Transurethral resection of prostate (TURP) syndrome is a complication characterised by symptoms changing from an asymptomatic hyponatremic state to convulsions, coma and death due to absorption of irrigation fluid during TURP. The syndrome appears to be related to the amount of fluid that enters the circulation via the blood vessels in the resection area. The first step in the course of action for therapy is to control bleeding and suspend the operation. In the case presented, we aimed to emphasise the importance of an early diagnosis and treatment of TURP syndrome in a patient that developed hyponatremia (90 mmol/l) while under general anaesthesia during a TURP procedure. In addition, multiple cystoscopic applications in the same session may facilitate development of the TURP syndrome.

Purpose: We evaluated the effects of body mass index (BMI) on thermoregulation in obese patients scheduled to undergo laparoscopic abdominal surgery. Methods: Sixty patients scheduled to undergo laparoscopic abdominal surgery with no premedication were included in the study. The patients were classified into 4 groups according to BMI 50. Anesthesia was provided with routine techniques. Tympanic and peripheral temperatures were recorded every 5 minutes starting with the induction of anesthesia. The mean skin temperature (MST), mean body temperature (MBT), vasoconstriction time, and vasoconstriction threshold that triggers core warming were calculated with the following formulas: MST = 0.3 (T_chest + T_arm) + 0.2 (T_thigh + T_calf). MBT was calculated using the equation 0.64T_core+0.36T_skin, and vasoconstriction was determined by calculating T_forearm-T_finger. Results: There was no significant difference between the groups in terms of age, gender, duration of operation, and room temperature. Compared to those with BMI 50 in the 5th, 10th, 15th, 20th, 25th, 30th, 50th, and 55th minutes were less than those with BMI <24.9 (P<0.05). There was no significant difference in terms of MST and MBT. Vasoconstriction occurred later, and that vasoconstriction threshold was significantly higher in patients with higher BMIs. Conclusion: Under anesthesia, the core temperature was protected more easily in obese patients as compared to nonobese patients. Therefore, obesity decreases the negative effects of anesthesia on thermoregulation.

Objective: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. Methods: Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded. Results: The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department. Conclusion: This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned. Cite this article as: Köroğlu M, Karakaplan M, Ergen E, et al. The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges. Acta Orthop Traumatol Turc., 2023;57(6):315-321.

A circumcision was planned for a four-month-old infant under local anesthesia. After the application of lidocaine, the infant stopped crying, and then generalized tonic-clonic convulsions and a diffuse erythematous rash developed. The patient was immediately monitored, ventilation was provided, and 1 mg midazolam was given intramuscularly. After insertion of a cannula, sodium thiopental 50 mg was given intravenously, the patient's convulsions were controlled, and endotracheal intubation was performed. The patient was extubated 30 minutes later. However, the patient was re-intubated due to his noisy breathing, and 10 mg prednisolone was given intravenously due to mild edema seen in the larynx during endotracheal intubation. Two hours after the second intubation, the patient started to breath spontaneously and opened his eyes; he was extubated and transferred to the intensive care unit. Two days later the patient was discharged. Systemic toxicity to the local anesthesia was considered in this patient. All precautions need to be considered during the application of local anesthesia in pediatric patients, including proper indication, monitoring of the patient in the preoperative period, establishment of venous access, and readiness to apply cardiopulmonary resuscitation in the event of local anesthetic toxicity. The maximum dose of local anesthesia should be considered and it should be diluted during application.