INTRODUCTION:Emergence agitation (EA) is a postoperative neurobehavioral complication characterized by a transient disturbance in cognition and perception following anesthesia. Neuroinflammation is thought to play a central role in its pathophysiology. Preoperative anxiety is the "acute preoperative stress response." This study aimed to evaluate the relationship between hemogram-derived inflammatory markers and the development of preoperative anxiety and EA in pediatric patients. METHODS:This prospective observational study included 350 pediatric patients aged 5-12 years with ASA grade I-II. Preoperative anxiety was assessed in the waiting room using the modified Yale Preoperative Anxiety Scale. Demographic and clinical data, anesthesia/surgical data, and hemogram parameters were recorded. EA was evaluated in the recovery room using the Pediatric Anesthesia Emergence Delirium scale. Pain was assessed at 0, 5, 10, 20, and 30 min using the FLACC scale in children < 7 years and the Visual Analog Scale in those ≥ 7 years. RESULTS:Of the total 350 patients, 130 (37.1%) developed EA. Compared with those without EA, children with EA had significantly higher leukocyte, monocyte, neutrophil, and platelet counts (p = 0.018, 0.005, 0.001, and 0.001, respectively), lower lymphocyte counts (p = 0.042), and elevated monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammatory index (SII) (all p < 0.001). Regression analysis showed that younger age, higher postoperative pain scores, and elevated SII were independently associated with EA. Preoperative anxiety was observed in 103 children (29.4%). These patients had higher white blood cell counts (p = 0.026), and regression analysis identified that younger age, anxious parents, and elevated SII were independently associated with preoperative anxiety. CONCLUSION:Easily obtainable hemogram-derived inflammatory markers, particularly SII, may be useful for identifying children at increased risk of preoperative anxiety and EA in children. These findings suggest that SII may assist anesthesiologists in identifying high-risk patients and implementing preventive strategies to reduce the incidence of EA. TRIAL REGISTRATION:The study was registered at ClinicalTrials.gov (NCT06648122).

BACKGROUND:Adult patients often experience preoperative anxiety that can influence their anesthetic requirements. We investigated the effect of a preoperative midazolam anxiolytic dose on intraoperative sevoflurane consumption. METHODS:This prospective, randomized, double-blind, placebo-controlled study involved 80 patients undergoing elective surgery. Participants were randomized to receive either intravenous midazolam (0.04 mg/kg) or saline preoperatively. Preoperative anxiety assessment was conducted using the short version of the State-Trait Anxiety Inventory. The primary outcome was cumulative sevoflurane consumption within the first hour of surgery. Secondary outcomes included minimum alveolar concentration (MAC), MAC-hour, inspiratory and end-tidal sevoflurane concentrations, and hemodynamic variables. RESULTS:Sevoflurane consumption in 60 minutes was comparable between the midazolam (mean ± standard deviation: 24.2 ± 3.9 mL) and control (25.2 ± 4.1 mL) groups (P = .291). The study found no statistically significant difference in mean MAC-hour values between the groups administered midazolam (3.3 ± 0.7) and saline (3.4 ± 0.7; P = .612). Anxiety levels and sevoflurane consumption or MAC-hour values were not significantly correlated. Hemodynamic parameters remained stable and comparable between groups. CONCLUSION:Preoperative anxiolytic dose of midazolam administration did not significantly reduce intraoperative sevoflurane consumption, and preoperative anxiety levels were not associated with sevoflurane requirements.

Objective:This study aims to assess the practices of anaesthesiologists in Türkiye regarding paediatric anaesthesia. It focuses on preoperative, intraoperative, and postoperative care protocols. Methods:Survey data were collected using a web-based electronic platform. The participants were asked to answer the questions based on the available equipment in their hospitals in daily practice. The questionnaire forms were sent to participants by the Turkish Society of Anesthesiology and Reanimation via e-mail. Results:Three hundred five anaesthesiologists responded to the survey. The specific practices and standards for paediatric anaesthesia in Türkiye along with how anaesthesiologists approach paediatric patients were concluded from the survey results. Conclusion:There are still gaps in paediatric anaesthesia practice. We believe that further research and dedicated discussions on this topic will play a key role in addressing these drawbacks.

