High, Low, and Minimal Flow Anaesthesia Management: Effects on Oxygen Reserve Index and Arterial Partial Oxygen Pressure.

OBJECTIVE: To determine the oxygen reserve index (ORI) as a supporting parameter to the arterial partial oxygen pressure (PaO2) in blood gases in hypoxia and hyperoxia monitoring with different fresh gas flows (FGF) in patients undergoing abdominal surgery. STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Samsun Education and Research Hospital, Turkey, from January to September 2020. METHODOLOGY: The study population of ninety patients was divided into three groups. After the high-flow period, the inspired oxygen fraction (FiO2) and flow-guided ventilation (FGF) were set to be 4 L/m and 40% in Group H (high-flow), 1 L/m and 50% in Group L (low-flow), and 0.5 L/m and 68% in Group M (minimal-flow), respectively. RESULTS: There was a very high statistically positive correlation between PaO2 and ORI in H, L, and M groups. When using a cut-off value of 0.005 for ORI for the detection of PaO2 >100 mmHg, the area under the curve (AUC) was 0.97 (p<0.001) with a sensitivity of 94.4% and specificity of 95.3%. The AUC was detected to be 0.95 in receiver operating characteristic (ROC) analysis when the hyperoxia cut-off value of ORI was used to determine PaO2 >150 mmHg in the estimation of hyperoxia. CONCLUSION: ORI can be used to complement SpO2 in low-flow anaesthesia in patients undergoing abdominal surgeries, provide guidance for PaO2, give information about tissue oxygen delivery, and contribute to the individualisation of oxygen therapy, and will therefore be included in the standard monitoring in the future. KEY WORDS: Anaesthesia, Index, Inhalation, Oxygen, Pressure, Surgery.

Ultrasound-Guided Suprainguinal Fascia Iliaca Block as Part of Anesthesia Management for Lower Extremity Surgeries: A Single-Center Retrospective Cohort Feasibility Study.

Study objective The ultrasound-guided (US-guided) suprainguinal fascia iliaca block (SIFIB) is a regional anesthesia procedure that targets the lumbar plexus. It offers versatility in clinical practice, serving as both a standalone method for adequate pain management and a primary anesthesia option. Our aim was to present clinical insights gained from the application of US-guided SIFIB, whether as a standalone procedure or in conjunction with another block, across various clinical indications for lower extremity surgeries. Methodology Our study is a retrospective cohort analysis designed to identify cases in which the SIFIB was used as a component of the main anesthetic method and to determine the success of the anesthetic method in patients undergoing lower extremity surgery between March 2022 and March 2023 in a tertiary hospital. Data such as block success, perioperative additional analgesic need, patients' demographic details, and block characteristics were obtained from electronic and paper-based patient records and analyzed. Main results  We analyzed data from 16 patients who underwent lower extremity surgeries under SIFIB. Among these, 10 patients received SIFIB as their sole anesthesia method, while six underwent surgery with a combination of sciatic block and SIFIB. Briefly, the types of surgery were amputations, soft tissue excision, revision of knee prostheses, excision of knee tumors, patella implant removal, patellar ligament repair, patellar fracture repair, distal femur fractures (internal fixation), and vascular surgery. Six patients necessitated additional analgesics. No statistically significant differences were observed in demographic details, block onset time, and surgical duration between patients requiring and not requiring sedoanalgesia during surgery (p>0.05). Conclusion For patients planning lower extremity surgery, considering SIFIB alone or combined with a sciatic block as part of anesthesia management is a valid option, offering an alternative to a lumbar plexus block.

Comparison of the effectiveness of transversus abdominis plane block with laparoscopy or ultrasonography in laparoscopic cholecystectomy operations.

