To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters. A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5minutes after intubation in the supine position); T2 (30minutes after CO2 insufflation); T3 (120minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evaluated. The mean IOP was 12.4mmHg at T1, 20mmHg at T2, 21.8mmHg at T3, and 15.6mmHg at T4. The mean ONSD was 4.87mm at T1, 5.21mm at T2, 5.30mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD. A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.

BACKGROUND: Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery. METHODS: Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated. RESULTS: Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p>0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001). CONCLUSION: To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.

Amaç: Yoğun bakım ünitesinde yatan kritik hastalarda, hipovoleminin değerlendirmesi için kullandığımız inferior vena kava kollapsibilite indeksi (İVCCİ), santral venöz basınç (CVP), pasif bacak kaldırma testi (PBKT), laktat ve veno-arterial karbondioksit farkı (ΔpCO2) parametrelerinin birbiriyle korelasyonu ve ΔpCO2’in bu amaçla kullanılabilirliğini saptamak.Gereç ve Yöntem: Hastalar supin-nötr pozisyondayken CVP ölçüldü. CVP’nin %45 değeri hipovolemi lehine değerlendirildi. Hastaya nabız basınç kontrollü PBKT uygulanıp sistolik tansiyonda >%12 artış pozitif olarak kabul edildi. Daha sonra hastalardan eş zamanlı santral venöz ve arteriel kan gazı çalışılarak ΔpCO2 ve arteriyel laktat düzeyine bakıldı.Bulgular: Çalışmamızda İVCCİ ve CVP arasında orta derecede negatif korelasyon (p=0.02), İVCCİ ile PBKT arasında orta derecede bir pozitif korelasyon (p<0.001) saptanırken, İVCCİ ile laktat düzeyi arasında zayıf pozitif korelasyon saptandı (p=0.032). ΔpCO2 ile diğer parametreler arasında herhangi bir korelasyon saptanmadı.Sonuç: İVCCİ’nin, non-invaziv bir yöntem olması ve aynı zamanda CVP, PBKT ve laktatla istatistiksel olarak korele olması nedenleriyle intravasküler sıvı volümü değerlendirmesinde kullanılabileceğini düşünmekteyiz.

Background: Acute kidney injury (AKI) is one of the more serious complications following cardiac surgery, consistently linked to prolonged mechanical ventilation and higher in-hospital mortality. This study examined whether preoperative anaemia and impaired renal function are associated with AKI and death in a high-risk cardiac-surgery cohort requiring extended postoperative ICU monitoring and how these associations behave after adjustment for procedure type and intraoperative variables. Methods: In this single-centre retrospective cohort study, we screened 950 patients admitted to a cardiothoracic ICU between January 2018 and January 2024. After standard exclusion criteria and an audit of operative records, 553 cardiac-surgery patients formed the principal analysis cohort. AKI was defined by KDIGO criteria using serial postoperative serum-creatinine measurements during the first 7 days. Multivariable logistic regression for AKI and in-hospital mortality was built sequentially: Model A (baseline only); Model B (+procedure type); and Model C (+intraoperative variables: aortic cross-clamp time, intraoperative RBC units, and intraoperative inotrope use). Calibration was assessed by the Hosmer–Lemeshow test. Total cardiopulmonary bypass duration was not separately captured in the institutional database and is disclosed as a limitation. Results: AKI occurred in 174 of 553 patients (31.5%), and in-hospital mortality was 16.6% (92/553). Patients with AKI were older (median 77 vs. 68 years, p < 0.001), with lower preoperative haemoglobin (11.4 vs. 12.3 g/dL, p < 0.001) and lower eGFR (38.1 vs. 63.7 mL/min/1.73 m², p < 0.001). The aortic cross-clamp time was shorter in AKI patients (56 vs. 70 min, p = 0.043), a counterintuitive finding likely reflecting residual confounding by case-mix and procedure selection rather than a protective operative effect. In the fully adjusted multivariable model, the haemoglobin–AKI association attenuated and was no longer independently significant (OR 0.89 per 1 g/dL, 95% CI 0.73–1.08, p = 0.24), while intraoperative RBC transfusion emerged as an independent predictor (OR 1.12 per unit, p = 0.046). For mortality, AKI remained an independent predictor after full adjustment for procedure type and intraoperative variables (OR 7.14, 95% CI 1.45–35.13, p = 0.016), with cross-clamp time (OR 1.30 per 10 min, p = 0.010) and intraoperative RBC units (OR 1.48 per unit, p < 0.001) also independently associated. Both fully adjusted models showed acceptable calibration (Hosmer–Lemeshow p = 0.48 for AKI, p = 0.56 for mortality). Conclusions: In cardiac-surgery patients with a prolonged ICU stay, AKI is independently associated with in-hospital mortality even after adjustment for operative variables. The univariable association between preoperative haemoglobin and AKI is attenuated after adjustment for procedure type and intraoperative transfusion exposure, suggesting confounding or mediation by operative and case-mix factors rather than an independent direct association. The contribution of this analysis is aetiological/analytical rather than predictive (modest discrimination, AUROC 0.67 for AKI), and findings should be interpreted within the selected high-risk ICU ≥ 72 h population.

Akut iskemik stroklu olguda mekanik trombektomi esnasında gelişen intrakranial hemorajiye nedenli Cushing refleksinin değerlendirilmesi amaçlandı. Beş saat önce gelişen sağ yan güçsüzlüğü ve konuşma bozukluğu nedenli BT-anjiyo çekilen 59 yaşında erkek hastada sol MCA'da M1 segment oklüzyonu görüldü. Tedavi kararı hastaya mekanik trombektomi uygulanması oldu ve hasta girişimsel nöroradiyoloji ünitesine sevk edildi. Genel anestezi altında prosedür olarak pıhtı lokalizasyonuna tromboaspirasyon kateterinin yerleştirilmesi esnasında rutin bir şekilde teknik olarak ilerlendi, Ansızın bradikardi ve hipertansiyon gelişti ve anestezi ekibi 1 mg atropin uyguladı. Bradikardi ve hipertansiyonun infarktüslü bir hastada yapılan mekanik trombektomiye bağlı olduğu düşünüldüğü için akut infarktüsten uzaklaşıldı. Eş zamanlı kateterden kontrast madde verilerek MCA M1 segmentinde rüptür ve kontrast maddenin dışarı sızması görüldü. Sonuç olarak, anestezi ve operasyon ekibi tromboaspirasyon kateteri yerleştirilmesi esnasında Cushing refleksi geliştiği zaman damar perforasyonu açısından uyanık olmalıdır.

What Has Changed in Renal Replacement Treatments? - Bagcilar Medical Bulletin