This study aimed to investigate the efficacy of superficial and deep serratus anterior plane blocks (SAPB) for simple mastectomy and modified radical mastectomy (MRM). The primary outcome was cumulative morphine consumption at 24 h. Secondary aims included pain scores, rescue analgesic and antiemetic requirement, nausea and vomiting incidence, and patient satisfaction. Patients were randomized to the superficial or deep SAPB group. Superficial or deep SAPB was applied with 30 ml of 0.25

Background and aimCardiac surgery requiring cardiopulmonary bypass (CPB) is associated with a high rate of postoperative pulmonary complications (PPCs). Mechanical power (MP) represents energy per breath multiplied by respiratory rate and conversion factor (0.098), resulting in J/min. This prospective observational study aimed to investigate the effects of two ventilation strategies applied during CPB on MP and their association with PPCs.MethodsIn this prospective observational study, ventilation during CPB was managed according to routine clinical practice. Ventilation was discontinued after full CPB flow in Group 1 (n = 125), while low-tidal volume ventilation (3 mL/kg) was maintained in Group 2 (n = 120). Mechanical power was measured before CPB (T1), after CPB (T2), and in the intensive care unit (T3). Patients were monitored for PPCs for 7 days postoperatively.ResultsMP, the primary endpoint of the study, did not differ significantly between the two ventilation strategy groups at any measured time point. In a secondary exploratory analysis, MP values were higher at T2 and T3 in patients who developed PPCs (T2: 8.54 ± 0.32 vs. 7.78 ± 0.19 J/min, p = 0.041; T3: 8.67 ± 0.33 vs. 7.82 ± 0.19 J/min, p = 0.029).ConclusionThe two ventilation strategies applied during CPB did not significantly affect the primary outcome, mechanical power. Higher post-CPB MP values were observed in patients who developed PPCs, although this finding was exploratory.

Augmented renal clearance (ARC) is a condition in which renal circulation increases, causing drug levels in the blood to remain at subtherapeutic levels in severe trauma patients. Vancomycin, a hydrophilic anti-Gram-positive drug, has been shown in the literature to have its levels fall below the therapeutic range in the case of ARC. However, vancomycin dosing recommendations in the case of ARC are still lacking. Here, we identify an ARC case measured with urinary creatinine clearance in a severe trauma paediatric patient, causing vancomycin blood trough levels to drop. We could not be able to increase the vancomycin trough levels with intermittent dosing; hence, we administered vancomycin with continuous infusion, and this resulted in vancomycin blood trough levels remaining in the therapeutic range. No adverse effect was seen. Continuous infusion of vancomycin can be safely administered to paediatric patients in these cases.

Objective: In this study, we evaluated the effects of a cup of coffee given to patients before surgery in a cesarean section by means of intraoperative hypotension, ephedrine requirement, and the incidence of postdural puncture headache (PDPH). Methods: A total of 140 patients undergoing elective cesarean section with spinal anesthesia were included in this study. Participants who drank a single cup of filtered coffee two hours before spinal anesthesia were included in the coffee group, and those who drank water were in the control group. In each group, 70 patients were included. Hemodynamic parameters were recorded every three to five minutes after spinal anesthesia. Intraoperative use of ephedrine was recorded. The PDPH was monitored for three days. Results: The incidence of intraoperative hypotension was 48.6% in the coffee group and 71.4% in the control group (p = 0.006). The rate of ephedrine usage (25.7%) was significantly lower in the coffee group (p = 0.001). The incidence of PDPH in the first 24 hours (2.9%) was significantly lower in the coffee group (11.4%). The visual analog scale (VAS) score was similar between groups (p = 0.048, p > 0.05). Conclusions: Consumption of a single cup of coffee before spinal anesthesia reduced the incidence of intraoperative hypotension and the rate of ephedrine usage in cesarean sections.

Purpose: To evaluate the effects of intranasal dexmedetomidine and midazolam-ketamine combination for premedication on sedation quality, oculocardiac reflex development, mask tolerance, and separation from parents in children who would undergo strabismus surgery.Methods: A total of 74 patients aged 2 to 11 years, were divided into two groups. The dexmedetomidine group (n = 37) received 1 mcg/kg of dexmedetomidine and the midalozam-ketamine group (n = 37) received 0.1 mg/kg of midazolam and 7.5 mg/kg of ketamine combination intranasally. Mean arterial pressure, peripheral oxygen saturation, Ramsay Sedation Scale values, and heart rate were recorded before and after the premedication. The children's separation from the family scores were evaluated and recorded. The mask compliance was evaluated and recorded. Patients who developed oculocardiac reflex and were administered atropine were recorded. In the postoperative period, nausea and vomiting, recovery times, and postoperative agitation were evaluated.Results: Ramsay Sedation Scale scores, mask acceptance, and family separation scores were similar in both groups (P > .05). Oculocardiac reflex was observed more in the dexmedetomidine group (P = .048). Atropine requirement and postoperative nausea and vomiting rates were similar in both groups (P > .05). Mean arterial pressures and heart rates were significantly lower in the dexmedetomidine group during the pre medication period. The recovery time was longer in the midazolam-ketamine group (P < .001). The incidence of postoperative agitation was significantly lower in the midazolam-ketamine group (P = .001).Conclusions: The sedation efficacy of intranasal dexmedetomidine and midazolam-ketamine combination that were given in premedication was similar. Oculocardiac reflex was observed more with dexmedetomidine. The recovery time was prolonged in the midazolam-ketamine group, but postoperative agitation was observed less.

