Zubeyir Cebeci

Background and Objectives: Movement-evoked pain captures pain experienced during postoperative activity and complements assessment of pain at rest after mastectomy. We evaluated whether the combined strategy of interpectoral and pectoserratus plane blocks with an additional superficial serratus plane injection was associated with lower movement-evoked pain during the first 24 postoperative hours. Materials and Methods: This single-centre retrospective cohort study included adults undergoing unilateral mastectomy from January 2023 through December 2025. Patients received interpectoral and pectoserratus plane blocks alone or the same strategy plus a superficial serratus plane injection. The primary outcome was movement-evoked numeric rating scale pain at 2, 6, 12, and 24 h. Repeated pain scores were analysed using covariate-adjusted linear mixed-effects models, with unadjusted models and inverse probability of treatment weighting as complementary analyses. Results: Among 216 patients assessed, 169 were included (81 interpectoral–pectoserratus; 88 combined strategy). Mean total bupivacaine doses were 66.39 mg and 110.06 mg, respectively. The adjusted mean between-group difference in movement-evoked pain, averaged across four assessments and expressed as interpectoral–pectoserratus minus combined strategy, was 2.09 points (95% CI 1.87–2.32); the unadjusted difference was 2.13 points (95% CI 1.90–2.36). The adjusted resting pain difference was 1.59 points (95% CI 1.38–1.80). Weighted estimates were similar. Rescue tramadol was administered to 13.6% and 8.0% of patients, respectively (p = 0.319). No block-related complications were documented. Conclusions: The combined strategy was associated with lower recorded movement-evoked and resting pain but involved approximately 66% more bupivacaine and a greater total injectate volume. These observational findings cannot establish whether the additional injection site provides an analgesic benefit independent of the higher local anaesthetic dose and volume.

Aim: A high Tp-e/QT ratio on electrocardiography is associated with adverse cardiovascular events. A prolonged QT interval is associated with mortality, while a prolonged Tp-e interval is associated with serious arrhythmias. The most significant undesirable events related to spinal anesthesia are bradycardia and hypotension. In this study, we investigated whether there is a relationship between a high preoperative Tp-e/QT ratio and cardiovascular adverse events related to spinal anesthesia.Methods: This prospective observational cohort study enrolled 249 adult patients who underwent spinal anesthesia. Preoperative Tp-e and QT intervals were measured manually, and the Tp-e/QT ratio was calculated. After spinal anesthesia, noninvasive mean arterial pressure (MAP) and heart rate (HR) were monitored at predetermined intervals.Results: Median Tp-e/QT ratios did not differ by sex (p = 0.336). An increase in the Tp-e/QT ratio was statistically significantly associated with decreases in MAP at the 1st, 5th, and 10th minutes (p = 0.007, p < 0.001, and p = 0.015, respectively). A statistically significant association was also found between the increase in the Tp-e/QT ratio and the decrease in HR at the 1st and 5th minutes (p = 0.011 and p < 0.001, respectively). Additionally, a statistically significant positive association was observed between increased Tp-e/QT ratios and ephedrine and atropine consumption (p = 0.018 and p < 0.001, respectively).Conclusion: This study demonstrated that patients with a high preoperative Tp-e/QT ratio may have a higher risk of developing hypotension and bradycardia following spinal anesthesia. Patients with high Tp-e/QT ratios should be closely monitored after spinal anesthesia.

How Surgical Positions Affect Cerebral Oxygenation? This study investigates the use of cerebral oximetry in various surgical positions and its impact on cerebral oxygenation. We conducted a literature review through Medline, and Ebscohost, focusing on articles published until October 30, 2023. Our findings indicate that: • Cerebral oxygenation is affected by all surgical positions, with the most significant clinical impact observed in the seated position. • Maintaining cerebral autoregulation is crucial for preventing cerebral hypoxia or desaturation. Upholding a mean arterial pressure above 60 mmHg is essential for this purpose. • Anesthesia can negatively impact cerebral oxygenation by potentially impairing cerebral autoregulation. • Inhalation anesthetics may have a more beneficial effect on cerebral oxygenation compared to intravenous anesthetics. • The risk of cerebral desaturation increases in elderly patients and those with comorbidities. • Standardization of cerebral desaturation definitions is needed to better assess its relationship with postoperative complications. • The position of the blood pressure transducer can affect the accuracy of intraoperative monitoring. In the seated position, placing it at the level of the acoustic meatus provides a more precise assessment. Our study highlights the importance of considering the effects of different surgical positions on cerebral oxygenation. This knowledge can assist anesthesiologists in monitoring patients intraoperatively and potentially preventing postoperative neurological complications. Keywords: Cerebral oximetry, Beach chair, cerebral oxygenation, Prone, Near-infrared spectroscopy

Aim: The aim of this study is to utilize machine learning techniques to accurately predict the length of stay for Covid-19 patients, based on basic clinical parameters. Material and Methods: The study examined seven key variables, namely age, gender, length of hospitalization, c-reactive protein, ferritin, lymphocyte count, and the COVID-19 Reporting and Data System (CORADS), in a cohort of 118 adult patients who were admitted to the hospital with a diagnosis of Covid-19 during the period of November 2020 to January 2021. The data set is partitioned into a training and validation set comprising 80% of the data and a test set comprising 20% of the data in a random manner. The present study employed the caret package in the R programming language to develop machine learning models aimed at predicting the length of stay (short or long) in a given context. The performance metrics of these models were subsequently documented. Results: The k-nearest neighbor model produced the best results among the various models. As per the model, the evaluation outcomes for the estimation of hospitalizations lasting for 5 days or less and those exceeding 5 days are as follows: The accuracy rate was 0.92 (95% CI, 0.73-0.99), the no-information rate was 0.67, the Kappa rate was 0.82, and the F1 score was 0.89 (p=0.0048). Conclusion: By applying machine learning into Covid-19, length of stay estimates can be made with more accuracy, allowing for more effective patient management.

