Objective: The aim of this study was to evaluate the demographic and clinical data from pediatric consultations referred to the pain clinic and to identify the causes of pain and treatment methods used in children.
Method: All pediatric consultations referred to the Algology Clinic of Ankara City Hospital between January 1, 2019, and May 30, 2021, were retrospectively evaluated in terms of demographic and clinical characteristics, compliance with consultation recommendations, and changes in visual analog scale scores before and after consultation.
Results: The study included 74 patients. Of the patients, 44 (59.5%) were male and 30 (40.5%) were female. The mean age of the patients was 12.2 ± 5.2 years. All patients were followed for cancer diagnosis and treatment. Solid tumors and hematologic malignancies were present in 55.4% and 44.6% of the patients, respectively. More than half of the patients had localized pain, most often in the trunk (35%), and 24.3% had generalized pain. There was a significant difference in the mean visual analog scale (VAS) scores at the time of and after the consultation (p<0.001). There was no statistically significant difference in VAS scores between genders. In the post-consultation evaluation, 43 (58.1%) of the patients experienced a decrease in VAS values of 30% or more. There was a statistically significant decrease in VAS scores for patients who complied with treatment recommendations during the consultation compared to those who did not (p<0.001). There was no statistically significant correlation between gender, local or generalized pain, or cancer type with decrease in VAS scores.
Conclusion: In children suffering from chronic cancer pain, favorable outcomes can be achieved with appropriate medical treatment if adequate treatment compliance can be ensured.

Objective: Every two minutes, a pregnancy-related death occurs worldwide, with one-third of these deaths being associated with bleeding. Tranexamic acid (TA) is an antifibrinolytic agent used to limit bleeding. We aimed to evaluate the efficacy of TA on bleeding by retrospectively reviewing the records of patients who underwent cesarean section (C/S) under general or spinal anesthesia; comparing groups administered different doses of TA within the same anesthetic method, as well as cases managed with different anesthetic techniques despite receiving identical TA doses.
Method: The study included 300 patients in total by retrospectively analyzing C/S procedures carried out under spinal and general anesthesia. Each anesthesia method was analyzed separately to assess the effects different doses of TA on bleeding, bleeding parameters, transfusion requirements, and intraoperative fluid administration. Additionally, groups administered the same dose of TA but different anesthetic methods were compared among themselves.
Results: In our study, the preoperative and postoperative hemoglobin (Hb) and hematocrit (Hct) values and the amount of bleeding in patients who received 1000 mg of TA in the general anesthesia group were statistically significantly lower than in patients in the other groups. In the spinal anesthesia group that received 1000 mg of TA, no significant difference was observed in Hb and Hct levels, but the amount of bleeding was found to be lower. Transfusion requirements did not differ significantly between the various TA dose groups across both anesthesia techniques.
Conclusion: Our study demonstrated that TA significantly reduces bleeding, with the most effective reduction observed at a 1000 mg dose. When comparing both anesthesia methods, we found that TA was more effective in reducing bleeding in patients who underwent general anesthesia. Based on these results, we conclude that TA has a particularly positive impact on the clinical outcomes of pregnant women receiving general anesthesia for C/S procedures.

Objective: Laparoscopic procedures are widely preferred in gallbladder surgery; however, effective postoperative analgesia remains an important clinical concern. This study was designed to evaluate whether bilateral ultrasound-guided anterior quadratus lumborum block (QLB) offers improved postoperative pain control compared with intravenous (IV) paracetamol in patients undergoing laparoscopic cholecystectomy.
Method: Sixty adult patients scheduled for elective laparoscopic cholecystectomy and meeting the inclusion criteria were retrospectively analyzed. Patients were allocated into two groups: those receiving anterior QLB (n=29) and those treated with IV paracetamol alone (n=31). Postoperative outcomes assessed during the first 24 hours included visual analog scale (VAS) pain scores, total opioid consumption, Richmond Agitation–Sedation Scale (RASS) scores, and the incidence of nausea, vomiting, and shoulder pain.
Results: Pain intensity and opioid requirements measured at 30 minutes, and at 2, 4, 12, and 24 hours after surgery were consistently lower in the QLB group than in the IV paracetamol group (p<0.001 at all evaluated time points). In addition, patients who received anterior QLB demonstrated a calmer and more stable emergence from anesthesia, as reflected by significantly lower RASS scores (p<0.001). The frequency of postoperative nausea, vomiting, and shoulder pain did not differ significantly between the groups.
Conclusion: Bilateral anterior quadratus lumborum block provides more effective postoperative analgesia than intravenous paracetamol in laparoscopic cholecystectomy and is associated with a marked reduction in opioid consumption. These findings support the use of anterior QLB as a valuable component of multimodal analgesia strategies for this surgical population.

