Background/aim: The aim of this study was to determine the incidence of residual neuromuscular block (RNMB) in a tertiary care hospital. Secondary goals were to examine the characteristics of the use of intraoperative neuromuscular monitoring (NMM) and different reversal agents by the attending anesthesiologists, and to determine the factors related to the patient and perioperative processes on the development of RNMB. Materials and methods: The patients? arrival time at the postanesthesia care unit was accepted as point zero (T0). The acceleromyography of the patients? adductor pollicis muscle was monitored for NMM. Train of four ratios (TOFRs) were recorded at 0, 10, 20, and 30 min. A TOFR < 0.9 was defined as RNMB. Patients? demographic and perioperative data were also recorded. Results: A total of 216 patients completed the study. RNMB was observed in 47 patients (21.8%). Seventy-eight patients (36%) were followed up with NMM. Neostigmine and sugammadex were used in 174 (80.5%) and 42 (19.5%) patients, respectively, and they were both underdosed (21.2 ± 3.0 mcg/kg and 1.5 ± 0.7 mg/kg, respectively). Use of neostigmine and absence of NMM were risk factors for RNMB (p: 0.01 and 0.001, respectively) along with the number of additional doses (>1 doses, p ? 0.02) and the timing of the last dose of rocuronium (<88 min, p ? 0.01). None of the patients who received both NMM and sugammadex experienced RNMB. Conclusion: The RNMB incidence was found to be 21.8%. The main reasons of it were the lack of intraoperative NMM and inappropriate use of reversal agents. Despite strong recommendations, the use of NMM is still insufficient and reversal agents are still underdosed.

Objective: Malnutrition is very commonly encountered in palliative care centers (PCC), especially in geriatric patients. It is known that development of malnutrition increases morbidity and mortality. In this study, we aimed to investigate the effectiveness of commonly used nutritional assessment parameters in predicting prognosis in geriatric patients diagnosed in PCC with malnutrition. Methods: Our study included 1451 patients aged ≥ 65 years, who were diagnosed with malnutrition in PCC between 2016– 2020 and did not yet start receiving nutritional support. Demographic data, comorbidities, The Nutritional Risk Screening 2002 (NRS-2002), body mass index (BMI), albumin, prealbumin and C-reactive protein (CRP) values of the patients were recorded. Prognostic course was evaluated by dividing the patients into 3 groups, namely mortal patients during PCC follow-up, patients transferred from PCC to Intensive Care (ICU) and patients discharged to home from PCC. Results: Logistic Regression analysis showed that low albumin levels affected transfer to ICU (P< 0.05). Elevated NRS-2002 and low albumin and prealbumin levels were found to be factors affecting mortality (P< 0.05). Areas under the ROC Curve were calculated to attain patients’ differential diagnosis. The area under the ROC Curve of low albumin in patients transferred to ICU was found to be significant (P< 0.05). In the differential diagnosis of patients with mortal course, the area under the ROC Curve of low albumin and prealbumin and high CRP was found to be significant (P< 0.05). Conclusion: We found that BMI had no prognostic predictive effects in geriatric PCC patients with malnutrition. We concluded that NRS-2002 and high CRP and low albumin and prealbumin can be used to predict mortality. In addition, we found that low albumin indicates a poor prognosis and predicts patients to be transferred to ICU.

Aim: The objective of this study was to investigate the effect of preincisional (preemptive) Transversus Abdominis Plane (TAP) block on perioperative opioid consumption, hemodynamic parameters and postoperative rescue anal¬gesic consumption in patients undergoing inguinal hernia repair. Methods: 60 adult patients were included in this prospective randomized controlled study. The patients were divided into two groups: those who received conventional systemic analgesia (Group C) and those who received US-guided TAP block (Group TAP). By ultrasonography, normal saline (1 mL) was injected between the internal oblique and transverse abdominal muscles, and after separation was observed, 20 mL of 0.25% bupivacaine was administered. Postoperatively, 1mg/kg Tramadol HCl was given to all patients as a rescue analgesic. Perioperative hemodynamic data, perioperative total amount of remifentanil consumption amount, postoperative Visual Ana¬logue Scale (VAS) scores, starting time and number of rescue analgesics were recorded. Results: There was no difference in demographic data. Intraoperative remifentanil dose, VAS values at all times, need for rescue analgesics and the number of applications were significantly lower in Group TAP than in Group C (p=0.012, p

