Objective: The aim of this study was to investigate the efficacy and safety of Computed Tomography (CT) guided percutaneous Radiofrequency Ablation (RFA) in the treatment of osteoid osteoma (OO). Methods: A total of 116 patients (82 male and 34 female patients; mean age of 17.7 years; age range 13- months-42 years) who had 118 CT guided RFA treatment between June 2015 and November 2018 (42 moths) with the diagnosis of OO were included in this study. All the patients had pre-procedural CT examinations. The clinical and technical success and the safety of the treatment were evaluated by assessing the clinical pain symptoms, complication rates and recovery of posture and gait. Results: All the patients had a favorable immediate relief of the known pain caused by osteoid osteoma in 24 h after the procedure. Only in two patients (15-years-old boy with OO in right femoral neck and a 12 years old boy with OO in femur diaphysis) pain relapse was occurred in 3 months and 12 months after RFA and a second RFA was performed. During follow-up they had no pain. The technical success and efficacy-rates of the procedure were recorded as 100% and 98% respectively in this study. No significant complication was observed during treatment or recovery period. Seven minor complications were noted which were successfully treated. Conclusion: The rapid relief of pain symptoms, low relapse rate and low complication rates demonstrate the efficacy and safety of RFA therapy. RFA is an out-patient procedure that patients can be mobilized immediately after the procedure. RFA can be safely used as a first choice of treatment method in OO therapy. Level of evidence: Level IV, therapeutic study.

Objectives: Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data. Methods: We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded. Results: Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6 +/- 3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54 +/- 2.14 minutes in patients for the supraclavicular block and 12.9 +/- 2.8 minutes for the infraclavicular block. The mean surgery time was 64 +/- 13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5 +/- 2 hours in patients who received supraclavicular block, and 7.4 +/- 1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5 +/- 1.7 hours in the supraclavicular block, and 10.45 +/- 1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7 +/- 0.5 hours, and the sensorial block period was 11.12 +/- 1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up. Conclusion: Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.

Objective: To compare the postoperative analgesic efficacy of quadratus lumborum block (QLB) and ilioinguinal-iliohypogastric nerve block (IIIHB) in paediatric patients who have undergone unilateral inguinal hernia surgery. Methods: This prospective randomized controlled study was designed in a single center and included 60 paediatric patients aged 2-7 years who had undergone inguinal hernia repair surgery and received an American Society of Anesthesiologists score of 1-2. Patients were randomized into two groups: those receiving ultrasound-guided QLB and those receiving IIIHB. The primary outcomes of the study were patients' face, legs, activity, cry, and consolability (FLACC) scores at 1, 2, 6, 12, and 24 hours post-surgery. Results: The mean heart rate 15 and 30 minutes post-surgery in the QLB group was lower than that of the IIIHB group, and the difference at both times was statistically significant (P < 0.001). The mean FLACC score of the QLB group was lower than that of the IIIHB group at 6, 12, and 24 hours post-surgery, and the differences were statistically significant (P=0.004, P=0.006, and P < 0.001, respectively). Between the groups, there was no statistically significant difference in the number of patients who were administered rescue analgesics or oral ibuprofen, the time of first ibuprofen administration, or the frequency of complications (P=1.000, P=0.145, P=0.195, and P=1.000, respectively). Conclusion: Compared with IIIHB, QLB achieves superior postoperative analgesic effects in paediatric patients who have undergone inguinal hernia surgery, as evidenced by longer analgesic periods, lower pain scores, and lower analgesic consumption.