"Coma" is defined as an inability to obey commands, to speak, or to open the eyes. So, a coma is a state of unarousable unconsciousness. In a clinical setting, the ability to respond to a command is often used to infer consciousness. Evaluation of the patient's level of consciousness (LeOC) is important for neurological evaluation. The Glasgow Coma Scale (GCS) is the most widely used and popular scoring system for neurological evaluation and is used to assess a patient's level of consciousness. The aim of this study is the evaluation of GCSs with an objective approach based on numerical results. So, EEG signals were recorded from 39 patients in a coma state with a new procedure proposed by us in a deep coma state (GCS: between 3 and 8). The EEG signals were divided into four sub-bands as alpha, beta, delta, and theta, and their power spectral density was calculated. As a result of power spectral analysis, 10 different features were extracted from EEG signals in the time and frequency domains. The features were statistically analyzed to differentiate the different LeOC and to relate with the GCS. Additionally, some machine learning algorithms have been used to measure the performance of the features for distinguishing patients with different GCSs in a deep coma. This study demonstrated that GCS 3 and GCS 8 patients were classified from other levels of consciousness in terms of decreased theta activity. To the best of our knowledge, this is the first study to classify patients in a deep coma (GCS between 3 and 8) with 96.44% classification performance.

Aim: In this tudy, it was aimed to investigate the complications that may develop during and after the anesthesia in patients undergoing spinal anesthesia, and the seasonal relationships of the monitored parameters in this study.Material and Methods: A total of 190 patients with ASA I-II group, aged between 18-65 years, who were scheduled for lower extremity operation, were included in the study after obtaining the ethics committee approval and the consent of the patients.The patients were divided into four groups: Group Su, Group Au, Group Wi, and Group Sp.Patient heart rate, blood pressure, peripheral oxygen saturation values were recorded.A subarachnoid puncture was performed with a 25G Quincke spinal needle and the number of attempts required for successful puncture was recorded.For spinal anesthesia, standard dose of 3 ml (15 mg) of 0.5% levobupivacaine was administered to all groups.All patients were visited on 6-12-24-48-72nd postoperative hours and on the 7th postoperative day, and the discharged patients were asked about complications via telephone.Results: The number of atropine injections due to complications of intraoperative bradycardia was significantly higher in Group Su than in the other groups (p = 0.010).Although there was no statistical difference between groups in terms of headache complications (p = 0.394), it was quantitatively higher in Group Su.The low back pain incidence was significantly higher in Group Su (37.7%, p = 0.01).Discussion: In this study, we concluded that intraoperative and postoperative complications were more common in the summer period in patients who underwent spinal anesthesia.

ÖZ Giriş: Nozokomiyal infeksiyonlar, COVID-19 Yoğun bakım ünitesinde (YBÜ) takipli hastalarda morbidite ve mortaliteyi arttırmaktadır. Bu çalışmada COVID-19 YBÜ'de takip edilen hastalarda gelişen nozokomiyal infeksiyonlar için risk faktörlerinin

Objective: This study aims to evaluate the differences in surgical interventions and out-comes for primary chest wall tumors in pediatric and adult patient groups.Materials and Methods: We reviewed records of patients operated on for primary chest wall tumors from January 2005 to June 2019. Patients aged 18 and younger were classified as pediatric (group I), while those above 18 were considered adults (group II). We analyzed demographic characteristics, histopathologic diagnosis, number of resected ribs, prosthetics requirements, complications, chemotherapy and radiotherapy applications, and related complications. The Kaplan-Meier method was used to analyze patient survival times, and the log-rank test was employed for comparing survival times between groups.Results: Of the 71 patients who underwent operations for primary chest wall tumors in our clinic between January 2005 and June 2019, 20 were pediatric (28.2%) and 51 were adults (71.8%). The 5-year overall survival rates for pediatric and adult patients were 72.9% and 68.8%, respectively (p=0.683), while the 5-year disease-free survival rates were 76.0% and 69.0%, respectively, showing no significant differences (p=0.709).Conclusion: Our findings indicate no significant differences between pediatric and adult primary chest wall tumors regarding disease-free survival times, overall survival rates, and surgical complications.

