Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.

Anesthesia-related complications, such as pulmonary aspiration of gastric contents, occur in approximately 0.02–0.1% of elective pediatric surgeries. Aspiration risk can be reliably assessed by ultrasound examination of the gastric antrum, making it an essential non-invasive bedside tool. In this prospective observational study, since most of our patients are immigrants and have communication problems, we wanted to investigate gastric contents and the occurrence of “high risk stomach” in children undergoing elective surgery for the possibility of pulmonary aspiration, even if the children and/or parents reported their last oral intake time. This risk is defined by ultrasound findings of solid content in the antrum and/or a calculated gastric volume exceeding 1.25 mL/kg. Children aged 2–18 were included in the study. Both supine and right lateral decubitus (RLD) ultrasound examinations were performed on the antrum before surgery. Using a qualitative grading scale from 0 to 2, we evaluated the gastric fluid content. The cross-sectional area (CSA) of the antrum was measured in the RLD position, aiding the calculation of the gastric fluid volume according to an established formula by Perlas. Ultrasound measurements of 97 children were evaluated. The median fasting duration was 4 h for liquids and 9 h for thick liquids and solids. Solid content was absent in all the children. Five children (5.2%) exhibited a grade 2 antrum, implying that fluid content was visible in both the supine and RLD positions. The median antral CSA in the RLD was 2.36 cm², with a median gastric volume of 0.46 mL/kg. For patients with a grade 0 antrum, a moderate and positive correlation was observed between the antral CSA and BMI, and a strong and positive correlation was evident between the antral CSA and age, similar to a grade 1 antrum. Only a single child (1%) had a potentially elevated risk of aspiration of gastric contents. Hence, the occurrence of a “high risk stomach” was 1% (95% confidence interval: 0.1–4.7%) and is consistent with the literature. As a necessary precaution, we propose the regular use of ultrasound evaluations of gastric contents, given their non-invasive, bedside-friendly, and straightforward implementation, for identifying risks when fasting times are uncertain and for ruling out unknown risk factors in each potential patient.

COVID-19 önlemleri alınarak elektif cerrahilerin yeniden başlatıldığı pandemi sürecinde elektif cerrahi uygulanacak hastaların preoperatif anksiyete düzeylerinin ve anksiyete seviyelerini etkileyen faktörlerin değerlendirilmesi amaçlandı. 18-75 yaş grubu elektif cerrahi uygulanacak 450 hasta dahil edildi. Yazılı onamları alınan hastalar preoperatif dönemde değerlendirildi. Demografik verileri, eğitim durumu, medikal geçmişi, anestezi ve cerrahi deneyimleri sorgulandı. COVID-19 hakkında soruların olduğu anket formu ile yirmişer maddelik durumluk ve sürekli kaygı ölçeklerinden oluşan Spielberger Durumluk-Sürekli Anksiyete Ölçeği (STAI) hastalar tarafından dolduruldu. Durumluk (STAI-I) ve sürekli (STAI-II) kaygı ölçeklerinde büyük puan yüksek anksiyete seviyesini, küçük puan ise düşük anksiyete seviyesini belirtir. 49.26±15.51 yaş ortalaması olan hastaların ortalama anksiyete düzeyi STAI-I’de 41.46±8.43, STAI-II’de 37.79±9.73 olarak bulundu. Opere edilen kliniklere göre hastaların STAI-I puanları orta düzeyde anksiyete, STAI-II puanları ise hafif düzeyde anksiyete ile uyumluydu. Hastaların yaşı ile STAI-I arasında negatif yönde korelasyon görüldü (r=-0.52, p=0.136), STAI-II’de ise yaş ile pozitif korelasyon saptandı (r=0.22, p=0.321). Cinsiyet, eğitim durumu, geçirilmiş ameliyat öyküsü ve anestezi deneyimi açısından değerlendirildiğinde preoperatif STAI-I ve II puanlarında farklılık saptanmadı. COVID-19 pandemisi hakkında yeterli bilgi sahibi olmadığını düşünen hastaların (%17,6) STAI-I ve STAI-II puanları anlamlı yüksekti (p= 0.000, p= 0.001). Ailesinde geçirilmiş COVID-19 enfeksiyonu bulunan hastaların STAI-I ve II puanları ile diğer hastaların puanları benzerdi (p=0.76, p=0.91). Hastane yatışında COVID-19 ile enfekte olma tedirginliği bulunan hastaların (287 hasta, %63.8) STAI-I puanı hastanede COVID-19’a yakalanmaktan korkmayanlara (163 hasta, %36.2) göre yüksek bulundu (p=0.05). Postoperatif dönemde hastane yatışı sırasında COVID-19 ile enfekte olan hasta olmadı. Elektif cerrahi geçirecek hastalarda COVID-19 pandemisinde preoperatif anksiyete düzeyleri artmıştır. Preoperatif dönemde hastalara COVID-19 ile ilgili rutin bilgilendirme yapılmasının ve alınacak önlemlerden bahsedilmesinin anksiyete düzeyini azaltmada faydalı olacağı düşüncesindeyiz

