Zeynep Yasemin Tavsanoglu

This study aimed to investigate the association of systemic inflammatory and metabolic indices with short-term adverse clinical outcomes in adult patients admitted to the post-anaesthesia care unit (PACU). In this retrospective single-center observational study, adults admitted to the PACU following surgical procedures were analysed. The association between systemic inflammatory and metabolic indices, calculated from routine laboratory data, and short-term clinical outcomes was evaluated. Missing data were handled using multiple imputation. Associated risk factors were examined using multiple statistical analyses, and ridge regression was performed to assess model stability and potential multicollinearity. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative ability of the investigated markers. A total of 860 patients were included in the analysis. In multiple analyses, use of inotropic agents on arrival at the PACU, higher monocyte-to-lymphocyte ratio (MLR), and higher blood urea nitrogen-to-albumin ratio were associated with poor short-term clinical outcomes. ROC analysis demonstrated limited discriminative performance, with area under the curve values of 0.545 for the MLR and 0.582 for the blood urea nitrogen-to-albumin ratio in predicting poor short-term clinical outcomes. Higher monocyte-to-lymphocyte and blood urea nitrogen-to-albumin ratios were associated with poor short-term clinical outcomes in adult patients admitted to the PACU. However, the low discriminative performance observed in ROC analyses suggests that these indices should not be interpreted as strong standalone predictors. Instead, they may provide supporting information within multiparametric clinical risk assessment models.

Purpose This study aimed to compare the effects of a conventional nasal cannula (NC) and a Procedural Oxygen Mask™ (POM™) on oxygenation and airway interventions during sedated endoscopic retrograde cholangiopancreatography (ERCP) in the semi-prone position. Methods In this prospective, randomized, controlled trial, 150 patients undergoing ERCP were randomized to receive oxygen via either an NC or a POM™. The primary outcome was the incidence of hypoxemia and secondary outcomes included the incidence of severe and prolonged desaturation, the duration of hypoxemia, the number of hypoxemic episodes per patient, and the lowest recorded SpO₂, along with the incidence of airway interventions, the incidence of procedure-disrupting body motions, hemodynamic changes, and satisfaction scores from both gastroenterologists and patients. Results Hypoxemia occurred in 14 patients (18.7%) in the NC group and in 4 patients (5.3%) in the POM™ group, with a significant difference between groups (p = 0.024). The lowest recorded SpO₂ was found to differ significantly between the two groups (p < 0.001). In the multiple logistic regression analysis, NC use (aOR = 9.675; 95% CI 2.263–41.372; p = 0.002), higher total propofol dose (aOR = 1.014; 95% CI 1.007–1.022; p < 0.001), lower preoperative hemoglobin levels (aOR = 0.635; 95% CI 0.455–0.886; p = 0.007), and elevated direct bilirubin levels (aOR = 1.296; 95% CI 1.078–1.559; p = 0.006) were independently associated with an increased risk of hypoxemia. Conclusions The use of a POM™ during ERCP while the patient is in the semi-prone position under sedation significantly reduces the incidence of hypoxemia and may therefore contribute to improved oxygenation management. This finding suggests that a POM™ is a viable alternative to NC. Trial Registration The clinical trial was registered at https://www.clinicaltrials.gov/ (NCT06681558) on October 31, 2024.

High-flow nasal cannula (HFNC) oxygen therapy is a commonly used respiratory support method delivering heated, humidified air at high flow rates with a positive end-expiratory pressure (PEEP) effect. HFNC improves oxygenation and facilitates awake fiberoptic intubation in the management of difficult airways. However, concerns about HFNC-induced gastric insufflation and intestinal distension have emerged, particularly in patients with lower esophageal sphincter dysfunction or hiatal hernia. We report a case of severe intestinal distension following HFNC-assisted awake fiberoptic intubation in a patient with a hiatal hernia scheduled for laparoscopic Nissen fundoplication. A 50-year-old male patient was scheduled for a Nissen fundoplication procedure. Following preoperative airway examination, it was decided to proceed with awake intubation. HFNC was used as recommended in the guidelines to improve oxygenation. The patient was intubated with minimal sedation and airway topicalization under 40 L/min flow using a fiberoptic bronchoscope. The procedure was uneventful and the patient was handed over to the surgical team. Surgery began laparoscopically. However, excessive intestinal distension did not allow the surgery to continue with an optimum image. Aspirations with an orogastric tube and rectal tube could not improve the image and the patient had to undergo open surgery. The 5-hour open surgical procedure was completed without complications. Postoperative direct abdominal radiography showed dense intestinal air compared to the preoperative radiography. This case underscores the potential risk of HFNC-induced intestinal distension, particularly in patients with predisposing factors such as hiatal hernia. Although HFNC is effective for airway management, careful patient selection and technique optimization are crucial. Further research is needed to clarify the impact of HFNC on gastrointestinal dynamics and to guide its safe application in at-risk populations.

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB.

Background: Hypotension is a common adverse effect associated with the use of propofol and sodium thiopental. The objective of this study was to examine the impact of thiopental and propofol on erythrocyte (RBC) nitric oxide (NO) synthase activity and RBC-mediated NO release. Methods: A prospective, interventional in vitro trial. Male patients aged between 18 and 45 years with a classification of American Society of Anesthesiologists (ASA) class I, defined as healthy individuals, were included in this study. Venous blood samples (20 mL) were obtained from patients who met the inclusion criteria. Measurements were performed using the specific fluorescent probes for NO and calcium (Ca²⁺). Propofol and sodium thiopental were added to the suspensions at doses of 100, 250, 500, and 1000 μM and incubated for 30 min. All suspensions were proceeded to flow cytometric analysis. Nitrite/nitrate concentration was measured in the supernatant of RBC suspensions after centrifugation. RBC deformability and aggregation were measured by laser diffraction analysis using an ektacytometer. The primary outcome was to evaluate the effects of sodium thiopental and propofol on RBC-NOS activity. Results: Sodium thiopental caused significant increase in intracellular NO concentrations at all doses studied (p < 0.001). Importantly, the intracellular NO concentration increment was positively correlated with sodium thiopental concentration in the suspensions. The presence of L-N-acetylmethyl-arginine in the experimental medium abolished NO production in RBCs in response to sodium thiopental. Sodium thiopental caused increased nitrite and nitrate levels in the suspension medium in a dose-dependent manner. Incubation with thiopental caused an increase in intracellular free Ca⁺² levels while propofol induced no change. Sodium thiopental and propofol caused significant decrement in RBC aggregation. Conclusions: This study presents the initial evidence of augmented RBC-mediated NO production and release in response to sodium thiopental administration. In contrast to the effects observed with sodium thiopental, our results demonstrated that propofol had no impact on RBC-mediated NO production.