Background and Aims: Serratus posterior superior intercostal plane block (SPSIPB) is a novel technique that can provide analgesia in the hemithorax, shoulder, and back of the neck. This study aimed to evaluate the post-operative analgesic effect of SPSIPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods: It is a double-blind, randomised controlled trial. Twenty-four adult patients who underwent VATS via the uniportal technique were randomised into two groups: the SPSIPB group (n = 12) received SPSIPB along with intravenous patient-controlled analgesia (PCA) with tramadol, whereas the control group (n = 12) received only PCA with tramadol. At the end of the surgery, patients in the SPSIPB group received a unilateral SPSIPB under ultrasound guidance with the use of 30-mL bupivacaine 0.25%. The primary outcome was the numerical rating scale (NRS) scores of the patients. Secondary outcomes included the amount of tramadol and rescue analgesic (paracetamol) consumed by the patients, followed up for post-operative 24 hours. Categorical variables were compared using the Chi-Square Test. Mann–Whitney U Test was used to compare groups of variables that were not normally distributed. Results: The SPSIPB group had lower NRS values during post-operative 24 hours ( P < 0.001). Mean (standard deviation) total tramadol consumption was 58.33 (26.23) mg in the SPSIPB group and 144.17 (13.11) mg in the control group ( P < 0.001). Rescue analgesic need was lower in the SPSIP group in the first 18 post-operative hours ( P < 0.05). Conclusion: Serratus posterior superior intercostal plane block provides good analgesia in the thoracic region after video-assisted thoracoscopic surgery.

Recent studies have shown that inflammation plays role in morphine analgesia and tolerance development. Anakinra is a competitive inhibitor of IL-1 receptors and an anti-inflammatory protein regulating IL-1ß?s biological activity by avoiding signal transduction. In this study, we aimed to examine the effects of anakinra on morphine analgesia and tolerance. In this study, 36 Wistar Albino (230-250 g) male rats were used. Animals were divided into six groups: Saline (S), 100 mg/kg anakinra (A), 5mg/kg morphine (M), M+A, morphine tolerance (MT) and MT+A. The resulting analgesic effect was measured with hot plate and tail flick analgesia tests. After analgesia tests the dorsal root ganglions (DRG) tissues were removed. Oxidative stress parameters [total antioxidant status (TAS), total oxidant status (TOS)], endoplasmic reticulum (ER) stress and apoptosis proteins [E74-like factor 2 (elF-2?), activating transcription factor 4 (ATF-4), the C/EBP homologous protein (CHOP), caspase-3 and bcl-2-associated X protein (bax)] were measured in DRG tissues. Anakinra showed anti-nociceptive effect when given alone (p <0.001). In addition, anakinra increased the analgesic effect of morphine (p <0.05 to p <0.001), also decreased the tolerance to morphine at a significant level (p <0.05 to p <0.001). Moreover, it decreased oxidative stress and ER-stress when giving single dose morphine and tolerance induction (p <0.01 to p <0.001). Furthermore, anakinra decreased apoptosis proteins after tolerance development (p <0.001). Anakinra have anti-nociceptive properties and it increases analgesic effect of morphine, in addition prevents tolerance development. These effects probably may occur by modulating oxidative stress and ER-stress pathways.

