The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males.

Objective: To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men.Methods: Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, n = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, n = 114). Preoperative, perioperative and postoperative outcome measures were examined.Results: Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney (p > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA (p < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications (p > 0.05). Stone-free rates and success rates were similar in both groups (p = 0.133 and p = 0.273, respectively).Conclusion: The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.

Combined spino-epidural anaesthesia (CSEA) can be safely administered in elderly men during PNL operation without affecting surgical success. CSEA patients less occupy the operating rooms. CSEA patients' postoperative period is more comfortable because of the less painful period.

Surgical treatment of caseous calcification of the mitral annulus causing mitral stenosis and mimicking the clinical picture of infective endocarditis: A case report.

Among masses involving the mitral valve and annulus, caseous calcification of the mitral annulus (CCMA) is a rare disease. CCMA accounts for .63% of all mitral annular calcification (MAC) cases. The pathophysiology is still unknown. The correct diagnosis and treatment of this disease is very important to prevent complications. We present a case of giant CCMA with advanced mitral stenosis and hypertrophic cardiomyopathy, presenting with symptoms of infection and therefore a preliminary diagnosis of infective endocarditis. Because of these features, we wanted to share our case as it is the 1st case in the literature.

Surgical treatment of recurrent subvalvular discrete membrane and left ventricular outflow tract stenosis in an adult patient with a history of congenital cardiac surgery.

Left ventricular outflow stenosis can develop at the supravalvular, valvular, and subvalvular levels. Resection of strictures at the diffuse subvalvular level is very difficult. In such pathologies, Konno-Rastan procedure provides very successful solutions as an anterior aortoventriculoplasty method. In this article, we performed anterior aortaventriculoplasty surgical treatment for tunnel type left ventricular outflow tract stenosis, recurrent subvalvular discrete membrane, and aortic regurgitation in an adult patient with a history of partial atrioventricular septal defect repair and subvalvular discrete membrane resection operation in early childhood. The Konno-Rastan procedure, which we applied to the redo case, which is rarely used in adult patients and rarely seen in the literature, is shared.

Increased maternal mortality in unvaccinated SARS-CoV-2 infected pregnant patients.

The aim of this study was to demonstrate the poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in unvaccinated pregnant women. In this retrospective study, the clinical and laboratory parameters of 26 pregnant or immediately postpartum patients, who were hospitalised and needed intensive care unit (ICU) follow-up due to coronavirus disease 2019 (COVID-19) infection were reported. All pregnant patients who followed up in the ICU were unvaccinated. The mortality rate was calculated as 34.62% in the patients included in the study who were admitted to the ICU. Among patients hospitalised in the ICU, the maternal mortality and stillbirth rates associated with COVID-19 infection were found to be 156.28/100,000 and 11.54%, respectively. Preterm birth occurred in 58.33% of the patients who delivered. 79.17% of the patients were delivered by caesarean section. Lymphopenia, high ferritin, interleukin-6, lactate dehydrogenase, D-dimer and C-reactive protein values were found to be associated with mortality. The course of pregnant patients with COVID-19 infection is not always predictable. Clinical and laboratory data should be evaluated in combination for disease prognosis. Adequate information should be given about the importance of vaccination.Impact StatementWhat is already known on this subject? The SARS-CoV-2 infection has caused a public health crisis worldwide. As a result of studies on coronavirus disease 2019 (COVID-19) infected pregnant women, it was observed that there was an increase in maternal and perinatal mortality. There has been an increase in intensive care unit (ICU) admissions, especially after patients infected with the Delta variant. The pandemic continues with an unpredictable course of the new variants.What do the results of this study add? Compared to the pre-pandemic period, COVID-19 infection caused a more than 10-fold increase in maternal mortality, particularly after the Delta variant. In intensive care follow-up, low lymphocyte count, high lactate dehydrogenase, D-dimer, C-reactive protein, ferritin and interleukin-6 values are indicators of poor prognosis.What are the implications of these findings for clinical practice and/or further research? COVID-19 infection causes increased maternal mortality. Considering that all of the patients admitted to the ICU in our study were unvaccinated, pregnant women should be encouraged to get vaccinated.

