Objective:This study aimed to determine the effect of non-invasive hemoglobin (SpHb) measurement on blood transfusion decisions in patients undergoing hip surgery and to analyze the effect of these decisions on mortality. Materials and Methods:Fifty-two patients (ASA I-III, ≥60 years) undergoing hip surgery were randomized into the SpHb or conventional (CONV) group for transfusion management. Hemoglobin (Hb) levels were recorded before induction, at transfusion decision points, immediately after transfusion, and after recovery. Postoperative survival was monitored at 1 and 3 months. Results:The SpHb group maintained significantly higher Hb levels at the first transfusion decision point, after transfusion, and during recovery (p=0.001, p=0.012, p=0.001). Partial oxygen pressure (PaO2) was also higher in the SpHb group at the corresponding time points. The CONV group required significantly more blood transfusions (p=0.025) and had longer hospital stays (p=0.043). Although 3-month mortality was numerically lower in the SpHb group than in the CONV group (11.53% vs. 19.23%), no statistically significant difference was detected in this pilot-sized cohort (p>0.05). Conclusion:According to our findings, SpHb monitoring during hip surgery may be a useful tool for enabling earlier transfusion decisions, which could help prevent significant Hb declines. In our study cohort, this strategy was associated with a trend toward fewer transfusion requirements, shorter hospital stays, and better perioperative oxygenation.

Diabetic gastroparesis is a chronic complication that increases the risk of perioperative aspiration. Despite adherence to current fasting guidelines, gastric emptying remains difficult to predict in patients with diabetes. However, comparative data on ultrasound-defined gastric contents and residual gastric volume in fasting patients with and without diabetes scheduled for elective surgery remain limited. This knowledge gap provides the rationale for the present study. Therefore, this study aimed to assess gastric contents and volume using gastric ultrasonography in patients with diabetes scheduled for elective surgery and to investigate clinical variables associated with a full stomach, indicative of an increased risk of aspiration. In this prospective observational study, 39 patients with diabetes and 39 control participants, all of whom had fasted for at least 8 h, were enrolled. Preoperative gastric ultrasonography was performed to assess the Perlas grade, antral cross-sectional area (CSA, cm²), and estimated gastric volume (mL). High aspiration risk was defined using ultrasound-based surrogate markers, rather than clinically observed aspiration events, and was identified by the presence of solid or thick fluid contents (Perlas grade 3) or an estimated clear fluid volume exceeding 1.5 mL/kg. Gastric aspirate volume (mL) and pH were subsequently recorded. Among patients with diabetes, the associations of glycemic control (HbA1c), disease duration, and diabetes-related complications (ascertained from pre-existing medical records) on gastric parameters were evaluated. Statistical analyses included the independent-samples t-test or Mann–Whitney U test for group comparisons, chi-square test or Fisher’s exact test, as appropriate for categorical variables, Spearman correlation analysis, and receiver operating characteristic (ROC) curve analysis. In the diabetes group, antral CSA was significantly greater than that in the control group (10.91 ± 9.49 cm² vs. 5.11 ± 2.01 cm²; p < 0.001), as were estimated gastric volume (94.21 ± 110.65 mL vs. 41.04 ± 29.78 mL; p = 0.008), aspirated gastric fluid volume (19.67 ± 14.49 mL vs. 8.69 ± 5.68 mL; p < 0.001), Perlas score (median 0 [range 0–3] vs. 0 [range 0–0]; p < 0.001), and gastric pH (2.56 ± 0.54 vs. 2.14 ± 0.85; p = 0.011). A full stomach was identified in 17.94

Aim: Postoperative emergence delirium (PED) is characterized by restlessness, disorientation, and agitation, particularly in children during emergence from anesthesia. Its etiology includes preoperative anxiety, head-neck surgery, inhalation agents, and pain. This study evaluated the effects of preemptive analgesia and preoperative anxiety on PED after pediatric adenotonsillectomy.Material and Methods: After ethics committee approval and written parental consent were obtained, 64 pediatric patients were enrolled. In this prospective observational study, patients were categorized according to the timing of intravenous acetaminophen administration: 30 minutes before surgical incision(Group 1) or 15 minutes before the end of surgery (Group 2). Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS), postoperative delirium using the Pediatric Anesthesia Emergence Delirium (PAED) scale, and pain using the Wong-Baker Faces Pain Scale (WBFPS). Measurements were recorded at 0, 5, 10, 15, 30, 45, and 60 minutes postoperatively. A p value

