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Introduction: Extracranial internal carotid stenosis (EICS) is a well-established cause of stroke. Carotid near-occlusion (CNO), either distally collapsed or not, is a rare sub-type of EICS with conflicting data regarding the necessity for treatment. The aim of this study is to evaluate the results of carotid artery stenting (CAS) for patients with symptomatic CNOs., Material and Methods: Institutional review board (I06-420-23) approval was obtained for this retrospective study. Consecutive data from January 2019 to January 2023 was obtained. Sixty-five patients underwent 66 procedures for symptomatic CNOs. Diagnosis of CNOs were made with DSA images. Treatment decisions were made by a multidisciplinary team. Patient data including age, gender, clinical presentation, affected side, complications (initial/ follow-up), and pre and post mRS scores were recorded and analyzed., Results: There were 22 female and 43 male patients with symptomatic CNOs (mean age: 71.52 ± 9.32 years). The mean time from symptom-to-treatment was 3.91 weeks ± 3.74 weeks (ranging from 0 to 20 weeks). There were eight events recorded in the 30 days period after CAS; five (7.7%) were cerebral hyperperfusion syndrome (one causing haemorrhage) and three (4.5%) ischemic complications. Permanent neurologic deficit rate was 6% and 61 patients (94%) mRS scores were unchanged during last follow-up. Mean follow-up period was 22.94 ± 16.67 months (ranging from 0.5 to 60 months)., Conclusion: Our study demonstrated that in the complex population of patients with symptomatic CNOs, CAS is a feasible option with acceptable rate of permanent neurologic deficits. Further studies are needed to assess its safety and long-term efficacy., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aims to identify the obstacles to recycling and environmental sustainability habits in a university hospital's operating room (OR) environment in Turkey and lay the groundwork for potential solutions., Methods: A questionnaire was used to measure current views among the 140 OR staff members aged 20-54 years. The survey assessed awareness and behaviors of recycling at home and in the OR, as well as awareness of environmentally safe anaesthesia practices., Results: Half of the participants believed that ORs significantly affected their carbon footprint, and most agreed that these environmental effects could be reduced. The primary barriers to recycling were inadequate knowledge, negative staff attitudes and insufficient services. Notably, 76% of participants paid attention to segregating OR waste, yet many lacked formal education about the environmental impact of their practices. Approximately 89% agreed that the environmental effects of ORs could be further reduced, with education being a critical need., Conclusion: The healthcare sector's contribution to carbon emissions and waste production is significant, especially in ORs. The lack of education regarding ecological implications is concerning. Implementing standardized training programs and enhancing recycling services can substantially reduce the environmental impact of ORs, highlighting the need for a more sustainable healthcare system., Competing Interests: Declaration of Interests: The authors declare no conflicts of interest., (©Copyright 2024 by the Turkish Anesthesiology and Reanimation Association / Turkish Journal of Anaesthesiology & Reanimation is published by Galenos Publishing House.)

Professional burnout syndrome (PBS) is an issue affecting individuals and organizations alike, characterized by emotional exhaustion and reduced effectiveness resulting from overwhelming work demands. Root causes include excessive workload, unrealistic expectations, and blurred work-life boundaries, which are often intensified by organizational culture and inadequate support systems. The consequences range from decreased productivity and creativity to high turnover rates and financial strain on organizations. Mitigating PBS requires a comprehensive approach that addresses both individual and organizational levels. Individually, stress management techniques and self-care practices are crucial for building resilience and coping with work-related stressors. Organizations play a vital role in promoting employee well-being by fostering a supportive work environment, promoting work-life balance and providing access to support systems such as counseling and mentorship programs. Leadership is key in creating a culture that values employee health and prioritizes open communication and empathy. Policy interventions can further support efforts to combat PBS by enforcing labor laws that protect employee rights, such as setting limits on working hours and ensuring access to mental health services. Additionally, incentivise organizations to prioritize employee well-being through tax incentives or certification programs can encourage proactive measures against burnout. The aim of this review is to provide a comprehensive exploration of PBS, examining its causes, consequences, and potential mitigation strategies in individuals and organizations, with a focus on anaesthesiology., Competing Interests: Declaration of Interests: The remaining authors have no conflicts of interest to declare., (©Copyright 2024 by the Turkish Anesthesiology and Reanimation Association / Turkish Journal of Anaesthesiology & Reanimation is published by Galenos Publishing House.)

