Purpose: The purpose of this study was to evaluate the effects of a bougie insertion on the endotracheal cuff pressure and incidence of sore throat in sleeve gastrectomies. Materials and Methods: In this study, 40 patients scheduled for sleeve gastrectomies were enrolled and randomly allocated into two groups. The endotracheal tube (ETT) cuff pressures were set to 25 mmHg after intubation and the pressures were continuously monitored. In Group 1, the ETT cuff pressure was adjusted to 25 mmHg after the insertion of the bougie device, whereas in Group 2, the cuff pressure was not manipulated after the insertion of the bougie. The peak airway pressures and cuff pressures were recorded every 5 min in both groups, and the bougie insertion time, bougie duration, laryngoscopic and bougie complications, and surgery durations were noted. The incidence of postoperative sore throat was assessed and classified as none, mild, moderate, and severe. Results: There were no differences between the groups in the demographic variables, duration of surgery, peak airway pressure, or duration of bougie use. The bougie insertion time was at 28 ± 9 and 30 ± 10 min into the surgery in Groups 1 and 2, respectively. The cuff pressures were significantly higher in Group 2 at 20, 25, 30, and 35 min (p < 0.05), and the endotracheal cuff pressures exceeded 30 mmH₂O in nine patients in Group 2. The postoperative sore throat scores were significantly higher in Group 2 at the 30th minute and at the 2nd and 24th hours. Conclusion: The insertion of a bougie may increase the cuff pressure and exacerbate a postoperative sore throat. Continuous cuff pressure monitoring and readjusting the cuff pressure after the bougie insertion procedure may alleviate a postoperative sore throat in bariatric surgery.

The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2h, the patient had a generalized tonic-clonic seizure. The necessary treatment was given and 9h later with hemodynamic improvement, the patients' mental status improved. Bupropion may cause unusual behaviors such as delusions, paranoia, hallucinations, or confusion. The risk of seizure is strongly dose-dependent. We want to emphasize the importance of early gastric lavage and administration of activated charcoal.

Background/Objective: Patients who have undergone Billroth II gastrectomy may develop gastroparesis, hypomotility, and reflux esophagitis. These patients are at risk of aspiration of gastric contents into the lungs when subsequently sedated for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. The aim of this study was to compare conscious sedation and deep sedation in terms of pulmonary complications in this selected cohort. Methods: Patients who had previously undergone Billroth II surgery and underwent ERCP procedure with sedation for gallstones or biliary tract strictures in a tertiary hospital between January 2020 and September 2023 were studied. Patient records were retrospectively obtained from the hospital information system. All the patients were divided into two groups as conscious sedation (Group CS) and deep sedation (Group DS). The groups were compared statistically in terms of pulmonary complications. Results: A total of 63 ERCP procedures were performed on 28 patients who had undergone Billroth II gastrectomy. There were 37 procedures involving conscious sedation (Group CS) and 26 involving deep sedation (Group DS). No statistically significant difference was found regarding pulmonary aspiration (p = 0.297) and other respiratory complications such as laryngospasm or desaturation between the two groups. In Group DS, it was observed that vomiting incidence was higher (p = 0.012), and airway maneuver requirements were increased (p = 0.007). Conclusions: In patients who have undergone Billroth II gastrectomy, both conscious sedation and deep sedation techniques can be used effectively during ERCP procedures. The complication rates and patient outcomes of the two techniques are comparable. The occurrence of respiratory complications leading to adverse post-procedural outcomes requires careful monitoring and meticulous follow-up for these patients.

The effects of different body positions on the middle ear were reported in several studies, but there are no data about the effects on patients under general anesthesia. The aim of this study is to determine the effect of prone position on middle ear pressure (MEP) during general anesthesia without using nitrous oxide. Twenty patients under general anesthesia during prone position were included in the study. The performed anesthesia method was the same for all patients. Remifentanil was used for analgesia instead of nitrous oxide. MEPs were measured 5 times with a middle ear analyzer: before induction (BI), after intubation (AI), after turned to the prone position (PP1), at the end of the prone position (PP2), and after returned to the supine position (SP). Duration of prone position was also recorded. Of the 20 patients were 11 women and 9 men with a 49 ± 13 mean age. BI-AI, AI-PP1, PP1-PP2, and PP2-SP comparisons of both MEPs were statistically significant (P < 0.0001). Right mean MEPs were BI, -1 ± 23 daPa; AI, 41 ± 51 daPa; PP1, 124 ± 76 daPa; PP2, 152 ± 59 daPa; and SP, 63 ± 29 daPa; whereas left mean MEPs were BI, -24 ± 55 daPa; AI, 28 ± 34 daPa; PP1, 132 ± 67 daPa; PP2, 162 ± 48 daPa; and SP, 70 ± 89 daPa. Significant increases were detected at the start and continuation of the prone position. The mean duration of prone position was 98 ± 51 per minute. The significant MEP increases during the prone position under general anesthesia depend on a number of reasons. Among them are inhaler agents, pressure changes in mucosal blood vessels due to venous congestion, and the mastoid bone volume. Further researches are required to determine and explain the mechanisms of increase in MEP during prone position.

PurposePostoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV.MethodsSixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I – Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II – Only propofol and remifentanil was used during maintenance, III – Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV – Only desflurane and remifentanil was used during maintenance. They have been followed up for 24h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated.ResultsVAS scores were significantly lowest in group I (p=0.001–0.028). PNV incidence was significantly lowest in group I (p=0.026). PNV incidence was also lower in group III compared to group IV (p=0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p=0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p=0.001) however blood pressures were similar in all groups (p=0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p=0.024–0.03).ConclusionUsing esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV

Aims: The aim of this study was to evaluate the potential of Bard AI to provide patients with accurate and comprehensive information about spinal and general anaesthesia for knee-related surgeries, while also emphasizing the importance of physician oversight in interpreting AI-generated content.Methods: Bard AI was asked to generate responses to questions on spinal and general anaesthesia and evaluated their accuracy based on current guidelines and physician experience. The questions were designed to emulate a real conversation. Two authors evaluated the responses for accuracy and comprehensiveness at the patient level.Results: Some of the answers include a note emphasizing that the approach to each patient may differ. Generally, no major errors or misdirection were observed but specific questions, such as those on migraine, received answers deemed incomplete.Conclusion: Bard Google AI can be utilized as a complementary tool in doctor-patient consultations for preoperative education. However, the role of doctors remains indispensable, and it is important for patients to consult their doctors to have their questions addressed and alleviate their concerns.