Background/Aim: Surgical procedures during pregnancy incur great difficulties for both the surgeon and the anesthesiologist. Changing maternal and fetal physiology changes both the pharmacodynamics and pharmacodynamics of the anesthetic drugs administered. In this study, the researcher aimed to determine the risk factors of non-obstetric surgery or anesthesia that cause preterm labor and/or low birth weight. Methods: Our study was planned as a single-center retrospective study and was carried out by scanning the data of 52 pregnant patients between 2015 and 2020. Preterm labor and low birth weight were defined as adverse events. The patients were divided into two groups: those who developed adverse events and those who did not. The effects of age, parity, type of surgery and anesthesia, duration of surgery, gestational age, mode of delivery, and birth weight on mortality have been investigated. Results: Comparing the patient groups with and without adverse events, no statistically significant difference was found between their general characteristics, anesthesia, and surgical characteristics (P>0.05). Conclusion: In the study, the researcher analyzed the surgical and anesthesia factors of non-obstetric surgery. It was concluded that neither surgical nor anesthetic factors independently increased the risk of preterm labor or low birth weight. '+st+' Upadya M, Saneesh PJ. Anaesthesia for non-obstetric surgery during pregnancy. Indian J Anaesth. 2016 Apr;60(4):234-41. DOI: https://doi.org/10.4103/0019-5049.179445 Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107 Suppl 1:i72-i78. DOI: https://doi.org/10.1093/bja/aer343 Balinskaite V, Bottle A, Sodhi V, Rivers A, Bennett PR, Brettet SJ, et al. The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy: Estimates From a Retrospective Cohort Study of 6.5 Million Pregnancies. Ann Surg. 2017;266(2):260-6. DOI: https://doi.org/10.1097/SLA.0000000000001976 Duncan PG, Pope WD, Cohen MM, Greer N. Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology. 1986 Jun;64(6):790-4. DOI: https://doi.org/10.1097/00000542-198606000-00019 Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005 Sep;190(3):467-73. DOI: https://doi.org/10.1016/j.amjsurg.2005.03.033 Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg. 2012 Nov;99(11):1470-8. DOI: https://doi.org/10.1002/bjs.8889 Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016 Feb;124(2):270-300. DOI: https://doi.org/10.1097/ALN.0000000000000935 Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesth Analg. 2016 Mar;122(3):786-804. DOI: https://doi.org/10.1213/ANE.0000000000001143 Rubinchik-Stern M, Eyal S. Drug Interactions at the Human Placenta: What is the Evidence? Front Pharmacol. 2012 Jul 9;3:126. DOI: https://doi.org/10.3389/fphar.2012.00126 Bonnet MP. Sedation and anaesthesia for non-obstetric surgery. Anaesth Crit Care Pain Med. 2016 Oct;35 Suppl 1:S35-S41. DOI: https://doi.org/10.1016/j.accpm.2016.06.009 Vujic J, Marsoner K, Lipp-Pump AH, Klaritsch P, Mischinger HJ, Kornprat P. Non-obstetric surgery during pregnancy - an eleven-year retrospective analysis. BMC Pregnancy Childbirth. 2019 Oct 25;19(1):382. DOI: https://doi.org/10.1186/s12884-019-2554-6 Cho S, Chung RK, Jin SH. Factors Affecting Maternal and Fetal Outcomes of Non-Obstetric Surgery and Anesthesia during Pregnancy: a Retrospective Review of Data at a Single Tertiary University Hospital. J Korean Med Sci. 2020 Apr 27;35(16):e113. DOI: https://doi.org/10.3346/jkms.2020.35.e113 Ní Mhuireachtaigh R, O'Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006 Feb;18(1):60-6. DOI: https://doi.org/10.1016/j.jclinane.2004.11.009 Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC. Non-obstetric surgery during gestation: risk factors for lower birthweight. Aust N Z J Obstet Gynaecol. 2003 Feb;43(1):27-31. DOI: https://doi.org/10.1046/j.0004-8666.2003.00001.x Yu CH, Weng SF, Ho CH, Chen YC, Chen JY, Chang YJ, Wang JJ, Wu MP, Chu CC. Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan. BMC Pregnancy Childbirth. 2018 Nov 26;18(1):460. DOI: https://doi.org/10.1186/s12884-018-2079-4 Devroe S, Bleeser T, Van de Velde M, Verbrugge L, De Buck F, Deprest J, Devlieger R, Rex S. Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study. Int J Obstet Anesth. 