The aim of this study was to demonstrate the utility of Shear Wave Elastography (SWE) in predicting the success of extracorporeal shock wave lithotripsy (ESWL) in pediatric patients. A total of 102 patients < 18 years of age with a diagnosis of kidney stones underwent ESWL between May 2021 and December 2023. SWE measurements of the stones were performed in all patients prior to ESWL. The subjects were divided into two groups: those who responded to ESWL and those who did not. Age, gender, stone location, stone size, body mass index (BMI), Hounsfield Unit (HU), and stone SWE values were compared between the groups. Among the 102 patients included in the study, 78 exhibited a positive response to ESWL. In the responder group, the SWE, HU, and stone size values were significantly lower than the non-responder group ( p < 0.05). SWE exhibited significant efficacy in discriminating between responders and non-responders [area under the curve (AUC): 0.979 & p = 0.000]. A SWE cutoff value of 13.70 kPa was identified for patient differentiation [AUC:0.929 & p = 0.000]. SWE appears to be an effective method for predicting the success of ESWL in pediatric patients and may serve as an alternative parameter to HU for pre-treatment evaluation.

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.

BACKGROUND: Traditional methods that evaluate the success of peripheral nerve block have been replaced by methods that allow objective evaluations over time. Multiple objective techniques for peripheral nerve block have been discussed in the literature. This study aims to investigate whether perfusion index (PI), non-invasive tissue hemoglobin monitoring (SpHb), tissue oxygen saturation (StO2), tissue hemoglobin index (THI), and body temperature are reliable and objective methods to evaluate the adequacy of infracla-vicular blockage.METHODS: Ultrasound-guided infraclavicular block in 100 patients undergoing forearm surgery. PI, SpHb, StO2, THI, and body tem-perature measurements was recorded 5 min before the block procedure, right after the procedure, and until the 25th min after the procedure at 5-min intervals. These values were compared between the blocked limbs and non-blocked limbs while being statistically compared between the successful and failed block groups.RESULTS: Although there were significant differences between the groups of blocked extremity and non-blocked extremity in terms of StO2, THI, PI, and body temperature, there was no significant difference between these groups in terms of SpHb. Moreover, a sig-nificant difference was detected between the groups of successful block and failed block in terms of StO2, PI and body temperature, while there was no significant difference between these groups in terms of THI and SpHb.CONCLUSION: StO2, PI, and body temperature measurements are the simple, objective, and non-invasive techniques to be used to evaluate success of block procedures. According to the receiver operating characteristic analysis, StO2 is the specific parameter with the highest sensitivity among these parameters.

Anesthesiologists avoid multiple upper extremity peripheral nerve block applications due to complications such as increased phrenic nerve palsy and local anesthetic systemic toxicity risk. With the introduction of ultrasound into clinical life and the increase in the number of experienced anesthesiologists, such complications are less common. We also discussed three cases that we think may contribute to the literature on this subject. Our first case was scheduled for operation due to a trigger finger in his left hand and carpal tunnel syndrome in his right hand. Our second case was scheduled for surgery due to distal radius and ulnar fractures in both forearms. Our third case scheduled for operation for a fracture of the right forearm distal radius and a second metacarpal fracture in the left hand. In this report series, we present our experience of bilateral infraclavicular block, which we successfully performed in three cases and did not encounter any complications.

Background: Propofol and thiopental are widely used intravenous anesthetics with rapid onset and short duration of action. However, their impact on mitochondrial integrity and cellular metabolism under high-dose exposure remains incompletely characterized. Materials and Methods: This study employed a metabolomics-based approach, we examined the dose-dependent effects of propofol and thiopental on intracellular amino acid and carnitine metabolism in HEK-293 cells. Cell viability was assessed by MTT assay, and targeted quantification of metabolites was performed via liquid chromatography-mass spectrometry (MS)/MS. All metabolite levels were normalized to total protein content to account for cellular variability. Results: Both anesthetics caused significant, dose-dependent metabolic alterations. Propofol led to marked depletion of key amino acids (glutamine, alanine, aspartate) and acylcarnitines (C0, C2), indicating compromised mitochondrial β-oxidation and redox homeostasis. Thiopental showed higher cytotoxicity at lower concentrations but induced less disruption in carnitine pathways. Effect size analysis (Cohen’s d) confirmed large-to-extreme differences, particularly at 200 μg/mL, underscoring distinct metabolic footprints for each agent. Conclusions: Propofol and thiopental elicit agent-specific metabolic signatures in renal cells, with implications for mitochondrial dysfunction and anesthetic-induced toxicity. These findings support the utility of targeted metabolomic profiling in guiding safer anesthetic practices, particularly in high-risk or long-duration clinical scenarios.