Korgün Ökmen

Background/Objectives: We compared five general-purpose multimodal AI configurations with anaesthesiologists classifying sonographic pecto-intercostal fascial plane block spread. Methods: This archived-image reader study used a prospective cohort of 120 ASA III adults undergoing isolated coronary artery bypass grafting at one centre. In June 2026, five free AI configurations and three experts classified identical sets of 8–10 left-sided frames. Direct binary comparisons used each expert’s labels in 115 block recipients; five no-block controls were separate. The senior expert reviewed expert labels before setting the final reference, precluding independent expert–AI accuracy comparison. Reference-conditioned balanced accuracy was defined as mean sensitivity and specificity. Results: Direct balanced agreement was 42.3–53.9% for four configurations and 55.4–64.9% for Kimi K2.6. AI asserted spread in 17/25 no-block classifications; all 20 human classifications indicated absence. Final-reference balanced accuracy was 76.9–91.9% for experts and 44.6–66.9% for AI, conditional on the expert-informed reference. Pain analyses were exploratory. Conclusions: Direct comparisons establish neither anatomical accuracy nor independent expert superiority. Limitations include one centre, operator and ultrasound system; selected frames; free access; no raw AI outputs, reproducible a priori power calculation or non-recruitment-day eligibility log.

Introduction: Hip fractures carry high perioperative mortality in elderly patients. The choice of anesthetic technique may influence outcomes and long-term survival. Objective: To compare early, mid-term, and long-term all-cause mortality across four anesthetic approaches in hip fracture surgery. Methods: This retrospective cohort study analyzed 1,453 patients (2020–2024) who underwent hip fracture surgery under one of four anesthetic techniques: lumbar and sacral plexus block (LSPB), hypobaric spinal anesthesia (hypobaric SA), hyperbaric spinal anesthesia (hyperbaric SA), or general anesthesia (GA). Propensity score matching (PSM; 1:1:1:1, multinomial logistic regression, caliper 0.2 SD) yielded 956 matched patients (n = 239 per group). Intergroup comparisons used chi-square and one-way ANOVA; survival analysis used Kaplan–Meier, log-rank test, and multivariable Cox proportional hazards regression. Results: At 30 days, mortality was significantly lower in the LSPB (7.5%, n=18/239) and hypobaric SA (8.8%, n=21/239) groups than in hyperbaric SA (15.5%, n=37/ 239) and GA (15.9%, n=38/239) (p=0.013). At 180 days, hypobaric SA had the lowest mortality (22.2%, n=53/239) versus LSPB (32.6%), hyperbaric SA (27.2%), and GA (31.8%) (p=0.031). No significant difference was observed at 1 year (p = 0.111) or 2 years (p = 0.319). In the multivariable Cox model, anaesthetic technique was not an independent predictor. Age (aHR = 1.018, 95% CI: 1.006–1.031, p = 0.004) and surgical delay (aHR = 1.120, 95% CI: 1.006–1.247, p = 0.038) were the only significant independent predictors. Conclusions: The LSPB and hypobaric SA groups were associated with lower short-term mortality. The anesthetic technique was not an independent risk factor for long-term survival. Age and delayed surgery were the primary determinants of long-term mortality.

Introduction: In thoracic surgery, one-lung ventilation (OLV) may increase intrapulmonary shunt and impair oxygenation, and this effect is modulated by anesthetic technique via its influence on hypoxic pulmonary vasoconstriction. Objective: This study aims to compare whether thoracic epidural anesthesia differentially affects intrapulmonary shunt during one-lung ventilation according to the maintenance anesthetic technique. Methods: This retrospective and observational study included 86 patients who underwent OLV during thoracic surgery. Patients were divided into four groups according to the anesthetic protocol: target-controlled infusion (TCI) (22 patients), TCI combined with thoracic epidural anesthesia (TEA) (21 patients), sevoflurane (22 patients), and sevoflurane combined with TEA (21 patients). The primary outcome was the intrapulmonary shunt (Qs/Qt) ratio, measured at T1 (5 minutes after intubation), T2 (20 minutes after initiation of OLV), and T3 (40 minutes after initiation of OLV) using arterial and venous blood gas analyses. Secondary outcomes included arterial oxygen tension (PaO₂) and hemodynamic parameters measured at T1, T2, and T3. Results: The Qs/Qt ratio was higher in all groups at T2 and T3 measurements than at T1 (p<0.001). A statistically significant difference was found between groups in the Qs/Qt ratio at T2 and T3 measurement times (p0.05) Conclusion: Inhalation and intravenous anesthesia methods increased shunt volume in thoracic surgery patients undergoing OLV. The addition of thoracic epidural anesthesia was associated with higher estimated shunt fractions in both anesthetic techniques.

