Background: Transcatheter aortic valve implantation (TAVI) is used for patients with severe aortic stenosis who are at high risk for surgery. Since these patients are elderly and have comorbidities, their management is of great importance. Objectives: This retrospective study compares two anesthesia techniques during TAVI: sedation (ketamine and propofol) and general anesthesia. Methods: Patients with severe aortic stenosis undergoing TAVI during 2021 in our hospital were retrospectively screened. Demographic data, comorbidities, anesthesia management, complications, and mortality of the patients were obtained from the records. Results: There were 137 patients treated with TAVI; 74 (54%) patients had sedation and 63 (46%) had general anesthesia. When the anesthesia management was evaluated, no significant difference in mortality was observed between the patients who received general anesthesia and sedation. After univariate and multivariate logistic regression analyses were performed to investigate factors having an impact on mortality, anemia (only in univariate analysis) in the whole study population was a statistically significant risk factor for mortality in patients undergoing TAVI (p<0.014). Conclusion: There was no significant difference in mortality in terms of anesthesia management. Anemia was a risk factor for mortality (only in univariate analysis) in the whole study population. We concluded that conscious sedation with ketamine and propofol is effective and safe for TAVI procedures compared to general anesthesia.

Background and Objectives: Neuroleptic malignant syndrome (NMS) is a rare but high-mortality clinical condition. The aim of this study was to describe the demographic characteristics, clinical and laboratory findings, management strategies, and clinical outcomes of adult patients with NMS treated in an adult intensive care unit. Materials and Methods: This retrospective descriptive study included adult patients admitted to a tertiary care ICU with a diagnosis of NMS. Data were obtained from medical records and included demographic characteristics, suspected NMS-related drug exposures, clinical and laboratory findings at ICU admission, disease severity indicators, treatments administered, and clinical outcomes. Continuous variables were expressed as median and interquartile range (IQR), and categorical variables as number and percentage. Results: A total of 42 patients were included. The median age was 48 years (IQR: 24.1–75.5), and 61.9% were male. Atypical antipsychotics were the most frequently implicated agents (69.0%). Altered mental status was observed in 92.9% of patients, tachycardia in 61.9%, and hyperthermia in 47.6%. Creatine kinase levels >1000 U/L were present in 57.1%, and leukocytosis in 71.4%. Mechanical ventilation was required in 59.5% of patients. Acute kidney injury developed in 31%, and continuous renal replacement therapy (CRRT) was initiated in 21.4%. Bromocriptine was administered in 54.8% of cases, dantrolene in 4.8%, and amantadine in 11.9%. The ICU mortality rate was 9.5%. Conclusions: Patients with neuroleptic malignant syndrome often present with a severe clinical course requiring advanced organ support in the intensive care unit. However, with early diagnosis and appropriate intensive care management, mortality can be maintained at acceptable levels.

Amaç: Kadınların hayatları boyunca yaşayabilecekleri en şiddetli ağrılardan biri doğum ağrısıdır. Epidural analjezi tekniği, doğum travayı sırasında oluşan ağrıyı gideren ve günümüzde en fazla kabul gören doğum analjezisi yöntemidir. Çalışmamızın amacı epidural analjezinin anne, fetüs ve doğum eylemi üzerine etkisini araştırmaktır. Gereç ve Yöntem: 2015-2016 yılları arasında epidural doğum analjezisi uygulanan gebelerin dosyaları retrospektif olarak incelendi. Gebelerin demografik verileri, hemodinamik parametreleri, çocuk kalp atım sayıları, APGAR skorları, doğumun birinci ve ikinci evre süreleri, yardımlı doğum oranları, sezaryen oranları, yan etkiler, VAS değerleri, işlemden memnuniyetleri incelendi. Bulgular: Epidural analjezi ile bupivakain ve fentanil kombinasyonu uygulanan gebelerde hemodinamik parametrelerde anormal değişiklik, yardımlı doğum sıklığı ve sezaryen oranında artış gözlemlemedik. Gebelerde yüksek oranda iyi analjezik etki elde edildiği ve doğum analjezisinden memnuniyet oranının oldukça yüksek olduğu bulundu. Epidural analjezinin çocuk kalp atım sayısıyla, 1. ve 5. dk APGAR skorlarına etkisi olmadığı gözlemlendi. Doğumun birinci ve ikinci evresini uzatmamanın yanında, fetüs üzerine yan etkisi olmadığı ve maternal yan etkilerin de düşük doz lokal anestezik ile opioid kombinasyonu uygulaması ile oldukça düşük olduğu görüldü. Sonuç: Annede yoğun ağrı ve strese yol açan doğum sırasında, epidural analjezi uygulanması, uzman kişiler tarafından, uygun hastaya, uygun zamanlama ile yapıldığı takdirde ağrıyı azaltarak memnuniyeti yüksek, rahat bir doğum sağlamaktadır.