Objective:Postoperative airway complications pose significant risks in pediatric patients and are often multifactorial. Anatomical and physiological differences in children make predicting these complications challenging. This study examines the association between ultrasonographic (USG) measurements and postoperative airway complications, primarily focusing on the subglottic diameter-to-wall thickness difference ratio. Methods:This prospective, double-blind study included pediatric patients aged 1-11 undergoing elective surgery between January and July 2024. Demographic and perioperative data, USG-measured airway diameters, wall thicknesses, and endotracheal tube (ETT) positions were recorded. The subglottic diameter-to-wall thickness difference ratio was the primary ultrasonographic measurement. Airway complications were assessed within the first postoperative hour, including cough, dysphonia, and laryngospasm. The relationship between USG measurements and complications was analyzed. Results:Eighty patients were included, and airway complications were observed in 37.5% (n = 30). Patients with complications had lower height, subglottic diameter, and subglottic diameter-to-wall thickness difference ratio but higher subglottic wall and vocal cord thickness differences. In 70% (n = 20) of these cases, ETT had shifted superiorly from the second tracheal ring. The subglottic diameter-to-wall thickness difference ratio was significantly associated with complications (AUC 0.896, cutoff 32, sensitivity 80%, specificity 92%). ETT positioned above the second tracheal ring was also associated with increased complication risk (OR = 107.747, 95% CI: 5.305-2188.504, P = 0.002). Conclusion:USG appears to be a valuable tool for assessing the association between the subglottic diameter-to-wall thickness difference ratio and postoperative airway complications in pediatric patients. Accurate evaluation of subglottic edema and proper ETT placement using USG may enhance patient safety.

Objective: This study presents a comprehensive investigation of the demographic data, institutional affiliations, pre-operative evaluations, pre-medication preferences, and induction practices of anesthesiologists in Turkey. This study aimed to examine the implementation of these elements and how they reflect on the attitudes and behaviors of Turkish anesthesiologists, particularly in relation to pre-medication. Methods: This study, conducted between 16.06.2012 and 16.06.2013, utilized an electronic questionnaire distributed to practising anesthesiologists nationwide after approval from the Çanakkale 18 Mart University Clinical Research Ethics Committee. The questionnaire was divided into five sections, encompassing 26 questions addressing demographics, institutional information, pre-anaesthetic assessment data, pre-medication data, and induction data. Results: The survey gathered responses from 419 anesthesiologists across Turkey. Our findings indicated that pre-anaesthetic evaluations were predominantly conducted 2-7 days before elective surgery. There were significant variations in the pre-operative evaluations based on the type of institution, with private sector hospitals being less likely to have a dedicated room for pre-anaesthetic evaluation. The study also revealed differences in pre-medication preferences based on sex and age groups, with midazolam, ketamine, and atropine being the most preferred agents. Interestingly, the location of pre-medication administration varied significantly between private and university hospitals. The predominant motivation for pre-medication was a reduction in patient anxiety. Pediatric anesthesia induction was primarily conducted without the presence of family members, and volatile anesthetic agents were the preferred option. The route of pre-medication administration varied with age, with oral pre-medication being more common in pediatric patients, and intravenous administration being preferred in adults. Concerns about respiratory depression were prevalent after pre-medication. Conclusion: This study emphasizes that pre-operative evaluation and pre-medication are routinely carried out by anesthesiologists in Turkey, although with variations among different types of hospitals. Given the patient safety implications and importance of standardization, this study underscores the need for regular similar surveys to monitor trends and inform practice guidelines.

