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Background: The nociception level (NOL) index is a quantitative parameter derived from physiological signals to measure intraoperative nociception. The aim of this systematic review and meta-analysis was to evaluate if NOL monitoring reduces intraoperative opioid use compared to conventional therapy (opioid administered at clinician discretion)., Methods: This meta-analysis comprises randomized clinical trials comparing NOL-guided opioid administration to conventional therapy in adult patients undergoing any type of surgery. A systematic search of PubMed, Scopus, and CENTRAL databases was conducted. The primary outcome was intraoperative opioid consumption and the effect estimate of the NOL index was measured using the standardized mean difference (SMD) where 0.20 is considered a small and 0.80 a large effect size. A random-effects model with Hartung-Knapp-Sidik-Jonkman adjustment was applied to estimate the treatment effect. Heterogeneity was explored clinically and statistically (using the inconsistency I ² statistic, prediction intervals, and influence analysis). The quality (certainty) of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines methodology., Results: This review comprised 9 trials (519 patients). The intraoperative opioid SMD (NOL monitoring versus conventional therapy) was -0.26 (95% confidence interval [CI], -0.82 to 0.30; P = .31; low certainty of evidence). We observed substantial clinical (intraoperative opioid regimens) and statistical heterogeneity with the I ² statistic being 86% (95% CI, 75%-92%). The prediction interval was between -1.95 and 1.42 indicating where the SMD between NOL and conventional therapy would lie if a similar study were conducted in the future., Conclusions: This meta-analysis does not provide evidence supporting the role of NOL monitoring in reducing intraoperative opioid consumption., Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article., (Copyright © 2024 International Anesthesia Research Society.)

Background: The erector spinae plane block is a relatively new regional anesthesia technique that is expected to provide some benefits for postoperative analgesia. This study investigated the effects of erector spinae plane block on postoperative opioid consumption in kidney donors undergoing hand-assisted laparoscopic donor nephrectomy for renal transplantation., Methods: Fifty-two donors scheduled for elective hand-assisted laparoscopic donor nephrectomy were randomly divided into the block (25 donors) and control (27 donors) groups. Donors in the block group received 30 mL of 0.25% bupivacaine under ultrasound guidance, whereas the control group received no block treatment. The primary outcome measure was the amount of fentanyl administered via patient-controlled analgesia at 24 h. Secondary outcomes included the duration of stay, opioid consumption in the post-anesthesia care unit, and pain scores during the recording hours., Results: No significant differences were observed between the groups regarding total opioid consumption converted to intravenous morphine equivalent administered via patient-controlled analgesia (33.3±21.4 mg vs. 37.5±18.5 mg; P=0.27) and in the postanesthesia care unit (1.5±0.9 mg vs. 1.4±0.8 mg; P=0.55). The duration of stay in the postanesthesia care unit (86.3±32.6 min vs. 85.7±33.6 min; P=0.87) was similar between the groups. There was no significant difference between the groups in the postoperative donor-reported NRS pain scores (P>0.05 for all the time points)., Conclusions: Preoperative erector spinae plane block is not an effective strategy for reducing postoperative pain or opioid consumption in patients undergoing hand-assisted laparoscopic donor nephrectomy. Different block combinations are needed for optimal pain management in hand-assisted laparoscopic donor nephrectomy.

Objective: For patient safety, maintaining hemodynamic stability during surgical procedures is critical. Dynamic indices [such as systolic pressure variation (SPV) and pulse pressure variation (PPV)], have recently seen an increase in use. Given the risks associated with such invasive techniques, there is growing interest in non-invasive monitoring methods-and plethysmographic waveform analysis. However, many such non-invasive methods involve intricate calculations or brand-specific monitors. This study introduces the simple systolic ratio (SSR), derived from pulse oximetry tracings, as a non-invasive method to assess fluid responsiveness., Methods: This prospective observational study included 25 adult patients whose SPV, PPV, and SSR values were collected at 30-min intervals during open abdominal surgery. The SSR was defined as the ratio of the tallest waveform to the shortest waveform within pulse tracings. The correlations among SSR, SPV, and PPV were analyzed. Additionally, anaesthesia specialists visually assessed pulse oximetry tracings to determine fluid responsiveness using the SSR method., Results: Strong correlations were observed between SSR and both SPV (r = 0.715, P < 0.001) and PPV (r = 0.702, P < 0.001). Receiver operator curve analysis identified optimal SSR thresholds for predicting fluid responsiveness at 1.47 for SPV and 1.50 for PPV. A survey of anaesthesia specialists using the SSR method to visually assess fluid responsiveness produced an accuracy rate of 83%., Conclusion: Based on the strong correlations it exhibits with traditional markers, SSR has great potential as a clinical tool, especially in resource-limited settings. However, further research is needed to establish its role, especially as it pertains to its universal applicability across monitoring devices., Competing Interests: Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose., (©Copyright 2024 by the Turkish Anesthesiology and Reanimation Association / Turkish Journal of Anaesthesiology & Reanimation is published by Galenos Publishing House.)