Objectives: Delayed gastric emptying create a risk of pulmonary aspiration during anesthesia. We aim to assess the antral cross-sectional area (CSA) and gastric volume using ultrasound techniques and to investigate the relationship between these variables and both the duration and regulation of type 2 diabetes mellitus (DM). Methods: Gastric volume was estimated by measuring the antral CSA in the supine and right lateral decubitus (RLD) positions in 80 patients. The antral content was qualitatively classified according to Perlas et al. (grades 0, 1, and 2), and gastric volume was computed using a previously described formula. The presence of solid content or > 1.5 mL/kg fluid in the stomach was classified as indicative of a full stomach. Results: The mean duration of diabetes among the subjects was 9.4 ± 3.7 years. The mean fasting duration was 10.2 ± 2.1 hours for solids and 2.5 ± 0.7 for liquids. Twelve of the 80 patients exhibited grade 2 stomach. Age (p = 0.005), Body mass index (p = 0.001), solid fasting duration (p = 0.027), and supine and RLD CSA (p < 0.001 for both) were significantly associated with full stomach. A history of ≥8 years of diabetes (p < 0.001) and peripheral neuropathy (p = 0.005) was identified as a risk factor for a full stomach. Conclusions: Despite adherence to standard fasting protocols, 15% of the type 2 DM patients were identified with a 'full stomach' condition. Preoperative ultrasound assessment of gastric contents in patients with type 2 DM, especially with long-standing diabetes (≥ 8 years) and with peripheral neuropathy is recommended. The findings of this study necessitate additional investigation to support the conceptualization of specific guidelines for diabetes to mitigate the risk of pulmonary aspiration.

BACKGROUND Acute renal failure (ARF) is a critical complication following open-heart surgery, significantly impacting morbidity and mortality. This study aimed to evaluate the association between intraoperative renal near-infrared spectroscopy (NIRS) findings and postoperative ARF in 357 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). MATERIAL AND METHODS This prospective study included 357 patients undergoing open-heart surgery with CPB. ARF diagnosis was based on KDIGO criteria. NIRS sensors were placed bilaterally at the T12/L2 level under ultrasound guidance, and renal oxygenation (rSO2) values were continuously monitored intraoperatively. Patients were categorized into ARF and non-ARF groups for comparative analysis. RESULTS ARF developed in 12.3% (n=44) of patients. ARF patients were older (p=0.024) and had longer surgery (p<0.001), CPB (p=0.004), and aortic cross-clamping durations (p=0.013). They required more blood products (p<0.001) and intra-aortic balloon pump support (p=0.027). Intensive care unit stays were significantly longer in ARF patients (p=0.036). NIRS analysis showed significant rSO2 reductions in ARF patients. Time spent with rSO2 below 80%, 70%, and 60% was a strong predictor of ARF. Receiver operating characteristic (ROC) analyses demonstrated that time exceeding 30 minutes below the 60% threshold predicted ARF with 96.5% specificity and 86.4% sensitivity. CONCLUSIONS Intraoperative NIRS monitoring is crucial for detecting renal perfusion abnormalities during high-risk surgeries. Declines below 80%, 70%, and 60% thresholds strongly predict ARF. Timely interventions, such as fluid resuscitation and hemodynamic support, can mitigate risks. ARF patients require intensive postoperative monitoring due to prolonged ICU stays and complications.