Background and Aims: Postoperative pain is one of the most common problems after thoracic surgery. In this study, we aimed to investigate the analgesic effects of two different doses of intrathecal morphine (ITM) based on ideal body weight in patients who underwent video-assisted thoracoscopic surgery (VATS). Material and Methods: Forty-six patients scheduled for elective lung resection were included in this study. Patients were allocated to receive 10 μg/kg (Group I) and 7 μg/kg (Group II) ITM according to the ideal body weight for postoperative analgesia. Intraoperative and postoperative hemodynamic variables, postoperative morphine consumption, pain scores (at rest and effort), side effects, and additional analgesic requirements were recorded. Results: Postoperative pain scores did not differ in the first 12 h between the groups, but were significantly lower in Group I compared with Group II at 18 and 24 hours (P = 0.024 and P = 0.017 at rest, and P = 0.025 and P = 0.002 at effort, respectively). Postoperative morphine consumption was statistically significantly lower in Group I at all time periods (P < 0.05). The incidence of side effects was similar for both groups (P > 0.05). Conclusions: The use of 10 μg/kg ITM according to the ideal body weight provides more effective analgesia without increasing the side effects compared to 7 μg/kg ITM after VATS.

Background and Objectives: Diabetes is a known risk factor for postoperative delirium (POD); however, the relationship between the markers of glycemic control and the occurrence of POD in noncardiac surgery is not established. We initiated this pilot study to determine any possible associations between preoperative HbA1c levels and POD development; this will allow for larger, definitive studies to be designed and preliminary effect sizes to be established for future research. Materials and Methods: This retrospective pilot study included 78 patients with diabetes who underwent elective noncardiac surgery under general anesthesia between July 2020 and January 2021. We obtained the patients’ demographic data, medical history, surgical parameters, and preoperative HbA1c levels to determine the occurrence of POD (using CAM-ICU). Univariate and multivariate regression analyses were applied to check the leading associations for the development of POD. Results: POD was observed in seven patients (9.0%). The results of the preliminary multivariate analysis suggested that HbA1c may be associated with POD (OR, 2.96; 95% CI [1.34–6.52], p = 0.007); fasting blood glucose (OR, 1.04; 95% CI [1.01–1.07], p = 0.013); and duration of anesthesia (OR, 1.02; 95% CI [1.00–1.04], p = 0.019). The ROC analysis of HbA1c showed an optimal threshold of 7.4%, with a sensitivity of 91.5%, and a specificity of 85.7% in terms of predicting POD (AUC = 0.91, p < 0.001). Conclusions: Through this pilot study, we have provided evidence that leads to the assumption that preoperative HbA1c at, or above, 7.4% can result in an increased risk of delirium in diabetic patients who undergo noncardiac surgery. The findings of this study allow for the implementation of the proposed methodology and the collection of critical data necessary for the design of appropriately powered definitive trials.

Background and Objectives: To assess the impact of preoperative inflammatory parameters on the necessity for intensive care unit (ICU) admission and survival after pneumonectomy. Materials and Methods: We enrolled 207 adult patients who underwent pneumonectomy between December 2016 and January 2022. We collected data from patients’ electronic medical records. Results: The preoperative albumin level was statistically lower, need for blood transfusion was higher, and length of hospital stay was longer in ICU-admitted patients (p = 0.017, p = 0.020, and p = 0.026, respectively). In multivariate analysis, intra-pericardial pneumonectomy and postoperative complications were predictive factors for ICU admission (OR = 3.46; 95%CI: 1.45–8.23; p = 0.005 and OR = 5.10; 95%CI: 2.21–11.79; p < 0.001, respectively). Sleeve or pericardial pneumonectomy (p = 0.010), intraoperative vascular injury (p = 0.003), the need for mechanical ventilation (p < 0.001), acute renal failure (p = 0.018), sepsis (p = 0.008), respiratory failure (p < 0.001), pneumonia (p = 0.025), the need for blood transfusion (p = 0.047), elevated blood urea nitrogen (BUN) (p = 0.046), and elevated creatinine levels (p = 0.004) were more common in patients who died within 28 days. Patients who died within 90 days exhibited higher preoperative neutrophil-to-lymphocyte ratio (NLR) values (p = 0.019) and serum creatinine levels (p = 0.008), had a greater prevalence of sleeve or intra-pericardial pneumonectomy (p = 0.002), the need for mechanical ventilation (p < 0.001), intraoperative vascular injury (p = 0.049), sepsis (p < 0.001), respiratory failure (p = 0.019), and contralateral pneumonia (p = 0.008) than those who did not. Conclusions: Intra-pericardial pneumonectomy and postoperative complications are independent predictors of ICU admission after pneumonectomy. Tracheal sleeve and intra-pericardial procedures, intraoperative and postoperative complications, the need for blood transfusion, preoperative NLR ratio, BUN and creatinine levels may also be potential risk factors for mortality.

