Background: Prolonged extubation and pain following cardiac surgery remain significant clinical challenges. The pecto-intercostal fascial plane block (PIFB) is an emerging regional anesthesia technique incorporated into multimodal analgesia protocols to reduce opioid consumption and facilitate early extubation. This study retrospectively evaluated extubation times, perioperative opioid consumption, and postoperative analgesic requirements in patients who underwent isolated open-heart surgery via median sternotomy, comparing those who received PIFB with those who did not. Methods: This retrospective single-center study included ninety-nine patients who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy between 1 June 2023 and 25 March 2024. The study included 46 patients who received PIFB (Group 1) and 53 patients who received no block (Group 2). Ultrasound-guided bilateral PIFB was performed after anesthesia induction, with a total of 40 mL administered to each side (30 mL 0.25% bupivacaine + 10 mL normal saline). Demographic data, perioperative data, extubation times, analgesic consumption, and complications were compared between groups. Results: Demographic data, EuroSCORE, body mass index, and ejection fraction were similar between groups. Perioperative opioid (fentanyl) consumption was statistically significantly higher in Group 2 (median 450 [IQR: 350–600] μg vs. 400 [IQR: 350–450] μg; p = 0.037). Extubation time was statistically significantly shorter in Group 1 compared to Group 2 (median 340 [IQR: 265–490] min vs. 495 [IQR: 420–555] min; p < 0.001). The number of patients requiring postoperative paracetamol and tramadol was statistically significantly lower in Group 1 (p = 0.015 and p < 0.001, respectively). No statistically significant difference was found between groups regarding chest drain removal, length of hospital stay, or ICU length of stay (p > 0.05). Mortality occurred in 1 patient in Group 1 and 2 patients in Group 2. Conclusions: PIFB application in isolated open-heart surgery performed via median sternotomy was associated with shorter extubation time and reduced perioperative fentanyl and postoperative analgesic consumption, without a statistically significant effect on hospital length of stay. Complication and mortality data are reported descriptively; the study does not have sufficient statistical power to draw inferences regarding safety outcomes.

During tympanoplasty surgery, the head and neck remain in the lateral position throughout the procedure. This situation may disrupt venous blood flow, comp

Aims: This study was designed to investigate the effect of prone position and predictive factors on hypotension in patients performing percutaneous nephrolithotomy.Methods: Patients aged >18 years and ASA I-III who underwent general or regional anaesthesia were included in the study. Percutaneous access was performed in all patients with fluoroscopy in the prone position. Age, gender, body mass index, smoking, type of anaesthesia, duration of anaesthesia and surgery were recorded. The ECG, SpO2, and non-invasive blood pressure values were recorded intraoperatively. Preoperative and postoperative 12th-hour Hb, BUN, Cr, Na, K and Cl were measured in a blood sample. Isotonic was used as an intravenous fluid in all patients. In the treatment of hypotension, routine ephedrine treatments were recorded.Results: The study included 153 patients, 49 with hypotension in Group H and 104 without hypotension in Group N. Hypertension and coronary artery disease increased the incidence of hypotension (respectively, p=0.028, p=0.007). Patients with hypotension had higher body mass index (p=0.044). Hypotension was found to be significantly higher in patients who underwent regional anaesthesia and had a large number of percutaneous accesses (respectively, p=0.048, and p=0.012). Age-Adjusted Charlson Index, ASA, smoking, and hospital stay were not statistically different.Conclusion: Hypertension and coronary artery disease increased the risk of hypotension during PCNL procedures in the prone position. In addition, high body mass index, an increase in the number of percutaneous accesses, and the use of regional anaesthesia also increase the risk of hypotension during the performance of percutaneous nephrolithotomy procedures.

Objective: To compare postoperative chest-tube drainage and cumulative allogeneic red blood cell (RBC) exposure between two integrated autologous blood-conservation strategies: post-heparinization pre-bypass acute autologous donation (PAAD), which incorporated autologous circuit priming, and pre-heparinization acute normovolemic hemodilution (ANH).Methods: This single-center retrospective cohort included 220 adults undergoing first-time elective on-pump cardiac surgery with preoperative hemoglobin ≥12 g/dL; 117 received PAAD and 103 ANH as routine care. The primary outcome was cumulative chest-tube drainage during the first 24 hours after intensive care unit admission. The key secondary outcome was allogeneic RBC exposure from cardiopulmonary bypass-flow start through discharge or death. Crude and covariate-adjusted estimates were calculated.Results: Mean (standard deviation) 24-hour drainage was 876.2 (692.2) mL with PAAD and 855.0 (657.8) mL with ANH. The crude PAAD-minus-ANH mean difference was 21.2 mL (95% confidence interval [CI], -159.1 to 201.6), and the adjusted difference was 44.3 mL (95% CI, -146.3 to 234.9). Cumulative RBC exposure occurred in 38/117 (32.5%) PAAD and 29/103 (28.2%) ANH patients (risk difference, 4.3 percentage points; 95% CI, -7.9 to 16.2; risk ratio, 1.15; 95% CI, 0.77 to 1.73).Conclusion: In this selected elective cohort, neither outcome clearly differed between the integrated strategies, but the wide intervals were compatible with clinically relevant associations in either direction. These observational data do not establish equivalence, causation, or a preferred strategy.

Background: Although patient positioning in neurosurgical procedures is essential for optimal surgical exposure, it may adversely affect venous drainage, airway management, hemodynamic stability, and peripheral neurovascular structures. The aim of this study was to prospectively evaluate perioperative complications related to surgical positioning and head fixation methods in neurosurgical procedures. Material and Methods: This prospective, single-center observational study included 61 adult patients scheduled for neurosurgical procedures under general anesthesia. Patients were divided into two groups according to the occurrence of position-related perioperative complications. The primary outcome was the development of position-related perioperative complications, while secondary outcomes included hemodynamic changes and perioperative time variables. Results: During the perioperative period, a total of 12 position-related complications were identified in 10 patients (16.4%). The most frequently observed complications were bilateral orbital edema and diffuse facial edema. Anesthesia duration was significantly longer in the complication group compared with the uncomplicated group (p = 0.021). No significant differences were observed between the groups with respect to surgical duration, intraoperative fluid administration, or blood product transfusion. There was no statistically significant association between surgical position and the development of complications. Mean arterial pressure and heart rate values measured at different perioperative time points were comparable between the groups (all p>0.05). Position-related complications were most commonly observed in the prone position and predominantly involved the facial and upper airway soft tissues. Conclusion: Position-related perioperative complications occur at a non-negligible frequency in neurosurgical procedures. Appropriate patient positioning, standardized padding, and meticulous intraoperative management are of critical importance in ensuring patient safety.