Aslı Mete

Aims: This study aims to investigate the association between perioperative optic nerve sheath diameter (ONSD), a noninvasive marker of intracranial pressure, and the incidence of postoperative cognitive dysfunction (POCD) on postoperative days 8 and 30 in patients undergoing elective open-heart surgery with cardiopulmonary bypass. Methods: It was designed as a prospective, observational, single-institution study conducted at a tertiary care hospital. Seventy nine adult patients scheduled for elective open-heart surgery using cardiopulmonary bypass were included. Perioperative ONSD measurements were obtained at five predefined time points during the perioperative period. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) preoperatively and on the 8th and 30th postoperative days. POCD was defined as a clinically significant decline in MMSE score based on the Reliable Change Index (RCI), using a test-retest reliability coefficient of 0.95. An RCI

Aims: This study was designed to compare the efficacy and safety of erector spinae plane block and serratus anterior plane block in VATS (video assisted thoracoscopic surgery) patients. Methods: This prospective, single-blinded, randomized controlled trial included fifty patients aged 18 to 70 years, classified as American Society of Anesthesiologists (ASA) physical status I-III, who were scheduled to undergo elective video-assisted thoracoscopic surgery (VATS) between February 2022 and February 2023. Patients were randomly assigned to receive either an erector spinae plane block (ESPB) or a serratus anterior plane block (SAPB). In the ESPB group, a catheter was inserted at the T5 vertebral level, and 30 ml of 0.25% bupivacaine was administered. In the SAPB group, the catheter was placed into the superficial fascia overlying the serratus anterior muscle at the level of the fifth rib, and the same volume and concentration of local anesthetic was used. Postoperatively, when the Numeric Rating Scale (NRS) pain score was ≥3, a patient-controlled analgesia (PCA) device delivering 0.125% bupivacaine was connected to the catheter, and continuous infusion was initiated. Intraoperative fentanyl consumption, time to PCA connection, NRS scores, and postoperative morphine use were recorded. Data were analyzed using R version 4.0.0. Appropriate parametric or non-parametric tests were used based on data distribution. Repeated measures were evaluated with the Friedman test, and a p-value

Aims: The aim of this study was to evaluate the impact of acute kidney injury (AKI) in the first 48 hours on clinical outcomes and mortality in COVID-19 patients admitted from the emergency department (ED) to the intensive care unit (ICU). Methods: This retrospective observational cohort study, conducted at Pamukkale University Faculty of Medicine, analyzed 243 COVID-19 patients admitted to the ICU between March 2020 and 2023. Patients were divided into two groups according to the development of AKI based on serum creatinine (Scr) values assessed within the first 48 hours after ICU admission: group 1 (AKI-) without AKI (n=186) and group 2 (AKI+) with AKI (n=57). The two groups were compared in terms of clinical outcomes and mortality rates. Results: AKI+ patients were generally older and had higher mortality rates. AKI- patients were more likely to be discharged. AKI+ patients stayed in the ICU longer and required more treatment, including hemodynamic support, respiratory support, and renal replacement therapy (RRT). Scr levels were significantly different between groups at 24 and 48 hours. AKI+ patients had higher blood urea nitrogen (BUN), albumin, and BUN/albumin ratio (BAR) levels, indicating renal dysfunction and metabolic imbalances. In addition, procalcitonin levels were also significantly higher in AKI+ patients, suggesting an increased inflammatory or septic response. Other elevated markers included C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (pro-BNP), D-dimer, and troponin T, indicating worsening cardiac and inflammatory conditions. Finally, AKI+ patients had lower APACHE II scores. Conclusion: In COVID-19 patients admitted from the ED to the ICU, developing AKI+ within the first 48 hours was associated with an increased risk of mortality and worse clinical outcomes. In contrast, AKI- patients showed more favorable clinical outcomes, including a higher chance of survival and less need for intensive interventions.

Purpose: Many risk factors affecting bladder cancer recurrence, such as genetic and environmental factors, have been previously identified. It has been stated that risk factors that cause immunosuppression play a role in the spread of cancer cells. Anesthetic agent, which is a perioperative factor, may affect the risk of cancer recurrence by disrupting the immune system. The aim of this study was to compare the effect of regional anesthesia (RA) and general anesthesia (GA) on non-muscle invasive bladder cancers (NMIBC) recurrence. Materials and methods: A total of one hundred seventy-eight patients who underwent transurethral bladder tumor resection (TURBT) for NMIBC and underwent surgery under GA or RA between 2011 and 2016 in the urology departments of Pamukkale University and Uludağ University were included in the study. In the first group, 80 patients had RA. In the second group, 98 patients underwent GA during TURBT for NMIBC. Results: The recurrence time was shorter in the GA group (5.5 months) than in the RA group (11 months) (p=0.015). First-year relapse was higher in the GA group than in the RA group (p=0.048), but there was no difference in third-year relapse between groups (p=0.810). The mean recurrence time was 11 months (95% CI; 9.058 - 12.942) in the RA group and 5 months (95% CI; 2.090 - 7.910) in the GA group (p=0.031). Conclusion: During transurethral resection of the bladder tumor, an increase in the recurrence time was observed in patients with intermediate-risk NMIBC who received RA compared to patients who received GA. RA provided a 7-month benefit in relapse delay.

