Background: To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS. Methods: This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations. Results: Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants’ institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%. Conclusion: Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities.

Rhabdomyolysis (RM) can lead to life-threatening myoglobinuric acute kidney injury (AKI). Despite various treatment modalities for AKI, their effectiveness remains limited. Dexpanthenol (DEX) is an antioxidant, anti-inflammatory, and anti-apoptotic agent with demonstrated protective effects on various tissues. The current study aimed to investigate the protective effects and genetic mechanisms of DEX in AKI due to glycerol-induced RM. Thirty-two female Wistar Albino rats weighing between 250–300 g were allocated into four groups of eight rats each. The control group was given five days of intraperitoneal saline. The RM group was treated with an intramuscular injection of 8 ml/kg of 50% glycerol solution. The RM + DEX group was administered an intramuscular injection of 8 ml/kg of 50% glycerol solution and an intraperitoneal injection of 500 mg/kg DEX for five days, starting one hour after glycerol administration. The DEX group was treated with an intraperitoneal injection of 500 mg/kg DEX for five days. On the sixth day, rats were sacrificed and kidney tissues were taken. Histopathological analyses were performed on kidney tissue. Biochemical analyses were performed on kidney tissue and blood to evaluate kidney function and oxidative stress (BUN, creatinine, urea, CK, LDH, cystatin C, TAS, TOS, MDA, and CAT). Additionally, PGC-1α and SIRT-3 gene expression levels in kidney tissue were determined by qRT-PCR. All biomarkers significantly increased in the RM group. DEX treatment significantly reduced urea and creatinine levels. The increase in TOS levels and OSI in the RM group was significant compared to the control group, DEX treatment significantly reversed these effects. The RM and RM + DEX groups exhibited RM and nephropathy. Histopathological analysis revealed improvements in the RM + DEX group compared to the RM group. DEX treatment increased the expression of PGC-1α and SIRT-3 in the RM + DEX group. Histopathological and biochemical improvements, including reduced kidney damage and oxidative stress, were observed with DEX treatment and was associated with increased expression of the PGC-1α and SIRT-3 genes.

ERAS (Enhanced Recovery After Surgery) is a multimodal approach which aims to optimize perioperative management. ERAS is a combination of changes in preoperative, intraoperative and postoperative care to reduce organ dysfunction and surgical stress response. This concept is managed by multidisciplinary teams that include various areas of expertise to minimize the patient’s surgical stress response, optimize physiological functions, and facilitate healing. In order to further increase these developments in various surgical specialties, protocols have been established on this subject and many health institutions offer their services in this way. With the use of ERAS protocols, perioperative and postoperative complications decreased, patient survival and quality of care improved, and patient satisfaction was significantly increased.

Koronavirüs hastalığı 2019 (COVID-19), yeni tip şiddetli akut solunum yolu sendromu koronavirüsü 2'nin (SARS-CoV-2) neden olduğu bulaşıcı bir solunum yolu hastalığıdır. Bu virüs tüm dünyada pandemiye yol açmıştır. Hastaneler COVID-19 salgını açısından yüksek riskli ve iyi yönetilmesi gereken kurumların başında gelmektedir. Hastanelerde de en riskli alanlar yoğun bakımlar ve ameliyathanelerdir. Salgının başlamasıyla birlikte cerrahi müdahale gerekli olan tüm hastalar, olası enfekte kabul edilerek hareket edilmelidir. Ameliyathane ekibi (cerrah, hemşire, anestezist ve diğer yardımcı sağlık personeli) olası/kesin tanılı COVID-19 hastaların yönetiminde bulaş önlemlerini acilen hayata geçirmelidir. Özellikle anestezistler havayolu ile hasta ve çalışan güvenliği açısından tecrübeli ve etkin olmaları nedeniyle, COVID-19 ‘un perioperatif yönetiminde lider rol üstlenmektedirler. Bu makalede, olası/kesin tanılı COVID-19 hastalarının ameliyat sürecinde kurumumuzda alınmış olan önlemler ve bu önlemler sonucu elde ettiğimiz başarının ortaya konması irdelenmiştir.

This study aimed to compare the effectiveness of the NoSAS, STOP-Bang, and Berlin scoring systems, which are utilized to predict obstructive sleep apnea syndrome (OSAS), in forecasting difficult airway management. Additionally, the study sought to determine which of these scoring systems is the most practical and effective for this purpose. Following the ethics committee approval, preoperative NoSAS, STOP-Bang, and Berlin scores were calculated for 420 patients aged 18 years and older who were scheduled for tracheal intubation. Mask ventilation and intubation were performed by research assistant with a minimum of two years of experience. Detailed examinations and recordings were conducted, including demographic data, neck circumference, OSAS diagnosis, history of difficult intubation, comorbidities, ASA classification, Mallampati classification, and Cormack-Lehane grade. Subsequently, the predictive efficacy of these three scoring systems for difficult mask ventilation and difficult intubation was compared. In our study, 83 patients (19.8%) were classified as having difficult mask ventilation, and 101 patients (24.0%) were classified as having difficult intubation. The NoSAS score demonstrated a higher predictive power compared to the other scoring systems for difficult mask ventilation and difficult intubation. The cut-off value for the NoSAS score was determined to be 6.5 for predicting difficult mask ventilation and 7.5 for predicting difficult intubation. The routine implementation of the NoSAS score, an easy-to-use, rapid and objective tool primarily developed for OSAS screening, is likely to be effective in preoperatively identifying difficult airways in patients undergoing general anesthesia.

Efficacy of Preoperative Pericapsular Nerve Group Block in Patients with Hip Fracture and its Effect on the Success of Spinal Anaesthesia: A Retrospective Study - Turkish Journal of Anaesthesiology and Reanimation