OBJECTIVES: This study aims to compare the effectiveness of the Transversus Abdominis Plane (TAP) block applied to reduce postoperative pain in laparoscopic cholecystectomy surgery by ultrasonography (USG) and laparoscopy. METHODS: A total of 170 patients who underwent laparoscopic cholecystectomy were divided into three groups. Group L received TAP block by laparoscopy, Group U received TAP block by USG, and the control group (Group C) did not receive TAP block. Bilateral subcostal 15 mL 0.5% bupivacaine was used for the TAP block. We recorded patients' demographic data and hemodynamic parameters, surgery time, anesthesia time, time of first postoperative analgesic need, visual analog scale (VAS) scores, time to first flatulence and stool, degree of nausea-vomiting, and the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-T) scores. RESULTS: We observed no statistically significant differences between the groups in terms of age, gender, or American Society of Anesthesiologists scores, and body mass index was higher in Group U compared to the other groups (p<0.05). The VAS score was significantly higher in the control group at all times compared to the other two groups (p<0.001). VAS measurements were higher in Group U at postoperative 1st and 12th h compared to Group L (p<0.001). Surgery time and anesthesia time were significantly different between the groups (p=0.001). Group C showed high VAS scores, high pain severity by APS-POQ-R-T at the 24th postoperative hour, and low sleep quality and patient satisfaction. CONCLUSION: For laparoscopic cholecystectomy surgery, applying TAP block with the help of USG is effective in postoperative pain management. Applying TAP block with laparoscopy is easy since it does not require additional preparation or equipment during the procedure and may be preferred in the absence of a USG device.

Validation of Thoracic Surgery Scoring System (Thoracoscore) in Turkish Population.

OBJECTIVE: To validate the Thoracoscore, a scoring system designed to predict 30-day mortality in patients undergoing thoracic surgery in the Turkish population. STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Thoracic Surgery, Ondokuz Mayis University, Medical School, from January 2015 to June 2022. METHODOLOGY: Patients who underwent thoracic surgery under general anaesthesia were evaluated. Thoracoscore was calculated using the online calculator located at https://www.samiuc.es/thoracoscore-thoracic-surgery-scoring-system/. Using the area under the ROC curve (AUC), the sensitivity and specificity of the Thoracoscore in predicting morbidity and mortality were assessed. RESULTS: The study included 745 patients (67.5% males and 32.5% females) with a mean age of 57.23±14.68 years. Nearly all of the patients underwent elective surgery (99.5%). In 56.9% of cases, the indication for thoracic surgery was malignancy. The 30-day and 90-day mortality rates of patients included in the study were 1.9% and 4.8%, respectively. The mean Thoracoscore was calculated to be -4.79±2.2 (Range: -7.37 to 7.37). In predicting morbidity, Thoracoscore had a sensitivity of 60.83% and a specificity of 73.12%. The sensitivity and specificity of Thoracoscore for predicting 30-day and 90-day mortality were calculated as being 85.7% and 68.7% for 30-day and 69.4% and 67.0% for 90-day, respectively. CONCLUSION: Although Thoracoscore's AUC had sufficient discrimination capacity, its sensitivity and specificity was found to be limited. In order to fully comprehend its limitations and accuracy, the authors believe that multicentric studies involving a greater number of patients and a control group of equal size are necessary. KEY WORDS: Morbidity, Mortality, Surgery, Thoracic, Thoracoscore, Validation.

Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study.

BACKGROUND: Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. METHODS: This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. RESULTS: the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. CONCLUSIONS: In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group.

Spontaneous massive hemothorax as an atypical presentation of bronchial carcinoid.

Bronchial carcinoid tumors can present with symptoms of distal airway obstruction, local airway irritation, or hemoptysis. Presentation with a spontaneous massive hemothorax has never been encountered before. In this article, we present a case of spontaneous massive hemothorax caused by the rupture of an atypical carcinoid tumor in the right upper lobe. The tumor appeared on the chest radiograph with a massive hemothorax surrounding the atelectatic lung. Spontaneous hemothorax associated with lung cancer is an exceedingly rare condition.

Assessment of Anxiety, Depression and Work-Related Strain Levels of Healthcare Professionals Working in Operating Rooms and Intensive Care Units During the COVID-19 Outbreak.