Objective: The aim of this study was to compare the efficacy of Near Infrared Spectroscopy (NIRS), Perfusion Index (PI), and Noninvasive Total Hemoglobin Monitoring (SpHb) methods in evaluating block quality in lower extremity surgeries performed with combined lumbar plexus and sciatic nerve block.
Method: The study included 50 orthopedic patients aged 18–65 years undergoing lower extremity surgery. Vital signs (systolic and diastolic blood pressure, heart rate, and oxygen saturation), tissue oxygen saturation (rSO₂), PI, and SpHb values were recorded 5 minutes before, immediately after, and every 5 minutes up to 25 minutes following the block. Data were compared between blocked and unblocked extremities.
Results: Heart rate and oxygen saturation showed no significant change (p>0.05). Mean arterial pressure increased significantly (p=0.001), but this was not clinically relevant. A significant progressive increase in PI was observed in the blocked limb (p=0.001), confirming its value as an early and objective indicator of block success. In contrast, rSO₂ and SpHb did not demonstrate significant changes (p>0.05), suggesting limited sensitivity of these parameters in detecting block efficacy in lower extremity surgery.
Conclusion: Perfusion index appears to be a reliable and effective parameter for assessing block success in lower extremity surgeries. However, the limited predictive value of rSO₂ and SpHb in this context indicates that further prospective studies are needed to clarify their potential role.

Amaç: Yüz maskesi ventilasyonu, kesin hava yolunu sağlamadan önce tüm hastalarda ventilasyon yöntemidir. Hava yolu muayeneleri, zor maske ventilasyonunu (ZMV) veya laringoskopiyi tahmin etmek için öykü ve fiziksel muayenelere dayanır. Ultrasonun hızlı ve yatak başında uygulanabilen bir araç olması, havayolu yönetiminde giderek daha fazla popülerlik kazanmasına yol açmıştır; hasta başı ultrasonografi, havayolunun değerlendirilmesinde klinik bir araç olarak kullanılabilmektedir. Standart anestezi indüksiyonu sonrasında, ZMV ile ultrasonografik olarak ölçülen lingual arterler arası mesafe (LAM), dil kalınlığı (DK) ve lateral farengeal duvar kalınlığı (LFDK) arasındaki ilişkiyi değerlendirmeyi amaçladık.
Yöntem: Genel anestezi gerektiren elektif cerrahi için planlanan 264 hasta dahil edildi. Ameliyat öncesi bekleme alanında, LAM, DK ve LFDK’nin ultrasonografik değerlendirmesi ölçüldü. Standart indüksiyon sonrasında maske ventilasyonu uygulandı ve Han sınıflamasına göre derecelendirildi. Han sınıflamasına göre derecesi 2 ve üzeri olan maske ventilasyonu, zor olarak kabul edildi.
Bulgular: Toplam 264 hastanın 230’unda (%87,1) maske ventilasyonu kolay iken, 34 hastada (%12,9) ZMV gözlendi. İndüksiyon öncesi LAM değerinin 2,52 cm’nin üzerinde olması %47,06 duyarlılık ve %76,09 özgüllük göstermiş olup, alıcı operatör karakteristiği altında kalan alan (AUROC) değeri 0,641 ve p değeri 0,004 olarak saptandı. Dil kalınlığı değerinin 4,67 cm’nin üzerinde olması ise %44,12 duyarlılık ve %83,04 özgüllük ile AUROC 0,636 ve p<0,001 olarak bulundu. Hem LAM hem de DK, ZMV için öngördürücü olup, LAM’ın öngörü gücü DK’ye kıyasla daha yüksekti.
Sonuç: Lingual arterler arasındaki mesafenin 2,52 cm’nin üzerinde olması ve DK’nin 4,67 cm’nin üzerinde olması, ZMV için prediktiftir.

Objective: This study aimed to evaluate the neuroprotective effect of normobaric hyperoxia preconditioning on postoperative cognitive dysfunction following repeated sevoflurane anesthesia in a rat model.
Method: Twenty-four male Sprague-Dawley rats were randomly assigned to four groups (n=6/group): control, normobaric hyperoxia, sevoflurane, and normobaric hyperoxia followed by sevoflurane. Rats in the hyperoxia groups received 95% oxygen for 3 hours on alternate days for 1 week. Rats in the sevoflurane groups were exposed to 2.9% sevoflurane for 2 hours daily over 5 consecutive days. Cognitive performance was assessed using the Morris Water Maze test. Hippocampal tissues were examined histopathologically for signs of neuronal damage and apoptosis.
Results: The sevoflurane group exhibited significantly impaired learning and memory performance compared to the control group (p<0.01). Rats preconditioned with hyperoxia before sevoflurane exposure showed significantly improved escape latency and platform crossing performance compared to the sevoflurane-only group (p<0.05). Histopathological analysis revealed marked hippocampal neuronal degeneration in the sevoflurane-only group, which was substantially reduced in the combined treatment group. No significant neuronal damage was observed in the control or hyperoxia-only groups.
Conclusion: Preconditioning with normobaric hyperoxia may mitigate hippocampal neuronal injury and cognitive dysfunction associated with repeated sevoflurane exposure. These preliminary findings highlight the potential neuroprotective effect of hyperoxic preconditioning and support the need for further research with larger cohorts and molecular-level validation.