BACKGROUND: The aim of our study is to assess the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR), lymphocyteto-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) on 28-day mortality in patients admitted to the intensive care unit with crush syndrome following the Kahramanmara & scedil; earthquake in T & uuml;rkiye. METHODS: A total of 63 adult patients with crush syndrome admitted to the intensive care unit after the earthquake were enrolled in this study. The medical records of the patients were examined using follow-up forms and the hospital data system. RESULTS: The mean age of the patients was 38.9 +/- 17.3 years, and the median time under debris was 31.5 hours. The 28-day mortality rate was 27%. In univariate generalized estimating equations (GEE) and other analyses, variables that are significant (or candidate variables) between 28-day mortality groups included age as a biological factor. These variables were included in the multivariate GEE model. The effects of continuous renal replacement therapy (CRRT), serum sodium concentration, Sequential Organ Failure AssessCONCLUSION: Elevated SOFA scores, the necessity for CRRT, increased serum sodium levels, and decreased PLR values are associated with increased 28-day mortality in patients with crush syndrome after an earthquake.

BACKGROUND:Endotracheal intubation is a frequently performed procedure in anesthesia practice, and ensuring the correct inflation of the cuff is essential for maintaining the airway seal. Overinflation of endotracheal tube (ETT) cuffs can lead to complications, such as postoperative sore throat. This study aimed to compare the incidence of elevated ETT cuff pressure between saline and air inflation in elective laparoscopic abdominal surgery. METHODS:The study involved 60 participants ranging in age from 18 to 65, with American Society of Anesthesiologists physical status levels 1-2, who underwent laparoscopic abdominal surgery. We randomly assigned patients to two groups: Group A (air-filled ETT cuffs, N.=30) and Group S (saline-filled ETT cuffs, N.=30). Intra-cuff pressure was recorded before and after CO2 insufflation, as well as during changes in patient position. The number of interventions to restore intra-cuff pressure to 18 mmHg was documented. Peak airway pressure, plateau pressure, and positive end-expiratory pressure (PEEP) were measured at 15-minute intervals. RESULTS:The number of interventions needed to maintain intra-cuff pressure was significantly lower in the saline group compared to the air group. All patients started with initial cuff pressures above 20 mmHg. After insufflation, the first-minute cuff pressures were higher in the air group (P=0.001). Both groups experienced a significant increase in intra-cuff pressure with the Trendelenburg position, and after moving to the reverse Trendelenburg position (saline and air groups, P=0.001 and 0.012, respectively), the air group had higher intra-cuff pressure than the saline group (P=0.002). There were no significant differences between groups in peak airway pressure, plateau pressure, and PEEP. CONCLUSIONS:Inflating ETT cuffs with saline instead of air during laparoscopic abdominal surgeries led to a reduced requirement for interventions in maintaining pressure. This indicates that the use of saline inflation may significantly lower the risk of high cuff pressure and related complications.

Introduction: Today, preoperative fasting guidelines have changed, allowing clear liquid intake up to 1 h before surgery. However, concerns remain regarding the risk of aspiration associated with clear liquid intake. This study aimed to investigate the impact of clear fluid given 1 h before surgery on child anxiety and gastric volumes. Methods: A prospective, randomized, controlled study included 90 patients aged 5-12 years. The patients were randomly allocated into three groups by a computer-generated randomization: group F (n = 30): standard fasting group, group W (n = 30): patients who received oral water at a dose of 5 mL/kg 1 h before surgery, group C (n = 30): patients who received oral carbohydrate fluid at a dose of 5 mL/kg 1 h before surgery. All patients were assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS) before and 1 h after fluid administration. Antral cross-sectional area (CSA) was measured with ultrasonography after intubation, and gastric residual volume (GRV) was calculated. Hemodynamic data, blood sugar level, and parental satisfaction were also recorded. Results: The m-YPAS scores obtained after 1 h were significantly lower in group C than in the other groups (p < 0.001). Antral CSA and GRV values were lower in group C and group W than in the fasting group (p < 0.001). Parental satisfaction was highest in group C. Conclusion: This study suggests that allowing a carbohydrate-rich clear liquid intake 1 h before surgery can significantly reduce preoperative anxiety in pediatric patients without increasing the risk of aspiration.