OBJECTIVE: The purpose of the study was to determine the levels of work-related strain, anxiety, and depression in health professionals working in operating rooms and intensive care units who deal with the diagnosis, treatment, and care of coronavirus disease 19 patients. METHODS: The population of the study consisted of 320 healthcare professionals working in the operating room and intensive care units. After providing detailed information about the study to the participants, a questionnaire consisting of 21 questions including sociodemographic infor- mation and working life characteristics, 14 questions from the Hospital Anxiety and Depression Scale, and 18 questions from the Work-Related Strain Inventory (WRSI) were administered under supervision. RESULTS: In total, 58.8% of the participants were working in intensive care units, and 41.2% of the participants were in the operating room. The scores obtained from Work-Related Strain Inventory were found to be statistically significantly high in those who wanted to choose a differ- ent profession, those who were on duty during the coronavirus disease 19 pandemic process, those whose spouses followed coronavirus disease 19 patients during the pandemic, those who encountered a suspicious situation and had a coronavirus disease 19 test, those who had difficulty in accessing personal protective equipment, and those who thought that their lives were in danger during the pandemic process. Participants with anxiety risk according to Hospital Anxiety and Depression Scale-Anxiety subscale and depression risk according to Hospital Anxiety and Depression Scale-Depression subscale were found to be 153 (47.8%) and 300 (93.8%), respectively. CONCLUSIONS: It was found that Work-Related Strain Inventory and anxiety-depression rates were significantly high in both the operating room and intensive care unit workers who actively provided healthcare services to patients diagnosed with coronavirus disease 19.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Is respiratory physiotherapy effective on pulmonary complications after lobectomy for lung cancer?

BACKGROUND: The aim of this study was to investigate the effects of a postoperative respiratory physiotherapy program on pulmonary complications, length of hospital stay, and hospital cost after lobectomy for lung cancer. METHODS: A total of 90 patients (75 males, 15 females; mean age 63.1±10.4 years; range, 30 to 82 years) who underwent elective lobectomy through thoracotomy due to lung cancer between June 2014 and December 2019 were retrospectively analyzed. The patients were divided into two groups as Group S who received standard postoperative care (n=50) and Group P who received postoperative respiratory physiotherapy in addition to standard care (n=40). Both groups were compared in terms of postoperative pulmonary complications, 30-day mortality, length of hospital stay, and hospital cost. RESULTS: The preoperative and surgical characteristics of the groups were similar. Group P had a lower incidence of postoperative pulmonary complications (10% vs. 38%, respectively; p=0.002) than Group S. The median length of stay in the hospital was six (range, 4 to 12) days in Group P and seven (range, 4 to 40) days in Group S (p=0.001). The drug cost (639.70 vs. 1,211.46 Turkish Liras, respectively; p=0.001) and the total hospital cost (2,031.10 vs. 3,778.68 Turkish Liras, respectively; p=0.001) of the patients in Group P were significantly lower. The multivariate logistic regression analysis showed that respiratory physiotherapy had a protective effect on the development of postoperative pulmonary complications (odds ratio =0.063, 95% confidence interval: 0.010-0.401, p=0.003). CONCLUSION: An intensive physiotherapy program focusing on respiratory exercises is a cost-effective practice which reduces the risk of development of postoperative pulmonary complications in patients undergoing lobectomy for lung cancer.

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)

Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: <2, low risk; 2­5, moderate risk; 5.1­8, high risk; >8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total IMPRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.

Central line-associated blood stream infections: characteristics and risk factors for mortality over a 5.5-year period.

BACKGROUND/AIM: Central line-associated bloodstream infections (CLABSIs) are associated with substantial morbidity and mortality and the infection rates vary in a wide range1397645907(high: 62.5%; low: 20%) in developing countries. We aimed to investigate the characteristics and the risk factors for mortality in patients with CLABSIs in intensive care units (ICUs) and provide the relevant data. MATERIALS AND METHODS: The electronic medical records database and file records obtained through active surveillance by an infection control committee of a hospital were screened to identify patients with CLABSIs hospitalized from January 2008 through July 2013. RESULTS: A total of 166 CLABSI episodes in 158 patients out of 17,553 on 38,562 catheter and 94,512 hospitalization days were evaluated. The infection developed in catheterized patients at a median of 14 days (range 2-88), and the highest infection rate with 13.4% (n = 20) was the femoral region among the places where the catheter was inserted. Of the patients catheterized, 54.4% survived whereas 45.6% died. In patients having Candida infection, the mortality was significantly higher. High APACHE II scores and Candida infections were found to be significant risk factors associated with mortality. CONCLUSION: APACHE II scores and bloodstream infection with Candida species were the most powerful predictors of mortality. In ICU practice, health-care givers must consider the emerging role of Candida for both invasiveness and mortality.