This article aims to introduce the Safe Brain Initiative (SBI) approach, focusing on collecting and leveraging Patient-Reported Outcome Measures (PROMs) to enhance patient-centred precision anaesthesia and prevent postoperative delirium (POD) and neurocognitive disorders (NCD). The SBI was implemented to systematically address the feedback gap in perioperative care by collecting and analysing real-world data. The initiative focuses on monitoring and preventing POD and NCD, providing effective anaesthesia care, assessing patient and team satisfaction, and evaluating environmental sustainability impact. Based on international guidelines, 18 core recommendations were established to address potential complications and challenges associated with anaesthesia. Preliminary results showed a notable reduction in POD and increased awareness among anaesthesia team members regarding PROMs. The SBI approach demonstrated significant benefits during emergency situations, such as the February 2023 earthquake in Turkey, by providing crucial support and comfort to victims requiring multiple surgical interventions. The SBI presents an innovative, cost-effective, and patient-centred approach to perioperative care. By integrating PROMs and systematic feedback mechanisms, the SBI aims to expedite the advancement of efficient, patient-centered precision perioperative care, improve patient outcomes, and elevate the quality of care. The initiative has shown promising results, and its adoption is growing globally. Collaboration among healthcare providers, researchers, and patients is crucial in shaping the future of anaesthesia practice and further improving patient outcomes. Turkish hospitals are encouraged to join the SBI to benefit from international collaborations and contribute to positive change in perioperative care standards. The SBI project significantly advances precision anaesthesia, emphasising personalised care and patient well-being.

Objective: Anxiety is an unpleasant emotional stat with systemic effects. The anxiety level of the patients may increase the requirements for sedation during colonoscopy. The aim of the study was to evaluate the effect of pre-procedural anxiety on the dose of propofol., Methods: After ethical approval and informed consent, a total of 75 patients undergoing colonoscopy were enrolled in the study. Patients were informed about the procedure and the anxiety levels were assessed. The level of sedation was defined as a Bispectral Index (BIS) of 60 and was achieved by target-controlled infusion of propofol. Patients' characteristics, hemodynamic profiles, anxiety levels, the propofol dosage and complications were recorded. The procedure duration, difficulty score for colonoscopy assessed by the surgeon, and the patient's and surgeon's satisfaction with sedation instrument scores were recorded., Results: A total of 66 patients were studied.Demographic and procedural data were similar among groups. The anxiety scores were not correlated with the total propofol dosage, hemodynamic parameters, the time needed to reach a BIS value of 60, surgeon and patient satisfaction and the time needed to regain consciousness. No complications were observed., Conclusion: In patients receiving deep sedation for elective colonoscopies, the pre-procedural anxiety level is not related to sedative requirement, post-procedural recovery, or surgeon and patient satisfaction.

Objective: Debates continue about the cricoid pressure, which has been used for many years to prevent gastric aspiration during intubation. Using ultrasound, the effects of this maneuver and alternatives like paralaryngeal pressure are revealed. The aim of this observational study was to determine the effect of paralaryngeal pressure with an ultrasound probe on the esophageal diameter in patients with different body mass indexes and neck circumferences., Methods: After measuring the neck circumference at the level of the cricoid cartilage, the esophagus was visualized by ultrasonography. Compression was applied medially at a 45° angle toward the vertebral column by the ultrasound probe and esophageal anteroposterior outer diameters were measured. Correlations between body mass index, neck circumference, esophageal diameter, and esophageal diameter change ratio were evaluated with Pearson's r value., Results: One hundred ten volunteers (52 women and 58 men) with mean age 33.7 ± 8.02 years and mean body mass index 25.6 ± 4.65 kg m-2 were recruited. The esophagus was located 78.18% partially to the left, 4.54% completely to the left, 1.81% to the right of the cricoid ring. In 15.45%, esophagus could not be displayed. The mean diameter of the esophagus was 7.6 ± 1.1 mm before pressure and 5.6 ± 0.09 mm after pressure (P < .001). There was no significant correlation between diameter change percentage and body mass index (r=-0.22; P > .05). However, weak correlation was found between diameter change percentage and neck circumference (r=-0.33; P=.016)., Conclusions: Paralaryngeal pressure with an ultrasound probe has the potential to occlude the esophagus and may be effective in all patient groups.