Aim: Moderate to severe pain is common after proximal humerus surgery, often requiring opioid-based analgesia. Superior trunk block (STB), a selective brachial plexus block, has been proposed as an alternative for postoperative pain control. This study aimed to evaluate the analgesic efficacy of STB compared with intravenous patient-controlled analgesia (PCA) following proximal humerus surgery.Methods: This prospective randomized controlled trial included 60 patients undergoing proximal humerus surgery who were randomly assigned to two groups. In the STB group (n = 30), patients received an ultrasound-guided superior trunk block with 10 mL of 0.25% bupivacaine in combination with intravenous PCA. The control group (n = 30) received intravenous PCA alone. The primary endpoint was pain level, as measured using a visual analogue scale (VAS), at rest at 1, 2, 6, 12 and 24 hours postoperatively. Secondary endpoints included total tramadol consumption at 12 and 24 hours, subjective respiratory complaints, adverse effects, and the requirement for rescue analgesia. Results: The STB group had significantly lower VAS scores at all time points (p < 0.001). Tramadol consumption at 12 and 24 hours was also significantly lower in the STB group (p < 0.001). Paracetamol was required by 12% of control patients but by none in the STB group (p = 0.007). Adverse effects were similar; two STB patients developed Horner’s syndrome, and no respiratory complications were observed.Conclusion: Ultrasound-guided STB provided effective postoperative analgesia for the shoulder and upper arm after proximal humerus surgery, reducing opioid consumption with minimal respiratory side effects.Keywords: Proximal humerus fracture, nerve block, superior trunk block, analgesia, brachial plexus

Background: Postoperative cognitive dysfunction (POCD) remains a common neurological complication after cardiac surgery, particularly among older patients. Intraoperative cerebral oxygen desaturation during cardiopulmonary bypass (CPB) may reflect impaired cerebral perfusion and is proposed as a contributing factor to postoperative cognitive impairment. This study aimed to evaluate the association between intraoperative cerebral oxygen desaturation and postoperative cognitive outcomes in patients undergoing cardiac CPB surgery. Methods: In this prospective observational study, 74 patients undergoing elective cardiac surgery with CPB between March 2023 and March 2024 were included. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) preoperatively and on postoperative days (PODs) 4, 7, and 30. Bilateral frontal regional cerebral oxygen saturation (rSO2) was continuously monitored intraoperatively using near-infrared spectroscopy (NIRS). Cerebral desaturation was defined as a reduction of >20% in rSO2 from baseline. A standardized intervention protocol was applied when this threshold was exceeded. Results: The incidence of POCD was 32.4% during the first postoperative week and decreased to 20.2% by POD 30. Patients who developed POCD were significantly older than those without POCD (median (interquartile range [IQR]): 63 [58–68] vs. 59 [52–65] years; p = 0.026). Intensive care unit (ICU) and total hospital stays were significantly longer in the POCD group (median ICU stay: 74 [51.3–96] vs. 50 [46–60] hours; p < 0.001; median hospital stay: 9 [8–15.5] vs. 7 [7–9] days; p < 0.001). Intraoperative rSO2 values were significantly lower in the POCD group following the initiation of CPB, particularly during the hypothermic and rewarming phases (T2–T4). Percentage decreases in rSO2 at T2, T3, and T4 showed significant positive correlations with MMSE scores on POD 4 (r = 0.283, p = 0.014; r = 0.312, p = 0.007; r = 0.312, p = 0.007, respectively) and POD 30 (r = 0.314, p = 0.006; r = 0.270, p = 0.020; r = 0.349, p = 0.002, respectively). Conclusions: Intraoperative cerebral oxygen desaturation during CPB, particularly during the initiation, hypothermic, and rewarming phases, was associated with decreased early and late-postoperative cognitive performance after cardiac surgery. Continuous intraoperative cerebral oxygenation monitoring using NIRS may enable earlier identification of cerebral hypoperfusion and facilitate timely interventions in patients at increased risk of POCD. Clinical Trial Registration: NCT07361068. https://clinicaltrials.gov/search?term=NCT07361068.