Pregnancy‐associated atypical haemolytic uraemic syndrome is a rare and potentially lethal complement-mediated disorder. It can mimic preeclampsia, gestational hypertension, thrombotic thrombocytopenic purpura and hemolysis, elevated liver enzymes and low platelets syndrome. Thus, it can be hard to distinguish pregnancy‐associated atypical haemolytic uraemic syndrome from other causes in peri/post-partum women presenting with features of microangiopathic haemolytic anemia, thrombocytopenia and acute kidney injury. We present a case of a 35-year-old woman in her third pregnancy at 32 weeks’ gestation who underwent caesarean section due to fetal distress. She developed severe renal impairment, thrombocytopenia and neurologic symptoms within 24 hours after delivery. A diagnosis of pregnancy‐associated atypical haemolytic uraemic syndrome was provided, and treatment with plasma therapy followed by eculizumab was initiated. A rapid improvement of both clinical and laboratory parameters was observed. This case demonstrates the significance of early initiation of anti-complement therapy to prevent irreversible renal damage and possible death in women with pregnancy‐associated atypical haemolytic uraemic syndrome.

Objective : This study aims to evaluate the approach of anaesthesiologist in Turkey and their applications toward postoperative pain treatment and in addition to raise awareness in this regard. Methods The target audience of this descriptive survey study was physician members of the Turkish Society of Anaesthesiology and Reanimation, who were volunteering/accepting to participate in the study. The doctors were contacted via their e-mail addresses. Data were collected online, between October 10, 2016, and November 30, 2016, using a web-based (SurveyMonkey®, https://tr.surveymonkey.com/) questionnaire form, and the data were analyzed by the Statistical Package for the Social Sciences (SPSS) version 20 software (IBM Corp.; Armonk, NY, USA). Descriptive data were presented with frequency, percentage, mean, standard deviation, median, minimum, and maximum values. Results A total of 315 people were included in the study. Around 34.9% anaesthesiologists had 5-10 years of professional experience and 61.9% of the anaesthesiologists stated that they routinely check the patients’ pain level in the postoperative period. Multimodal analgesia is mostly preferred (25.3%) after major surgical intervention. Around 71.9% of the participants stated that they cannot find the required time for postoperative analgesia in their institution, and they associated this matter with excessive workload and lack of staff time. Conclusion In this study, we found that anaesthesiologists in Turkey are doing the follow-up of patients during the postoperative period pain-wise and that they use specific pain scales. Anaesthesiologists think that postoperative pain treatment is not done effectively and time required for the pain treatment is not enough. They also stated that a separate team should be formed for postoperative pain management in the hospital. We believe that this study will raise awareness on this issue and will contribute to the creation of algorithms for postoperative pain treatment, the establishment of pain teams, and the provision of more effective and safer health services.

BACKGROUND:Studies on higher doses of sugammadex effect on QT interval and leading arrhythmia have been limited. In this study, we aimed to investigate possible proarrhythmic effect of higher doses of sugammadex in conditions that required urgent reversal of neuromuscular blockade during general anesthesia in an experimental animal model.METHODS:It was experimental animal study. Total of 15 male New Zealand rabbits were randomly divided into three groups for low (4 mg/kg, n = 5), moderate (16 mg/kg, n = 5), and high dose of sugammadex (32 mg/kg, n = 5). All rabbits were premedicated by intramuscular ketamine 10 mg/kg, and general anesthesia was inducted by intravenous injection of 2 mg/kg of a propofol, 1 mcg/kg fentanyl, and 0.6 mg/kg rocuronium injection. Airway was provided by V-gel rabbit and connected to anesthetic device and ventilated at about 40 cycle/min and 10 ml/kg; oxygen 50% plus air 50% mixture was used with 1 MAC isoflurane to maintain anesthesia. Electrocardiographic monitorization and arterial cannulation were provided to follow-up mean arterial pressure and for arterial blood gas analyses. Intravenous sugammadex in three different doses were injected at 25th min of induction. After observing adequate respiration of all rabbits, V-gel rabbit was removed. Parameters and ECG recordings were taken basal value before induction and at the 5th, 10th, 20th, 25th, 30th, and 40th min to measure corrected QT intervals and were stored on digital media. QT interval was calculated as the time from the beginning of the Q wave to the end of the T wave. Corrected QT interval was calculated according to the Bazett's formula. Possible adverse effects were observed and recorded.RESULTS:In all three groups, there was no significant statistical difference in mean arterial blood gases parameters, arterial pressures, heart rates, and Bazett QTc values, and no serious arrhythmia was recorded.CONCLUSION:We found in animal study that low, moderate, and high doses of sugammadex did not significantly altered corrected QT intervals and did not cause any significant arrhythmia.

