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    Comparison of the effects of two different low-doses of isobaric bupivacaine on intraoperative hemodynamics under spinal anaesthesia during caesarean section: a randomized controlled trial
    (IMR Press Limited, 2023) Dostbil, Ayşenur; Atalay, Canan; İnce, İlker; Aksoy, Mehmet; Özmen, Özgur; Kasali, Kamber; Yapca, Ömer Erkan; Küçün, Tuğberk; Aksoy, Ayşe Nur; Şenocak, Gamze Nur Cimilli
    Background: The objective of this study was to conduct a randomized controlled trial in order to examine the hemodynamic impacts of two different doses of intrathecal isobaric bupivacaine (5 mg and 7 mg) when combined with 15 μg fentanyl in the context of patients undergoing caesarean section under combined spinal epidural anesthesia. Methods: Eighty patients with American Society of Anesthesiologists physical status I and II, aged between 16-50 years, who would undergo elective caesarean section under combined spinal epidural anaesthesia were randomly allocated to Group A and Group B (n = 40, for each group). Group A patients received a solution containing 5 mg isobaric bupivacaine + 15 μg fentanyl (1.3 mL), while Group B patients received a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl (1.7 mL) intrathecally. Incidences of hypotension, intraoperative systolic blood pressure, diastolic blood pressure, heart rate, motor block resolving time, and analgesia duration were recorded. Results: Group A had a substantially lower incidence of hypotension than Group B (p = 0.022). Patients in Group B had significantly lower systolic blood pressure values at the 6th, 8th, 10th, 12th, 14th, 15th, and 30th minutes of the surgery compared to Group A (p = 0.012, p = 0.014, p = 0.005, p = 0.016, p < 0,001, p = 0.002, and p = 0.011; respectively). Both groups had similar diastolic blood pressure and heart rate values during surgery (p > 0.05). The motor block resolving time and analgesia duration were longer in Group B compared to Group A (p < 0.001 for both). Two (5%) patients in Group A and ten (25%) patients in Group B experienced postoperative itching (p = 0.012). Conclusions: We concluded that combining 5 mg isobaric bupivacaine with 15 mcg of fentanyl administered intrathecally provides adequate anaesthesia while maintaining better hemodynamic stability in patients undergoing caesarean section.
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    Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis
    (2023) Qiu, Yuwei; Rivas, Eva; Tanios, Marianne; Sreedharan, Roshni; Mao, Guangmei; İnce, İlker; Salih, Ahmed; Saab, Remie; Devarajan, Jagan; Ruetzler, Kurt; Turan, Alparslan
    Background and objectives: Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. Methods: We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. Results: Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p = 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p = 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p = 0.002) than in winter. Conclusions: In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.
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    Intra-operative hypertension and myocardial injury and/or mortality and acute kidney injury after noncardiac surgery: A retrospective cohort analysis
    (European Journal of Anaesthesiology, 2022) Shimada, Tetsuya; Mascha, Edward J.; Yang, Dongsheng; Bravo, Mauro; Rivas, Eva; İnce, İlker; Turan, Alparslan; Sessler, Daniel I.
    Background: Whether intra-operative hypertension causes postoperative complications remains unclear. Objective: We sought to assess whether there is an absolute systolic hypertensive threshold associated with increased odds of a composite of postoperative myocardial injury and mortality, and acute kidney injury. Design: A retrospective cohort analysis using an electronic medical record registry. Setting: The Cleveland Clinic Main Campus, Cleveland, Ohio, USA, between January 2005 and December 2018. Patients: A total of 76 042 adults who had inpatient noncardiac surgery lasting at least an hour, creatinine recorded preoperatively and postoperatively, and had an available clinic blood pressure within 6 months before surgery. Main outcome measures: Univariable smoothing and multivariable logistic regression were used to estimate the probability of each outcome as a function of the highest intra-operative pressure for a cumulative 5, 10, or 30 min. We further assessed whether the relationships between intra-operative hypertension and each outcome depended on baseline systolic blood pressure. Results: The composite of myocardial injury and mortality was observed in 1.9%, and acute kidney injury in 4.5% of patients. After adjustment for confounders, there was little or no relationship between systolic pressure and either outcome over the range from 120 to 200 mmHg. There were also no obvious change points or thresholds above which odds of each outcome increased. And finally, there was no interaction with preoperative clinic blood pressure. Conclusions: There was no clinically meaningful relationship between intra-operative systolic pressure and the composite of myocardial injury and mortality, or acute kidney injury, over the range from 120 and 200 mmHg.
