Purpose: To determine the differences among the hemodynamics, neuroendocrine stress response (NESR), and postoperative visual analogue scale (VAS) scores of pain between the procedures of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole kidney stones. Patients and Methods: Fifty-six patients undergoing RIRS and PNL with lower puncture approach, under general anesthesia, were prospectively enrolled in our study. Perioperative blood pressure (systolic, diastolic, and mean), heart rate, and peripheral oxygen saturation (SpO₂) values were recorded at intervals. Arterial blood gas (ABG) and blood glucose, serum insulin, and cortisol levels as stress response markers were analyzed in the perioperative period. Postoperative VAS scores were recorded at 30 minutes and 2, 4, 6, and 12 hours after extubation. Duration of surgery, stone sizes, and stone-free rates (SFRs) were noted. Results: SFRs were 93.3% in the PNL group (28/30 patients) and 88.5% in the RIRS group (23/26 patients) (p = 0.52). There was no statistical difference between the hemodynamics of both groups. Perioperative ABGs and NESRs were similar between groups (p > 0.05). Postoperative VAS scores and analgesic consumptions were also similar between groups (p > 0.05). Duration of surgery was significantly shorter in the RIRS group (p = 0.001). Stone size was significantly higher in the PNL group (p = 0.013). Conclusion: Although the PNL is assumed to be more invasive than the RIRS procedure among urologists and anesthesiologists, both techniques may have similar perioperative outcomes in terms of hemodynamics, ABG, NESR, and pain scores in the management of lower pole stones with lower pole approach.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) and acute respiratory failure are critical clinical conditions associated with high mortality rates in intensive care units (ICUs). Electrolyte imbalances are significant variables that may influence all-cause ICU mortality in this patient group. In this retrospective study, we aimed to investigate the relationships between the serum levels of sodium (Na⁺), chloride (Cl⁻), potassium (K⁺), calcium (Ca²⁺), and magnesium (Mg²⁺) and all-cause ICU mortality in patients admitted with respiratory failure. Additionally, we conducted a detailed mortality analysis on the basis of sodium quartiles and pathological absolute sodium thresholds to reveal their associations with ICU mortality from all causes. Materials and Methods: A total of 1109 patients were analyzed between January 2022 and January 2024. The electrolyte levels measured at ICU admission, demographic data, APACHE II and SOFA scores, arterial blood gas results, BUN and creatinine levels, need for noninvasive mechanical ventilation, length of ICU stay, and survival outcomes were assessed. Statistical analyses were performed via Kaplan—Meier survival analysis and the Cox regression method. Results: Our findings revealed that patients with low potassium and calcium levels had significantly higher mortality rates (p < 0.05). When sodium levels were divided into quartiles, mortality risk markedly increased in both the lowest (Q1) and highest (Q4) quartiles. Cox regression analysis revealed that the mortality risk in hyponatremic patients was 2.2 times greater than that in normonatremic patients (p = 0.005). In the hyponatremic group, the increased mortality risk was statistically borderline significant (p = 0.06). In the logistic regression analysis conducted to evaluate ICU mortality, which included all electrolyte levels and clinical scoring systems, higher APACHE II and SOFA scores were identified as significant risk factors for ICU mortality. Conversely, the presence of COPD was found to be relatively protective compared with other underlying causes of respiratory failure in terms of mortality. Conclusions: Electrolyte imbalances are important predictors of mortality in patients with respiratory failure. Sodium levels exhibit a “U-shaped” relationship with mortality, with hyponatremia emerging as a prominent risk factor. Careful assessment of electrolyte imbalances is crucial in the clinical management of these patients.

Background: Intraocular pressure (IOP) alters during bariatric surgery according to body position, anesthetic agents, and intra-abdominal pressure. This study investigates the comparison of the effects of sevoflurane and total intravenous anesthesia (TIVA) procedure on IOP in bariatric surgery. Methods: Following local ethics committee approval, 55 American Society of Anesthesiologists I–III patients undergoing bariatric surgery were included. Patients were randomly allocated into two groups: Group P (n: 28) and Group S (n: 27). Sevoflurane (one minimum alveolar concentration) was administered to Group S, 5–10 mg/kg/h propofol infusion was performed in Group P, and 0.1–0.3 μg/kg/min remifentanil infusion was performed in both groups. Mean arterial pressure (MAP), heart rate (HR), and IOP were measured at the sitting position before the induction, supine before induction, after induction, 5 min after intubation, 10 min after pneumoperitoneum during head-down position, 5 min after terminating pneumoperitoneum, 5 min after extubation, and at postoperative 24th hour. Results: Demographic data, MAP, and HR were similar in groups. There were statistically significant decreases in IOP after induction of anesthesia in both groups (p < 0.05). In all time points, the IOP levels had no statistically significant differences between groups (p > 0.05). Conclusions: This study reveals that sevoflurane and TIVA procedures have similar effects on IOP in bariatric surgery.

Aim: Pain is the major problem early postoperative period after perianal operations. In this study, we aimed to evaluate the effect of adding 50 μg or 100 μg of morphine on intrathecal 5 mg hyperbaric bupivacaine on postoperative analgesia before anal surgery. Material and Method: A total of 60 patients divided into 3 groups, including 20 patients in each group, were included for the study; Group 1: 5 mg 0.5% heavy bupivacaine (HB), Group 2: 5 mg 0.5% HB and 50 μg Morphine, Group 3: 5 mg 0.5% HB and 100 μg Morphine was intrathecally administered. Intraoperative and postoperative hemodynamics, time to urination and first analgesia requirement, perioperative and postoperative side effects were recorded Results: The time to first analgesic need in Group 1 (305.40 ± 143.86) was statistically significantly lower than Group 2 (435.50 ± 171.70) and Group 3 (435.50 ± 156.08) was determined (p=0.015). No significant difference was found between urinary retention (p>0.05). It was determined that the postoperative nausea and vomiting percentages (25.0%) in Group 3 were statistically significantly higher than Group 2 (5.0%) and Group 1 (0.0%) (p