Purpose: The aim of this study was to investigate whether wake up and recovery from anesthesia is earlier or later in patients with insomnia. Material and Methods: This study included adult patients who were scheduled for elective ureteroscopy under general anesthesia. Using the Jenkins-Sleep Questionnaire (JSQ), the patients were separated into two groups: Insomnia Group and Control Group. Anaesthesia was standardized. After anesthesia induction, 4-6 % desflurane in nitrous oxide/oxygen (60-40%) concentration at flow of 3 L min¯¹ was administered. The parameters recorded were noninvasive arterial blood pressure, heart rate, peripheral oxygen saturation, end-tidal carbon dioxide values, inspiratory and expiratory concentrations of desflurane, anesthesia time, surgery time, time of eye opening, time of transfer to the recovery room. Pain was assessed with a Visual Analogue Scale (VAS) and recovery with the Modified Aldrete Recovery Score (MARS). Results: Evaluation was made of 80 patients, comprising 25 females and, 55 males, grouped as 42 patients in the insomnia group and 38 in the control group. The demographic and hemodynamic data were not significantly different between the groups. The time of eye opening, transfer to the recovery room, VAS and MARS values were similar in both groups. When operation times were classified as ˂ 30 min. and ≥ 30 min, no significant differences were determined between the groups in respect of wake up, recovery and pain parameters. Conclusion: Compared with normal sleepers, patients with insomnia showed no differences in respect of wake up and recovery from anesthesia.

Purpose: In this study, we investigated the relationship between integrated pulmonary index and patients’ demographic data, surgical characteristics, postoperative complications, blood gas analysis, and hemodynamic values after thoracic surgery. Materials and Methods: A total of 97 patients scheduled for elective thoracic surgery were included in this study. After surgery, integrated pulmonary index monitoring was performed for all patients in the post-anesthetic care unit. Patients’ characteristics, postoperative hemodynamic values, arterial blood gas analysis, length of hospital stay, postoperative complications, duration of anesthesia, and duration of surgery were recorded. Their correlations with postoperative integrated pulmonary index scores at 30 minutes, 1 hour, and 2 hours were investigated. Results: Patients’ demographic data and surgical characteristics did not affect integrated pulmonary index scores. No significant correlation was found between integrated pulmonary index scores and duration of anesthesia, duration of surgery, postoperative complications, or length of hospital stay. However, there was a correlation between postoperative hemodynamic values, arterial blood gas analysis and integrated pulmonary index score. Conclusion: Integrated pulmonary index monitoring is a bedside and non-invasive method that displays multiple parameters on a single screen, corraletes with arterial blood gas analysis and hemodynamic values. Therefore, it may provide advantages in early follow-up of thoracic surgery patients. However, multicenter, randomized controlled studies with a larger number of patients are needed to investigate the efficacy of integrated pulmonary index in patients undergoing thoracic surgery.

Objective: Foreign body aspiration (FBA) is a potentially life-threatening emergency in children. Urgent rigid bronchoscopy (URB) should be performed when presentation includes severe respiratory failure with suspicion for FBA. To the best of the knowledge, this is the first study that evaluates URB in English literature. Methods: Forty-eight patients who underwent URB were included in this study. From the medical records, the patients’ demographic characters, endotracheal intubation status, peripheral oxygen saturation, bronchoscopy results, type and location of foreign body (FB), intra- and postoperative complications and mortality, X-ray, length of hospital stay were evaluated. Results: Twenty-four of the 48 patients were non-intubated. Peripheral oxygen saturation values were 60 ± 14.40 in the preoperative period. No statistical differences were found between intubated and non-intubated patients in terms of intra- and postoperative complications. There were no statistical differences between patients with negative and positive results for bronchoscopy in terms of intra- and postoperative complications. Conclusions: Bronchoscopy is not without risk; however, it is a life-saving procedure. Despite negative FB results, urgent bronchoscopy should be performed in suspicious cases.