Intraoperative positioning-related nerve injuries, particularly those affecting the brachial plexus, are concerning complications believed to arise from stretching and/or compression of peripheral nerves. Although sonoelastography, a new ultrasound technology, is emerging as a valuable tool in the musculoskeletal system, its utility in evaluating peripheral nerves remains unclear. This study aimed to utilize sonoelastography to assess the brachial plexus during surgery, specifically investigating changes in its stiffness values in relation to different head and arm positions. In this prospective cohort study, bilateral brachial plexuses of 8 volunteers in 3 different positions were enrolled. Using a high-frequency linear probe, the stiffness of the brachial plexus was quantitatively measured in kilopascals (kPa) under 3 different positions: neutral, head rotated, and head rotated with arm hyperabducted. Intra-class agreement was evaluated. The stiffness of the brachial plexus was 7.39 kPa in the neutral position (NP), 10.28 kPa with head rotation, and 17.24 kPa when the head was turned, and the ipsilateral arm was hyperabducted. Significant increases were observed in stiffness values when the head was turned, whether ipsilaterally or contralaterally, and during hyperabduction of the arm while the head was turned (for all P < .001). Strong intra-class correlations were found for the measurements of stiffness values (ICC = 0.988-0.989; P < .001; Cronbach Alpha = 0.987-0.989). Sonoelastography revealed significant increases in the stiffness of the brachial plexus with various head rotations and arm positions compared to the neutral state. These findings suggest that sonoelastography could potentially serve as a valuable tool for assessing the risk of brachial plexus injury during surgery and for guiding optimal patient positioning. Further research with larger sample sizes is needed to establish definitive clinical applications., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study aims to evaluate the sympathectomy effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and of the radial arteries., Methods: This prospective study included a total of 25 patients (14 males, 11 females; median age: 67 years; range, 23 to 75 years) who underwent erector spinae plane block categorized as the American Society of Anesthesiologists Class III and underwent off-pump coronary artery bypass grafting between June 01, 2020 and March 01, 2021. The effects of erector spinae plane block on the diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries were assessed using ultrasonography images taken both before and 45 min after the procedure, from the third, fourth, and fifth intercostal spaces for the left and right internal mammary arteries and from 3 cm proximal to the wrist for the radial arteries., Results: The diameters and cross-sectional areas of the left and right internal mammary arteries and radial arteries significantly increased compared to baseline values after the erector spinae plane block (p<0.05). There was no significant difference in the pre- and post-procedural heart rate and mean arterial pressure values (p>0.05)., Conclusion: The bilateral erector spinae plane block, which was performed at the T5 level, provided vasodilatation of the left and right internal mammary arteries and radial arteries without causing any significant difference in the heart rate and mean arterial pressure. These findings indicate that the sympathetic block produced by the erector spinae plane block may facilitate better surgical conditions by preventing arterial spasms. Thus, bilateral erector spinae plane block may be a promising technique to achieve regional anesthesia for off-pump coronary artery bypass grafting., 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.)

Background: Ibuprofen is a NSAID that has anti-inflammatory, antipyretic, and analgesic effects. The oral form of the drug has been used safely for a long time and is one of the most preferred NSAIDs. It has been shown that ibuprofen is effective in the treatment of postoperative pain; however, there have not been sufficient studies on ibuprofen. We evaluated and compared the influence of IV forms of ibuprofen and acetaminophen on pain management and opioid consumption on patients undergoing laparoscopic cholecystectomy surgery., Methods: Patients were stratified into three groups. Group I (group ibuprofen, n = 30) was administered 800 mg of IV ibuprofen; group A (group acetaminophen, n = 30) was administered 1000 mg of IV acetaminophen; and group C (control group, n = 30) was given 100 ml of saline solution. We evaluated opioid consumption and VAS scores postoperatively., Results: Pain scores in group I and group A at all time periods were lower than those in group C (p < 0.05). Group I had significantly lower VAS scores than those in group A at all time periods postoperatively (p < 0.05). Those in group C had significantly higher opioid consumption than the other groups (p < 0.05). Opioid consumption in group I at all time periods postoperatively was significantly lower than those in group A (p < 0.05). Group I had statistically lower rescue medication than the other groups at all time periods., Conclusion: Our study suggested that IV ibuprofen resulted in lower pain scores and reduced opioid use compared with acetaminophen postoperatively in the first 24 h in patients undergoing laparoscopic cholecystectomy surgery.