Simulation training is useful to become familiar with new technology, to practice behaviours and strategies, to acquire routines for specific scenarios, and to reflect on one's behaviour. Processes that have to function almost automatically (e.g., resuscitation) have to be practised repeatedly until they can be reliably executed even under stress or fatigue. Simulators offer the opportunity to acquire these skills without endangering the patient. Various types of simulators (from pig liver to premature baby simulator) are already being used extensively for this purpose. Significant advantages of this learning environment include the freedom from risk in the event of errors, the repeatability of procedures, the possibility of varying conditions, and the possibility of practising processes with different complexities. Simulators are used in a variety of settings, providing valuable training in non-technical skills and creating awareness of other aspects of human factors. In addition, working with simulators through targeted testing of technology and work processes can help to structure work in hospitals more closely based on human factors.

Background and Objectives: Sugammadex is a modified gamma-cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway oedema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium-induced moderate neuromuscular blockade in those who received intraoperative 1 mg.kg -1 methylprednisolone or saline., Method: This single-centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear-nose-throat procedures (aged from 18-65, an ASA physical status I-II, a BMI less than 30 kg.m -2 , and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg.kg -1 of methylprednisolone in 5mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg.kg -1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study., Results: Median time to TOFr = 0.9 was for 130.00 s (range of 29-330) for Group C and 181.00 s (100-420) for Group M (p < 0.001). The differences between the two groups were statistically significant., Conclusion: When using 2 mg.kg -1 of sugammadex to reverse rocuronium-induced neuromuscular blockade in patients who received 1 mg.kg -1 of intraoperative methylprednisolone, demonstrated delayed recovery times., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Tracheal stenosis is a rare but a life-threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO 2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure., Case Report: We described a patient undergoing craniotomy with tracheal stenosis., Conclusion: Detailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain of a good balance between cerebral dynamics and airway dynamics were the pearls of this case., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Tracheal stenosis is a rare but a life-threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure., Case Report: We described a patient undergoing craniotomy with tracheal stenosis., Conclusion: Detailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain a good balance between cerebral dynamics and airway dynamics were the pearls of this case., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.

Objective: This prospective, randomized, double-blinded study aimed to compare the effects of three different doses of ketamine or lidocaine on intubating conditions and haemodynamics in a rapid-sequence induction model with 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium., Methods: A total of 128 ASA I-III patients who were scheduled for elective surgery were randomized in the following five groups: Group 1 (n=24), 1 mg kg(-1) lidocaine+3 mg kg(-1) propofol+0.6 mg kg(-1) rocuronium; Group 2 (n=23), 0.1 mg kg(-1) ketamine+3 mg kg(-1) propofol+0.6 mg kg(-1) rocuronium; Group 3 (n=29), 0.3 mg kg(-1) ketamine+3 mg kg(-1) propofol+0.6 mg kg(-1) rocuronium; Group 4 (n=26), 0.5 mg kg(-1) ketamine+3 mg kg(-1) propofol+0.6 mg kg(-1) rocuronium and Group 5 (n=26), 3 mg kg(-1) propofol+0.6 mg kg(-1) rocuronium+saline as placebo. After preoxygenation, induction was performed with the assigned combination, and intubation was initiated after 60 s. The time to intubation, intubation score (Viby-Mogensen score) and haemodynamic data were recorded. Postoperative hoarseness, sore throat and hallucination incidences were followed up., Results: Demographic, time to intubation and haemodynamic data were comparable among groups. Group 4 [13.5 (4-14)] revealed a higher intubation score then groups 1, 2 and 5 [12 (3-14), 11 (2-14) and 9.5 (0-13) and p=0.026, p=0.001 and p=0.000001, respectively]. Groups 3 [13 (4-14)] and 4 [13.5 (4-14)] had similar intubation scores. Side effects were comparable among all groups., Conclusion: The combination of 0.5 mg kg(-1) ketamine and 0.6 mg kg(-1) rocuronium along with propofol improves intubation conditions in a stimulated rapid-sequence induction model.

Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through a tick bite or exposure to blood or tissues of viremic hosts. The clinical presentation is characterized by sudden onset high fever, headache, myalgia, abdominal pain and nausea-vomiting followed by gastrointestinal, urinary, respiratory tract and brain hemorrhage. Laboratory findings include leucopenia, thrombocytopenia, elevated liver enzymes, prolonged prothrombin time and activated partial thromboplastin time. We report a case of CCHF who was treated with a combination of DFPP and ribavirin therapy. As a result of this multimodal treatment, patient's clinical symptoms and laboratory findings improved gradually., (Copyright © 2013. Published by Elsevier Ltd.)