Purpose: Delayed graft function (DGF) is a poor clinical prognostic factor in kidney transplantation (KT) which frequently occurs due to acute kidney injury (AKI) within the postoperative first week. In the present study, we researched the effect of SBP on early graft function after reperfusion in living-donor kidney transplantation. Materials and methods: We retrospectively obtained preoperative patient clinical data from anesthesia followup forms. The research data included demographic data, laboratory data, medical past and kidney-related information. SBP, central venous pressure [CVP], anesthesia duration, infusion and transfusion volumes, blood loss and urine output, surgery duration, ischemia duration and onset of graft diuresis were used as intraoperative data. Results: There was no significant difference between 4 different systolic blood pressure categories assigned after reperfusion of the kidney in terms of the related characteristics of the recipients. Table 3 shows the relationship of systolic blood pressure after reperfusion with intraoperative anesthetic and surgical variables. There were significant differences between the 4 groups categorized according to SBP after reperfusion (p<.001). Conclusions: Systolic blood pressure over 140 mm Hg after reperfusion may be a safe level regarding long-term graft survival and mortality. It is needed to research the long-term prognosis of living donor kidney transplantation in larger study population to confirm the outcomes of our study.

Introduction: Covid-19 virus is a viral disease that is transmitted quickly between people through close contact and droplets. It spread from China to the rest of the world easily and within a few months. The limited information about COVID 19 and the fact that it has changed the life routine has inevitably affected hospitals and many operating room settings, similar to all everywhere and in all departments of countries. The aim of this article is to discuss the use of personal protection methods in our hospital, to examine the virus exposure of our personnel working in the operating room with the current protection methods in the operating room during the pandemic period lasting more than two years, and to examine and evaluate the effects of vaccination on the severity of the disease. Material method: This study was based on prospective data obtained from Pamukkale University Faculty of Medicine operating room staff between March 2020 and 2022 after receiving the approval from the Ethics Committee. The use of personal protection equipment against COVID-19 virus, exposure to the virus, vaccination status, and hospitalization status of healthcare workers in operating rooms, which is an isolated part of the hospital, were evaluated from the first period of the COVID-19 pandemic. At the same time, the the groups was divided into 2 different time periods: before and after vaccination. The use of personal protective equipment, status of having COVID 19 infection, hospitalizations due to the virus, symptoms in case of illness, vaccination status and the number of doses of vaccine were examined. Those who terminated their employment at the hospital during this period were excluded from the study. Results: The findings of the study were obtained through analysis at 2 different time points. Data were collected at 2 different time points as before and after the vaccination of healthcare workers. Demographic data, personal protective equipment use, COVID positivity and negativity and symptoms of 144 participants were analyzed at two different time points. It has been found in many different analyses that women are better protected than men, but also that the protection of anesthesiologists is higher than that of other groups. Hospitalizations were very rare in operating room staff and they did not have severe symptoms. Finally, there was a significant decrease in symptoms and their severity after vaccination. In conclusion, this study revealed the fact that operating rooms are the most important places where precautions should be taken during pandemics. This study aims to shed light on the protection of operating room staff during possible future outbreaks.

Objective :Brain death can be defined as the irreversible loss of brain functions. It is evident that a delay occurred in the diagnosis of brain death will result in the loss of many cadaveric organs and thus, the number of patients waiting for organ transplantation will increase. Despite there being many studies in the literature about the diagnosis and difficulties of brain death, family interviews, and organ donation, the studies regarding the effects of the regulation change in Turkey on organ donation are limited. The present study includes 10-year retrospective data and it has been conducted to offer an insight to the scientists about the diagnosis of brain death and organ donation. Method: The study was conducted by using data obtained from the examination of the retrospective files of patients diagnosed with brain death between 2011 and 2021 at Pamukkale University, Faculty of Medicine after obtaining the approval of the ethics committee. Results: After the study was initiated, the files of 71 patients diagnosed with brain death between 2011 and 2021, were accessed. Due to the missing information in the files of 4 patients, these patients were excluded from the study. Of 67 patients with registered brain death, 36 were male (53.7%) and 31 were female (46.2%). The age average was 49.07. When the treatment units of these patients were evaluated, 50 patients (74.6%) diagnosed with brain death were treated at the neurosurgery intensive care unit, 7 (10.4%) at the neurology intensive care unit, 6 (9%) at the anesthesia intensive care unit, and 4 (6%) at the cardiovascular surgery intensive care unit. Conclusions:The study concluded that the importance of the diagnosis duration of brain death and the number of specialists who diagnosed brain death in the previous years may have affected this process. It is clear that the formal process, which changed after 2014, showed an acceleration in diagnosis. The importance of the interviews with family members besides the brain death diagnosis has emerged as a result of the study