Background: This study aims to evaluate the most appropriate analgesic method of minimizing postoperative pain to prevent complications in patients scheduled for cardiac surgery., Methods: Between January 2016 and June 2016, a total of 60 patients with the American Society of Anesthesiologists Physical Status Class III (27 males, 33 females; mean age 63 years; range, 49 to 77 years) with an ejection fraction of above 50% who underwent elective coronary artery bypass grafting were included. The patients were divided into two groups following admission to the intensive care unit. Group 1 (n=30) was administered intravenous fentanyl citrate with patient-controlled analgesia protocol, while Group 2 (n=30) was administered 0.1% bupivacaine hydrochloride analgesia protocol with catheter placed between the sternum and subcutaneous tissue., Results: In Group 1, pain intensity scores at two h and visual analog scale scores except at 24, 36, and 48 h were higher than Group 2 (p<0.05). The length of intensive care unit stay and urine cortisol levels were higher in Group 1 than Group 2 (78±12 h and 631±505 ?g at 24 h vs. 66±13 h and 401±297 ?g at 24 h, respectively p<0.05). Partial pressure of oxygen levels at 10 and 16 h during the postoperative intensive care unit stay were lower, while partial pressure of carbon dioxide levels at 24 h was higher in Group 1 than Group 2 (p<0.05)., Conclusion: The bupivacaine protocol is a relatively more useful analgesic method which produces improved results in blood gas analysis by reducing the effects of pain and shortens the length of intensive care unit stay. Low levels of free cortisol also confirm this finding., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish Society of Cardiovascular Surgery.)

Background: PECS type-1 block, a US-guided superficial interfacial block, provides effective analgesia after breast surgery. Aesthetic breast augmentation is one of the most common surgical procedures in plastic surgery. Subpectoral prostheses cause severe pain. The aim of this study was to investigate the effect of different volumes of the solution on the efficacy of PECS type-I block for postoperative analgesia after breast augmentation surgery., Methods: Ninety ASA status I-II female patients aged between 18 and 65 years who scheduled breast augmentation surgery under general anesthesia were included in this study. The patients were randomly divided into three groups of 30 patients each (Group 20 = 20 ml of anaesthetic solution, Group 30 = 30 ml anaesthetic solution, and Group K = Control group). Postoperative assessment was performed using the VAS score. The VAS scores were recorded postoperatively at 1, 2, 4, 8, 16 and 24 h., Results: Fentanyl consumption was statistically significantly lower in Group 20 and Group 30 compared to the Control group (p < 0.05). There was no statistically significant difference in fentanyl consumption between Group 20 and Group 30. The right and left VAS scores were statistically significantly lower in Groups 20 and 30 than in the Control group (p < 0.05). There was no statistical difference in terms of VAS scores between Group 20 and Group 30. The use of rescue analgesia was statistically lower in Groups 20 and 30., Conclusions: PECS type-1 block using 20 ml of 0.25% bupivacaine can provide effective analgesia after breast augmentation surgery., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Laparoscopic sleeve gastrectomy (LSG) is defined as the first-step bariatric surgery for the treatment of obesity. Opioid analgesics are often preferred for pain management because of their strong analgesic potentials. However, opioids have undesirable adverse effects., Objectives: The objective of this study is to evaluate and compare the influence of IV forms of ibuprofen and paracetamol on pain management and opioid consumption on patients undergoing LSG surgery., Setting: This study was conducted at Istanbul Medipol University Hospital., Methods: Patients were stratified into three groups. Group I (group ibuprofen, n = 30) was administered 800 mg of IV ibuprofen, group P (group paracetamol, n = 30) was administered 1000 mg of IV paracetamol, and group C (control group, n = 30) was given 100 ml of saline solution. We evaluated opioid consumption and VAS scores postoperatively., Results: This study included 90 patients who underwent LSG. The use of rescue medication in group I was statistically lower than the other groups. VAS scores in group I and group P at recovery and at 2, 4, 8, 12, and 24 h were lower than those in group C. In particular, the VAS scores in group I at the first 2 h postoperatively were significantly lower than those in group P (p < 0.05). Opioid consumption in group C was significantly higher than the other groups (p < 0.05)., Conclusion: Our study suggested that IV ibuprofen resulted in lower pain scores compared to paracetamol by reducing postoperative opioid use in the first 24 h in patients undergoing LSG surgery.

Background: Central venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver., Objective: Compare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique., Design: Prospective clinical study., Setting: University hospital., Subjects and Methods: Healthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated., Main Outcome Measure(s): Hemodynamic measurements and RIJV dimensions., Results: In 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P < .001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and < .001 for cross-sectional area and diameter, respectively)., Conclusion: Channelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position., Limitations: No catheterization and study limited to healthy volunteers.

Grammosciadium pterocarpum subsp. bilgilii and Grammosciadium pterocarpum subsp. sivasicum from Turkey are herein described as two new subspecies, and the species Grammosciadium schischkinii is synonymied under Grammosciadium pterocarpum subsp. pterocarpum. Quantitative variation of morphological and anatomical characters have been analysed to provide discriminative characters between the taxa of section Stenodiptera and to provide a key to the species. The taxonomic status of the taxa has been discussed in light of these morphological and fruit anatomical data using multivariate statistics such as MANOVA and Principal Component Analysis. The results are also used to present a critical discussion of characters used to distinguish and determine different taxa within Grammosciadium . MANOVA showed that ten characters, except stylopodium and style length, differed significantly among the taxa, and the results were confirmed by Tukey tests and PCA analysis (except the character of fruit number). However, only ranges of the characters of sepal length, fruit length, fruit width, fruit width/wing width ratio, and width of fruit wing are not overlapped. Qualitative characters of petiolate stipular segments of lower leaves and presence of funicular oil ducts in transvers section of mericarps were found as diagnostic characters.

