Ferda Yaman

Background: Chronic pain following thoracotomy remains a common and clinically significant complication that adversely affects functional recovery and quality of life. Despite advances in perioperative analgesic techniques, chronic post-thoracotomy pain continues to be under-recognized and insufficiently managed in routine clinical practice. In this study, we aimed to determine the incidence of chronic pain after thoracotomy and evaluate its impact on daily activities and postoperative pain management behaviors. Methods: This retrospective observational study was conducted after institutional ethics committee approval was received (approval no. 2023/61). Patients aged ≥15 years who underwent thoracotomy between 15 June 2022 and 15 June 2023 and had undergone an operation at least three months prior to the study were included. Patients who underwent video-assisted thoracoscopic surgery were excluded. Demographic, surgical, anesthetic, and postoperative analgesia data were obtained from medical records. Patients were contacted by telephone to assess pain intensity using a Numeric Rating Scale (NRS), functional impact on daily activities, and analgesic medication use. The primary outcome was the incidence of chronic post-thoracotomy pain, defined as pain persisting beyond three months and reported at the time of the interview. Results: A total of 56 patients were included in the analysis. Chronic pain was reported by 55.4% of the patients. Pain that interfered with daily activities and required medication use was reported by 51.5% of the patients. Thirty-three patients (57.9%) reported an NRS score > 3 during movement. Among patients with chronic pain, 64.7% reported self-medication without physician consultation, whereas only 11.8% sought medical advice for pain management. Conclusions: Chronic pain remains highly prevalent after thoracotomy and substantially interferes with daily functioning. A considerable proportion of patients self-manage their pain without medical supervision, underscoring the need for structured postoperative follow-up, early identification of high-risk patients, and individualized multimodal analgesic strategies to reduce the burden of chronic post-thoracotomy pain.

Background: Chronic pain following thoracotomy remains a common and clinically significant complication that adversely affects functional recovery and quality of life. Despite advances in perioperative analgesic techniques, chronic post-thoracotomy pain continues to be under-recognized and insufficiently managed in routine clinical practice. This study aimed to determine the incidence of chronic pain after thoracotomy and to evaluate its impact on daily activities and postoperative pain management behaviors. Methods: This retrospective observational study was conducted after institutional ethics committee approval (approval no. 2023/61). Patients aged ≥15 years who underwent thoracotomy between 15 June 2022 and 15 June 2023 and were at least three months postoperative were included. Patients who underwent video-assisted thoracoscopic surgery were excluded. Demographic, surgical, anesthetic, and postoperative analgesia data were obtained from medical records. Patients were contacted by telephone to assess pain intensity using a Numeric Rating Scale (NRS), functional impact on daily activities, and analgesic medication use. The primary outcome was the incidence of chronic post-thoracotomy pain, defined as pain persisting beyond three months and reported at the time of the interview. Results: A total of 56 patients were included in the analysis. Chronic pain was reported by 55.4% of patients. Pain that interfered with daily activities and required medication use was reported by 51.5% of patients. Thirty-three patients (57.9%) reported an NRS score >3 during movement. Among patients with chronic pain, 64.7% reported self-medication without physician consultation, whereas only 11.8% sought medical advice for pain management. Conclusions: Chronic pain remains highly prevalent after thoracotomy and substantially interferes with daily functioning. A considerable proportion of patients self-manage their pain without medical supervision, underscoring the need for structured postoperative follow-up, early identification of high-risk patients, and individualized multimodal analgesic strategies to reduce the burden of chronic post-thoracotomy pain.

Background: Postoperative nausea and vomiting is a prevalent complication during the postoperative phase. Numerous factors affect postoperative nausea and vomiting, which can be categorized into patient-related, anesthesia-related, and surgery-related factors. The management of postoperative nausea and vomiting is multifaceted and consists of both prophylactic and therapeutic approaches. Objectives: This study aimed to investigate the attitudes and behaviors of anesthesiologists regarding the prophylaxis and treatment of postoperative nausea and vomiting, while also raising awareness of current practices and gaps in adherence to guideline-based management. Methods: This prospective observational study involved the online administration of a web-based questionnaire comprising 17 questions to physicians actively working in anesthesiology and reanimation clinics. The first five questions pertained to demographic data, while the remaining 12 questions assessed anesthesiologists’ attitudes and behaviors regarding the prophylaxis and treatment of postoperative nausea and vomiting. Results: The rate of missing to conduct postoperative nausea and vomiting risk assessments and not providing prophylaxis ( n = 67) was 33.5%, whereas the rate of administering prophylaxis with a single agent to each patient without risk assessment ( n = 85) was 42.5%. Among the anesthesiologists who participated in the study, the awareness rate regarding the prophylaxis and treatment of postoperative nausea and vomiting was found to be 90.0%. Conclusions: This study demonstrates that, in current clinical practice, postoperative nausea and vomiting risk assessment and prophylaxis remain an overlooked complication. A clear gap exists between awareness and evidence-based practice in postoperative nausea and vomiting management. Therefore, the most appropriate prophylaxis and treatment strategies should be identified on a patient-specific basis. These findings highlight the need for structured risk assessment and guideline-based prophylaxis strategies to optimize patient outcomes.