Lumbar disc herniation surgery is associated with considerable postoperative pain despite its minimally invasive nature. Regional fascial plane blocks may reduce opioid consumption and improve recovery as part of multimodal analgesia. This study compared the analgesic efficacy of ultrasound-guided intertransverse process (ITP) and modified thoracolumbar interfascial plane (mTLIP) blocks with conventional analgesia in patients undergoing lumbar disc herniation surgery. In this prospective randomized controlled trial, 84 patients undergoing elective lumbar disc herniation surgery under general anesthesia were allocated to a Control group, an mTLIP group, or an ITP group (n = 28 each). The primary outcome was cumulative morphine consumption during the first 24 postoperative hours. Secondary outcomes included postoperative pain scores, Quality of Recovery-15 (QoR-15) scores, intraoperative remifentanil consumption, and adverse events. Twenty-four-hour morphine consumption was significantly higher in the Control group than in the mTLIP and ITP groups (28.79 ± 10.11 mg vs. 16.93 ± 10.11 mg and 12.86 ± 6.14 mg, respectively; both p < 0.001), with no difference between the block groups. Intraoperative remifentanil consumption was significantly lower in the ITP and mTLIP groups than in the Control group (p < 0.001 and p = 0.001, respectively). Resting pain scores were significantly lower in the ITP group than in the Control group throughout the postoperative period, while dynamic pain scores were lower at the PACU time point and at 6, 12, and 24 h. No significant differences in pain scores were observed between the mTLIP and Control groups or between the two block groups. QoR-15 scores at 24 h were significantly higher in the ITP group than in the Control group (137 [102–150] vs. 130 [60–147]; p = 0.010). No significant differences in postoperative nausea and vomiting were observed, and no block-related complications occurred. Both ITP and mTLIP blocks reduced perioperative opioid requirements after lumbar disc herniation surgery, with no significant difference between the two blocks. Compared with conventional analgesia, the ITP block was additionally associated with lower postoperative pain scores and improved recovery quality. Both techniques appear to be safe, comparably effective, opioid-sparing components of multimodal analgesia. ClinicalTrials.gov NCT06391541. Prospectively registered on April 26, 2024.

Insufficient lung expansion due to inadequate pain management and opioid consumption is one of the most important factor for perioperative atelectasis and and the use of ultrasound in the diagnosis of atelectasis has been quite common in recent years. The effectiveness of posterior quadratus lumborum block (QLB) in postoperative analgesia after open surgery is well established. The present study aimed to investigate the effects of posterior QLB on perioperative atelectasis in pediatric surgeries. Sixty patients who underwent elective inguinal hernia repair and orchipexy surgery under general anesthesia were included in the study. The patients were divided into 2 groups: Control (n = 30) and QLB, (n = 30). Posterior quadratus lumborum block was administered to the QLB group. Incidence of atelectasis and modified lung ultrasound (LUS) scores were recorded before induction (T1), at the end of surgery (T2), and before leaving the recovery unit (1 h after extubation) (T3). Pain was evaluated with Face, Legs, Activity, Cry, Consolability (FLACC) scores in the postoperative period. The analgesics administered in the recovery unit and ward were recorded. A significant difference was observed in the incidence of atelectasis and total LUS scores between groups at T2 and T3. Both outcomes were higher in the control group. A significant difference was observed between the groups in terms of FLACC scores at 0, 2, and 6 h postoperatively. In all three time periods, the scores in the QLB group were lower. A significant difference was observed between the groups in terms of rescue analgesic usage in the recover room and during ward follow-up. Analgesia requirement was higher in the Control group. Ultrasound-guided posterior QLB in pediatric patients undergoing inguinal hernia repair and orchiopexy surgery decreases the incidence of atelectasis and total LUS scores by reducing pain scores and the amount of opioids required. Trial registration: NCT04830280 registered 2021/03-11.