Objective: Fentanyl is frequently used during anesthesia induction. The use of fentanyl can cause cough through different mechanisms. Here, we aimed to investigate effects of pheniramine maleate (PM), an antihistaminic agent, and compare it with lidocaine on fentanyl induced cough., Methods: This is a randomized double-blind prospective clinical study of ASA I-II, 120 patients scheduled for elective abdominal surgery. Patients were administered drugs intravenously and randomly allocated into three groups: Group C (2 ml 0.9 % normal saline), Group L (1mg/kg lidocaine), and Group F (PM 45.5 mg). 90 seconds after administration, 2µ/kg fentanyl was applied in three seconds to all patients. Severity of cough (mild: 1-2, moderate: 3-5, severe> 5), time of the cough and vital parameters were recorded 90 seconds after fentanyl injection., Results: Eight patients (25%) in Group C had fentanyl induced cough whereas three patients (7.5%) in Group L and one patient (2.5%) in Group F experienced this phenomenon. There was statistically significant difference between Group F and Group C (p<0.05); however, differences between Group L and Group C or Group F and Group L were not statistically significant (p>0.05)., Conclusions: Pheniramine Maleate 45.5 mg is better that placebo and as effective as lidocaine to prevent fentanyl induced cough.

Objective: The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated., Material and Methods: The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed., Results: Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage., Conclusion: Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.

Objective: The aim of this study was to assess the risk factors and preventive measures for gossypibomas and their medico-legal implications in forensic medicine in the Turkish legal system., Material and Methods: This study involved a retrospective analysis of the records of 39 patients with gossypiboma. Records were available from the Istanbul Forensic Medicine Institution and were surveyed for faulty treatment between 2008 and 2012. Parameters such as distribution of the cases according to specializations, elective and emergency procedures, surgical procedures, radio-opaque sponge and fluoroscopy availability, routine sponge and instrument counting, number of nurses for counting, and control of the operative field by a second surgeon were investigated., Results: All cases were evaluated by the Istanbul Forensic Medicine Institute 3rd Expertise Committee. This committee comprised of specialists from the departments of forensic medicine, orthopedics and traumatology, general surgery, neurology, internal medicine, pediatrics, chest disease, and infectious diseases. All cases were considered as poor medical practice (malpractice) and surgeons were found to be responsible. In 16 of these 39 cases (41%) emergency procedures were performed. No unexpected event was reported in any procedure. In 16 cases (41%), sponge count was performed and was reported to be complete. Operation notes were available in 16 (41%) cases. Control of the operative field was performed by 1 surgeon, and sponge and instrument count was performed by 1 scrub nurse. Radio-opaque sponge and fluoroscopy were available in 9 (23%) centers in these cases., Conclusion: Gossypiboma can be prevented not only with surgeons' care but also with adequate support of medical device and material. However, it is considered as a poor medical practice. Presence of only 1 general surgeon in the expertise committee and ignorance of the working conditions by the surgeons should be questioned.

Objective: The aim was to evaluate the parameters that were considered by Forensic Medicine in bile duct injury as well as the issues that the physicians were found to be faulty., Material and Methods: The following parameters were investigated in 21 files that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012; expert decisions, patient's age, gender, written patient consent, diagnosis, type of first surgery, surgical complications, timing of complication diagnosis within the scope of complication management, patient's referral timing, troubleshooting procedures and mortality rate., Results: Physicians were found to be faulty in all files. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, late recognition of injury and late transfer of the patient in 20 (95.3%) files. Written consent had not been obtained in any of the files. Thirteen patients were female (61.9%) and 8 (30.1%) were male, with a mean age of 43.3 years. Nineteen patients had cholelithiasis (90.4%), and two patients (9.5%) had a mass in the head of the pancreas. Cholecystectomy was performed laparoscopically in 15 patients (78.9%), and with open surgery in 4 patients (21.1%). The Whipple procedure was performed in two patients. The diagnosis was made during the operation in one patient (4.7%), and in the post-operative period in 20 patients (95.3%). The time to diagnosis after surgery was between 3-6 days. All of the patients had been referred to third level health care facilities. The timing of transfer was 1 day in the patient who was diagnosed during the operation, and ranged between 4-10 days in those who were diagnosed postoperatively. Reasons for late referral were delays related to pending test results in 12 patients, vague signs in 3 patients, and following-up patients with the thought that the biliary fistula will heal by itself in 5 patients. Mortality was not observed in any of the examined files., Conclusion: The issues where physicians were most frequently found to be faulty were failure to obtain written patient consent, late recognition of injury and late transfer of the patient.