Lumbar plexus blockade can be performed using both the classical landmark technique and ultrasound guidance. Reports suggest that ultrasound-guided blockade may enhance the safety of the procedure. Various approaches can be utilized for ultrasound-guided lumbar plexus blockade, including the paravertebral paramedian transverse scan, the Shamrock approach, and Trident imaging. In these imaging methods, needle guidance can be accomplished using either an in-plane or out-of-plane technique. Each of these application methods has limitations concerning needle imaging and guidance. In this case report, we present the outcomes of five patients who underwent lumbar plexus blockade for hip fracture surgery using an out-of-plane approach with Shamrock imaging, which could serve as a viable alternative to other methods.

Objectives: The aim of this study was to investigate the effects of thoracic epidural analgesia (TEA) on brain tissue oxygenation in thoracic surgery operations performed single lung ventilation (SLV) with the near infrared spectroscopy (NIRS) method. Materials and method: In this prospective, observational study, fifty patients aged between 18 and 65 years in the American Society of Anesthesiologists (ASA) I-III risk class, who would undergo thoracic surgery with the application of SLV, were included in the study. Patients were divided into two groups: TEA (n=25), with TEA applied, and Control (n=25), with TEA not applied. The primary outcome measure was cerebral regional oxygen saturation (ScO₂) values to be measured by NIRS throughout the operation. Results: The results were statistically evaluated, and when the demographic data of both groups were compared, no statistically significant difference was found (p>0.05). A statistically significant difference was found in the evaluation of the difference scores and percent change scores calculated between the ScO₂ measurement value in the T1 time period, the other measurement times T1-T2, T1-T3 difference scores in the control group were found to be statistically significantly lower (p=0.011, p=0.024, respectively). Conclusion: The results of this study are that TEA performed for analgesia has no effect on cerebral oxygen saturation (ScO₂) and hemodynamics during SLV during the intraoperative period.

Background: Coronavirus disease 2019 (COVID-19) may lead to severe viral pneumonia and acute respiratory failure requiring intensive care unit (ICU) admission. During the early phase of the pandemic, favipiravir was widely used as an antiviral agent; however, evidence regarding the optimal timing of its initiation in critically ill patients has remained limited. This study aimed to evaluate the effect of favipiravir initiation timing on clinical outcomes and mortality in ICU patients with COVID-19. Material and Methods: This retrospective cohort study included adult patients (≥18 years) with laboratory-confirmed COVID-19 who were admitted to the ICU between April 1 and June 1, 2020. Patients were divided into two groups according to the timing of favipiravir initiation: Group I, favipiravir initiated at ICU admission; and Group II, favipiravir initiated prior to ICU admission and continued during the ICU stay. Demographic characteristics, comorbidities, clinical outcomes, laboratory parameters, and treatment-related data were obtained from electronic medical records and ICU follow-up charts. The primary outcomes were ICU length of stay and mortality. Secondary outcomes included respiratory support requirements and corticosteroid use. Results: A total of 158 patients were analyzed (Group I, n=76; Group II, n=82). Baseline demographic and clinical characteristics were comparable between the groups. The ICU length of stay was significantly shorter in Group II compared with Group I (6.57 ± 5 vs. 10.91 ± 8.54 days, p=0.001). Corticosteroid therapy was required more frequently in Group I than in Group II (36.8% vs. 15.8%, p=0.003). Rates of intubation, noninvasive mechanical ventilation, high-flow nasal cannula use, and tocilizumab therapy did not differ significantly between the groups. Mortality was numerically lower in Group II, but this difference was not statistically significant (46% vs. 56.6%, p=0.148). Laboratory parameters, including d-dimer, ferritin, and C-reactive protein, were similar between the groups. Conclusion: Earlier initiation of favipiravir prior to ICU admission was associated with a shorter ICU stay and reduced corticosteroid requirement but did not significantly affect mortality. These findings suggest that early antiviral therapy may modestly influence clinical progression in critically ill COVID-19 patients without altering overall survival.