Objective: Tracheoesophageal fistula (TEF) is a congenital anomaly necessitating early surgical intervention. Enhanced recovery after surgery - ERAS principles are increasingly applied in neonatal surgical care to improve outcomes. The choice of anesthetic induction agent plays a pivotal role in determining recovery quality and duration.
Method: This was a randomized, double-blind, prospective clinical trial involving 60 neonates under 10 days old undergoing TEF repair. Subjects were assigned to receive either propofol (1.5 mg kg⁻¹) or ketamine (1 mg kg⁻¹) as induction agents, with standard maintenance anesthesia and postoperative care. The primary outcome was recovery score at extubation using the Modified Steward Score. Secondary outcomes included duration of mechanical ventilation, postoperative pain using the neonatal pain agitation and sedation scale, and hemodynamic stability.
Results: Recovery scores were significantly higher in the propofol group (mean 4.86 ± 0.89) compared to the ketamine group (mean 3.09 ± 1.01) (p<0.001). The mean duration of mechanical ventilation was shorter in the propofol group (18.00 ± 3.70 h) than in the ketamine group (21.45 ± 2.55 h), (p=0.001). Postoperative pain scores were consistently lower in the ketamine group at all time intervals, with significant differences (p<0.05). Hemodynamic parameters were more stable and elevated in the ketamine group post-induction.
Conclusion: Propofol is associated with faster recovery and reduced ventilation time, whereas ketamine offers superior postoperative analgesia and hemodynamic stability. Anesthetic choice should be individualized based on surgical and patient-specific needs.

Objective: Fat embolism syndrome (FES) is a relatively infrequent, yet potentially life-threatening complication associated with long bone fractures, exhibiting an incidence of approximately 2-5%. This study investigates the utilization of corticosteroids as a prophylactic measure to reduce the occurrence of FES in such cases.
Method: This retrospective, single-centre study was conducted at the Trauma University Hospital in Tirana, Albania, from January 2011 to January 2012. The study encompassed a cohort of 232 patients diagnosed with fractures of the lower extremities. The primary goal was to evaluate the prophylactic role of corticosteroids, specifically methylprednisolone at a dosage of 10 mg kg-1, in the development of FES. Patients were dichotomized into two groups: Group 1, consisting of 116 patients administered corticosteroid prophylaxis, and Group 2, encompassing 116 patients without corticosteroid prophylaxis for FES.
Results: Within Group 1, the incidence of FES was recorded at 2.58%, with an absence of severe respiratory manifestations. In contrast, Group 2 exhibited a FES incidence of 11.20%, out of which 6.03% necessitated intensive care unit respiratory support. The prevalence of FES was significantly lower in Group 1, subjected to corticosteroid prophylaxis, in comparison to Group 2, where no such prophylaxis was administered (p<0.05). Group 2 patients also displayed heightened instances of pulmonary complications.
Conclusion: Administration of corticosteroid prophylaxis in cases of lower extremity fractures was correlated with a notable reduction in FES incidence. Furthermore, this intervention demonstrated its merit by effectively attenuating pulmonary complications associated with FES.

Hypopharyngeal carcinomas often present at an advanced stage, causing dysphagia, malnutrition, and difficult airway management. In these patients, alternative anesthetic methods for surgical gastrostomy may be required, as endoscopic gastrostomy can fail due to tumor-related anatomical changes and general anesthesia carries a high airway risk. This case report presents the use of a bilateral subcostal transversus abdominis plane (TAP) block and multimodal analgesia for open surgical gastrostomy in a 70-year-old male patient with advanced hypopharyngeal carcinoma and a difficult airway. In the patient for whom the endoscopic procedure failed due to laryngeal edema, fibrosis, and hypopharyngeal stenosis, a subcostal TAP block was performed under ultrasound guidance with 15 mL of 0.25% bupivacaine on each side. Anesthesia was achieved in the T6-T10 dermatomes. The procedure was completed uneventfully under sedation with intravenous low dose ketamine, midazolam, and fentanyl. The patient’s hemodynamics remained stable, and his postoperative pain was assessed as 2-3/10 on the visual analog scale, with no need for rescue analgesics. The patient was discharged on the second postoperative day. In conclusion, subcostal TAP block with multimodal analgesia can reduce perioperative risks by offering a safe and effective anesthetic alternative for surgical gastrostomy in patients with hypopharyngeal cancer and a difficult airway.

The right internal jugular vein is the standard route for central venous catheterization. However, anatomical anomalies such as masses may necessitate alternative access. In this case, catheter placement via the left internal jugular vein was required due to compression of the right jugular vein by a thyroid mass. Following insertion, the absence of blood return raised concerns regarding malposition. While chest X-ray and computed tomography were inconclusive in identifying the catheter tip location, definitive confirmation was achieved through echocardiographic evaluation. Transesophageal echocardiography (TEE) with agitated saline accurately revealed extravascular placement within the pleural space. Subsequently, the catheter was safely removed under transthoracic echocardiographic guidance without complications. This case underscores the superior diagnostic accuracy and procedural guidance offered by echocardiography—particularly TEE—over conventional imaging modalities in the detection and management of catheter-related complications.