Comparison of the clinical efficacy of ultrasound-guided GON blockade using low and high concentrations of bupivacaine in chronic migraine.

Background/aim: In this study, it was aimed to retrospectively compare the effect of greater occipital nerve (GON) block performed with ultrasonography using low (0.3%) and high (0.5%) concentrations of bupivacaine on pain scores and patient satisfaction in chronic migraine (CM). Materials and methods: The mean number of days with pain, the mean duration of pain in the attacks, and the highest numerical rating scale (NRS) scores recorded in the 1 month preblock and 1 and 3 months postblock of 80 patients (40 for Group 1, 0.3% bupivacaine; 40 for Group 2, 0.5% bupivacaine) who underwent ultrasonography-guided GON block were recorded from the patient file data. According to the protocol applied by our clinic, GON block was applied to each patient 6 times with the same procedures, in total. Results: While there was a statistically significant difference between the groups in terms of the number of days with pain and the maximum NRS score in the 1-month preblock evaluation (p = 0.01, p < 0.001), at 3 months postblock, no statistical difference was observed in terms of the number of days with pain, duration of pain, or NRS score (p = 0.961, p = 0.108, and p = 0.567). In the intragroup evaluations, at 3 months postblock, the number of days with pain decreased from 17.5 days to 7 days in Group 1 and from 24.0 days to 8.0 days in Group 2. The duration of pain and maximum NRS values were statistically significantly decreased in the intragroup evaluation in both groups pre and postblock. Conclusion: Complications arising from the procedure and the local anesthetic used are essential points to consider in applying GON block. In CM treatment using GON block application, a similar effect to the standard local anesthetic application (0.5%) can be achieved by administering local anesthetic at a lower dose (0.3%).

Factors Influencing Morbidity and Mortality Rates in Tertiary Intensive Care Units in Turkey: A Retrospective Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: The objective of this study was to determine the correlation between the prognosis of patients admitted to a tertiary intensive care unit (ICU) and the admitted patient population, intensive care conditions, and the workload of intensive care staff. MATERIALS AND METHODS: This was a retrospective cross-sectional study that analyzed data from all tertiary ICUs (a minimum of 40 and a maximum of 59 units per month) of eight training and research hospitals between January 2022 and May 2023. We compared monthly data across hospitals and analyzed factors associated with patient prognosis, including mortality and pressure injuries (PIs). RESULTS: This study analyzed data from 54,312 patients, of whom 51% were male and 58.8% were aged 65 or older. The median age was 69 years. The average number of tertiary ICU beds per unit was 15 ± 6 beds, and the average occupancy rate was 83.57 ± 19.28%. On average, 7 ± 9 pressure injuries (PI) and 10 ± 7 patient deaths per unit per month were reported. The mortality rate (18.66%) determined per unit was similar to the expected rate (15-25%) according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score. There was a statistically significant difference among hospitals on a monthly basis across various aspects, including bed occupancy rate, length of stay (LOS), number of patients per ICU bed, number of patients per nurse in a shift, rate of patients developing PI, hospitalization rate from the emergency department, hospitalization rate from wards, hospitalization rate from the external center, referral rate, and mortality rate (p < 0.05). CONCLUSIONS: Although generally reliable in predicting prognosis in tertiary ICUs, the APACHE II scoring system may have limitations when analyzed on a unit-specific basis. ICU-related conditions have an impact on patient prognosis. ICU occupancy rate, work intensity, patient population, and number of working nurses are important factors associated with ICU mortality. In particular, data on the patient population admitted to the unit (emergency patients and patients with a history of malignancy) were most strongly associated with unit mortality.

The Effect of the Ultrasonography Measurement Method and the Conventional Measurement Method Used in Endotracheal Tube Size Selection in the Pediatric Patient Group on Postextubation Complications and Patient Recovery.

INTRODUCTION:  In this study, we aimed to compare the cuffed intubation tube selected with the Cole formula and tracheal ultrasonography (USG) measurement method regarding postextubation complications in providing airway patency and determine its effects on patient recovery. MATERIALS AND METHOD:  Between 01 July 2022 and 30 June 2023, American Society of Anesthesiologists (ASA) risk group I-III, 4-6-year-old patients who underwent pediatric orthodontic surgery (multiple tooth extraction) were included in the study. Data of age, gender, weight, ASA risk group, history, Cole formula, USG measurement results used in the endotracheal tube (ETT) selection (one of the two whichever application was used), fasting time, intubation success, operation time, 30th-minute modified Aldrete recovery score (MASS), and postoperative complications due to intubation (within the first postoperative hour) were analyzed retrospectively. The patients were divided into two groups according to the method used by the anesthesiologists in selecting the ETT at the beginning of the operation. The group that used Cole formula management was named I, while the group that used the USG measurement method was called II. Intubation-related complication data of the patients in the first 1 hour postoperatively and MASS values at the 30th minute were compared between the groups. RESULTS: In this study, 52.5% of the cases were male (n=42), 47.5% were female (n=38), the mean age was 4.84±0.84 years, and the mean body weight was 22.56±7.58 kilogram. There was no statistically significant difference between the groups regarding age, gender, body weight, ASA score, operation time, and period without oral consumption. ETT diameter measurement values according to groups were 4.73±0.46 mm in Group I and 4.41±0.61 mm in Group II. Postoperative 30th-minute MASS values were median 7 in Group I and median 8 in Group II (p<.001). MASS values were significantly higher in the Group II patient group. Intubation-related complications (postoperative cough, stridor, laryngospasm, tachypnea, wheezing, dysphonia) were observed in Group I with a rate of 40% within the first postoperative hour, while complications were marked with a rate of 17.5% in Group II (p=0.026). Complications in group II were significantly lower. CONCLUSION:  In the pediatric age group, especially under the age of 6, trachea measurement with USG and ETT selection is an effective, safe, and noninvasive method compared to other conventional methods. ETT size selection with USG accelerates postoperative patient recovery and reduces the risk of intubation-related complications. In addition, inflating the tube cuff under USG guidance can prevent cuff-related complications.