Amaç: İstanbul’da üçüncü basamak bir hastanede çalışan asistan hekimlerin anafilaksi ile ilgili bilgi düzeylerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Tanımlayıcı tipte olan çalışmamız; İstanbul’da üçüncü basamak bir hastanede çalışan asistan hekimler ile yürütüldü. Hekimlere; anafilaksinin tanısı, tedavisi ile ilgili soruları içeren anket uygulandı. Çalışmada; hekimlerin yaşı, cinsiyeti, görev yaptıkları bölüm, meslekteki çalışma süreleri de değerlendirildi. Bulgular: Çalışma kapsamında 172 asistan hekime anket uygulandı. Hekimlerin %47,0’si (n=79) dahili branş asistan doktoruyken; %53,0’ü (n=89) cerrahi branş asistan dokturuydu. Meslekteki çalışma süreleri değerlendirildiğinde %76,2’sinin (n=131) çalışma süresi 5 yıl ve altındaydı. Yaş medyan değeri 29,0 iken; minimum yaş 25,0 maksimum yaş 53,0 idi. Tamamı anafilaksinin hayatı tehdit edebileceğini düşünmekteydi. Anafilaksi teşhisi için klinik kriterleri doğru bilenlerin oranı ise %63,4 (n=109) idi. Anafilaksi tedavisinde ilk seçenek ilacın adrenalin olduğunu bilenlerin oranı %95,9 (n=165) idi. Hekimlerin %86,6 (n=149) adrenalinin intramüsküler yoldan uygulandığı cevabını verirken; %70,0 (n=119) adrenalinin dozunu, %76,0 (n=130) adrenalinin uygulandığı kasın adını doğru yanıtladı. Anafilaksi hastası 24-72 saat takip edilmelidir diyen hekimlerin oranı cerrahi branşlarda (%82,0; n=73) dahili branşlara göre anlamlı olarak daha yüksekti (%68,4; n=54) (p<0,001). Sonuç: Asistan hekimlerin anafilaksi ile ilgili bilgileri yeteri kadar yüksek değildir. Hekimlere yönelik anafilaksi ile ilgili bilgi düzeyini ve farkındalığı arttıracak eğitimler düzenlenmelidir. Aim:The aim of this study is to evaluate the level of knowledge about anaphylaxis among resident physicians working in a tertiary care hospital in Istanbul. Materyal and Methods:Our descriptive study was conducted with resident physicians working in a tertiary hospital in Istanbul.A questionnaire including questions about the diagnosis and treatment of anaphylaxis was administered to physicians. Results:172 resident physicians were surveyed within the scope of the study.While 47.0% (n=79) of the physicians were internal medicine residents, 53.0%(n=89) were surgical medicine residents. In terms of duration of employment in the profession, 76.2% (n=131) had a working period of 5 years or less.Median age was 29.0 years; minimum age was 25.0 years and maximum age was 53.0 years.All resident physicians felt that anaphylaxis could be life-threatening.The rate of those who correctly knew the clinical criteria for the diagnosis of anaphylaxis was 63.4% (n=109).The rate of those who knew that adrenaline was the first-line drug in the treatment of anaphylaxis was 95.9% (n=165).While 86.6% (n=149) of the physicians answered that adrenaline was administered intramuscularly, 70.0% (n=119) correctly answered the dose of adrenaline and 76.0% (n=130) correctly answered the name of the muscle where adrenaline was administered.The proportion of physicians who stated that anaphylaxis patients should be followed up for 24 to 72 hours was significantly higher in surgical branches (82.0%; n=73) than in internal branches (68.4%; n=54) (p<0.001). Conclusion:The knowledge of resident physicians regarding anaphylaxis is not at a desired level. Trainings should be organized for physicians to increase their knowledge and awareness about anaphylaxis.

Objective: We aimed to compare the superiority of I-Gel and Auragain, the second-generation supraglottic airway devices (SGAD) with different cuff structures, in terms of speed and ease of placement, oropharyngeal leak pressure (OLP), resistance of gastric contents, and post-operative oropharyngeal pain. Materials and Methods: A total of 70 patients aged 18-65 years, with ASA scores I-II, who used I-Gel or Auragain to provide airways under general anesthesia were included in the study. Patients were divided into two groups as I-Gel and Auragain according to the type of SGAD used. Results: OLP, placement duration and Visual Analogue Score (VAS) were found to be statistically significantly higher in the Auragain group (p 0.05). Conclusion: The use of I-Gel provides faster airway and less postoperative throat ache. The use of Auragain provides more efficient ventilation and higher OLP values. In addition, throat ache increases with the number of attempts and the duration of placement in both groups.