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    Intraperitoneal instillation versus wound infiltration for postoperative pain relief after cesarean delivery: A prospective, randomized, double-blind, placebo-controlled trial
    (2022) Dağaşan Çetin, Gözdenur; Dostbil, Ayşenur; Aksoy, Mehmet; Kaşali, Kamber; İnce, Ramazan; Kahramanlar, Agah Abdullah; Atalay, Canan; Topdağı Yılmaz, Emsal Pınar; İnce, İlker; Özkal, Miraç Selcen
    Aim: To compare local anesthetic wound infiltration with intraperitoneal instillation of local anesthetic for analgesia after cesarean section under spinal anesthesia. Methods: This study was conducted on 150 pregnant women undergoing elective cesarean section under spinal anesthesia. Spinal anesthesia was performed with 7 mg isobaric bupivacaine and 15 μcg fentanyl. The patients were randomized into three groups of 50 patients each: Group local anesthetic wound infiltration (LWI): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was administered subcutaneous wound infiltration at the end of surgery prior to skin closure and 20 ml saline was instilled into the uterine peritoneal area before fascia closure. Group intraperitoneal local anesthetic (IPLA): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was instilled into the uterine peritoneal area and 20 ml saline was administered subcutaneous wound infiltration. Group Placebo: 20 ml saline was instilled into the uterine peritoneal area and 20 ml saline was administered local subcutaneous wound infiltration. Pain scores at rest and on movement, total fentanyl consumption at 24 h, maternal satisfaction, and the time to first analgesic request were recorded. Results: No statistically significant difference was observed in the postoperative pain scores at rest at 2, 12, and 24 h (p = 0.314, 0.343, and 0.735, respectively) and on movement at 12 and 24 h (p = 0.318 and 0.642, respectively) between the groups. The pain scores on movement at 2 h were significantly lower in Group IPLA compared with Group Placebo (p = 0.047). There were no significant differences between the groups in terms of total fentanyl consumption and the time to first analgesic request. Conclusion: The use of intraperitoneal instillation of bupivacaine and lidocaine reduces early the pain score on movement in women undergoing cesarean section under spinal anesthesia.
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    The comparison of postoperative analgesic efficacy of ultrasound-guided paravertebral block and mid-point transverse process pleura block in mastectomy surgeries: A randomized study
    (Taylor & Francis, 2022) Kahramanlar, Agah Abdullah; Aksoy, Mehmet; İnce, İlker; Dostbil, Ayşenur; Karadeniz, Erdem
    PURPOSE/AIM OF THE STUDY The purpose of this triple-blind randomized study is to compare the postoperative analgesic efficacy of Mid-Point Transverse Process Pleura Block (MTP) and Paravertebral Block (PVB) in patients undergoing breast surgery. MATERIALS AND METHODS The study was retrospectively registered on ClinicalTrials.gov (NCT 05332028). A total of 64 patients undergoing unilateral simple mastectomy operation due to breast cancer were included in the study. Before the anesthesia procedure, participants were randomly assigned to one of two groups: Group 1: Participants undergoing PVB or Group 2: Participants undergoing MTP block. All block applications were performed using 20 mL of 0.25% bupivacaine. Routine general anesthesia protocol was performed on all patients. In the postanesthetic care unit, fentanyl infusion was given to all patients postoperatively via a patient-controlled analgesia device. Postoperative fentanyl consumption, time to the first request for analgesia, VAS score values at rest and in motion, and blocked dermatome areas were recorded. RESULTS Postoperative total opioid consumption, the number of patients given rescue analgesia, the time requiring postoperative supplemental analgesia, postoperative pain scores at rest and in motion, and blocked dermatome areas at both anterior and posterior lower and upper limits were not different between groups (p > 0.05, for all). CONCLUSIONS It was concluded that ultrasound-guided PVB and MTP blocks have similar postoperative analgesic efficacy in patients undergoing breast surgery. The MTP block may be preferred as an alternative to PVB for breast surgeries with less risk of complications.
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    Treatment approach in bilateral pulmonary hydatid cysts: analysis of 107 consecutive cases
    (Springer, 2024) Aydın, Yener; Ulaş, Ali Bilal; Kaşali, Kamber; Dostbil, Ayşenur; İnce, İlker
    Objective: Bilateral pulmonary involvement is observed in around 14% of cases of pulmonary hydatid cysts and the treatment can be challenging. This study evaluates the clinical characteristics and treatment strategies used for cases of bilateral pulmonary hydatid cysts. Materials and methods: A retrospective examination was conducted on 107 consecutive cases of bilateral pulmonary hydatid cysts treated in our clinic between January 2003 and December 2023. Results: Out of the 107 cases analyzed, 57 (53.3%) were male and 50 (46.7%) were female. Surgical intervention was performed for pulmonary hydatid cysts in 92 cases (86.0%), while medical treatment was prescribed for the remaining 15 cases (14.0%). Bilateral thoracotomies were consecutively conducted in 77 cases; in 11 cases, thoracotomy was carried out on one side and contralateral hydatid cysts were treated medically. Three cases underwent sternotomy, and one underwent bilateral thoracotomy during a single session. One case experienced postoperative hemorrhage, three cases had prolonged air leakage, two cases had empyema, one case had a wound infection, and one case had a recurrence of hydatid cyst. For bilaterally operated cases, albendazole treatment commenced after the second operation and was carried out in two 15-day cycles. Patients who declined, or were not eligible for surgery, were treated with albendazole for an extended period. Conclusions: Consecutive bilateral thoracotomy, followed by two cycles of albendazole therapy, is a highly effective treatment for patients with bilateral pulmonary hydatid cysts. In cases with widespread involvement, ruptured small cysts, or serious comorbidities, long-term medical treatment including albendazole administration may be applied.