Our Clinical Experience With Patients Requiring Intensive Care for Tracheal Stenosis: A Retrospective Case-Control Study.

Background and objective The clinical course in patients with tracheal stenosis (TS) ranges from being asymptomatic to respiratory failure requiring follow-up in the ICU. In this study, we aimed to assess the clinical characteristics, management, and outcome of TS patients who were admitted to the ICU. Materials and methods The data of patients hospitalized in the ICU due to TS between January 01, 2015, and January 01, 2016, were analyzed. The patients were classified into two groups: the post-intubation tracheal stenosis (PITS) group and the post-tracheostomy tracheal stenosis (PTTS) group. Demographic characteristics, body mass index (BMI), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Sequential Organ Failure Assessment (SOFA) score of patients, factors that caused TS, management of TS, and ICU data of patients were compared. The outcome measures of our study were the ICU management of patients diagnosed with PITS or PTTS, their clinical characteristics, and differences in the treatment between patients diagnosed with PITS and those with PTTS in the ICU. Results Fifteen (75%) patients had PITS and five (25%) had PTTS. While BMI was significantly lower in patients in the PTTS group, the APACHE II and SOFA scores were significantly higher in PTTS patients (p<0.05). In most of the patients in the PITS group, the location of the stenosis was subglottic and at the 1/3 upper part of the trachea, while in the PTTS group, it was located only at the upper 1/3 of the trachea (p>0.05). Mechanical dilatation was performed in all patients in both groups. Mechanical dilatation and cryotherapy were performed in 10 (66.7%) patients in the PITS group (p>0.05), and a stent was applied in addition to this treatment in three (20%) patients in the PITS group and four (80%) patients in the PTTS group (p<0.05). Mechanical ventilation was not needed in 10 (66.7%) PITS patients and three (60.0%) PTTS patients after the interventional procedure. All patients were eventually discharged from the ICU after treatment. Conclusion While higher BMI was common in PITS patients, the PTTS patients were generally in worse condition. In this patient group, interventional pulmonology procedures in the ICU can be life-saving.

When a caesarean section is necessary: Analysis of cesarean sections performed in the Republic of Turkey in 2022 in accordance with the World Health Organization Multi-Country Research Guidelines.

Objective: The aim of our study, in light of the World Health Organization Multi-Country Survey (WHO-MCS) data examining the data of the Ministry of Health for the year 2022, comparing the cesarean sections (C/S) performed in the Republic of Turkey (TR) with the WHO-MCS data, and comparing the number of cesarean sections applied more than the reference values. Materials and Methods: According to the database of the Turkish Ministry of Health, in 2022, 1166175 deliveries took place in the Republic of Turkey, and 706370 (60.5%) cesarean section deliveries were recorded as 365764 (51%) primary C/S. Using the Ministry of Health registration system based on the Robson classification. Results: The number and rate of C/S operations performed per birth in 2022 in TR (n=706370; 60.50%) were found to be significantly higher when compared to the number and rate of C/S on a global scale (n=246062; 21.10%), (p<0.001). When cesarean section operations performed in the Ministry of Health hospitals, private institutions, foundation universities, public universities and other public unit hospitals were compared with WHO MCS reference values and C/S ratios, 44.2% versus 24.7% (p=0.05), versus 77.4%, versus 34.2% (p<0.001), 74.3% versus 29.5% (p<0.001), 75% versus 35.8% (p<0.001), 69.3% versus 35.9% (p<0.001). Conclusion: The amount of cesarean sections performed according to the total number of births in the Turkish Republic is relatively high and its cost nearly 1 billion 750 million TL.

How Effective are Intensive Care Unit Beds Used in Our Region?

OBJECTIVE: The demand for critical care facilities is also growing in our country. The aim of the present study was to investigate the incidence and causes of inappropriate admissions to adult intensive care units (ICUs) in our region to facilitate the planning of bed numbers. METHODS: A team of specialists made an unannounced visit to level 1, 2 and 3 adult ICUs in 12 hospitals in our region between June 2014 and January 2015. A total of 290 ICU patients were evaluated. RESULTS: The rate of inappropriate ICU admission was 55.9%, and the most common reason was the lack of a lower level ICU. Palliative patients comprised 35.5% of the ICU patients, 68% of whom should have been in home care. The rate of inappropriate admission was 16.7% higher in open ICUs than in closed ICUs. CONCLUSION: Our results indicate that instead of increasing the number of beds in level 2 and 3 ICUs, hospitals should increase the number of level 1 ICU beds. In addition, we believe that the existing beds could be utilised more effectively if all ICUs implemented a closed management style and if there was better coordination between ICUs.