Tourniquet deflation during lower extremity surgery is associated with abrupt physiological changes that may influence intracranial pressure (ICP) and cerebral oxygenation. This prospective observational study aimed to evaluate changes in ICP following tourniquet deflation using ultrasonographic optic nerve sheath diameter (ONSD) measurements and to investigate their association with cerebral oxygenation parameters. This prospective observational study included 43 adult patients undergoing lower extremity surgery with tourniquet application under standardized general anesthesia. In addition to routine hemodynamic monitoring, bilateral cerebral oxygen saturation (rSO2) was continuously monitored using near-infrared spectroscopy, and ONSD measurements were performed at predefined time points. End-tidal carbon dioxide (EtCO2) levels and tourniquet duration were recorded. Patients were stratified into 2 groups according to ONSD values (≥5 mm and <5 mm), and rSO2, EtCO2, and tourniquet times were compared between groups. Correlation analyses were conducted to assess the relationships among these variables. ONSD and EtCO2 values measured at 5 and 15 minutes after tourniquet deflation were significantly higher than pre-deflation values. Bilateral rSO2 values following tourniquet deflation were significantly higher compared with measurements obtained before anesthesia induction, tourniquet inflation, and immediately prior to deflation. At 5 minutes after tourniquet deflation, EtCO2 levels and tourniquet duration were significantly higher in patients with ONSD ≥5 mm compared with those with ONSD <5 mm. Moderate, positive, and statistically significant correlations were observed between EtCO2 and ONSD, EtCO2 and bilateral rSO2, and between ONSD and tourniquet duration at this time point. Tourniquet deflation during lower extremity surgery is associated with transient increases in EtCO2, ONSD, and cerebral oxygenation parameters. These findings suggest significant physiological associations between tourniquet duration, carbon dioxide levels, and surrogate markers of ICP and cerebral oxygenation; however, further studies incorporating direct ICP measurements and clinical neurological outcomes are required to determine their clinical significance.

Background: We aimed to investigate the effects of the external oblique intercostal plane block (EOIPB) and subcostal transversus abdominis plane (TAP) block on postoperative pulmonary function in patients undergoing laparoscopic cholecystectomy. The primary outcome was spirometric pulmonary function test (PFT) results. Secondary outcomes included postoperative pain scores, opioid consumption, and postoperative recovery assessed using the Quality of Recovery (QoR)-15 questionnaire. Methods: A total of 102 patients aged 18-65 years with ASA physical status I-III who underwent elective laparoscopic cholecystectomy were included in this prospective observational study. According to the perioperative analgesia technique applied, patients were evaluated in three groups: Group Subcostal (n=34), Group EOIPB (n=34), and Group Control (n=34). After losses to follow-up, 90 patients were included in the final analysis. Preoperative and postoperative spirometric PFTs, postoperative pain scores, opioid consumption, and QoR-15 scores were recorded and compared among groups. Results: Postoperative reductions in FVC, FEV1, predicted FEV1, and PEF values were observed in all groups but were significantly more pronounced in the Control group. At postoperative hour 1, pulmonary function parameters were significantly lower in the Control group compared with both block groups (p < 0.05). Predicted FEV1 at postoperative hour 1 was significantly higher in the EOIPB group than in Subcostal group (p = 0.003). Postoperative pain scores and opioid consumption were significantly lower in both block groups compared with the Control group (p < 0.05), whereas QoR-15 scores were significantly higher (p < 0.05). No significant differences were observed between the two block groups for most postoperative outcomes. Conclusion: Both EOIPB and subcostal TAP block were associated with attenuated decline in postoperative pulmonary function, reduced opioid consumption, and improved early postoperative recovery after laparoscopic cholecystectomy.

Objective:This study compared automatic gas control (AGC) mode with manual minimal-flow and manual medium-flow techniques in elective breast surgery, evaluating sevoflurane consumption, cost, hemodynamics, and recovery. Methods:Following ethics approval, 90 American Society of Anaesthesiologists I-II patients (age 18-65 years) undergoing elective breast surgery were randomized to AGC mode (Group AGC, n = 30), manual minimal-flow control (Group ManCo, n = 30), or manual medium-flow control (Group ModFA, n = 30). All received standard induction after preoxygenation, with maintenance via sevoflurane and remifentanil infusion in a mixture of oxygen and medical air. After reaching a minimum alveolar concentration of 1.0, sevoflurane was adjusted to maintain a bispectral index of 40-60. Mean arterial pressure (MAP), heart rate, peripheral capillary oxygen saturation, bispectral index, inspired sevoflurane fractions and expired sevoflurane fraction, end-tidal carbon dioxide, temperature, and instantaneous sevoflurane consumption were recorded pre-induction and every 15 minutes. Extubation time, recovery time, surgery duration, and total anaesthesia time were documented. Total sevoflurane consumption and cost were calculated postoperatively. Results:Sevoflurane consumption and related costs were significantly lower in Group AGC versus Groups ManCo and ModFA (both P <0.001) and lower in Group ManCo than in Group ModFA (P <0.001). MAP and recovery times did not differ significantly among groups (P >0.05). Pre-extubation temperature was higher in Group AGC compared to Group ManCo (P=0.014) and Group ModFA (P=0.002). Extubation time was longer in Group ManCo versus Groups AGC and ModFA (P <0.001). Conclusion:AGC mode significantly reduces sevoflurane consumption and cost compared to both manual minimal-flow and manual medium-flow techniques, without adversely affecting hemodynamics or recovery.