OBJECTIVE:To assess whether the use of an aerosol box for percutaneous tracheostomy in patients with COVID-19 can protect healthcare workers and affect the procedure-related outcomes and complications.STUDY DESIGN:Descriptive study.PLACE AND DURATION OF STUDY:Çanakkale Onsekiz Mart University Hospital, Çanakkale, Turkey from March to August, 2020.METHODOLOGY:A retrospective evaluation of patients, who underwent percutaneous tracheostomy with an aerosol box, was conducted. Patients aged over 18 years, diagnosed with COVID-19 and requiring percutaneous tracheostomy were included. Exclusion criteria were: age under 18 years and refusal to participate in the study. Patients' age, gender, comorbidities, APACHE II scores at intensive care admission, numbers of intubated days, durations of tracheostomy opening time, and complications were recorded.RESULTS:Twenty-four patients underwent the procedure. Tracheostomy was performed successfully in all 24 cases (100%). The mean age of the cases was 67.2 ± 10.1 years. Four patients experienced minor bleeding related to performing the percutaneous tracheostomy using the aerosol box. No healthcare workers were infected with SARS-CoV-2 while performing the tracheostomy procedure.CONCLUSION:Use of the aerosol box had adequate efficacy and safety for performance of the percutaneous tracheostomy procedure in intubated patients with COVID-19, who were being followed up in the intensive care unit. This procedure could be used as an alternative to traditional tracheostomy methods in patients with contagious respiratory infections. Key Words: Tracheostomy, Intensive care unit, COVID-19, Aerosol box.

Introduction: The assessment of disease severity and the prediction of clinical outcomes at early disease stages can contribute to decreased mortality in patients with Coronavirus disease 2019 (COVID-19). This study was conducted to develop and validate a multivariable risk prediction model for mortality with using a combination of computed tomography severity score (CT-SS), national early warning score (NEWS), and quick sequential (sepsis-related) organ failure assessment (qSOFA) in COVID-19 patients. Methods: We retrospectively collected medical data from 655 adult COVID-19 patients admitted to our hospital between July and November 2020. Data on demographics, clinical characteristics, and laboratory and radiological findings measured as part of standard care at admission were used to calculate NEWS, qSOFA score, CT-SS, peripheral perfusion index (PPI) and shock index (SI). Logistic regression and Cox proportional hazard models were used to predict mortality, which was our primary outcome. The predictive accuracy of distinct scoring systems was evaluated by the receiver-operating characteristic (ROC) curve analysis. Results: The median age was 50.0 years [333 males (50.8%), 322 females (49.2%)]. Higher NEWS and SI was associated with time-to-death within 90-days, whereas higher age, CT-SS and lower PPI were significantly associated with time-to-death within both 14 days and 90 days in the adjusted Cox regression model. The CT-SS predicted different mortality risk levels within each stratum of NEWS and qSOFA and improved the discrimination of mortality prediction models. Combining CT-SS with NEWS score yielded more accurate 14 days (DBA: -0.048, p = 0.002) and 90 days (DBA: -0.066, p < 0.001) mortality prediction. Conclusion: Combining severity tools such as CT-SS, NEWS and qSOFA improves the accuracy of predicting mortality in patients with COVID-19. Inclusion of these tools in decision strategies might provide early detection of high-risk groups, avoid delayed medical attention, and improve patient outcomes. (c) 2021 Elsevier Inc. All rights reserved.

