Fatma Çiğdem Özakın

Background and Objectives: Postspinal hypotension (PSH) remains a common complication of cesarean delivery under spinal anesthesia. Simple prespinal predictors may assist in identifying patients at increased risk. This study evaluated the associations of shock index (SI), modified shock index (MSI), diastolic shock index (DSI), and right internal jugular vein collapsibility index (RJV-CI) with postspinal hypotension (PSH). Materials and Methods: This prospective observational study included term parturients undergoing elective cesarean delivery under spinal anesthesia. Prespinal SI, MSI, DSI, and RJV-CI were measured before intrathecal injection. PSH was defined as systolic arterial pressure <90 mmHg or a reduction of ≥30% from baseline within 15 min after intrathecal injection. Receiver operating characteristic (ROC) analyses were performed for individual predictors. Three logistic regression models combining RJV-CI with SI, MSI, or DSI were evaluated using bootstrap internal validation. Results: Of 80 enrolled patients, 76 were included in the final analysis; 36 (47.4%) developed PSH. SI, MSI, DSI, and RJV-CI were significantly higher in the PSH group than in the non-PSH group. The areas under the ROC curve (AUCs) were 0.757 for SI, 0.747 for MSI, 0.693 for DSI, and 0.709 for RJV-CI. In multivariable models, RJV-CI remained significantly associated with PSH after adjustment for the respective shock index. The model combining RJV-CI and SI showed the highest apparent AUC (0.790; 95% confidence interval, 0.688–0.886) and an optimism-corrected AUC of 0.775. The RJV-CI plus MSI model showed an optimism-corrected AUC of 0.774. Conclusions: Prespinal SI, MSI, DSI, and RJV-CI were associated with PSH in this cohort. Models combining RJV-CI with SI or MSI showed numerically higher discrimination than the individual predictors. The derived cutoff values should be considered exploratory and require external validation before routine clinical use.

Aim: In this retrospective study, it was aimed to compare wound healing, infection parameters and survival outcomes in patients undergoing upper extremity procedures under Peripheral Nerve Block versus General Anesthesia. Methods: A total of 5666 patients who underwent upper extremity surgery between 2014 and 2024 at İstanbul Gaziosmanpaşa Training and Research Hospital and included patients were subjected to the study. Patients were grouped according to anesthesia type as Peripheral Nerve Block (n=1259) and general anesthesia (n=4407). Age, gender, comorbidities, operation duration and hospitalization duration, sedimentation, procalcitonin, urine culture, CRP, wound site culture, blood culture and mortality at 6th month parameters of patients were analyzed. Results: Mean age, female sex, chronic renal failure, Chronic Obstructive Pulmonary Disease, diabetes mellitus and hypertension frequencies were significantly higher in the general anesthesia group (p0.05). Procalcitonin level was significantly higher in general anesthesia group (p0.05). Correlation between anesthesia type and sedimentation, procalcitonin, urine culture, CRP, blood culture and mortality at 6th month were statistically insignificant (p>0.05). Chronic renal failure (OR=0.331; p0.05) Conclusion: In patients undergoing upper extremity procedures, wound healing, infection parameters and survival outcomes were similar for both general and peripheral nerve block anesthesia procedures.