Aim: To evaluate the anesthetic techniques used for cesarean deliveries and their perioperative outcomes at Zonguldak Bülent Ecevit University Hospital.Material and Methods: This retrospective study included 1,229 women who underwent cesarean delivery between January 2018 and September 2019 at Zonguldak Bülent Ecevit University Hospital. Demographic characteristics, anesthesia type, 1- and 5-minute APGAR (activity, pulse, grimace, appearance, respiration) scores, and perioperative complications were assessed.Results: Spinal anesthesia was performed in 58.4% of the cases, while general anesthesia was used in 41.3%. The APGAR scores at 1 and 5 minutes were significantly higher in the spinal group (p < 0.001). The requirement for ephedrine was significantly higher in the spinal anesthesia group (36.9%) compared to the general anesthesia group (3.7%). The duration of anesthesia was shorter in the spinal group (p < 0.001), whereas the length of hospital stay did not differ significantly between the groups (p = 0.086).Conclusion: Spinal anesthesia represents a safe and effective technique for cesarean delivery, demonstrating improved neonatal outcomes. Nevertheless, the increased incidence of hypotension and the need for vasopressor support necessitate vigilant hemodynamic monitoring.

Background and Objectives: The aim of our study is to determine the effects of analgesia nociception index (ANI) monitoring on intraoperative opioid consumption, postoperative analgesia, and the recovery unit length of stay in patients with a preoperative femoral nerve block (FNB) undergoing total knee arthroplasty (TKA) surgery under general anesthesia. Materials and Methods: Seventy-four patients in the American Society of Anesthesiologists Physical Status (ASA-PS) I-III scheduled for TKA under general anesthesia were included in this study. After FNB, the patients were divided into two groups (control group (n = 35)–ANI group (n = 35)). After standard anesthesia induction in both groups, maintenance was conducted using sevoflurane and remifentanil infusion with a bispectral index (BIS) between 40 and 60. In the control group, the intraoperative remifentanil infusion dose was adjusted using conventional methods, and in the ANI group, the dose was adjusted using ANI values of 50–70. The duration of operation, duration of surgery, extubation time, tourniquet duration and pressure, and the amount of remifentanil consumed intraoperatively were recorded. Results: Intraoperative remifentanil consumption was lower in the ANI group compared to the control group (p = 0.001). The time to reach a Modified Aldrete Scale score (MAS) ≥ 9 was shorter in the ANI group (p < 0.001). NRS scores in the recovery unit and 4, 8, 12, and 24 h postoperatively were lower in the ANI group compared to the control group (p = 0.006, p < 0.05). There was a weak significant inverse relationship between the last ANI values measured before extubation and NRS scores in the postoperative recovery unit (r: −0.070–0.079, p: 0.698–0.661). No difference was observed between the groups in other data. Conclusions: In patients undergoing TKA with FNB under general anesthesia, ANI monitoring decreased the amount of opioids consumed intraoperatively and postoperative pain scores and shortened the length of stay in the recovery unit. We suggest that ANI monitoring in intraoperative analgesia management may be helpful in determining the dose of opioid needed by the patient and individualized analgesia management.

