Gökhan Sertçakacılar

Objective: Trendelenburg positioning and pneumoperitoneum during laparoscopic surgeries can impair pulmonary function and increase the risk of postoperative pulmonary complications (PPCs). This study aimed to investigate the effects of individualized positive end-expiratory pressure (PEEP) on respiratory parameters and PPCs compared to conventional PEEP strategies in patients undergoing laparoscopic total hysterectomy.Materials and Methods: In this prospective, randomized controlled trial, 113 patients with ASA physical status I–III were randomized into two groups: individualized PEEP group (PEEPᵢ, n=56) and fixed PEEP 5 cmH₂O group (PEEP₅, n=57). Optimal PEEP in the PEEPᵢ group was determined via a stepwise recruitment maneuver guided by dynamic compliance. The primary endpoint was the incidence of PPCs within the first 7 postoperative days. Secondary endpoints included oxygen requirement, CPAP or mechanical ventilation use, and length of hospital stay.Results: The mean optimal PEEP in the PEEPᵢ group was 14 cmH₂O (IQR: 10–14). The incidence of PPCs was significantly lower in the PEEPᵢ group compared to PEEP₅ (7.7% vs. 34.7%, p=0.001). Dynamic compliance was higher and driving pressure significantly lower in the PEEPᵢ group (p

Background: Pulmonary embolism (PE) is a life‐threatening condition resulting from the obstruction of the pulmonary arteries, typically caused by thromboembolic material. This case report presents a patient diagnosed with massive PE following cervical hernia surgery, who did not have the usual PE risk factors. Case Presentation: A 41‐year‐old female, 1 day after undergoing C6‐7 discectomy, was diagnosed with a massive PE following cardiac arrest. Diagnostic imaging confirmed the presence of a massive PE. After thrombectomy and thrombolysis, treatment was managed using electrical impedance tomography (EIT) in the intensive care unit. PEEP titration was employed to optimize ventilation, whereas thrombolytic therapy was administered to improve perfusion. Both interventions were monitored using EIT, and extubation timing was guided by the achievement of adequate ventilation–perfusion (V/Q) matching. The patient was extubated on the sixth day, transferred to the service on the ninth day, and discharged home on the 20th day. Conclusion: PE should be considered in any patient presenting with chest pain, respiratory symptoms, and syncope after surgery even in the absence of typical PE risk factors. After cardiopulmonary resuscitation and thrombolysis, treatment can be optimized, and weaning success may be improved by evaluating (V/Q) matching using bedside EIT in mechanically ventilated patients.

Article: Comparison of postoperative analgesic efficacy between PENG block and suprascapular nerve block in shoulder arthroscopy: a randomized controlled trial - Minerva Anestesiologica 2025 Jun 30 - Minerva Medica - Journals

The Effect of Prone Position on Right Ventricular Functions in CARDS: Is Survival Predictable when Evaluated Through Transesophageal Echocardiography? - Turkish Journal of Anaesthesiology and Reanimation

Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians’ analgesic portfolios.

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure with lower pain scores and less morbidity than thoracotomy. However, it is necessary to provide adequate pain control in VATS. For this purpose, blocking visceral and somatic nerve fibers results in successful pain management. This retrospective study evaluated the effect of using different numbers of ports on the success of erector spinae plane block (ESPB) for postoperative analgesia management in patients undergoing VATS. We conducted a retrospective, single-center study between Sep 2020 and Aug 2021. According to the number of ports used, fifty-eight patients were assigned to three groups (single port, dual port, and three-port). Preoperative ultrasound-guided ESPB was performed on all patients. The primary outcome was the numerical rating scale (NRS) score assessed for pain severity at different periods after surgery. The secondary outcome was the postoperative cumulative opioid consumption, and the exploratory outcomes were to determine the length of hospital stay and the incidence of opioid-related side effects. Static and dynamic NRS scores were significantly higher in the three-port group in the first 12-hour postoperative period after admission to the post-anesthesia care unit (p<0.05). After the first 12-hour period after surgery, static and dynamic NRS scores did not differ significantly between the groups (p=0.158 and p=0.125, respectively). Cumulative opioid consumption in the first 24 hours postoperatively was considerably higher in the three-port group than in the other groups (33.04±21.35 mg, p=0.001). Rescue analgesia consumption was similar between all groups (p=0.341). Preoperative single-shot ESPB injection may be associated with better analgesia and less opioid consumption in the first 12 hours postoperatively in patients undergoing single or two-port VATS compared to the multi-port technique.

Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.

Aim: Postpartum hemorrhage is a life-threatening obstetric emergent clinical situation accompanied by blood loss of more than 500 ml after vaginal delivery and more than 1000 ml after cesarean section. This situation, frequently encountered in placental adhesion anomalies, is essential in terms of follow-up, treatment, and multidisciplinary management. We aimed to retrospectively evaluate the perioperative anesthesia management, transfusion requirement, and postoperative intensive care unit requirement of patients diagnosed with placental invasion anomaly who had an intraoperative hemorrhage Methods: In our single-center study, a total of 58 female patients diagnosed with of placental invasion anomaly with a cesarean section between 2017-2020 were examined. Patients under 18 years of age and missing data were excluded from the study. Demographic data of patients (age, American Society of Anesthesiologists score (ASA)), diagnosis, duration of operation, perioperative laboratory findings, anesthesia type, perioperative hemodynamics (highest heart rate, lowest mean arterial pressure, shock index), amount of bleeding, blood products, and fluids used, surgical interventions (B-Lynch, Bacri balloon application, uterine artery ligation, hysterectomy), intraoperative vasopressor/inotrope use, ICU stay, laboratory results in the first 24 hours postoperatively, and total hospital stay were recorded. Results: In the preoperative evaluation, 27 (46.5%) patients were diagnosed with placenta accreta, and placenta previa was diagnosed in 19 (32.7%) patients. Perioperatively mean of 3.08 ± 1.7 units of Red blood cell was used. In patients with postoperative intensive care unit hospitalization, the highest intraoperative lactate value was 3.5±1.8 mmol/L, shock index was 1.3±0.3 (0.6-1.8). In patients given intraoperative fibrinogen concentrate, the intraoperative shock index was 1.5±0.2 (0.9-1.8), the amount of intraoperative bleeding was 2575±302.2 ml, and the fibrinogen levels measured in the first 24 hours after surgery were 294.7±79.7 mg/dl. Conclusions: Anesthesia management of patients diagnosed with abnormal placental invasion is important because of significant hemorrhage. Due to unstable hemodynamics, preoperative blood product preparation with a multidisciplinary approach and a postoperative intensive care unit plan should be made for these patients.

New-onset atrial fibrillation (NOAF) is one of the leading causes of morbidity and mortality, especially in older patients in the intensive care unit (ICU). Although many comorbidities are associated with NOAF, the effect of anemia on the onset of atrial fibrillation is still unknown. This study aimed to test the hypothesis that anemia is associated with an increased risk of developing NOAF in critically ill patients in intensive care. We performed a retrospective analysis of critically ill patients who underwent routine hemoglobin and electrocardiography monitoring in the ICU. Receiver operating characteristics analysis determined the hemoglobin (Hb) value that triggered NOAF formation. Bivariate correlation was used to determine the relationship between anemia and NOAF. The incidence of NOAF was 9.9% in the total population, and 12.8% in the patient group with anemia. Analysis of 1931 patients revealed a negative association between anemia and the development of NOAF in the ICU. The stimulatory Hb cut-off value for the formation of NOAF was determined as 9.64 g/dL. Anemia is associated with the development of NOAF in critically ill patients in intensive care.

Turkish Journal of Geriatrics is the official publication of Turkish Geriatrics Society and is published four times a year. Turkish Journal of Geriatrics is a peer-reviewed journal and is devoted to high standards of scientific rules and publication ethics.