ABSTRACT BACKGROUND: The novel coronavirus (COVID-19) emerged in Wuhan, China, in December 2019. OBJECTIVES: To evaluate the knowledge of intensive care physicians in Turkey about COVID-19 and their attitudes towards the strategies and application methods to be used for COVID-19 cases that need to be followed up in an intensive care unit, and to raise awareness about this issue. DESIGN AND SETTING: The population for this descriptive study comprised clinicians working in a variety of healthcare organizations in Turkey who provide monitoring and treatment within the intensive care process for COVID-19 patients. METHODS: Data were collected online using a survey form on the SurveyMonkey website between April 20 and April 25, 2020. RESULTS: The mean age of the 248 intensive care clinicians participating in the study was 37.2 ± 13.7 years and 49.19% were female. High rates of classical laryngoscope use were observed, especially among clinicians employed in state hospitals. Among all the participants, 54.8% stated that they were undecided about corticosteroid treatment for patients who had been intubated due to COVID-19. CONCLUSIONS: Many medications and methods are used for COVID-19 treatment. All national science committees are attempting to create standard treatment protocols. For intensive care treatment of COVID-19 patients, many factors require management, and clinicians’ experience is guiding future processes. We believe that this study will create awareness about this topic and contribute to the creation of standard treatment algorithms and the provision of better and safer healthcare services for this patient group.

Amaç: Lomber disk hernisi (LDH) toplumda giderek artan bir hastalık olarak karşımıza çıkmaktadır. Günümüzde minimal invaziv tedaviler hem maliyet hem de zaman açısından önemini artırmıştır. Bizde çalışmamızda LDH olan hastalarda minimal invaziv tedavilerden biri olan intradiskal ozon enjeksiyon tedavisinin retrospektif olarak radiküler ağrıda kısa ve uzun dönemde etkilerini incelendik.Gereç ve Yöntemler: Kafkas Üniversitesinde Ağustos 2015-Kasım 2016 tarihleri arasında, LDH sebebiyle ağrı polikliniğimize başvuran ve ameliyathanede C kollu floroskopi eşliğinde intradiskal ozon uygulanan 40 hastanın (13 erkek, 27 kadın) dosyaları geriye dönük olarak incelendi. Bulgular:İşlem öncesi vizuel analog skala (VAS), direk bacak kaldırma testi (DBKT) ve el parmak zemin mesafesi (EPZM) değerleri ile 1. ay ve 6. ay VAS, DBKT VE EPZM değerleri karşılaştırıldığında istatistiksel olarak anlamlı fark saptandı. Sonuç: Günümüzde disk hernilerinde cerrahi tedavi en son alternatif olarak düşünülmekte olup minimal invaziv yöntemler ön plana çıkmıştır. İntradiskal medikal ozon enjeksiyon tedavisinin kısa ve uzun dönemde etkin olduğu ve bu nedenle LDH olan hastalarda tercih edilebilecek bir tedavi yöntemi olduğunu düşünmekteyiz.

Objective: In our study, we hypothesised that using high doses, ie. 16 mg / kg sugammadex during general anesthesia after acute renal failure in rabbits would lead to a deteriorated renal histopathology due to the accumulation of rocuroniumsugammadex complex in the tubules. We aimed to investigate the effect of different doses of sugammadex (4 or 16 mg) on experimental kidney histopathology in rabbits with acute renal failure.Methodology: Eight New Zealand white adult male rabbits were used in the study. The rabbits were divided into 2 groups of four. The first group received low dose (4 mg) sugammadex and the second group received high dose (16 mg) sugammadex. Rabbits were administered 20 mg / kg of cisplatin intravenously 4 hours before general anesthesia and an acute renal failure model was established. After general anesthesia was applied, V-GEL® Rabbit was placed to all experimental animals to provide airway safety. All animals were manually ventilated using an anesthesia device. At the 25th min after induction, the rabbits in Group D received 4 mg / kg sugammadex iv, and the those in Group Y received 16 mg / kg sugammadex iv. At the end of the experiment, all experimental animals were sacrificed, and the kidneys were removed, and histopathologic examination was performed.Results: At the end of our study all experimental animals were sacrificed. There was no statistically significant difference between findings in the kidneys of animals of Group Y and Group D on histopathologic evaluation.Conclusion: The results of our study did not reveal any differences between the renal histopathological appearances of rabbits receiving 4 mg / kg or 16 mg /kg sugammadex IV.

