Ferda Yilmaz Inal

Objective: Supraglottic airway devices are alternatives to endotracheal intubation under general anesthesia. However, their performance in older patients remains understudied, particularly in different head positions. Methods: This prospective randomized controlled study included 120 patients aged ≥75 years undergoing elective urologic surgery. Patients were randomly allocated into four groups based on the device type and head position during insertion: (a) i-gel with neutral head position; (b) i-gel with right head rotation; (c) classic laryngeal mask airway with neutral head position; and (d) classic laryngeal mask airway with right head rotation. The primary outcome was the insertion time. Secondary outcomes included insertion attempts, oropharyngeal leak pressure, and perioperative variables, which were assessed in patients with successful device placement. Results: The overall insertion success rate was 94.2% (113/120). The i-gel was associated with a significantly shorter insertion time and higher oropharyngeal leak pressure than the classic laryngeal mask airway (both p = 0.001). Two-way factorial analysis revealed that device type significantly influenced insertion time and oropharyngeal leak pressure, whereas head position and device-by-head position interaction exerted no significant effects. No significant differences were observed in the number of insertion attempts, fiberoptic view scores, peak airway pressure, recovery times, hemodynamic variables, or perioperative and postoperative complications. Conclusions: In patients aged ≥75 years undergoing elective surgery, the i-gel was associated with a shorter insertion time and higher oropharyngeal leak pressure than the classic laryngeal mask airway. Head position did not significantly influence insertion time, oropharyngeal leak pressure, or peak airway pressure. These findings suggest that airway device selection exerts a greater impact on supraglottic airway performance than head position, whereas the i-gel may offer practical advantages in selected clinical settings. Trial registration : ClinicalTrials.gov ( https://clinicaltrials.gov ), Identifier: NCT07027293, registered on 27 May 2025.

Background: This study aimed to compare the effects of equipotent doses (one minimum alveolar concentration) of sevoflurane and desflurane on respiratory mechanics, haemodynamics and oxygenation in patients undergoing spinal surgery in the prone position. Methods: Fifty patients were randomised to receive either sevoflurane (n = 25) or desflurane (n = 25). Respiratory parameters (dynamic compliance (Cdyn); peak (Ppeak), mean (Pmean) and plateau (Pplateau) airway pressures; driving pressure (∆P); tidal volume; and dead space), haemodynamic parameters (heart rate (HR) and systolic, mean and diastolic arterial pressures) and oxygenation parameters were recorded intraoperatively at baseline, after prone positioning, during surgery, and after returning to the supine position. Results: Prone positioning led to significant increases in Ppeak and reductions in Cdyn in both groups (p < 0.05). Although Ppeak, Pmean, Pplateau and ∆P fluctuated intraoperatively, no intergroup differences were detected (p > 0.05). After returning to the supine position, respiratory mechanics approached baseline in both groups. Oxygenation (arterial oxygen pressure), ventilation (arterial carbon dioxide pressure), end-tidal carbon dioxide, and pH remained stable and comparable. Sevoflurane was associated with slightly greater decreases in arterial pressures, whereas HR was similar between groups. Conclusions: Both desflurane and sevoflurane maintained stable intraoperative respiratory mechanics, oxygenation, and haemodynamics in patients without pulmonary disease. Prone positioning increased Ppeak and decreased Cdyn similarly in both groups. Both agents appear safe for spinal surgery in the prone position. Clinical Trial Registration: This study was registered at ClinicalTrials.gov (NCT06118489).

This study aimed to demonstrate the association between high-dose corticosteroid administration and adverse outcomes in coronavirus disease 2019 patients. Data were collected retrospectively from medical records. The primary outcome was invasive mechanical ventilation or death, whichever occurred first. The secondary outcome was all-cause in-hospital mortality. The standard dose was defined as a daily dose of ≤1.5 mg/kg of prednisolone or equivalent, and the high-dose was defined as ≥250 mg of prednisolone or equivalent. Data were analyzed using frequentist and Bayesian logistic models. In addition, a propensity score–matched subgroup was analyzed for the association between high-dose corticosteroid use and adverse outcomes. A total of 1072 patients hospitalized between September 29, 2020, and April 20, 2021, were enrolled in the study. Of these, 188 patients (18%) had a primary outcome; 55 patients (29%) died, and 133 (71%) required invasive mechanical ventilation. Higher age was associated with adverse outcomes in all analyses. Standard dose corticosteroid use was found to be protective (odds ratio [95% confidence interval], 0.53 [0.35–0.81]) in the final logistic model. Point estimates in the propensity score–matched subgroup did not encourage high-dose corticosteroid use (odds ratio [95% confidence interval], 3.06 [0.98–9.50]). The posterior probability density distributions generated by the Bayesian logistic model implicated standard-dose corticosteroid use as protective (80% credible intervals, −0.839 to −0.313), whereas it implicated high-dose corticosteroid use as associated with adverse outcomes (80% credible intervals, 0.163–0.941). This study found high-dose corticosteroid (≥250 mg prednisolone daily) use associated with adverse outcomes.