Emergency surgical gastrostomy in an esophageal cancer patient unable to receive COVID-19 treatment due to obstruction, and operating room measures as per pandemic guidelines: Case report.

We present here a gastrostomy procedure performed on a patient diagnosed with COVID-19 with no oral intake due to esophageal cancer in order to permit the initiation of COVID-19 treatment, and the COVID-19 protocols followed as per the pandemic guidelines. A 55-year-old female patient diagnosed recently with esophageal squamous-cell carcinoma was consulted for a surgical gastrostomy in the absence of oral intake due to complete esophageal obstruction prior to neoadjuvant chemotherapy. The patient had a new-onset cough and elevated body temperature (38°C) on admission to our clinic, and so was tested for COVID-19, with the final diagnosis established with PCR. In order to initiate COVID-19 treatment, a surgical gastrostomy was performed under semi-emergency conditions, following COVID-19 infection prevention guidelines. COVID-19 treatment, nutrition, and supportive therapy were initiated through the gastrostomy catheter. The patient is clinically stable on day 7 of treatment. A COVID-19 patient may require emergency surgical intervention during the fight against pandemic. When a surgical procedure is performed, all guidelines defined to protect healthcare workers from COVID-19 infection should be followed.

Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study.

Background: The aim of this study was to compare the effectiveness of ultrasound-guided (USG) subcostal transversus abdominis plane (TAP) block and quadratus lumborum (QL) block as preventive analgesia methods after laparoscopic cholecystectomy. Methods: A total of 120 patients, 18-75 years of age, were separated into 2 groups preoperatively. Patients in group TAP (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral subcostal TAP block; patients in group QL (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral QL block. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 h were recorded. Results: Fifty-three patients in group TAP and 54 in group QL were ultimately evaluated. No statistically significant difference was found in at rest and dynamic visual analog scale scores between the groups. There was also no statistically significant difference between the groups with regard to total analgesia consumption. Although the duration of anesthesia was significantly longer in group QL, no statistically significant difference was found in the duration of surgery between the groups (p < 0.05). Conclusions: Results of this study demonstrated that USG subcostal TAP and QL blocks similarly reduced postoperative pain scores and analgesia consumption, with high patient satisfaction. However, subcostal TAP block could be considered preferable to QL block because it can be applied easily and in a shorter time.

Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: A randomized controlled double blind study.

STUDY OBJECTIVE: Laparoscopic techniques are commonly used in surgical operations of the gallbladder. There are very few regional anesthesia methods used to achieve this goal. We aimed to investigate the effect of ultrasound-guided posterior quadratus lumborum block (QLB), administered bilaterally on pain scores after laparoscopic cholecystectomy operations. DESIGN: Prospective, double blind, randomized controlled clinical trial. SETTING: Single-institution, tertiary hospital. PATIENTS: 60 patients underwent laparoscopic cholecystectomy were included in the study. INTERVENTIONS: Patients were randomized to either Group B (intravenous patient-controlled analgesia (IV PCA) + posterior QLB with 0.3 ml/kg 0.25% bupivacaine; n = 30) or Group S (IV PCA + posterior QLB with 0.3 ml/kg 0,9% saline; n = 30). MEASUREMENTS: Postoperative pain (during rest) was evaluated at the 30th minute, 2nd, 6th, 12th, and 24th hours using the VAS scores. Postoperative activity pain was also evaluated with VAS at the 2nd, 6th, 12th, and 24th hours. Postoperative 6th, 12th, and 24th hour follow-up results were recorded to identify the quantity of tramadol use. Secondary outcomes included the Ramsey sedation scale (RSS), side effect profile, and additional analgesic use. MAIN RESULTS: The VAS scores between the two groups were found to be statistically significantly lower in Group B (p < 0.001). The mean values of the quantity of tramadol use at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (p < 0.001). There was no statistically significant difference in the rate of side effects (p = 0.309) and RSS (p = 0.505) outcomes between the groups. CONCLUSIONS: As a result of this study, we think that posterior QLB administered for pain palliation after laparoscopic cholecystectomy operation is an effective analgesia technique.