Ventricular arrhythmias are an important cause of morbidity and mortality, manifesting in various forms, ranging from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. General anesthesia provides advantages in terms of secured airway, increased patient comfort and satisfaction, and controlled respiration; however, its disadvantages are exacerbated by compromised cardiopulmonary function, typically requiring vasopressors and inotropic support. This study aimed to examine the anesthetic challenges and risk assessment in patients receiving epicardial ablation for ventricular tachycardia. In this retrospective, observational study, we collected data by examining the files of all patients who underwent percutaneous epicardial catheter ablation in our electrophysiology unit between October 30, 2020, and October 30, 2022, after obtaining ethics committee approval. All procedures were performed under general anesthesia. Midazolam, fentanyl, and low-dose propofol were used for induction. Maintenance was achieved using sevoflurane. The baseline characteristics of the patients and follow-up periods were recorded. Twenty patients were eligible for inclusion in the study. The mean age of the patients was 63.0 (57.5–66.0) years, 17 patients were male, and the mean body mass index was 25.9 (25.0–27.5) kg/m ² . The mean American Society of Anesthesiologists physical status classification score was 4. Fourteen cases were evaluated as New York Heart Association classes III-IV. The mean left ventricular ejection fraction was 22.5% (16.5–43.0). Seventeen patients required dopamine, and cardiopulmonary resuscitation was performed in 1 patient. No procedure-related deaths were observed in any of the patients. Anesthesiologists and cardiologists should take a personalized approach to patient care, beginning with the preoperative process and continuing through the post-procedure period, ensuring good communication and collaborative planning.

Backgrounds and Objectives: In this study, we aimed to assess preoperative frailty among hospitalized patients over 60 undergoing colorectal cancer surgery. We investigated the impacts of frailty and sarcopenia on postoperative recovery, complications, and discharge time, while also identifying a cost-effective, bedside-accessible USG parameter for diagnosing sarcopenia among patients assessed using the “Sonographic Thigh Adjustment Ratio” method. Materials and Methods: In this prospective study, we investigated the impacts of frailty and sarcopenia on the postoperative outcomes of 42 geriatric patients (with American Society of Anesthesiologists (ASA) scores of I–III) undergoing colorectal cancer surgery under general anesthesia. Frailty was assessed using the FRAIL scale, and sarcopenia was evaluated using the STAR (sonographic thigh adjustment ratio). Ultrasonographic measurements of rectus femoris and vastus intermedius muscle thicknesses were taken, and thigh lengths (TLs) were recorded. Ratios, including rectus femoris thickness/TL (RFT/TL), vastus intermedius thickness/TL (VIT/TL), and total muscle thickness/TL (TMT/TL), were calculated. Postoperative anesthesia recovery was monitored using the Modified Aldrete Score, indicating the time until discharge from the recovery unit. Complications were classified using the Clavien–Dindo system, and hospital discharge times were noted. Results: We observed significant differences between frailty status and ASA scores, as well as between age and frailty status. Muscle thickness significantly differed between the frail and pre-frail patients. Among the sarcopenic patients, age differences were significant. In men, VIT/TL was significantly correlated with sarcopenia diagnosis, whereas, in women, RFT/TL, VIT/TL, and TMT/TL were all correlated with sarcopenia. Conclusions: Based on our results, we conclude that VIT/TL measurement can serve as a predictive marker for preoperative sarcopenia, optimizing patient health before surgery.

Postoperative extubation is a critical phase. Various medications and different ventilation modes are employed during extubation to minimize potential issues. This study aimed to observe the early effects of the concurrent use of positive end-expiratory pressure (PEEP) and pressure support ventilation (PSV) modes during the extubation-emerge period on the respiratory system. After laparoscopic cholecystectomy, patients were administered a remifentanil infusion following the cessation of inhalation agents. PSV and PEEP modes were used on the mechanical ventilator, and the patients were extubated upon awakening. Hemodynamic and respiratory parameters, as well as complications during intraoperative and extubation periods, were recorded. A total of 199 patients were evaluated. Patients with complications were defined as group I (n = 37), and those without complications as group 0 (n = 167). Post-extubation complications included cough (3 or more, persistent or repetitive coughing) in 12 patients (6.04%), desaturation (SPO2 < 90% for 10 s) in nine patients (4.53%), bronchospasm in eight patients (4.02%), agitation (5 and above on the agitation scale) in three patients (1.5%), need for rescue mask ventilation (SPO2 < 90% lasting longer than 10 s) in three patients (1.5%), and airway obstruction (2 and above according to laryngospasm score) in two patients (1%). Statistically significant differences were observed between the two groups for ASA III (p = 0.0365). The use of PSV and PEEP modes during extubation-emergence period in laparoscopic cholecystectomy results in a low rate of respiratory system complications, which are mostly minor. These modes can be safely used during the extubation phase. However, since these complications are seen in patients with high ASA physical scores, further studies are needed for these patients. NCT06356649.