Cerrahi Pozisyonlar Yadigar YILMAZ Ferda YILMAZ İNAL Çocuklarda Postoperatif Derlenme Ajitasyonu Ayşe Hande ARPACI Berrin IŞIK Erişkin Hastalarda Elektif, Non-Kardiyotorasik Cerrahi Öncesi Ferda KARTUFAN Geriatrik Anestezi Onur KARACA İntrakranial Kitlelerde Anestezi Yönetimi Onur KARACA İskemik Beyin Hasarı Ve Anestezi Yönetimi Tuncer ŞİMŞEK Lokal Anestezikler Selçuk KAYIR Robot Yardımlı Ürolojik Cerrahilerde Anestezik Zorluklar Arzu AKDAĞLI EKİCİ Sakroiliak Eklem Bozukluğu İlişkili Ağrıda Girişimsel Yöntemler Birzat Emre GÖLBOYU Tavi ‘De (Transkatater Aort Valv Replasmanı) Anestezi Yönetimi Senem GİRGİN Toraks Cerrahisinde Anestezi Yönetimi Güvenç DOĞAN Yanık Hastalarında Ağrı Yönetimi ve Tedavisi Hakan AKELMA Yanıklı Hastalarda Anestezi Yönetimi ve Tedavisi Hakan AKELMA

We analysed a carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak in the coronavirus disease (COVID) ICU. We retrospectively collected data from ICU records. We identified 25 cases between 12 November 2020 and 19 December 2020, and compared them to 42 controls present in the ICU during the same period. The presence of a femoral haemodialysis catheter was strongly associated with invasive CRKP infections (cases, 9 [36%]; controls, 0 [0%]; odds ratio [OR] 95% confidence intervals [CIs], 21 (5; 89)). We found a significant association between old age and CRKP infection with adverse outcomes. Sequence analysis revealed three distinct carbapenemase genes: bla_NDM-1, bla_OXA-48 and bla_KPC-2. We launched rectal swab sampling upon admission to the ICU, cohorted colonized patients and cases and conducted an intensive training programme for newly employed staff. This study revealed that the emergence and dissemination of CRKP in COVID ICUs were associated with increased adverse outcomes. The presence of a femoral haemodialysis catheter was a significant risk factor for CRKP infections.

Masif kan transfüzyonu (MKT), genellikle 24 saat içinde 10 ünite veya daha kısa sürelerde belirli hacimlerde eritrosit süspansiyonu verilmesi olarak tanımlanan hayat kurtarıcı bir müdahaledir. Temel endikasyonu akut kan kaybına bağlı hemodinamik instabilite olup; travma, aort rüptürü ve cerrahi komplikasyonlar gibi durumlarda kritik öneme sahiptir. Tanı koymada ABC skoru gibi yöntemler kullanılarak hastanın MKT ihtiyacı belirlenir. MKT uygulamasında, koagülopatiyi önlemek için eritrosit, plazma ve trombositlerin belirli oranlarda (genellikle 1:1:1) verilmesi önerilir. Uygulama sırasında yüksek akış hızını sağlamak için kısa ve geniş çaplı kateterlerin kullanımı ile kanın vücut sıcaklığına ısıtılması esastır. Süreç, ortalama arter basıncı 60-65 mmHg ve hemoglobin 7-9 g/dL gibi hedef değerlere ulaşılana kadar devam ettirilir. Masif transfüzyon; koagülopati, sitrat toksisitesine bağlı hipokalsemi, hipotermi, hiperkalemi ve hacim yüklenmesi gibi ciddi komplikasyon riskleri taşır. Ayrıca akciğerde mikroembolizasyon kaynaklı solunumsal sorunlar görülebilir. Bu nedenle MKT, komplikasyonların yakın takibiyle deneyimli bir ekip tarafından yönetilmelidir. Massive blood transfusion (MBT) is a life-saving intervention traditionally defined as the transfusion of 10 units of red blood cell suspension within 24 hours or specific volumes within shorter periods. Its primary indication is hemodynamic instability due to acute blood loss, and it is of critical importance in cases such as trauma, aortic rupture, and surgical complications. Scoring systems like the ABC score are utilized to determine the patient's need for MBT. In MBT administration, it is recommended to provide red blood cells, plasma, and platelets in specific ratios (usually 1:1:1) to prevent coagulopathy. During the procedure, the use of short, large-bore catheters to ensure high flow rates and the warming of blood products to body temperature are essential. The process continues until target values, such as a mean arterial pressure of 60-65 mmHg and hemoglobin levels of 7-9 g/dL, are achieved. Massive transfusion carries risks of serious complications, including coagulopathy, hypocalcemia due to citrate toxicity, hypothermia, hyperkalemia, and volume overload. Additionally, respiratory issues stemming from microembolization in the lungs may occur. Therefore, MBT must be managed by an experienced team with close monitoring of potential complications.