Introduction: Nosocomial infections (NI) increase morbidity and mortality in patients in the COVID-19 ICU. In this study, it was aimed to determine the risk factors for nosocomial infections in patients treated in the COVID-19 ICU. Materials and Methods: Patients who were treated in the COVID-19 and non-COVID-19 ICU between March 2020 and June 2021 were analyzed retrospectively. Demographic data, chronic diseases, invasive procedures and risk factors were compared between patients with and without NI. Results: The study included 174 patients, and 84 from COVID-19 ICU. The median age of the patients was 66.5 (21-92) and the male gender rate was 56.9%. The frequency of hospitalization in the last three months and the mean Charlson comorbidity index were higher in patients treated in the COVID-19 ICU (p= 0.001). Presence of any nosocomial infection (64% vs 46%), rate of nosocomial pneumonia (10.7% vs. 2.2%), and catheter-related bloodstream infection rate were higher in the COVID-19 ICU. The 14-day mortality rates were 57% in the COVID-19 ICU, while it was 33% in the non-COVID-19 ICU (p=0.002). Advanced age [OR=0.97 (95% CI= 0.94-1.0) p= 0.049], prolonged stay in the ICU [OR= 1.28 (95% CI= 1.16-1.41) p=0.001], chronic kidney disease [OR= 10.57 (95% CI= 2.02-54.56) p= 0.05], and coronary artery disease [OR= 4.61 (95% CI= 1.44-14.79) p= 0.010] were found to be risk factors for NI, while other risk factors were enteral nutrition [OR= 2.69 (95% CI= 1.03-7.04) p= 0.043], central catheter [OR= 4.60 (95% CI= 1.88-11.22) p= 0.001] and a history of hospitalization in the ICU in the last three months [OR= 3.59 (95% CI= 1.01-12.83) p= 0.048]. Risk factors for NI in the COVID-19 ICU include prolonged ICU stay and enteral nutrition. Conclusion: The presence of COVID-19 in patients treated in the ICU is important . Long-term ICU follow-up, invasive procedures and enteral nutrition practices are important risk factors for the development of NI in patients with a diagnosis of COVID-19.

BACKGROUND:Percutaneous nephrolithotomy operation is a minimally invasive surgical procedure for the treatment of kidney stones. AIM:This study aimed to evaluate the effectiveness of ultrasound-guided erector spinae plane block (ESPB) on analgesic consumption in patients who underwent percutaneous nephrolithotomy. SUBJECTS AND METHODS:The data of 60 cases who underwent percutaneous nephrolithotomy operation between 01.01.2020 January and 12.01.2020 were retrospectively analyzed. Hemodynamic parameters, verbal analogue scale adjectives, total morphine consumption, additional analgesic and antiemetic need, duration of hospitalization, and patient satisfaction score were compared in patients who had ESPB and did not have block. RESULTS:Demographic data and hemodynamic parameters were similar between the two groups. Verbal rating scale values were lower for Group I at 2, 6, 12, and 24 h (P < 0.05). Patient satisfaction score was significantly higher in Group I over 24 h (P = 0.039). Total morphine consumption at postoperative 2nd, 6th, and 24th h was less than that of Group II (P < 0.05). Analgesia consumption in postoperative 24 h of group I was less than that of Group II (P = 0.001). The amount of fentanyl given intraoperatively was significantly higher in Group II (P = 0.001). Nausea and vomiting rates were significantly lower for Group I (P = 0.002). CONCLUSION:Ultrasound-guided ESPB reduced postoperative morphine consumption and the rate of nausea and vomiting.

Background Thoracic surgery is one of the most painful surgeries. Effective analgesia is important in postoperative pain management. In this study, we aimed to compare the two new fascial block techniques. Methods A total of 107 patients who underwent thoracic surgery between October 2018 and November 2019 were retrospectively evaluated. The study included 59 patients in the serratus anterior plane block (SAPB) group and 48 patients in the erector spinae plane block (ESPB) group. Both groups were administered 30mL of 0.25% bupivacaine and their morphine consumption was evaluated by a patient-controlled analgesia (PCA) method during the 2nd, 6th, 12th, 24th, and 48th postoperative hours. Pain was measured with the visual analog scale (VAS). Intraoperative mean arterial pressure (MAP) and heart rate (HR) were recorded. Results During the first 24hours, VAS values were significantly lower in the ESPB group ( p <0.05). Moreover, morphine consumption was significantly lower in the ESPB group in the 24th and 48th hours ( p <0.05). Intraoperative remifentanil consumption was also significantly lower in the ESPB group ( p <0.05). Intraoperative MAP in the ESPB group was found to be significantly lower after the 4th hour. HR was similar in both groups. Conclusion ESPB was more effective compared with SAPB in postoperative thoracic pain management.