2019 Aug;39:74-81. DOI: https://doi.org/10.1016/j.ijoa.2019.01.006 Committee Opinion No. 696: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2017 Apr;129(4):777-8. DOI: https://doi.org/10.1097/AOG.0000000000002014 Copyright (c) 2023 Mustafa Altınay, Ayşe Surhan Çınar This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background/Aim: Advancements in medical technologies and prolonged life expectancy have increased the number of surgical interventions for elderly patients. Despite this however, emergency surgical interventions remain associated with a high mortality rate. Managing an emergency abdominal surgery in elderly patients poses great challenges for both the surgeon and the anesthesiologist. However, knowing the risk factors that increase mortality may offer advantages to the clinician managing the treatment process. There are studies in the literature examining the mortality of emergency surgeries in elderly patients. However, there are very few studies that work with a specific patient group such as abdominal surgery and then analyze laboratory test results. Here, we aimed to identify the risk factors that can be used to predict mortality in elderly patients undergoing emergency abdominal surgery. Methods: The study was designed retrospectively in a single center; 100 patients over the age of 80 who underwent emergency abdominal surgery were included in the study. The patients were divided into two groups as survivor and non-survivor. Demographic, surgical, and anesthetic characteristics, laboratory tests, American Society of Anesthesiologists (ASA) physical status scores, postoperative intensive care needs, and treatments of the groups were compared using the chi-squared and Mann Whitney U-test. Determining factors were investigated with logistic regression analysis. Results: In multivariate analysis, ASA 3 and major surgery significantly increased mortality (P=0.041, P=0.011). Receiver operating characteristic (ROC) curve analysis showed that C-reactive protein with a cut-off value of >84 mg/L had a sensitivity of 58.8% and a specificity of 71.2% (AUC=0.636, P=0.004), while lactate with a cut-off value of >3.6 mmol/L had a sensitivity of 50% and a specificity of 95.5% in predicting mortality (AUC=0.776, P<0.001). Conclusion: The magnitude of surgery and the ASA score were the best predictors of mortality in elderly patients undergoing emergency abdominal surgery. '+st+' Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, et al. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018;84(6):864-75. DOI: https://doi.org/10.1097/TA.0000000000001829 Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 summary. National health statistics reports. 2010;(29):1–24. Ingraham AM, Cohen ME, Bilimoria KY, Raval MV, Ko CY, Nathens AB, et al. Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. Surgery. 2010;148(2):217–38. DOI: https://doi.org/10.1016/j.surg.2010.05.009 Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age and ageing. 1997;26(4):315–8. DOI: https://doi.org/10.1093/ageing/26.4.315 Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. DOI: https://doi.org/10.1186/s12877-016-0329-8 Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg. 2016;103(2):e52-61. DOI: https://doi.org/10.1002/bjs.10044 Rubin DS, Huisingh-Scheetz M, Ferguson MK, Nagele P, Peden CJ, Lauderdale DS. U.S. trends in elective and emergent major abdominal surgical procedures from 2002 to 2014 in older adults. J Am Geriatr Soc. 2021;69(8):2220-30. 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Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting. Geriatrics & gerontology international. 2018;18(8):1211–4. DOI: https://doi.org/10.1111/ggi.13456 Adeva-Andany M, López-Ojén M, Funcasta-Calderón R, et al. Comprehensive review on lactate metabolism in human health. Mitochondrion. 2014;17:76-100. DOI: https://doi.org/10.1016/j.mito.2014.05.007 Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem. 2004;279(47):48487-90. doi:10.1074/jbc.R400025200 DOI: https://doi.org/10.1074/jbc.R400025200 Fukuda N, Wada J, Niki M, Sugiyama Y, Mushiake H. Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg. 2012;7(1):12. DOI: https://doi.org/10.1186/1749-7922-7-12 Copyright (c) 2023 Mustafa Altınay, Sibel Oba This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.