Objective: The Pain Sensitivity Questionnaire (PSQ) is a clinically beneficial instrument that has been proven to be correlated with various experimental pain sensitivity assessments in healthy people and in patients with chronic pain. In this study, we aimed to translate the PSQ into Turkish (PSQ-T) and validate it for the measurement of pain sensitivity among Turkish people. Methods: Seventy-three patients with chronic back pain who were planning to undergo an interventional procedure completed the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory (BDI), Beck Anxiety Inventory, Pain Catastrophizing Scale, and PSQ prior to their procedure. Subcutaneous infiltration of lidocaine was used as a standardized experimental pain stimulus. Pain was evaluated using a visual analog scale (VAS 1: infiltration in the hand, and VAS 2: infiltration in the procedure area) Results: Scores on the PSQ-T were significantly correlated with those on the BPI-SF. A significant positive relationship was observed between VAS 1 and VAS 2 values and the PSQ-T score, BPI pain score, and BPI interference score. Conclusions: The PSQ-T can be used as a valid and reliable tool for the assessment of pain sensitivity in the Turkish population.

Introduction The present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain. Methods The present study includes 80 ASA 1–2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg kg⁻¹ intravenous midazolam, 1 mg kg⁻¹ lidocaine, 1 µ kg⁻¹ fentanyl, and then a bolus dose of 1 mg kg⁻¹ propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg kg⁻¹ h⁻¹ propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg kg⁻¹ propofol (IV) was administered to ensure sedation depth with a BIS level of 65–75, and the propofol infusion was halted once the BIS value dropped below 65. Results STAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T. Conclusion The significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption. Trial Registration The study was registered with the number NCT03114735 on ClinicalTrials.gov.

Background: It is known that ischemia-reperfusion damage in the kidney is one of the most common causes of acute kidney failure. It is also known that reduced renal damage has a nephroprotective effect by reducing the release of inflammatory and vasoactive peptides that cause tissue damage. Therefore, we think that reperfusion caused by ischemia in kidney damage may be an important focus for clinical research. Methods: A total of 21 healthy 230-250 g female rats were used in our experimental study. During the experiment, animals were randomly divided into three groups, each containing seven rats. Group 1: The group that underwent left nephrectomy with a sham operation. Group 2: Left renal ischemia for 60 minutes, then left nephrectomy followed by 45 minutes of reperfusion. Group 3: Left renal ischemia for 60 minutes, then reperfusion for 45 minutes, followed by left nephrectomy. In this group, sugammadex was given intravenously at a dose of 100 mg/kg at the beginning of reperfusion. In the histomorphological examination, damage findings of tubules atrophy, dilation and cast formation, tubular epithelial brush border loss and vacuolization, presence of fibrosis as interstitial structural change, capillary vasodilatation/congestion and neutrophilic cell infiltrates in interstitial spaces, and morphological changes in glomeruli were evaluated. Results: When evaluated based on tubular brush border, there were no significant differences between Group 2 and Group 1 (P = 0.454), while the damage in Group 3 was less significant than Group 2 (P = 0.017). When evaluated in terms of tubular vacuolization, there was no significant difference between Group 2 and Group 1 (P = 0.902), while the damage in Group 3 was less significant than Group 2 (P = 0.017). Conclusion: We believe that 100 mg/kg sugammadex given at the beginning of reperfusion after one hour of ischemic condition on rats has a histochemically detectable nephroprotective effect.