Uğur Serkan Çitilcioğlu

Perioperative inflammation is associated with adverse postoperative outcomes, and anesthetic management may modulate this response. However, the influence of fresh gas flow strategies during volatile anesthesia on perioperative inflammatory responses has not been adequately characterized. Evidence in obese surgical patients remains particularly limited despite the chronic low-grade inflammatory state and exaggerated responses to surgical stress associated with obesity. In this retrospective cohort study, 155 obese adult patients undergoing laparoscopic sleeve gastrectomy under sevoflurane anesthesia were evaluated. Patients received either low-flow (1 L/min, n = 76) or standard-flow (4 L/min, n = 79) anesthesia. Perioperative changes (Δ = postoperative − preoperative) in red cell distribution width (RDW), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were assessed using preoperative and 24-hour postoperative values. Between-group changes in these 3 designated primary outcomes were compared, and multivariable linear regression analyses were performed as adjusted supportive analyses. Intraoperative hemodynamic and oxygenation parameters and postoperative hospital length of stay were evaluated as exploratory secondary outcomes. ΔRDW and ΔCRP were greater in the standard-flow group than in the low-flow group (both P < .001) and remained statistically significant after Bonferroni correction (α = 0.0167), whereas no statistically significant between-group difference was observed for ΔNLR ( P = .902). After adjustment for the measured covariates and calendar period, standard-flow anesthesia remained associated with greater ΔRDW and ΔCRP. No statistically detectable between-group differences were observed in the longitudinal hemodynamic and oxygenation outcomes or postoperative hospital length of stay. Low-flow sevoflurane anesthesia was associated with smaller postoperative increases in RDW and CRP compared with standard-flow anesthesia in obese patients undergoing laparoscopic sleeve gastrectomy. These findings suggest an association between fresh gas flow strategy and selected postoperative inflammatory marker changes during bariatric surgery.

This letter comments on the article “The Effect of Bispectral Index Monitoring on Emergence Delirium in Pediatric Patients: A Retrospective Observational Study.” The study addresses an important clinical issue in pediatric anesthesia by evaluating the potential role of bispectral index monitoring in reducing emergence delirium and improving postoperative recovery. In this commentary, we highlight several clinically relevant points, including anesthetic depth monitoring, volatile anesthetic exposure, pain assessment, and standardized delirium evaluation, and offer suggestions based on recent evidence to support future research in this field.

Comments on regional analgesia strategies in total knee arthroplasty.

Aim: To compare the effects of proton pump inhibitors (PPIs) and histamine-2 receptor blockers (H₂RBs) on renal function in critically ill adults with preserved baseline kidney function.Methods: This retrospective cohort study included 210 intensive care unit (ICU) patients (105 PPIs, 105 H₂RBs) hospitalized for at least 15 days at Mersin City Training and Research Hospital. Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded on ICU days 0, 5, 10, and 15. Acute kidney injury (AKI) was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Group comparisons were performed using appropriate parametric and non-parametric tests. A sensitivity analysis was conducted after excluding patients exposed to sepsis, vasopressors, contrast, or nephrotoxic drugs.Results: Baseline demographics, illness severity, and potential confounders were comparable between groups. The incidence of AKI was similar in the PPI and H₂RB groups (12.4% vs 13.3%, p = 0.81). Serial eGFR measurements followed parallel patterns, showing an early decline and partial recovery by day 15 (p > 0.05 for all time points). Results remained consistent after sensitivity analysis.Conclusion: Short-term PPI therapy did not increase AKI risk or impair renal function compared with H₂RB use. PPI administration limited to the acute ICU phase appears safe regarding renal outcomes; however, unnecessary or prolonged administration should be avoided in accordance with current stewardship recommendations.