We analysed the data in the medical records of six patients admitted for tetanus in the intensive care unit (ICU) of the anaesthesia department in the Medical Faculty of Ataturk University from 1 January 2010 to 31 December 2012. All patients received the generalized form of treatment for tetanus in the ICU. The average age of the patients was 65.33 ± 13.45 years. Treatment modalities were administered to the patients in accordance with the literature. Four patients died despite all therapeutic interventions and two patients were discharged uneventfully. All those who died had chronic disease and infected wounds on their head, but only one patient had an infected wound on his leg. The surviving patients had no chronic illnesses but did have injuries on their legs. The presence of chronic disease increases tetanus-related mortality. More information about the disease must be made available in order to make it preventable with regular vaccinations.

Background: Ibuprofen and acetaminophen are widely used as adjuvant analgesics for postoperative pain. This meta-analysis compared the effects of intravenous (IV) ibuprofen and acetaminophen on postoperative opioid consumption and pain intensity after general anesthesia. Methods: PubMed/MEDLINE, EMBASE, and Cochrane Library databases were searched to identify relevant studies published up to May 2023. Randomized controlled trials comparing the effects of perioperative IV ibuprofen and acetaminophen on postoperative opioid consumption and pain after general anesthesia were included in the meta-analysis and trial sequential analysis (TSA). Results: Eight studies with 494 participants were included. Compared to IV acetaminophen, IV ibuprofen significantly reduced 24 h opioid consumption, presented as morphine equivalents (mean difference [MD]: -6.01 mg, 95% CI [-8.60, -3.42], P < 0.00001, I² = 55%), and pain scores (on a scale of 0-10) at 4-6 h (MD: -0.83, 95% CI [-1.29, -0.37], P = 0.0004, I² = 65%) and 12 h (MD: -0.38, 95% CI [-0.68, -0.08], P = 0.01, I² = 11%) postoperatively. These results were statistically significant in TSA. Pain scores at 24 h postoperatively and side effects were not significantly different between the two groups in the meta- analysis, and TSA revealed that the sample size was too small to adequately evaluate the effects, requiring further studies for conclusive results. Conclusions: Perioperative IV ibuprofen reduced 24 h opioid consumption and pain severity up to 12 h postoperatively compared to acetaminophen. Additional research is required to assess pain intensity beyond 12 h and side effects. [ABSTRACT FROM AUTHOR]

Effective postoperative pain management is pivotal for recovery, with an increasing focus on non-opioid analgesics. This study evaluates the efficacy of gabapentin in reducing postoperative opioid usage and pain after spinal surgeries in adults. We conducted a meta-analysis of prospective randomized placebo- controlled trials comparing preoperative gabapentin with placebo in adult spinal surgery patients. Primary outcomes included opioid consumption in the first 24 hours postoperatively, converted to oral morphine equivalents. Secondary outcomes assessed were Visual Analog Scale (VAS) pain scores and side effects within the same period. Thirteen of 674 studies met inclusion criteria, encompassing 843 participants. Gabapentin significantly decreased opioid consumption (mean difference [MD]: -39.91, 95% CI: -66.40 to -13.41; p=0.0069) and reduced VAS pain scores at various postoperative intervals, despite high heterogeneity (I²=96.8%). Preoperative gabapentin reduces opioid consumption and early postoperative pain in spinal surgery patients. Further research is needed to ascertain the optimal dosing and potential impacts on postoperative complications. [ABSTRACT FROM AUTHOR]

