Background/Aim: Conventional physiological parameters such as heart rate and mean blood pressure may not adequately detect hypovolemia. Esophageal Doppler monitoring (EDM) is a device that continuously measures blood flow in the descending aorta using a transesophageal Doppler transducer. In this study, we aim to compare Esophageal Doppler Monitoring (EDM) with conventional targeted fluid treatment in major orthopedic surgery cases. Methods: Forty patients, aged between 18–65 years and falling within the American Society of Anesthesiologists (ASA) classifications I-III, who were slated for major orthopedic surgery were included in the study. Patients were escorted to the operating room and standard monitoring along with arterial monitoring was applied. Baseline systolic arterial pressure (SAP) and heart rate were recorded. The patients were then divided into two groups of 20 each, using a sealed method. For induction, 2–3 mg/kg propofol and remifentanil 1 μg/kg were administered to both groups and muscle relaxation was achieved with 0.6 mg/kg rocuronium before intubation. The first group, labeled as Group D, was monitored by EDM and fluid management followed using EDM. The second group, labeled as Group K, had its fluid management guided by conventional methods (pulse, blood pressure, urine output). For maintenance of anesthesia, both groups were administered 2–3% sevoflurane along with a 50% O2 + 50% air mixture. In both groups, we recorded hemodynamic parameters, urine output, serum lactate level, the total given fluid and blood volume, inotropic or vasopressor requirement, anesthesia and surgery times, postoperative recovery time, hospital stay, oral diet starting time, and potential complications associated with postoperative nausea and vomiting. Results: No difference was observed between the two groups in terms of demographic data. SAP in the control group was found to be statistically and significantly lower at the 10th, 20th, 25thh, 30th, and 90th minutes, compared to the Doppler group. Diastolic blood pressure was also noticeably lower in the control group at the 20th and 30th minutes than in the Doppler group. When comparing the lactate levels of the Doppler and control groups, the lactate level of the Doppler group was significantly lower at the 90th minute. Tachycardia was significantly lower in the postoperative Doppler group. Conclusion: In major orthopedic surgery cases, we concluded that better results are obtained in perioperative vital signs with targeted fluid therapy, especially when accompanied by EDM. Specifically, the lactate level, which is considered important in terms of mortality and morbidity, is lower.

Background: This study aimed to assess the reliability of pleth variability index (PVI), perfusion index (PI), and regional cerebral oxygen saturation (rSO₂) across two ventilation strategies in patients un-dergoing septorhinoplasty under general anaesthesia. Materials and Methods: After induction, patients were ventilated with a volume-controlled mode for 20 minutes, during which heart rate (HR), PI, PVI, peripheral oxygen saturation (SpO₂), non-invasive blood pressure (NIBP), and rSO₂ were recorded at 5-minute intervals. Subsequently, ventilation was switched to a pressure-controlled mode for another 20 minutes with repeated measurements at the same intervals. Results: Fifty patients with American Society of Anesthesiologists (ASA) I–III classification and a body mass index (BMI) under 30 were included. Preoperative PI values were significantly lower compared with intraoperative recordings under both ventilation strategies (p<0.05). Preoperative PVI was higher than subsequent measurements, with significantly elevated values during volume-controlled ventilation (VCV) at the 10-minute mark (p<0.05). Left-sided rSO₂ values showed a gradual decrease relative to baseline, whereas right-sided rSO₂ demonstrated progressive increases; however, fluctua-tions remained within 10%. Conclusions: Parameters including HR, PI, PVI, SpO₂, NIBP, and rSO₂ were not interchangeable between the two ventilatory modes. Overall, the transition from VCV to pressure-controlled ventila-tion (PCV) did not yield significant alterations in these variables.

Background and Objectives: Sepsis is a life-threating organ dysfunction condition caused by the body’s uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients’ sepsis. The inflammatory prognostic index (IPI) is also a novel marker of inflammation. As there are no studies examining the association of the IPI with in-hospital mortality in patients with sepsis nor its performance compared with other inflammatory markers, we aimed to investigate the clinical importance of the IPI for predicting in-hospital mortality in sepsis patients. Materials and Methods: A total of 157 consecutive patients diagnosed with sepsis were retrospectively included in this study. The systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte), the systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte), the aggregate index of systemic inflammation (AISI; neutrophil × platelet × monocyte/lymphocyte) and the IPI (C-reactive protein × neutrophil-to-lymphocyte ratio [NLR]/albumin) were calculated for all patients. Patients were divided into two groups: survivors (n = 81) and non-survivors (n = 76). Results: Non-survivor patients had significantly higher SII (p = 0.002), SIRI (p < 0.001), AISI (p = 0.002) and IPI (p < 0.001) than survivors. The AUC of the IPI was significantly higher than those of the SII (0.751 vs. 0.645; p = 0.010) and the AISI (0.751 vs. 0.648; p = 0.021) and tended to be higher than that of the SIRI (0.751 vs. 0.687; p = 0.091). Based on logistic regression analysis, the IPI was found to be an independent predictor of mortality (OR: 1.007, 95%CI: 1.002–1.012, p = 0.006). Conclusions: The IPI is a novel combined inflammatory marker that can be easily obtained from laboratory parameters. We determined that the IPI had moderately higher discriminatory ability than the SII and the AISI in patients with sepsis, which indicates that it may be used for risk stratification in this population.