Background/Objectives: Awake procedures performed under spinal anesthesia (SA) have been associated with reduced hospitalization, costs, and postoperative complications compared with general anesthesia (GA). Endocan, an endothelial cell-specific proteoglycan, serves as a biomarker of endothelial activation and vascular dysfunction and may reflect the differential vascular and immunomodulatory effects of anesthetic techniques. This prospective observational study aimed to compare perioperative changes in circulating endocan levels between patients undergoing surgery under GA and SA. Methods: Eighty adult patients (aged 18–65 years, ASA I–II) scheduled for elective surgery were included and assigned to GA (n = 42) or SA (n = 38) based on standard clinical indications. Serum endocan levels were measured preoperatively, at 6 h, and at 24 h postoperatively using an ELISA assay. Results: In the GA group, endocan levels increased significantly from baseline (304.5 ± 80.7 pg/mL) to 6 h (511.5 ± 88.7 pg/mL, p < 0.001), and although partially decreased by 24 h (427.5 ± 87.9 pg/mL, p < 0.001), remained above baseline. In the SA group, endocan rose from baseline (320.7 ± 72.5 pg/mL) to 6 h (415.2 ± 79.5 pg/mL, p < 0.001) but returned near baseline at 24 h (352.6 ± 84.7 pg/mL, p = 0.233). Conclusions: These findings suggest that while surgery induces endothelial activation in both groups, GA is associated with a more sustained endothelial response than SA.

Amaç: Vazovagal senkop arteriyel kan basıncının ve serebral kan akışının azalmasından kaynaklanan ani bilinç kaybıdır. Gereç ve Yöntem: ASA I-II, 18-45 yaş aralığında, elektif şartlarda spinal anestezi uygulanan 133 erkek hastanın anestezi kayıtları retrospektif olarak incelendi. Premedikasyon uygulanan ve uygulanmayan hastaların anestezi kayıtlarında yer alan hemodinamik veriler ve spinal anesteziye bağlı gelişen fenalaşma hissi, hipotansiyon, senkop ve asistoli kayıtları incelendi ve iki grup hastanın verileri istatistiksel olarak karşılaştırıldı. Verilerin analizinde bağımsız örneklem t test, mann-whitney u, ki-kare test, ki-kare test koşulları sağlanmadığında fischer test kullanıldı. Bulgular: Spinal anestezi öncesi midazolam kullanan grupta anksiyete oranı midazolam kullanmayan gruptan anlamlı olarak daha yüksekti (p0,05). Midazolam kullanılmayan grupta bradikardi, senkop, fenalaşma oranı midazolam kullanılan gruptan anlamlı (p<0,05) olarak daha yüksekti. Midazolam kullanılan grupta yatar pozisyon oranı midazolam kullanmayan gruptan anlamlı olarak daha düşüktü (p0,05). Sonuç: Sonuçlarımız spinal anestezi öncesi uygulanan midazolam sedasyonunun genç erkek hastalarda spinal blok sırasında görülen bradikardi, fenalaşma ve senkopu önlemede etkin olabildiğini göstermektedir.

Mukopolisakkaridoz (MPS), lizozomal depo hastalıkları grubuna ait, nadir görülen genetik bozuklukdur. Foramen magnum stenozu ve atlantooksipital dislokasyonu olan Mukopolisakkaridoz olgusunun anestezi ve cerrahi yönetimi dikkatli ve özverili olmalıdır. Standart monitörizasyon sonrası anestezi indüksiyonu yapıldı. Videolaringoskopi ile entübe edildi. Endotrakeal entübasyon, kapnograf değeri görülmesi ile doğrulandı. Sevofluran ile anestezi idamesi sağlandı. Verilen sıvı miktarı da 10 ml kg/st verildi. Sol femoral arterde invazif arter monitörizasyonu yapıldı. Sağ femoral venden santral kateter takıldı. Posterior oksipitoservikal enstürmantasyon yapıldı. Cerrahi ve/veya anesteziye bağlı herhangi bir komplikasyon gelişmedi ve sorunsuz olarak ekstübe olarak kontrol ve yakın takip ve tedavi amaçlı yoğun bakıma alındı. MPS hastalarında entübasyon ve genel anestezi yönetimi zorlayıcı olabilir. Havayolu yönetimi zor olduğundan, cerrahi ekip ile anestezi ekibinin yakın iş birliği yapması önemlidir. En uygun yaklaşım, mümkünse fiberoptik entübasyon veya video laringoskopi gibi tekniklerin kullanılmasıdır. Mucopolysaccharidosis (MPS) is a rare genetic disorder belonging to the group of lysosomal storage diseases. The anesthesia and surgical management of a Mucopolysaccharidosis case with foramen magnum stenosis and atlantooccipital dislocation should be careful and dedicated. Anesthesia induction was performed after standard monitoring. He was intubated with video laryngoscopy. Endotracheal intubation was confirmed by capnography values. Anesthesia was maintained with sevoflurane. The amount of fluid administered was also 10 ml kg/hr. Invasive arterial monitoring was performed in the left femoral artery. A central catheter was inserted from the right femoral vein. Posterior occipitocervical instrumentation was performed. No complications related to surgery and/or anesthesia developed and he was extubated without any problems and taken to the intensive care unit for control and close follow-up and treatment. Intubation and general anesthesia management can be challenging in MPS patients. Since airway management is difficult, close cooperation between the surgical team and the anesthesia team is important. The most appropriate approach is to use techniques such as fiberoptic intubation or video laryngoscopy, if available.

