To compare the landmark-guided technique versus the ultrasound-guided technique for internal jugular vein cannulation in spontaneously breathing patients. A total of 380 patients who required internal jugular vein cannulation were randomly assigned to receive internal jugular vein cannulation using either the landmark- or ultrasound-guided technique in Bursa, Uludag University Faculty of Medicine, between April and November, 2008. Failed catheter placement, risk of complications from placement, risk of failure on first attempt at placement, number of attempts until successful catheterization, time to successful catheterization and the demographics of each patient were recorded. The overall complication rate was higher in the landmark group than in the ultrasound-guided group (p < 0.01). Carotid puncture rate and hematoma were more frequent in the landmark group than in the ultrasound-guided group (p < 0.05). The number of attempts for successful placement was significantly higher in the landmark group than in the ultrasound-guided group, which was accompanied by a significantly increased access time observed in the landmark group (p < 0.05 and p < 0.01, respectively). Although there were a higher number of attempts, longer access time, and a more frequent complication rate in the landmark group, the success rate was found to be comparable between the two groups. The findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of immediate complications.

In this study, we aimed to examine the effect of neutrophil-lymphocyte ratio (NLR) on mortality and morbidity in elderly patients over the age of 65 who presented to our clinic and were operated on due to hip fracture. The study included patients over the age of 65 who were operated on in our hospital between January 2014 and December 2018 due to hip fracture. Those with multiple fractures and those who were operated on due to cancer-related fracture were excluded. Patients' age, gender, American Society of Anesthesiologists (ASA) score, preoperative waiting time, type of anesthesia, operation duration, amount of erythrocyte suspension used, and duration of intensive care unit (ICU) stay were recorded. The effect of increased preoperative and postoperative 5th day neutrophil-lymphocyte ratios (NLR 1 and NLR 5, respectively) on mortality and morbidity was investigated. We examined 132 patients operated on due to hip fracture. NLR 5 was higher among patients who were admitted to the ICU (p = 0.007) and among those who died (p = 0.007). Additionally, the rate of increase of NLR 5 was higher among patients who were admitted to the ICU (p = 0.044) and among those died (p = 0.009). The rate of increase of NLR in the postoperative period can be used as a criterion for predicting mortality in patients who are operated on due to hip fracture.

Background: Post-cardiac arrest syndrome is the insufficiency of cardiac and cerebral functions caused by ischemia after sudden cardiac arrest. We aimed to determine the hematological parameters associated with mortality in the intensive care follow-up of patients with post-cardiac arrest syndrome. Methods: The hematological parameters of 285 cardiovascular patients who were admitted to the emergency department of Harran University Medical Faculty between 2013 and 2018 and followed up in the intensive care unit with post-cardiac arrest syndrome were examined. A total of 85 patients were included in the study. These parameters were recorded as the time of arrival to the emergency department (0 hour) and hematological parameters at the 24^th and 48^th hours of intensive care follow-up. Results: In the mortality group, albumin (P:0.030), hemoglobin (Hg) (P: 0.049), and hematocrit (HCT) (P: 0.020) values ​​in the blood parameters, at the time of admission to the emergency department, were significantly lower than those in the survival group. Red blood cell distribution width (RDW) (P: 0.009) and urea (P <0.001) values ​​at the time of arrival were higher than the survival group. In the 24^th and 48^th hours, mean hemoglobin (MCHC) (P <0.05) values ​​were lower and RDW (P <0.05) values ​​were higher in the mortality group compared to the survival group. Conclusions: In this retrospective validation, low albumin, Hg, HCT, MCHC, and high RDW and urea levels may increase mortality in cardiovascular patients who develop post-cardiac arrest syndrome within the first 48 hours. Correcting these values ​​early may reduce mortality.