Ketamine (KET), an anesthetic, analgesic, and a sedative N-methyl-d-aspartate (NMDA) receptor antagonist agent, exposure during neonatal period may lead to learning impairment, behavioral abnormalities, and cognitive decline in the later years of life. In recent studies, it has been reported that sedative-acting α2 agonist dexmedetomidine (DEX), which is commonly used in clinical practice with KET, has neuroprotective effects and prevents the undesirable effects of anesthesia. To elucidate the underlying mechanisms of these actions, we investigated the interaction between NMDA receptors α2 adrenoceptor and adulthood behaviors in neonatally KET and/or DEX administrated mice. Balb/c male mice were administrated with saline, KET (75 mg/kg), DEX (10 µg/kg), or KET + DEX (75 mg/kg + 10 µg/kg) on postnatal day 7. During adulthood (8–10 weeks old) mice were subjected to elevated plus maze, open field, and Morris water maze tests. After behavioral tests, hippocampus samples were extracted for mRNA expression studies of NMDAR subunits (GluN1, GluN2A, and GluN2B) and α2 adrenoceptor subunits (α2A, α2B, and α2C) by real-time PCR. Ketamine increased horizontal and vertical locomotor activity (p < 0.01) and impaired spatial learning-memory (p < 0.05). DEX increased anxiety-like behavior (p < 0.01), but did not affect spatial learning-memory and locomotor activity. KET + DEX impaired spatial learning-memory (p < 0.01), increased horizontal locomotor activity (p < 0.01), and anxiety-like behavior (p < 0.05). Our study implies that DEX cannot prevent the adverse effects of KET, on spatial learning-memory, and locomotor activity. In addition to this, it can be thought that during brain development, there is an interaction between NMDAR and α2 adrenoceptor systems.

Objective: Most children under general anesthesia need mechanical ventilation (MV), but it has been reported in the literature that many parameters for this application are derived from adult patients.There is lack of literature about intraoperative MV for children.We conducted this survey to seek an answer for the question "How intraoperative respiratory parameters based on MV are managed for newborns and children among Turkish anesthesiologists?".Method: A questionnaire containing 30 questions was sent to anesthesiologists.This survey collected information on clinical practice related to MV modes, tidal volume, positive end-expiratory pressure (PEEP), fraction of inspired oxygen (FiO 2 ), respiratory rate, monitoring of peripheral oxygen saturation (SpO 2 ) and end-tidal carbon dioxide (EtCO 2 ) and recruitment maneuvers (RMs).Results: A total of 148 anesthesiologists and anesthesia residents responded to this survey.Of these respondents, 77% were working at a university hospital.More than 60% of respondents were using volume-controlled modes for newborns and children.The most commonly used tidal volume and PEEP values were 6-8 mL kg -1 and 3-4 cmH 2 O, respectively.Monitorization, including SpO 2 and EtCO 2 was used by over 85% of respondents, while 75.7% of them were using recruitment maneuvers (RMs), which were often (55.4%)used during hypoxia with application of manual inspiratory pressure (71.6%). Conclusion:The results of the present study indicate differences with the existing literature data.However, information about intraoperative application of mechanical ventilation in pediatric patients is limited, and there is a need for further study on this field.

Purpose: The aim of this study was to evaluate the effects of dexmedetomidine on the use of laryngeal mask airway and the cobra perilaryngeal airway in children.Materials and Methods: The medical records of 112 children who received sevoflurane alone and sevoflurane plus dexmedetomidine (loading dose 1 µg/kg + infusion 0.5 µg/kg/h) during elective inguinal region surgery with LMA or CobraPLA were retrospectively reviewed: Group LMA, Group CobraPLA, Group Dex+LMA and Group Dex+CobraPLA. Patients’ demographic data, hemodynamic parameters, the number of trials and time to achieve an effective airway, the end-tidal sevoflurane (ETSevo) concentration, plateau pressure (P plateau), peak inspiratory pressure (PIP), end-tidal carbondioxide (ETCO2) values, and complications were noted.Results: Demographic and anesthetic data, hemodynamic parameters, and complications were similar between the groups. The number of attempts, the time for insertions, P plateau, and PIP were statistically higher in the LMA group compared to other groups. ETSevo concentrations were lower in the Dex+CobraPLA group compared to LMA and CobraPLA group. The ETCO2 measurements were higher in the CobraPLA and Dex+CobraPLA groups compared to other groups. Conclusion: Dexmedetomidine reduced airway pressures and ETSevo concentrations without side effects in the children with SADs.

Anaesthesia management of the conjoined twins poses some difficulties both for the anaesthesiologist and the twins. The airway management, presence of cross circulation, hypothermia and positioning are significant points during anaesthesia. We report the anaesthetic management during the colostomy opening of omphalopagus twins with anal atresia, and ultrasound-guided central venous catheterisation.