=42) of the patients in group 1 and 62.6% (n=62) of the patients in group 2 remained in sinus rhythm. One patient (1.5%) in group 1 and two patients (2.0%) in group 2 developed early postoperative cerebrovascular accident. Conclusion: Monopolar and bipolar ablation methods are safe and effective methods to ensure long-term sinus rhythm. Both procedures do not increase the morbidity risk with very low thromboembolic complication rates.