Backgraound: Optic nerve sheath diameter measurement is a non-invasive method that provides rapid results in intracranial pressure assessment. Our aim in this study is to investigate how spinal anesthesia and tourniquet use affect optic nerve sheath diameter values in total knee arthroplasty operations. Methods:30 cases were included in the study. After spinal anesthesia, the tourniquet cuff was inflated. Right and left optic nerve sheath diameter measurements were performed 5 times with ocular ultrasound before spinal anesthesia, after spinal anesthesia, at 10th minutes after tourniquet inflation, 30th minutes after tourniquet inflation, and after tourniquet was deflated. The measurements were recorded in centimeters. During the first 24 hours postoperatively, the patients were followed up for the headache and/or visual impairment. Results: A significant difference was found between optic nerve sheath diameter values before and after spinal anesthesia (p<0.001, p<0.001). When comparing the optical diameter, tourniquet and tourniquet deflation values obtained on the right and left sides over time, we found a linear increase. Conclusion: The use of a tourniquet in spinal anesthesia and orthopedic surgery increases intracranial pressure. Optical measurement of nerve sheath diameter is a non-invasive and successful method that can be used safely for diagnosis and follow-up of elevated intracranial pressure. We believe that anesthesiologists should pay more attention to the measurement of optic nerve sheath diameter in clinical practice.

Objective: Sleep is one of the basic daily activities that are important for an individual with physical, mental, social, and intellectual needs to be in good physical and mental health. Although many definitions are made, sleep; is a complex and physiological event affected by pathophysiological, physical, psychological, and environmental factors. Anesthesiologists often work in closed environments and with long working hours, which can cause severe, chronic sleep loss and sleep disruption. Sleeplessness and low sleep quality can cause decreased attention during the day, impaired judgment, and delays in decision-making. This study, it is aimed to determine the sleep quality of Anesthesiology and Reanimation specialists working in Turkey. Methods: The study included all anesthesiologists whose e-mail addresses were registered with the Turkish Society of Anesthesiology and Reanimation and who worked in Turkey. Survey questions, which the participants can answer electronically, were sent to the participant's e-mail addresses. To increase the number of participants, a reminder email was sent three weeks after the first email. The data were expressed as a number, percentage, mean, and standard deviation and the correlation between the parameters will be evaluated at a 95% confidence interval by performing Pearson correlation analysis; p< 0.05 was accepted as significant. Results: Due to seven people with sleep disorders being excluded from the study, 210 out of 217 people who answered the questionnaires sent by email to the anesthetists who are members of the Turkish Society of Anesthesiology and Reanimation were included in the study. Of the respondents who worked in the following fields: 30% (n = 63) State Hospital, 33.3% (n = 70) University Hospital, 17.1% (n = 36) Ministry of Health Affiliate Hospital, 19.5% (n = 41) Private Hospital, and 73.3% (n = 154) at the Operating Room, 10% (n = 21) at the Intensive Care, 15.2% (n = 32) at the Operating Room + Intensive Care, and 1.4% (n = 3) at other departments, 48.4% (n = 105) were male, 51.6% (n = 112) were female, with a mean age of 41.5±7.6 years. The average hourly shift for the participants, 61% of whom were on the night shift, was 50 hours per month, and 25% were working more than 45 hours per week. Conclusion: The sleep quality of anesthesiologists is poor, which causes daytime dysfunction. It is thought that the reason for poor sleep quality, in general, is the adverse effects of their duties and responsibilities, working environment, and operating conditions on sleep quality.

Bu kitabı ortaya çıkarabilmek bizler için bir ayrıcalıktır. Bu kitabın ortaya çıkmasındaki temel fikrimiz, zor şartlarda çalışmakta olan siz değerli meslektaşlarımıza bu zorluklar içinde bir nebze de olsa faydalı olabilmekti. Anestezi gibi her sistemin kontrol altında tutulması ve değerlendirilmesi gereken bir disiplinde, komplikasyonun ortaya çıkma oranı da doğal olarak diğer disiplinlere göre daha yüksektir. Bu kaynak ile Anestezi pratiğinde karşılaşılan güncel komplikasyonların kaynağından tedavisine kadarki periyot ile ilgili bir fikir oluşturabilmek temel amacımızdır.

BACKGROUND:Epiduroscopy is commonly used for the evaluation and treatment of low back pain. Saline with or without local anesthetic addition was used to visualize epidural space structure during this procedure. A rapid increase in epidural space pres...