It has been stated that red blood cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) have prognostic value in cardiovascular surgery, as well as various clinical conditions. This study aimed to determine whether preoperative NLR and RDW values had an effect on postoperative mortality and morbidity in patients undergoing isolated heart valve surgery. Methods: This study was retrospectively conducted by examining the medical records of patients who underwent isolated heart valve replacement surgery between 2016 and 2020. Preoperative RDW and NLR values, postoperative extubation, mechanical ventilation, intensive care unit stay, and hospital stay, presence of postoperative cerebrovascular disease (CVD) and new-onset atrial fibrillation (AF), and dialysis requirement were recorded. The data of 68 patients were evaluated. In all the patients, the mean preoperative NLR value was 4.67±3.67, and the mean preoperative RDW value was 15.06±2.19. The NLR and RDW values were determined as 4.91(p=0.756) and 15.48 (p=0.032); respectively in the patients that developed postoperative AF, 3.34 and 17.56, respectively in those that developed postoperative CVD, and 9.26 and 14.93, respectively in those that required dialysis. Although preoperative the NLR and RDW values were high among the patients undergoing heart valve replacement surgery, it is not possible to state that these two markers have prognostic value for postoperative adverse events in this patient population.

Enfeksiyon, yoğun bakım ünitelerinde önemli mortalite ve morbidite nedenidir. Yoğun bakım ünitesinde dirençli organizmaların üremesini ve bulaşmasını azaltmak için önerilen stratejilerden biri, organizmaların komşu yataklardan bulaşma olasılığını azaltmak ve enfeksiyon kontrol önlemlerine uyumu artırmak için hastaları tek yataklı odalara yerleştirmektir. Açık koğuş sistemi ile yönetilen yoğun bakım ünitesi yeniden yapılandırılarak kapalı koğuş sistemi ile yönetilmeye başlandı. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte yatan hastalardaki enfeksiyon oranlarını retrospektif olarak incelemeyi amaçladık. Yeni yoğun bakım ünitesinde 6 aylık periyodda 274 hasta (grup A) takibi yapılmış ancak çalışma kriterlerine uygun 35 hasta, eski yoğun bakım ünitesinde 6 aylık periyodda yatan (grup B) 203 hastadan 23 hasta çalışmaya dahil edildi. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte en az 1 hafta yatışı olan mekanik ventilatör desteği alan hastalar çalışmaya dahil edildi. Dış merkezlerden kabul edilen hastalar ile entübe halde kabul edilen hastane içi hastalar çalışma dışı bırakıldı. Bilgisayar data sistemi kullanılarak hastaların APACHE II, GKS, yaş, cinsiyet, yatış nedeni ve kültür sonuçları ile kaçıncı gün üreme olduğu kayıt edildi. Bu kayıtlara göre hastalardaki enfeksiyonların görülme yerleri, sıklıkları, etkenler ve dirençli mikroorganizmaların üreme oranları karşılaştırıldı. İstatistiksel analiz sonucunda kolistin dirençli üreme sonuçları yönünden anlamlı bir fark olduğu (p<0,05), Grup B hastalarında kolistin direnci gelişme oranının daha yüksek olduğu bulunmuştur. Trakeal aspirat kültür sonuçları incelendiğinde Grup B’de istatistiksel olarak anlamlı bir fark olduğu (p<0,05) üreme oranlarının daha yüksek olduğu bulunmuştur. Sonuç olarak; yoğun bakım ünitelerinde çoklu ilaca dirençli bakterilerin ortaya çıkmasını ve yayılmasını önlemeye yönelik stratejiler antimikrobiyal tedavinin etkinliğini ve kullanımını artırmaya çalışan stratejilerin yanısıra enfeksiyon kontrol önlemleri arasında hasta izolasyonu önem arzetmektedir. Çalışmamızın sonucunda izole oda yoğun bakım ünitesinde daha az dirençli mikroorganizma üreme oranı olduğu gösterilmiştir.

Gebelik ve doğum her anne için eşsiz bir deneyim olmakla birlikte doğum eyleminin tanımlanan ve bilinen en şiddetli ağrılardan birisi olmasından dolayı birçok anne adayında endişe ve korkuya neden olmaktadır. Bu etkilerin yanında kontrol altına alınamayan şiddetli ağrılar anne, fetüs veya yeni doğanda istenmeyen patofizyolojik sonuçlara yol açabilir. Etkin bir analjezi yönetimi sağlanması için gebelikteki fizyolojik değişiklikler, ağrı mekanizmaları ve iletimi iyi anlaşılmalı ve ağrıya yönelik tedavi planlanırken anne ve yenidoğan üzerindeki etkiler göz ardı edilmemelidir. Temel amaç doğum eyleminin sebep olduğu ağrının kontrol altına alınması ile sağlıklı, bilinci açık ve ağrısız bir annenin kucağına yeni doğan çocuğunu verebilmektir. Ağrısız doğuma yönelik birçok farklı teknik halen geliştirilmekte ve bu amaca yönelik çalışmalar devam etmektedir. Birçok fizyolojik bulgunun değiştiği gebe hasta grubundaki ağrının tedavisine yönelik bu pratik uygulamalarda teorik bilgi son derece önemlidir.