Klebsiella pneumoniae is the cause of complicated and difficult-to-treat nosocomial infections such as sepsis, urinary tract infection, catheter related infections, pneumonia and surgical site infections in intensive care units. The biggest problem in infections with K.pneumoniae is that treatment options are limited due to multiple antibiotic resistance and consequently the increased morbidity and mortality. The widespread and improper use of carbapenems can lead to epidemics that are difficult to control, especially in intensive care units because of the acquired resistance to this group of antibiotics. Outbreaks and sporadic cases caused by carbapenem resistant K.pneumoniae (CRKP) species have been reported all over the world in recent years with increased frequency. The aim of this study was to determine the risk factors related to carbepenem resistance and mortality caused by K.pneumoniae infections in a university hospital anesthesia intensive care unit. The study was conducted between January 1st, 2016, and December 31st, 2018. Retrospective data were obtained from the patient and laboratory-based surveillance records. Adult patients (>= 18 years) with K.pneumoniae growth in the blood, urine, abscess and tracheal aspirate samples collected 48 hours after admission to the intensive care unit were considered as the relevant infection locus-related agent and treated with antibacterial therapy. Clinical samples collected from patients were inoculated onto 5% sheep blood and eosin-methylene-blue (EMB) agar except the blood samples. Blood samples were cultured in blood culture bottles and incubated in an automated system. Gram staining was performed for the samples showing growth signal within five days and then inoculated onto 5% sheep blood and EMB agar media and were incubated for 18-24 hours at 35.5-37 degrees C. Identification of the isolates was performed using Bruker IVD MALDI Biotyper 2.3 (Bruker Daltonik GmbH, Bremen, Almanya) based on "matrix-assisted laser desorption/ionization time-of-mass spectrometry (MALDI-TOF MS)". K.pneumoniae isolates were identified by obtaining reliability scores of 2.0 and above in the study. Antibiotic susceptibility tests were performed with Phoenix 100 (BD, New Jersey, ABD) automated system. Interpretations were made according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Combination disk diffusion test and polymerase chain reaction based tests were used to show the presence of carbapenemase in CRKP isolates. A total of 88 patients with K.pneumoniae infection were included in the study. The mean age of the patients was 74 +/- 15 (range= 21-93) years and 60.2% were female. CRKP was detected in 32 patients (36.4%) and carbapenem-sensitive K.pneumoniae (CSKP) was detected in 56 patients. The presence of OXA-48 was found to be 68.8% in the carbapenem screening test performed by combination disc method in patients with CRKP. Multivariate logistic regression analysis showed that previous use of colistin [Odds ratio (OR)= 19.108; 95% confidence interval (CI). 2.027-180.133; p= 0.010] and aminoglycoside (OR= 12.189; 95% CI= 1.256-118.334; p= 0.031) was an independent risk factor in terms of CRCP among the patients with K.pneumoniae infection. The 28-day mortality rates were 71.9% in the CRKP group (23/32) and 37.5% in the CSKP group (21/56). Presence of CRKP in terms of 28-day mortality (OR= 5.146; 95% CI= 1.839-14.398; p= 0.002) was an independent risk factor. The data obtained in this study will guide for conducting effective and continuous surveillance studies and implementing rational antibiotic programs to prevent the increase in CRKP.

We aimed to retrospectively investigate the efficacy of ultrasound guided rectus sheath block (RSB) method in our study. We scanned 235 patient files operated for abdominal pathology. Patients meeting the criteria were evaluated for intra-operative rectus sheath block and two different groups were formed. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from patient controlled analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated. Postoperative VAS values (Postoperative 1, 12 and 24 hours p<0.001), DEM values (Postoperative 1, 12 and 24 hours p<0.001) and total amount of morphine consumed (Postoperative 1, 12 and 24 hours p<0.001) were lower in patients with RSB. Also, in patients with RSB nausea (p=0.014) and vomiting was less seen postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with RSB and constipation was seen in 30 patients without RSB (p=0.00). Ultrasound guided rectus sheath block is an effective method for postoperative pain control.

Hypoxemic respiratory failure caused by coronavirus disease 2019 (COVID-19) may lead to prolonged intensive care unit stay and mechanical ventilation. Critically ill patients often develop intensive care unit acquired weakness (ICUAW), which is an umbrella term that encompasses critical illness polyneuropathy and critical illness myopathy. The aim of this paper is to report the clinical, neurophysiological, and radiological findings suggesting critical illness myopathy in three patients with critical COVID-19. Muscle magnetic resonance imaging may serve as a diagnostic tool for critical illness myopathy. Weaning failure and generalized muscle weakness with preserved sensation and cranial nerve function should alert physicians for ICUAW.