Anesthesia and surgical stress may produce distinct neuronal and metabolic responses, but comparative data on perioperative biomarker trajectories after general and spinal anesthesia remain limited. This prospective observational study aimed to compare circulating neuron-specific enolase (NSE), adiponectin, and visinin-like protein-1 (VSNL1) in adults undergoing elective surgery under general anesthesia (GA) or spinal anesthesia (SA). Ninety-seven patients (GA, n = 52; SA, n = 45) underwent serum sampling preoperatively and at 6 and 24 hours postoperatively, and biomarker concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Longitudinal associations were assessed using linear mixed-effects models adjusted for age, body mass index (BMI), operation duration, and surgical procedure type, with additional baseline-adjusted analyses for adiponectin. NSE increased in both groups but rose less in the SA group than in the GA group at 6 hours (adjusted interaction estimate, −7.765 ng/mL; p < 0.001) and 24 hours (−4.005 ng/mL; p < 0.001). Adiponectin decreased postoperatively, but group-by-time interactions were not significant, and baseline-adjusted analyses showed no significant association between anesthesia modality and adiponectin at either postoperative time point. VSNL1 increased over time; the group-by-time interaction was not significant at 6 hours but was significant at 24 hours (estimate, 0.635 ng/mL; p < 0.001), indicating a differential late trajectory. Perioperative biomarker trajectories differed between GA and SA, most consistently for NSE. However, nonrandom anesthesia assignment, substantial differences in surgical case mix and operation duration, and the absence of neurocognitive outcome assessment preclude causal or clinical interpretation. These findings should be regarded as exploratory adjusted associations and validated in larger, more homogeneous surgical cohorts.

Background: Postoperative pain management in bariatric surgery remains challenging, particularly in patients with obesity-related comorbidities that limit opioid use. Ultrasound-guided regional anesthesia techniques are therefore essential components of multimodal analgesia. Among these, the transversus abdominis plane (TAP) block and the erector spinae plane (ESP) block are commonly used, yet comparative data in bariatric surgery are limited. Methods: This retrospective observational study included adult patients who underwent elective laparoscopic sleeve gastrectomy and received either an ultrasound-guided TAP block or ESP block as part of postoperative analgesia. All patients received standardized general anesthesia and multimodal analgesia. Postoperative pain was assessed using the Visual Analog Scale and analyzed as categorical pain distributions at predefined time points. Perioperative hemodynamic parameters, time to first rescue analgesia, and postoperative adverse events were also evaluated. Results: A total of 64 patients were analyzed (TAP group, n = 30; ESP group, n = 34). Demographic characteristics, intraoperative variables, and perioperative hemodynamic parameters were comparable between groups. The proportion of pain-free patients was significantly higher in the ESP group at postoperative 2 hours, whereas pain distribution at later time points (6–48 hours) was similar between groups. Time to first rescue analgesia and the incidence of postoperative adverse events did not differ significantly. Conclusions: Both TAP and ESP blocks provided effective and safe postoperative analgesia following laparoscopic bariatric surgery. The ESP block was associated with superior early postoperative pain control, while overall analgesic efficacy and safety profiles were comparable between techniques. ESP block may be preferentially considered when enhanced early postoperative analgesia is desired.