Background: To retrospectively evaluate 58 patients who underwent percutaneous tracheostomy in our intensive care unit.Materials and Methods: The study included 58 patients that underwent percutaneous tracheostomy in the ICU at our Anesthesiology and Reanimation department between January 2017 and December 2020.Results: The percutaneous tracheostomy group comprised 33 (56.9%) men and 25 (43.1%) women with a mean age of 65±18.2 (range, 19-90) years. Most common primary diagnosis of hospitalization was neurological disorders (51.7%). Mean APACHE II score was 23.2±3.6, mean time to percutaneous tracheostomy was 18.3±5.1 (range, 7-30) days, mean procedural time was 11.1±2.4 min, mean duration of mechanical ventilation was 62.1±37.8 (range, 15-167) days, mean intensive care unit stay was 67.2±43.5 (range, 15-247) days, and mean hospitalization time was 77.5±50.4 (range, 15-277) days. Hypoxia and hypotension were the most common intraoperative complications and minor bleeding was the most common postoperative complication.Conclusions: Performing early tracheostomy in intensive care unit patients requiring prolonged mechanical ventilation increases patient comfort, facilitates discontinuation of mechanical ventilation, reduces the dead space, facilitates the clearing of airway secretions, and shortens the duration of intensive care unit and hospital stay. Additionally, percutaneous tracheostomy was revealed as a safe procedure for intensive care unit patients due to its lower complication rates.

Background and objectives: Brachial plexus block is one of the most effective anesthesia and analgesia methods for upper extremity surgeries across different age groups. However, the number of studies on this block in children is insufficient. The aim of this study was to retrospectively analyze and discuss the efficacy and safety of ultrasound (US)- and Ultrasound with nerve stimulator (US + NS)-guided infraclavicular brachial plexus block (ICB) in pediatric patients. Materials and Method: In this study, we retrospectively analyzed the data of 240 pediatric patients admitted to our clinic between October 2020 and April 2023, 120 of whom underwent US-guided ICB and 120 who underwent US + NS-guided ICB. Results: Demographic data of both groups who underwent US and US + NS-guided ICB were similar. The mean procedure time was 6.1 ± 0.8 min for the US group and 8.31 ± 0.82 min for the US + NS group (p < 0.001). The mean operative time was 62.4 ± 11.3 min in the US group and 62.4 ± 9.5 min in the US + NS group (p = 0.73). Intraoperative and postoperative opioid and additional analgesia use and pain scores at 1, 3, 6, 9, 12, 15, and 24 h were recorded in both groups. The mean duration of the motor block (MBD) was 6.20 ± 0.95 h in the US group and 6.29 ± 0.88 h in the US + NS group (p = 0.46). The mean duration of sensory block (SBD) was 9.38 ± 2.13 h in the US group and 9.53 ± 2.05 h in the US + NS group (p = 0.38). Conclusions: In pediatric patients, US and US + NS-guided ICB applications are effective and safe in ease of application, prolonged analgesia, and low complication rates. In skilled hands, US-guided ICB can be as effective as US + NS-guided ICB. Further prospective studies with more significant patient populations are needed to validate these findings.

Amaç: Cerrahi prosedür için verilen farklı pozisyonlar doku perfüzyonunda ve kardiyak outputta değişikliklere neden olabilir. Bu çalışmada spontan solunuma sahip katılımcılarda plet değişkenlik indeksinin (PVI), perfüzyon indeks (PI) ve noninvaziv sürekli kardiyak output ölçüm yöntemi (EscCO) nin farklı cerrahi pozisyonlardaki değişimlerini araştırmayı amaçladık.Materyal ve Metod: 20 katılımcıdan oluşan bir sağlıklı birey grubu prospektif gözlemsel çalışmaya dahil edildi. Sırasıyla Supin, 30 derece baş yukarı, 45 derece baş yukarı, 20 derece Trendelenburg, 20 derece ters-Trendelenburg, ve pron pozisyonları uygulandı. Her pozisyon arası 10 ar dk olacak şekilde süre tutuldu. Her pozisyon değişikliğinden önce gönüllüler sırtüstü pozisyona alındı ve beş dakika dinlendikten sonra yeni pozisyon verildi. Pozisyon değişiminden sonraki 5. dakika PI, PVI, EscCO, SpO2 değerleri kayıt altına alındı.Bulgular: Katılımcıların farklı pozisyondayken ölçülen PI, PVI ile EscCO değerlerinde istatistiksel olarak anlamlı bir fark bulunamadı.Sonuç: Bu çalışma, PI, PVI ile EscCO nun tüm cerrahi pozisyonlarda herhangi bir değişikliğe uğramadığını ve her üç parametrenin de spontan solunumuna sahip genç sağlıklı bireylerde pozisyondan etkilenmediği ortaya koymuştur.