Background: To evaluate the postoperative analgesic efficacy and safety of nerve block (NB) in patients undergoing breast surgery for cosmetic purposes. Methods: PubMed, Web of Science, Embase and Cochrane Libraries were searched from inception to September 2022, to identify all eligible randomized controlled trials (RCTs). Continuous data are presented as mean difference (MD) with 95% confidence intervals (CI), whereas dichotomous data are provided as odds ratios (OR) with 95% CI. This meta-analysis was performed in RevMan 5.4. Results: A total of 10 RCTs with 565 patients were meta-analyzed. Compared to the control group, the pain score of the NB group was significantly lower at postoperative 2, 3–4, 6–8, 12–16 and 24 h. Opioid consumption in the first postoperative 24 h was significantly lower in the NB group (MD = − 9.02, 95% CI − 14.29 to − 3.75, P < 0.05), I2 = 95%). In addition, the NB group showed a prolonged time to first postoperative analgesic requirement (MD = 43.15, 95% CI 4.74–81.56, P < 0.05, I2 = 96%), decreased incidence of additional postoperative analgesia (OR 0.14, 95% CI 0.07–0.28, P < 0.05, I2 = 0%) and reduced incidence of postoperative nausea or vomiting (OR 0.33; 95% CI 0.22–0.48; P < 0.05; I2 = 0%). There was no significant difference in operation duration between the two groups. Conclusions: Nerve block is an effective and safe option for postoperative analgesia after breast cosmetic surgery. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this systematic review and network meta-analysis was to evaluate the efficacy and safety of different preemptive analgesia measures given before laparoscopic cholecystectomy (LC) for postoperative pain in patients., Methods: We conducted a comprehensive search in databases including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected relevant research data on the 26 preemptive analgesia measures defined in this article in LC surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24 h), opioid consumption within 24 h post-operation, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness., Results: Forty-nine articles involving 5987 patients were included. The network meta-analysis revealed that multimodal analgesia, nerve blocks, pregabalin, and gabapentin significantly reduced postoperative pain scores at all postoperative time points and postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin significantly extended the time to first rescue analgesia. Ibuprofen was the best intervention for reducing PONV incidence. Tramadol significantly reduced the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin showed that compared to placebo, pregabalin (300 mg, 150 mg) and gabapentin (600 mg, 300 mg, and 20 mg/kg) were all more effective without significant differences in efficacy between these doses. Higher doses increased the incidence of PONV and postoperative headache and dizziness, with gabapentin 300 mg having a lower adverse drug reaction (ADR) incidence., Conclusions: Preemptive analgesia significantly reduced postoperative pain intensity, opioid consumption, extended the time to first rescue analgesia, and decreased the incidence of PONV and postoperative headache and dizziness. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin all showed good efficacy. Gabapentin 300 mg given preoperatively significantly reduced postoperative pain and ADR incidence, recommended for preemptive analgesia in LC., Trial Registration: PROSPERO CRD42024522185., (© 2024. The Author(s).)

In face recognition systems, light direction, reflection, and emotional and physical changes on the face are some of the main factors that make recognition difficult. Researchers continue to work on deep learning-based algorithms to overcome these difficulties. It is essential to develop models that will work with high accuracy and reduce the computational cost, especially in real-time face recognition systems. Deep metric learning algorithms called representative learning are frequently preferred in this field. However, in addition to the extraction of outstanding representative features, the appropriate classification of these feature vectors is also an essential factor affecting the performance. The Scene Change Indicator (SCI) in this study is proposed to reduce or eliminate false recognition rates in sliding windows with a deep metric learning model. This model detects the blocks where the scene does not change and tries to identify the comparison threshold value used in the classifier stage with a new value more precisely. Increasing the sensitivity ratio across the unchanging scene blocks allows for fewer comparisons among the samples in the database. The model proposed in the experimental study reached 99.25% accuracy and 99.28% F-1 score values ​​compared to the original deep metric learning model. Experimental results show that even if there are differences in facial images of the same person in unchanging scenes, misrecognition can be minimized because the sample area being compared is narrowed. [ABSTRACT FROM AUTHOR]

Background: Tetanus is a life-threatening vaccine-preventable disease found more commonly in tropical climates. It accounted for up to 60 deaths annually until the introduction of the tetanus toxoid. It is now rare in Canada by immunization. This study aims to describe a case of tetanus in Saskatchewan with possible occupational exposure. Case Report: We describe the case of a vaccinated soil expert with tetanus resulting from skin abrasions. This report highlights the early diagnosis, atypical presentation with possible vaccine attenuation and management approach, including acute care, intensive care unit referral, surgical management and physical rehabilitation. We also describe the public health management provided in this case. Despite the severity, the patient returned to his previous home environment with minimal motor sequelae. Conclusion: Occupational exposure to tetanus is an important risk, even in regions where the disease is rare. Prevention through vaccination is a key public health intervention that must be encouraged to avoid health complications that are often fatal. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer is the most common malignancy in women. Mammography screening is crucial for early detection. However, breast compression can cause pain and may impact patients' participation. In this study, we aimed to determine the pain level perceived by patients during mammography examination with the visual analog scale (VAS). Materials and Methods: The study included a total of 140 consecutive patients (all female, mean age of 51±9, between 35 and 89) who applied to the Radiology Department of a tertiary hospital and underwent mammography for screening or diagnostic purposes. Cases undergoing mammography-guided interventional procedures were not included. Immediately, after mammography, patients were asked to rate their pain levels under the compression effect of mammography on the VAS in a face-to-face interview with an anesthesiologist. A statistical analysis was performed to determine the association between the breast pattern, applied pressure, the results of the mammogram, and the VAS score. Results: About 66% of the patients stated that they felt 4 or more pain during mammography compression. The median VAS was 5 (interquantile range: 4). Breast patterns affected the VAS score. The VAS score of 57% of the patients with fatty breasts and 77% of the patients with dense breasts reported pain with a VAS of 4 and above (Pearson Chi-square, p=0.01). Applied pressure (p=0.07) or the mammography results (p=0.31) did not affect the VAS score. Conclusion: Mammography is a moderately painful procedure. It is necessary to use pain-relieving strategies to stop women from avoiding mammography. All appropriate medical interventions, including algology, should be used in this situation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the potential of intrathecal administration of lipid emulsions as a targeted therapeutic strategy to mitigate the hemodynamic consequences of high or total spinal anesthesia induced by bupivacaine in a rat model. Materials and Methods: After receiving approval from Koç University's Local Ethics Board of Animal Experiments, 14 adult female Wistar Albino rats were randomized into two groups: Lipid and Saline. After inducing a high spinal block, each group was treated with either intrathecal lipid emulsions or isotonic saline solutions, respectively. Hemodynamic parameters such as systolic, diastolic, and mean arterial blood pressures, as well as heart rate, were continuously monitored. A histological analysis was conducted upon completion of the study. Results: The Lipid group exhibited a significant increase in mean systolic (p=0.002), diastolic (p=0.002), and arterial pressures (p=0.002) compared to the Saline group. The mean pulse rate also differed significantly between the groups (p=0.009). Notably, while all rats in the Saline group succumbed, only two fatalities occurred in the Lipid group, with the other five rats surviving (p=0.021). Conclusion: This study suggests that intrathecal administration of lipid emulsions can serve as a rapid and effective intervention to counteract the hypotension and bradycardia induced by high or total spinal anesthesia with bupivacaine in rats. While these findings are promising, further experimentation and clinical trials are required to confirm this method's potential, focusing on its long-term safety, efficacy, and the establishment of an optimal administration protoco. [ABSTRACT FROM AUTHOR]