BACKGROUND:The lateral approach is commonly used in hip fracture surgery. Pericapsular nerve group (PENG) block cannot block the lateral femoral cutaneous nerve (LFCN), which is involved in sensing the skin incision during the lateral approach. Therefore, we compared the effect of adding the LFCN block to the PENG block on opioid consumption and pain scores in hip fracture operations under spinal anesthesia. METHODS:In this prospective randomized-controlled study, patients undergoing hip fracture surgery under spinal anesthesia were randomized into 3 groups: PENG, PENG + LFCN, and CONTROL group. In the PENG group, 20 mL of 0.25% bupivacaine was injected under ultrasound guidance, while in the PENG + LFCN group, LFCN block, involving 5 mL of 0.25% bupivacaine, was performed in addition to the PENG block. Spinal anesthesia was the preferred method in all patients. Postoperative opioid consumption, numerical rating scale (NRS) pain scores at 0-, 2-, 6-, 12-, and 24-hours postoperatively and while giving spinal anesthesia position, time of first analgesic requirement, and the time of first mobilization were recorded. RESULTS:A total of 20 patients from each group were included in the statistical analysis. Postoperative opioid consumption was lower in the PENG and PENG + LFCN groups as compared to the CONTROL group, while the PENG and PENG + LFCN groups did not differ significantly (PENG: 8.10 ± 6.72 mg, PENG + LFCN: 8.40 ± 4.38 mg, CONTROL: 15.30 ± 5.59 mg, P < .001). Postoperative NRS pain scores during activity (NRSA) were significantly lower at all-time points in the PENG + LFCN than in the CONTROL group, and were lower at 2, 6, and 24 hours in the PENG than in the CONTROL group. These scores did not differ significantly between the PENG and PENG + LFCN groups at any time point. The time to first postoperative analgesic requirement was significantly shorter in the CONTROL than in the PENG and PENG + LFCN groups. CONCLUSION:Addition of an LFCN block to the PENG block did not contribute to postoperative opioid consumption and pain scores in patients undergoing hip fracture surgery under spinal anesthesia. Preoperative PENG block plays an important role both during positioning for spinal anesthesia and in postoperative analgesia management.

To determine the effect of monitoring the Analgesia Nociception Index (ANI) on intraoperative opioid use, postoperative recovery, and analgesia in patients receiving preoperative bilateral erector spinae plane block (ESPB) for gynecological surgery under general anesthesia. Eighty patients classified in the American Society of Anesthesiologists physical status I-III scheduled for hysterectomy under general anesthesia were included in the study. After ultrasound-guided ESPB, patients were divided into 2 groups: control and ANI. In the control group, the intraoperative remifentanil infusion dose was adjusted using conventional methods; in the ANI group, the dose was adjusted according to ANI values of 50–70. Intraoperative remifentanil consumption, postoperative pain scores, additional analgesic requirements, and complications were recorded. Intraoperative remifentanil consumption was lower in the ANI group than in the control group (p < 0.001). Numerical rating scale (NRS) scores and requirements for additional analgesics in the postoperative recovery unit were both lower in the ANI group (p < 0.05). There were no significant differences between the groups in terms of nausea or vomiting in the recovery unit. ANI monitoring in patients undergoing gynecological surgery under general anesthesia with ESPB reduced opioid consumption during the intraoperative period. Intraoperative ANI monitoring enabled individualized opioid administration and guided determination of the required dose of analgesic agent.

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method.

Aim: The majority of alcohol-related deaths are due to acute alcohol consumption. There are many factors affecting the prognosis of alcohol toxicity. It has been reported that by determining these factors, mortality rates can be reduced by early diagnosis and early initiation of treatment. In this study, we aimed to determine the prognosis by evaluating the clinical status and laboratory factors of patients followed up in intensive care unit (ICU) due to acute alcohol intoxication. Materials and Methods: The study included 21 patients with acute alcohol intoxication who were followed up in the ICU of our hospital between 2013-2021.Laboratory parameters, demographic characteristics and clinical status of the patients were recorded. Patients were divided into both exitus and survivors and according to the type of alcohol consumed (ethanol and methanol). Results: All patients were male with a mean age of 40.10 ± 15.9 years. 52.4% of the admissions were ethanol poisoning and 47.6% were methanol poisoning. Mortality rate was 33.3%. It was observed that symptoms appeared later in methanol intoxication compared to ethanol intoxication (p

Surgical trauma can induce systemic inflammation. The selected anesthesia method may modulate the inflammatory response and surgical results in the inflammatory process that occurs during surgical trauma. In this retrospective study, we aimed to compare the anti-inflammatory effects of general anesthesia and peripheral nerve block (infraclavicular block). Demographic, clinical, and laboratory records (hemogram, total leukocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume) were obtained from the archival data. The patients were divided into 2 groups: Group G, who received general anesthesia, and Group P, who received a peripheral nerve block (infraclavicular block) for forearm surgery. The amount of opioid consumed postoperatively was significantly lower in Group P. Infraclavicular block as an alternative to general anesthesia was found to be associated with a significant decrease in the neutrophil-to-lymphocyte ratio, total leukocyte count, and platelet-to-lymphocyte ratio levels compared to those observed after general anesthesia. Peripheral nerve blocks may play a role in reducing inflammation and alleviating stress.

