Muzeyyen Beldagli

Background: Different regional anesthesia (RA) techniques have been used for laparoscopic cholecystectomy (LC), but there is no consensus on their comparative effectiveness. Our objective was to evaluate the effect of RA techniques on patients undergoing LC using a network meta-analysis approach.Methods: We conducted a systematic review and network meta-analysis. We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (Science and Social Science Citation Index) using the following PICOS criteria: (P) adult patients undergoing LC; (I) any RA single-shot technique with injection of local anesthetics; (C) placebo or no intervention; (O) postoperative opioid consumption expressed as morphine milligram equivalents (MME), rest pain at 12 h and 24 h post-operation, postoperative nausea and vomiting (PONV), length of stay; and (S) randomized controlled trials.Results: A total of 84 studies were included. With the exception of the rectus sheath block (P = 0.301), the RA techniques were superior to placebo at reducing opioid consumption. Regarding postoperative pain, the transversus abdominis plane (TAP) block (−1.80 on an 11-point pain scale) and erector spinae plane (ESP) block (−1.33 on an 11-point pain scale) were the most effective at 12 and 24 h. The TAP block was also associated with the greatest reduction in PONV.Conclusions: RA techniques are effective at reducing intraoperative opioid use, postoperative pain, and PONV in patients undergoing LC. Patients benefit the most from the bilateral paravertebral, ESP, quadratus lumborum, and TAP blocks.

This review assesses the efficacy of inhalation anesthetics and propofol in cardiac surgery, primarily focusing on their impact on myocardial protection and subsequent clinical outcomes. The review provides a concise summary of the current scientific information regarding the protective efects of inhalation anesthetics and propofol, particularly in the context of ischemia–reperfusion injury during cardiac surgery. The review delves into the mechanisms of action and discusses clinical studies comparing the 2 anesthetic strategies regarding mortality, complication rates, and length of hospital stay. Inhalation anesthetics exhibit cardioprotective properties through many mechanisms, such as preconditioning, scavenging of free radicals, and stabilizing mitochondria. Propofol demonstrates certain protective benefits but does not possess the preconditioning capability of inhalation medications. Clinical investigations yield contradictory findings, as several studies indicate enhanced outcomes with inhalation anesthetics, while others observe no substantial disparity between the 2 approaches. The cardioprotective efcacy of propofol against ischemia–reperfusion injury remains limited. While its inherent antioxidant properties ofer direct myocardial protection, propofol demonstrably lacks the preconditioning-mediated signaling pathways triggered by inhalation anesthetics. As a result, propofol’s protective efect may be slightly inferior to preconditioning strategies, and its potential to inhibit organ-protective impact of other interventions needs further investigation. The question of which anesthetic approach ofers superior myocardial protection remains debatable. Current evidence is inconclusive, potentially due to patient heterogeneity, surgical complexity, and methodological limitations of existing studies. Future research, including pharmacogenetic studies and large, welldesigned, randomized controlled trials, are necessary to provide definitive guidance on anesthetic selection for optimal myocardial protection in cardiac surgery. Cite this article as: Dost B, Turunc E, Sarikaya Ozel E, et al. Myocardial protection in cardiac surgery: Exploring the influence of anesthetic agents. Eurasian J Med., 2023;55(Suppl. Issue: 1): S138-S141.

Amaç: Koronavirüs hastalığı-2019 (COVİD-19) pandemisi tüm sağlık hizmetlerini olumsuz etkilemektedir. Bu çalışmada pandemi döneminde merkezimizde, yoğun bakım ünitelerinin önemli kalite göstergesi olan yoğun bakım mortalite oranının nasıl etkilendiğini araştırdık. Gereç ve Yöntem: Bu retrospektif tek merkezli çalışmada, dahili cerrahi non-COVİD-19 hastaların kabul edildiği 20 yataklı yoğun bakım ünitesinde mortalite oranları, pandemi öncesi ve sonrası 6 aylık zaman periyotlarında karşılaştırıldı. Bulgular: Pandemi döneminde yoğun bakım ünitemizde takip edilen hastalarda mortalite oranı artmıştır. Mortalite ile yoğun bakım ünitesine kabul endikasyonu (cerrahi nedenle kabul sonrası, medikal nedenle kabul sonrası, travma sonrası) ve yoğun bakım ünitesine kabul yeri (acil servis, farklı hastane) arasında anlamlı bir ilişki olduğu görülmüştür (p