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for perioperative opioid-sparing multimodal analgesic treatments. Concerns regarding the potential for serious adverse events (SAEs) associated with perioperative NSAID treatment are especially relevant following gastrointestinal surgery. We assessed the risks of SAEs with perioperative NSAID treatment in patients undergoing gastrointestinal surgery., Methods: We conducted a systematic review of randomised clinical trials assessing the harmful effects of NSAIDs versus placebo, usual care or no intervention in patients undergoing gastrointestinal surgery. The primary outcome was an incidence of SAEs. We systematically searched for eligible trials in five major databases up to January 2024. We performed risk of bias assessments to account for systematic errors, trial sequential analysis (TSA) to account for the risks of random errors, performed meta-analyses using R and used the Grading of Recommendations Assessment, Development and Evaluation framework to describe the certainty of evidence., Results: We included 22 trials enrolling 1622 patients for our primary analyses. Most trials were at high risk of bias. Meta-analyses (risk ratio 0.78; 95% confidence interval [CI] 0.51-1.19; I 2  = 4%; p = .24; very low certainty of evidence) and TSA indicated a lack of information on the effects of NSAIDs compared to placebo on the risks of SAEs. Post-hoc beta-binomial regression sensitivity analyses including trials with zero events showed a reduction in SAEs with NSAIDs versus placebo (odds ratio 0.73; CI 0.54-0.99; p = .042)., Conclusion: In adult patients undergoing gastrointestinal surgery, there was insufficient information to draw firm conclusions on the effects of NSAIDs on SAEs. The certainty of the evidence was very low., (© 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

This study aims to evaluate the efficacy and safety of multiple or single‐dosage intravenous ibuprofen (IVIB) in managing postoperative pain and fever in adults who are unable to take oral medications. A systematic review and meta‐analysis was conducted based on randomized controlled trials (RCTs) comparing IVIB with placebo or other analgesic and antipyretic medications for postoperative pain and fever management. Data were collected from 8 main databases from the inception to June 2022. Risk of bias assessment was performed, and the GRADE methodology was used to assess the certainty of pooled evidence. Primary outcomes included visual analogue scale (VAS) scores within 24 h postoperative and reduction of temperature. Meta‐analyses were conducted to calculate the mean difference (MD) or risk ratios (RR) and 95% CIs. As a result, a total of twenty‐three RCTs with 3716 participants were included. For postoperative pain, with moderate‐to‐low certainty evidence, IVIB was associated with lower postoperative VAS scores than placebo, with MD ranging from −3.53 (95% CI, −4.32 to −2.75) at 0 min to −0.96 (95% CI, −1.35 to −0.57) at 24 h. Compared with intravenous acetaminophen, IVIB demonstrated lower VAS scores (MD, −1.54 at 0 min; −0.36 at 24 h). For fever, IVIB showed satisfactory antipyretic efficiency in a short period of time, but no difference was observed between IVIB and intravenous acetaminophen. IVIB was well‐tolerated for both pain and fever management. In conclusion, moderate‐to‐low certainty evidence supports the use of IVIB for adults with postoperative pain and fever who are unable to take oral medications. [ABSTRACT FROM AUTHOR]