Aim: The type and diameter of the needle used in spinal anesthesia (SA) affect the procedure's success and the sensation of clicking during a dura puncture. This study aimed to compare the effects of Quincke and pencil-point needles of the same thickness, when used by anesthesia residents new to SA application, on procedural success and the number of trials required to perceive click sensation. Methods: This prospective randomized study included 213 adult patients undergoing elective surgery under SA, divided into six groups based on needle type and diameter: Group I: Quincke (Q)-25 Gauge (G), Group II: Q-26G, Group III: Q-27G, Group IV: Pencil-point (P)25G, Group V: P-26G, and Group VI: P-27G. The number of interventions for SA (1-3), the attempt (1, 2, or >= 3) during which the stylet was removed and cerebrospinal fluid (CSF) flow occurred, considering that the click sensation was felt during the procedure, and the time taken for CSF appearance (<1.9 s or >= 2 seconds) were recorded. Results: No difference was found between the groups in terms of demographic data, the American Society of Anesthesiologists risk, puncture site, number of click sensation trials, time for CSF appearance, and feasibility of the procedure (p>0.05). The SA success rate in the first trial (p<0.001) was higher when pencil-point needles were used. Conclusion: Although the effects of spinal needles with different tip designs and diameters on the number of trials required to perceive click sensation are similar, due to the high rate of SA success in the first trial, the use of pencil-point needles is recommended for anesthesia residents new to SA application.

Respiratory functions may be impaired in cesarean section (C/S) delivery performed under spinal anesthesia (SA) and oxygen supplementation may be required. Therefore, we conducted a randomized controlled study aimed to evaluate the effects of different oxygen administrations in pregnant women on the lungs during C/S under SA using ultrasound and oxygen reserve index (ORI). We conducted a randomized, controlled, single-center study from May 1, 2021, to March 31, 2022. A total of 90 patients scheduled for C/S under SA were randomly divided into 3 groups. Following the SA, patients in group 0 were treated with room air, in Group 3 were administered 3 L/min O₂ with a nasal cannula (NC), in Group 6 were administered 6 L/min O₂ with a simple face mask. In addition to routine monitoring, ORI values were measured. Lung aeration was evaluated through the modified lung ultrasound score (LUS) before the procedure (T0), at minute 0 (T1), 20 (T2), and hour 6 (T3) after the procedure, and ∆LUS values were recorded. After SA, the ORI values of Group 3 were higher than Group 0 at all times (p < 0.05), while the intraoperative 1st minute and the 10th, 25th and 40th minutes after delivery (p = 0.001, p = 0.027, p = 0.001, p = 0.019) was higher than Group 6. When the LUS values of each group were compared with the T0 values a decrease was observed in Group 3 and Group 6 (p < 0.001, p = 0.016). While ∆LUS values were always higher in Group 3 than in Group 0, they were higher only in T1 and T2 in Group 6. We determined that it would be appropriate to prefer 3 L/min supplemental oxygen therapy with NC in C/S to be performed under SA.

Background: Patients diagnosed with Obstructive Sleep Apnea (OSA) syndrome have a tendency towards hypoventilation, hypoxia, and hypercarbia in the perioperative period. This study hypothesized that the Oxygen Reserve Index (ORi) could predict possible hypoxia and determine difficult airways in patients at risk for OSA, as determined by the STOP-Bang questionnaire. Methods: This prospective study included adult patients undergoing elective surgery under general anesthesia with endotracheal intubation, divided into two groups: low risk (0 -2 points) and high risk (3 -8 points) based on their STOP-Bang questionnaire results. The primary outcome measure was the highest ORi value reached during preoxygenation and the time to reach this value. Data were recorded at four time points: before preoxygenation (T1), end of preoxygenation (T2), end of mask ventilation (T3), and end of intubation (T4), as well as partial oxygen pressure values in T1, T2, and T4. The secondary outcome measures were the grading scale for mask ventilation, Cormack-Lehane score, tonsil dimensions, use of a stylet, and application of the burp maneuver during intubation. Results: In the high-risk group, preoperative peripheral oxygen saturation values, the highest ORi value reached in preoxygenation, and ORi values at T3 and T4 times were lower, and the time to reach the highest ORi value was longer ( p < 0.05). Conclusion: Using ORi in patients with OSA may be useful in evaluating oxygenation, and since difficult airway is more common, ORi monitoring will better manage possible hypoxic conditions. (c) 2023 Sociedade Brasileira de Anestesiologia. Published by Elsevier Espa & ntilde;a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).