Amaç: Kardiyovasküler sistem üzerine etkileri ve düzeltilmiş QT değeri (QTc) değişiklikleri açısından ünilateral ve bilateral spinal anestezi yöntemlerinin hasta grupları üzerinde karşılaştırılması amaçlandı. Gereç ve Yöntem: Artroskopi ve inguinal herni cerrahilerinde toplamda 40 hastaya rastgele geliş sırasına göre bilateral ve ünilateral spinal anestezi uygulandı. Lokal anesteziğin intratekal olarak verilmesi sonrasındaki 1, 3, 5, ve 15. dakikalarda ve ardından cerrahi başladığından itibaren 1, 3, 5, 15.dk ve ardışık gelen 10 dakikalık sürelerde 30 saniye süren holter EKG kaydı alındı. Hastaların hemodinamik parametreleri kaydedildi. Düzeltilmiş QT değerleri hesaplandı. Bulgular: Kalp atım hızları 25. dakikada ve 35. dakikada bilateral spinal grupta daha fazla olup gruplar karşılaştırıldığında anlamlı fark saptandı (p=0,046; p=0,021). QTc değerlerinin, spinal anestezi ve cerrahi süre ölçümlerinde her iki grupta da uzadığı görüldü. Bazzet’e göre QTc değerlerinin spinal anestezinin 1., 3., 5. ve 15. dakikasında ve cerrahi süresinin 1., 3., 5., 15., 25. ve 35. dakikasında bilateral grupta ünilateral gruba göre istatistiksel anlamlı daha uzun olduğu tespit edildi (p<0,05). Sonuç: Ünilateral spinal anestezinin QTc uzamasına bağlı kardiyovasküler komplikasyonları önleme açısından bilateral spinal anesteziye göre daha üstün bir yöntem olduğu değerlendirilmektedir..

Objective: Inj thiopental is known to result in hypotension during induction, and the effect is more pronounced in hypertensive patients. This study aimed to compare the effect of two different anesthesia induction regimens with pentothal in managing the hemodynamic response to laryngoscopy and endotracheal intubation in known hypertensive patients. Methodology: The study was conducted in Van Educational Research Hospital in 2014 after approval from the ethics committee and informed consent from patients were obtained. The prospective, double-blind, randomized study included the American Society of Anesthesiologists (ASA) grade II-III 90 patients, aged 40-65 y, scheduled for elective abdominal surgery with general anesthesia. Thiopental (3-7 mg/kg) was given to the patients in Group 1 (n = 45) with single dose injection in 20 s. In Group 2 (n = 45), first 75% of the thiopental dose was given, and after the bispectral index- based scale (BIS) value was < 60 and after injecting neuromuscular blocking agent, the rest of the thiopental dose was added and injection duration was recorded. In both groups, midazolam 0.05-0.1 mg/kg was administered for premedication. Fentanyl and rocuronium were used in both groups to complete induction. During the first 25 min, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and heart rate of the patients were recorded. Also, BIS values after induction and total additional fentanyl requirement were recorded. Results: Heart rate, mean arterial pressure, and additional fentanyl requirement was significantly lower in Group 2. BIS values were also lower in Group 2. Induction duration was higher in Group 2, but hemodynamic control was more satisfying. Conclusion: The study indicated that injection of thiopental in divided doses is more comfortable and safe when considering hemodynamic instability during anesthesia induction in hypertensive patients.