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There is conflicting evidence regarding the analgaesic efficacy of single-shot serratus anterior plane block (SAP) for breast surgery. This meta-analysis aimed to evaluate the analgaesic efficacy of SAP compared with non-block care (NBC) and other regional blocks, i.e. paravertebral block (PVB) and modified pectoral nerve block (PECS block) for breast surgery. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomized controlled trials reporting the use of the SAP block in adult breast surgery. The primary outcome was postoperative oral morphine equivalent (OME) consumption for up to 24 hours. Random-effects models were used to pool results and mean difference (MD), and odds ratio (OR) was calculated for continuous and dichotomous outcomes, respectively. GRADE guidelines were used to evaluate the strength of evidence, and trial sequential analysis (TSA) was performed to provide certainty to the conclusion. Twenty-four trials enrolling 1789 patients were included. Moderate strength evidence suggested that SAP provided a significant reduction in 24-hour OME compared with NBC [MD - 24.9 mg (95% CI - 41.54, -8.25; P < 0.001, I2 = 99.68%)]. TSA ruled out the possibility of false-positive results. Subgroup analysis for the SAP demonstrated that the superficial plane approach was more effective in reducing opioid consumption than the deep approach. The odds of developing PONV were significantly lower in SAP compared to NBC. Compared with PVB and PECS, SAP block was not statistically different for 24-hour OME and time to first rescue analgaesia. Single-shot SAP reduced opioid consumption, prolonged analgaesia duration, lowered pain scores, and decreased the incidence of PONV compared to NBC. There was no statistically significant difference in the studied endpoints between SAP, PVB, and PECS blocks. [ABSTRACT FROM AUTHOR]

In this study, detailed light microscopy (LM) and scanning-electron microscopy (SEM) analyses of pollen grains belonging to 11 taxa of genera Grammosciadium, Vinogradovia and Caropodium were performed. The pollen is radially symmetrical and generally isopolar with the exception of Grammosciadium macrodan ssp. nezaketiae where 65% of the grains have asymmetrical appearance. All the taxa are tricolporate. Ectoapertures are discontinuous (colpus length: 14.7 ± 0.8 and colpus width: 21.20 ± 2.28) with narrow and acute at the ends extending to the subpolar region. Endoapertures are in the mid-section of the ectoapertures, which is lolangate, prolate-spheroidal in Grammosciadium scabridum, while lalongate, ellipsoidal, oblate or suboblate in the other taxa. Pollen shape is triangular and semi-triangular in polar-view. Pollen outline in equatorial view is subrectangular-straight in G. scabridum and Caropodium platycarpum, however, those were subrectangular and slightly constricted in equatorial region in all others. Based on the P/E ratio, it is prolate in G. macrodon ssp. macrodon while it is perprolate in the other taxa. Ornamentation variation (i.e. psilate, psilate-perforate, psilate-rugulate, rugulate and rugulate-perforate) was observed around the apertural, equatorial and polar regions. This character has been found as taxonomically important for the studied taxa. [ABSTRACT FROM AUTHOR]

The morphological characteristics, phytochemical composition of Pimpinella anisoides fruits was investigated. The morphological analysis of the monocarps contributed to distinguish P. anisoides from other related Pimpinella species used for commercial purposes, in particular P. anisetum and P. anisum. Our study showed that these fruits are different for their surface and shape: in particular, P. anisoides monocarps are glabrous, whereas the other two species are strigose. Two main compounds were identified in the essential oil of the five studied accessions: limonene (46.78-50.74%) and anethole (38.50-42.77%) whose sum ranged between 85.28 and 93.51%. estragole and β-phellandrene were other two representative compounds. All other volatiles accounted for less than 1% of the total volatile composition. One-way ANOVA analysis showed significant differences in almost all volatiles, whereas non-significant differences were found in the compounds detected in very low quantity. Hierarchical cluster analysis allowed to group the five accessions in three main clusters. Principal Component Analysis (PCA) showed that the first two principal components explained 71.80% of total variance. Results show that morphological and phytochemical features of the ripe fruits of P. anisoides can be used to distinguish this species from others, to avoid commercial sophistications and for a better conservation. [ABSTRACT FROM AUTHOR]

Background. Primary breast augmentation remains the most frequently performed aesthetic surgery worldwide. Advances in this surgery have been incredible, not only from a surgical technique point of view but also since the appearance of new technologies and the better understanding of the interactions between the patient, the breast implant, the usual bacterial flora, and surgical maneuvers. However, there are still several instances of surgical procedure or postoperative medical indications that differ remarkably from one surgeon to another and may even be totally opposite. Due to the lack of a clinical practice guide for performing a primary augmentation mastoplasty, it is important to compare surgeon's procedures and decisions with scientific evidence. Methods. An anonymous survey composed of 25 multiple choice questions was designed to assess current practice in primary breast augmentation among active members of the Argentinian Society of Plastic Surgery. In January 2020, it was distributed via email. The results of the surveys were compiled by 2 independent reviewers and contrasted with current medical evidence. Results. A total of 146 surveys were completed by members of the Argentinian Society of Plastic Surgery. Conclusion. Many differences were found in the behavior of the surgeons surveyed, as well as a lack of correlation between the evidence based on medicine and the usual medical practices or indications. These results should serve as the basis for the realization of a clinical practice guide from a scientific society of plastic surgeons. [ABSTRACT FROM AUTHOR]