Background/aim: In this study, we aimed to compare the effects of propofol-ketamine and propofol-fentanyl sedations on post-procedure nausea-vomiting in children undergoing magnetic resonance imaging (MRI). Materials and methods: This study included 100 pediatric patients (2-10 years old) who had propofol-ketamine and propofol-fentanyl for sedation to undergo MRI. The patients were divided into two groups, and sedation was performed through propofol-ketamine (Group K; n = 50) or propofol-fentanyl (Group F; n = 50). For sedation induction, intravenous (IV) bolus of 1.2 mg/kg propofol and 1 mg/kg ketamine were administered in Group K, IV bolus of 1.2 mg/kg propofol, and 1 mu g/kg fentanyl in Group F. All patients received 0.5 mg/kg IV bolus propofol in additional doses when the Ramsay Sedation Score (RSS) was below 4 for maintenance. Perioperative heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate, and nausea-vomiting scores were recorded for each patient. Results: There was no difference between the groups in terms of nausea incidences at the 1st hour. However, the rate of vomiting was significantly higher in Group K. Conclusion: In our study, we showed that the vomiting rate was higher in the 1st hour in Group K compared to Group F.

This study aims to evaluate the analgesic efficacy of dexmedetomidine added to levobupivacaine following anterior cruciate ligament (ACL) surgery. Fifty patients undergoing ACL reconstruction were included. Group DL (dexmedetomidin-levobupivacaine) received 20mL 0.5% levobupivacaine plus 1mL (100 mu g) dexmedetomidine. Group L (levobupivacaine) patients received 20mL 0.5% levobupivacaine plus 1mL saline 10minutes before tourniquet release. A patient-controlled analgesia (PCA) pump was then connected, delivering 0.5mg at every 10minutes and 1-mg morphine and 75-mg diclofenac sodium was used as a rescue analgesic. Postoperative pain was evaluated 0, 2, 4, 6, 12, and 24hours after extubation at rest and during movement. A rehabilitation program was started after surgery. Postoperative continuous passive motion (CPM) starting time, postoperative leg flexion angle, and straight leg lifting time were evaluated for each group. There were no significant differences between the groups in terms of demographic data and operation time. Morphine consumption, analgesic requirements, and visual analogue scale (VAS) assessments were significantly lower in group DL during the 24-hour period after surgery. The time to start CPM in the postoperative period was significantly shorter in group DL. Passive joint flexion angle was significantly higher in group DL. Postoperative straight leg lifting time was significantly shorter in group DL. Adding dexmedetomidine to the intra-articular levobupivacaine provided better postoperative pain control and improved rehabilitation period after ACL surgery.

Pleuropulmonary blastoma is a rare and aggressive childhood tumor of mesenchymal origin. It has a poor prognosis and mainly classified as cystic (type 1), mixed type (type 2), and solid (type 3). Herein, we present two cases of pleuropulmonary blastoma type 3 presenting with pneumothorax, a rare clinical presentation of pleuropulmonary blastoma, which was successfully treated with surgery.

Objective: The aim of this study was to investigate the effects of a perioperatively administered low dose of ketamine on postoperative acute, chronic pain following thoracotomy. Methods: Forty patients with ASA I–III and aged between 18 and 65 years were included in the study. Patients were randomly divided into two groups. Group I (n=20) was administered a ketamine 0.5 mg.kg-1 bolus followed by a 2 mcg.kg-1.dk-1 infusion for 24 hours before the incision. Group II (n=20) was given normal saline at the same dose and duration. Postoperative analgesia was achieved through patient-controlled morphine administration. Postoperative resting and moving Visual Analogue Scale values, total morphine consumption, preoperative and postoperative values of FVC, FEV1 and FEF25-75 from pulmonary function tests were recorded. Patients were evaluated in terms ofchronicpain in the surgical incision area at 1 and 3 months after the operation. Nausea, vomiting, agitation, delirium, hallucination and sedation scores were recorded. Results: No statistical difference was found between groups in terms of demographic characteristics and operational features. Visual analogue scale values at rest and on movement were significantly lower in Group I. Total morphine consumption was also significantly lower in Group I. There was no difference between the groups in terms of pulmonary function tests. There was no difference between groups in terms of the incidence of chronic pain and development during the first month after the operation, while the incidence of chronic pain in the third month was significantly lower in Group I.No significant difference was observed between groups in terms of sedation scores. The incidence of side effects such as nausea, vomiting, agitation, delirium and hallucinations was similar in both groups. Conclusion: Low-dose ketamine infusion is an efficient method in postoperative acute and chronic pain management after thoracotomy, it reduces analgesic consumption.