PURPOSE:The effect of a prophylactic oleuropein-rich diet before anesthesia accompanied by the widely-used steroid-based neuromuscular drug rocuronium on mast cell activation was investigated in the study.METHODS:14 rabbits used in the study. The rabbits in the oleuropein group were given oleuropein-rich extract added to the animals' water at doses of 20 mg/kg oleuropein for 15 days orally. After 15 days, all rabbits in the two groups were given general anesthesia with rocuronium of 1 mg/kg. After 1 day, animals were sacrificed and the liver tissue sections stained with H&E, toluidine blue and tryptase for immunohistochemical study.RESULTS:There was no statistically significant difference between ALT, AST and albumin averages of the oleuropein and control groups (p> 0.05). The tryptase average of the control group was higher than the tryptase average of the oleuropein group and this difference was statistically significant (p=0.003). The T. blue average in the oleuropein group was higher than the control group. However, there was no statistically significant difference between groups (p=0.482).CONCLUSIONS:Rocuronium adverse effects, like hypersensitivity and anaphylaxis, may limit routine use of this substance. The use of oleuropein reduced the number of inflammatory cells and prevented degranulation.

To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78 ± 15.45 years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (p = 0.74), ulnar (p = 0.35) and radial (p = 0.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (p = 0.02). The localization of the median (p = 0.85), ulnar (p = 0.27) and radial (p = 0.88) nerves did not differ remarkably between patients with BMI < 25 kg/m2 and patients with BMI ≥ 25 kg/m2. Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMI ≥ 25 kg/m2 (p = 0.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade.

PURPOSE:To evaluate the preventive effect of ascorbic acid on sevoflurane-induced acute renal failure in an experimental rat model.METHODS:Twenty-four adult male Wistar rats were randomly distributed into three groups. Subjects were allocated into 3 groups: Group I received sevoflurane only, whereas Groups II and III had moderate (150 mg/kg) and high (300 mg/kg) doses of AA in addition to sevoflurane, respectively. Rhabdomyolysis and myohemoglobinuric ARF was formed by intramuscular administration of glycerol on the upper hind limb on the 15th minute of inhalation anesthesia. Biochemical parameters consisted of serum levels of blood urea nitrogen, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), total antioxidant capacity (TAC), and protein carbonyl content. Histopathological variables were tubular necrosis, fibrin, and cast formation.RESULTS:NGAL levels were significantly lower in Group III than Group II and Group I. On the other hand, TAC, PCO, urea and creatinine levels were notably higher in Group I compared with Groups II and III. There was a significant difference between 3 groups on frequencies of acute tubular necrosis (p=0.003), fibrin (p<0.001) and cast (p<0.001). Acute tubular necrosis and fibrin formation were more prominent in Group I. Casts were more common in Groups II and III.CONCLUSIONS:The ascorbic acid serve as a prophylactic agent against renal damage in patients receiving sevoflurane anesthesia and higher doses were associated with more apparent protective effects.

Accidental caustic ingestions are serious medical problems especially in childhood. Various treatment modalities are being used for the complications of caustic injuries such as stricture formation. The aim of this study is to establish whether ursodeoxycholic acid (UDCA) has protective effects on experimental corrosive esophagitis in rats. Twenty four Wistar-albino rats, weighing 220-240 g, were used in the study. Experimental animals were divided in three groups randomly: UDCA treatment group (Group T, n:8), control group (Group K, n: 8) and sham group (Group S, n: 8). In group T and S corrosive esophagitis was induced. UDCA (5 mg/kg) was performed to the group T for 10 days orally. All animals were sacrificed at the end of procedures and histopathological changes in esophageal tissue were scored by a single investigator who was blind to the groups. In group T inflammation was present in two rats, muscularis mucosa injury in two rats, grade 1 collagen deposition in six rats and grade 2 in two rats. In comparison with group S these were statistically significant (p value was 0.003, 0.003 and 0.015, respectively). UDCA has protective effect in experimental corrosive esophagitis. KEY WORDS Corrosive esophagitis, Rat, Stricture, Ursodeoxycholic acid.

