Introduction: Spinal anesthesia (SA) is one of the most frequently applied anesthesia procedures today. However, SA failure rate varies between 1 and 17%. The age of the patient, the position at which the procedure is performed, or the characteristics of the technical operation can affect success. In this study, we aimed to compare the most frequent SA failures according to the types of surgery and causes of failure. The results of SA procedures performed in a university hospital were compare to those published in the current literature. Materials and Methods: After obtaining ethics committee ­approval for our study, the hospital archives were examined retrospectively for 1 year with respect to SA procedures. SA application and failure rates were examined. Three or more SA attempts, failed dural puncture, or unsuccessful injection, and anesthesia applications that did not provide sufficient sensory block for surgery despite successful drug treatment were defined as failure. Results: Of all anesthesia procedures, SA was applied at a rate of 23.5%. Our SA failure rate was calculated as 16.6%. Considering a single surgical procedure, obstetric anesthesia was the most common surgery with failed SA (28.7%). The most common cause of failure was insufficient analgesia (32.9%). Discussion: SA failure rates were observed to be in a variable distribution range in the literature, and in some studies, SA failure was defined as a block that did not occur despite a full dose and successful injection, and this rate was found to be 3.9%. The high rate in our study group may be explained by differences in the definition of SA: blocks performed with several trials and any block that could not be applied were also recorded as SA failure. The reasons for failing to apply this procedure is an issue that is worth examining also in terms of patient satisfaction and safety, which is an important issue. Conclusion: Although the definition of unsuccessful SA is confusing, SA failure rates are worth examining and improving for each hospital.

Anesthesia induced hypotension may have negative consequences in geriatric patients. Therefore, predicting hypotension remains an important topic for anesthesiologists. Pleth Variability Index (PVI) measurement provides information about the fluid status and vascular tonus of the patients. In our study, the ability of Pleth Variability Index to predict hypotension after general anesthesia induction was evaluated. PVI values obtained from pulse oximetry were recorded in addition to preoperative standard anesthesia monitoring. The correlation between the PVI value and mean arterial pressure (MAP), systolic arterial blood pressure (SAP) changes and the power of PVI values to predict the incidence of hypotension after anesthesia induction (>20% MAP decrease) was tested. Eighty patients over 65 years of age who were operated under general anesthesia were included in the study. Hypotension was observed in 20 patients (25%). PVI values were mild and positively correlated with MAP changes (r = 0.195 and p=0.041). According to the ROC analysis, the incidence of hypotension increased in patients with PVI values above 15.45%. We also found the following diagnostic results for PVI value for predicting hypotension: p=0.044 and Area Under ROC Curve 0.651 ± 0.073 (95%, Confidence Interval: CI 0.507?0.794), Sensitivity of 40%, specificity of 80%, PPV of 40%, NPV of 80%, cut-off value of 15.45, positive likehood ratio of 2, negative likehood ratio of 0.75, Youden Index of 0.2. Predicting hypotension in geriatric patients is an important issue for anesthesiologists. As an easily applicable test, The Pleth Variability Index is useful in predicting MAP reduction in patients. This practical technique can be used routinely in all geriatric patient groups.

Objective: The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. Materials and Methods: Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant. Results: Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C. Conclusion: In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.

Sugammadex is a new generation drug that has led to significant changes in the practice of anesthesia. However, its effects on fetal development are not yet fully known. The aim of this study is to investigate the teratogenic effects of sugammadex on neural tube and embryonic development in early chick embryos. In this study, 50 0-day fertile specific non-pathogenic (SPF) eggs were used. Fifty eggs were divided into 5 different groups, each consisting of 10 pieces. While no substance was given to the control group at the 28th hour of the study, 4 different doses of sugammadex were administered to the experimental groups, respectively 2, 4, 8, 16 mg/kg. Cranio-caudal lengths of embryos, somite numbers, average number of argyrophilic nucleolar regulatory regions (AgNOR) per nucleus, total AgNOR area/total nuclear area (TAA/NA) ratios, Caspase-3 H-Score results, and presence of neural tube defect were compared among the groups. While the mean cranio-caudal lengths, somite counts, TAA/NA ratios and AgNOR counts of the embryos were found to be statistically significantly lower than the control group, Caspase-3 H-Score mean results were found to be significantly higher (p < .05). In addition, it was observed that there was an increase in neural tube patency and developmental delay. As a result, sugammadex crossing the placenta was revealed to increase the release of proapopitotic molecules and disrupt the developmental stages of embryos. Thus, it was determined that sugammadex in increased developmental delay and incidence of neural tube defects in early chick embryos with increased dose dependent. Despite these results, the effects of sugammadex on fetal development in in vivo and in vitro environments should be studied with further studies.

Background: Perioperative hypothermia is an unintended decrease in the core temperature of patients. Hypothermia has many proven complications. The aim of this study is to investigate the perioperative temperature monitoring rates and the difficulties encountered during monitoring, particularly in patients undergoing neuraxial anesthesia.Methods: Two hundred anesthesiologists were included in the study who work in Turkey and actively work in an operating room. A questionnaire was applied to the participants via printed form or e-mail.Results: In Turkey, the overall temperature monitoring ratio was measured as 5.5%. Temperature monitoring was the most frequently used for cardiovascular surgery patients group. In neuraxial anesthesia, temperature monitoring was only 1.5%. The most common reason for not using a temperature monitor was the lack of appropriate equipment (45%). The most common temperature monitoring area was the axillary zone (48%).Conclusion: Participants were aware of the importance of temperature monitoring but concluded that it was not sufficient in practice. Where and how to measure core temperature in awake patients is a controversial issue. Furthermore, the accuracy of measurements in neuraxial anesthesia should be discussed. Interestingly, raising awareness about this issue was not effective in the resolution of the problem. Still, in order to keep this issue up to date, the importance of perioperative temperature monitoring should be emphasized more frequently in anesthesia meetings and education programs.

Awake tracheal intubation is advised for patients with known difficult airways. While flexible bronchoscopy is the conventional technique, video laryngoscopy offers faster intubation. Recent studies reveal that supraglottic airway devices can also be effectively used for awake intubation; however, few investigations compare their effectiveness with that of flexible bronchoscopy and video laryngoscopy. This study aims to compare the effectiveness of these three. methods: flexible bronchoscopy, video laryngoscopy, and awake tracheal intubation using supraglottic airway devices. Patients were divided into three groups: fiberoptic bronchoscopy, video laryngoscopy, and supraglottic airway groups. All patients received Sedation with remifentanil and midazolam, Topical anesthesia with inhaled and sprayed lidocaine, Oxygenation with high-flow oxygen therapy, and intubation Performed by the same operator, known as the ‘STOP’ protocol. The primary outcomes encompassed first-attempt success rate, alternative method success rate, and overall success rates. Secondary outcomes included intubation times and procedural complications. Success and complication rates were similar across groups. The supraglottic airway group had a mean vocal cord imaging time of 74.93 ± 55 s, longer than video laryngoscopy but shorter than fiberoptic bronchoscopy. Intubation times were longer for the supraglottic airway group (210.0 ± 120 s) than for video laryngoscopy but shorter than fiberoptic bronchoscopy. The awake supraglottic airway technique offers advantages over traditional awake intubation methods, including the ability to monitor tidal volume and maintain continuous oxygenation throughout the procedure. This technique achieves comparable success rates, intubation times, and complication rates to video laryngoscopy and fiberoptic bronchoscopy, making it a reliable alternative for difficult airways. https://clinicaltrials.gov (NCT06279416, registered on 19.02.2024).