Aims: Postoperative intensive care unit (ICU) demand frequently exceeds capacity in high-volume tertiary hospitals. Enhanced post-anesthesia care units (ePACUs) have been proposed as an intermediate level of care providing advanced postoperative monitoring and short-term organ support. This study aimed to evaluate the real-world role of an ePACU in postoperative intensive care management.Methods: This retrospective observational study was conducted at a high-volume tertiary hospital and included all consecutive patients admitted to the ePACU over a 12-month period. Demographic characteristics, surgical specialty, anesthetic technique, presence of a preoperative ICU request, ePACU length of stay, advanced treatments applied and disposition after ePACU observation were evaluated. Results: A total of 180 patients admitted to the ePACU were included. Preoperative ICU admission was requested for 121 patients (67.2%), of whom 20 (16.5%) required ICU admission. Care was provided to 59 patients without a preoperative ICU request, and only 2 of these patients (3.4%) subsequently required ICU admission. In multivariable logistic regression, ASA ≥III status independently predicted ICU admission, whereas age ≥65 years was associated with lower odds (OR 0.26, 95% CI 0.10 -0.72); preoperative ICU request, male sex, and type of anesthesia were not independent predictors. The positive predictive value of preoperative ICU request was low (16.5%), whereas the negative predictive value was high (96.6%). Conclusion: In a high-volume tertiary center, the ePACU functioned as an effective intermediate postoperative care setting, allowing selected patients to be managed without immediate ICU admission. These findings suggest that ePACUs may support more flexible postoperative intensive care management.

Perioperative Management of Patients using GLP-1 Receptor Agonists Current Evidence, Risks, and Practical Recommendations-A Narrative Review - Turkish Journal of Anaesthesiology and Reanimation

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Accurate preoperative prediction of difficult intubation is essential for perioperative safety. Ultrasonographic airway evaluation has emerged as a promisi

Batı Nil virüsü enfeksiyonu, çoğu olguda asemptomatik veya hafif seyirli olmakla birlikte, özellikle ileri yaş ve komorbid hastalığı bulunan bireylerde ciddi nörolojik tutulum ve çoklu organ disfonksiyonu ile seyreden yaşamı tehdit edici klinik tablolara yol açabilmektedir. Nöroinvaziv Batı Nil enfeksiyonu; menenjit, ensefalit ve akut flask paralizi gibi tablolarla ortaya çıkabilir ve yoğun bakım gereksinimi ile ilişkilidir. Bu bölümde, ateş ve halsizlik yakınmaları ile başvuran, kısa sürede nörolojik bozulma gelişen ve beyin omurilik sıvısı incelemesi ile Batı Nil virüsü tanısı doğrulanan bir olgu üzerinden yoğun bakımda tanı, izlem ve tedavi yaklaşımları ele alınmaktadır. Olgu temelinde; ayırıcı tanı süreci, destekleyici tedavinin önemi, mekanik ventilasyon gereksinimi, hemodinamik izlem, sekonder komplikasyonların yönetimi ve immünmodülatör tedavi seçenekleri (özellikle plazmaferez uygulamaları) ayrıntılı olarak tartışılmaktadır. Ayrıca güncel literatür eşliğinde Batı Nil virüsünün patofizyolojisi, epidemiyolojisi ve prognozu gözden geçirilerek, yoğun bakım pratiğinde erken tanının ve multidisipliner yaklaşımın mortalite ve morbidite üzerindeki belirleyici rolü vurgulanmaktadır. Bu bölüm, klinisyenlere nöroinvaziv viral enfeksiyonlara yaklaşım konusunda pratik bir rehber sunmayı amaçlamaktadır. Although West Nile virus infection is asymptomatic or mild in most cases, it may lead to life-threatening clinical conditions characterized by severe neurological involvement and multiorgan dysfunction, particularly in elderly patients and those with comorbidities. Neuroinvasive West Nile disease may present as meningitis, encephalitis, or acute flaccid paralysis and is frequently associated with the need for intensive care. In this chapter, diagnostic, monitoring, and therapeutic approaches in the intensive care unit are discussed based on a representative case of a patient who presented with fever and fatigue, rapidly developed neurological deterioration, and was subsequently diagnosed with West Nile virus infection through cerebrospinal fluid analysis. Key aspects such as the differential diagnosis, the role of supportive care, indications for mechanical ventilation, hemodynamic monitoring, management of secondary complications, and the use of immunomodulatory therapies—particularly plasmapheresis—are reviewed in detail. In addition, the pathophysiology, epidemiology, and prognosis of West Nile virus infection are summarized in light of current literature. Emphasis is placed on the critical importance of early recognition and a multidisciplinary approach in reducing morbidity and mortality in patients with neuroinvasive viral infections. This chapter aims to provide clinicians with a practical framework for the intensive care management of severe West Nile virus disease.