It is aimed to evaluate of the effectiveness of the application of epidural steroid injection(ESE) in patients with lumbar disc herniation (LDH) in this study. Between November 2010- December 2011 patients applied Yahyali State Hospital Algology Clinic withlow back pain for at least 3 months was evaluated in a prospective study. Application of the lumbar epidural steroid injection was planned for 150 patients. visual analogue scale (VAS) were used for scoring pain of patients. Besides, patients with hand-finger floor distance and the degree of straight leg raising were evaluated before and after ESE injection. Ages of patients were between 27-65 years old, of all patients 67 were men (44,7%), 83 were women (%55,3). Before and after treatment in VAS, direct leg increase, hand- finger ground distance of patients were found to be significantly different between measurements one by one (p=0,0037, p=0,0053, p=0,0062). Epidural steroid administration can provide earlier symptomatic treatment for the patients suffering from low back pain with lumbar disc herniation who did not respond to conservative treatment.

General anesthesia and surgical stress cause an acute endocrine, metabolic, and immunologic inflammatory response in organisms and an increase in neutrophil lymphocyte ratio (NLR) and ischemia-modified albumin (IMA) levels. Ozone, other than inhalation administration, reduces the release of antioxidants and some proinflammatory cytokines and has been shown to have an anti-inflammatory effect. Our aim is to research how the NLR and IMA response is affected in rabbits undergoing surgical intervention with general anesthesia given prophylactic with ozone therapy. We divided 12 New Zealand rabbits into 2 groups: group O was given 70 μg/mL 10 mL ozone by the rectal route in 6 sessions on alternate days, and group C was given air by the rectal route. The rabbits underwent surgical intervention under general anesthesia. Blood samples were taken at basal, preoperation, 30 minutes postanesthesia, and 24 hours postoperation and were examined for hemogram and IMA. At 24 hours postoperation, an increase in NLR was observed in both groups, more clearly in group C (P < 0.05). In both groups, comparisons within the groups showed a significant increase in NLR only at 24 hours postoperation compared to other times (P < 0.05).When IMA values were compared, differences between the groups were observed between preoperative values and those at the 30 minutes postanesthesia and 24 hours postoperation (P < 0.05). When general anesthesia and surgical stress response were evaluated using inflammatory parameters of both NLR and IMA, there was significantly less of an increase in levels in rabbits given ozone compared to the control group.

Objective: When faced with unexpected difficult intubation, despite all the technological advances, there is still a need of equipments that are easy to use and very reachable. In this study, we offer our experiences in use of gum elastic bougie in 10 cases with unexpected difficult intubation in our operation rooms.Material and Methods: In Canakkale 18 March University Medical Faculty's Operating Rooms and between the years 2013-2014, all the encountered unexpected difficult intubation cases are classified and the patients who has Mallampati score I-II and having any airway pathology evaluated for the use of Gum elastic bougie (GEB). Auxiliary equipments used in intubation, number of intubation attempts, number of anesthesiologists who tried for intubation, the number of trials with GEB and the complications due to the use of GEB were recorded.Results: A total of 10 cases with unexpected difficult intubation were included in the study. All of the cases were male and intubation was attempted with size 4 blades. Stylet in 6 cases, fast trach laryngeal mask in 1 case were used after unsuccessful intubation attempts. However the use of this equipments patients couldn't be intubated and after at least 3 three attempts GEB used this time for intubation. An experienced anesthesiologist with the help of GEB intubated all the patients at once. There were no complications related to the use of GEB.Conclusion: GEB is widely used in European countries for unexpected difficult intubation. In our patients, despite the absence of any complications, due to the blind insertion of bougie trauma cases have been reported. GEB when performed by an experienced anesthesiologist is a good alternative airway equipment in unexpected difficult airway management, because it's inexpensive, easy to use and portable.