Peripheral nerve blocks have brought a new perspective to regional anesthesia following the use of neuraxial blocks. The fact that they can be administered for anesthetic and/or analgesic purposes in many situations where neuraxial blocks are contraindicated has led to a marked increase in their use. With the integration of ultrasound into routine anesthetic practice, their use has become widespread not only in adult patients but also in the paediatric age group, thanks to safe procedures with high success rates. Although they are performed with the aid of nerve monitoring techniques and monitors alongside ultrasound, it is evident that complications encountered in various systems have not been completely eliminated. Complications affecting the neurological system constitute the group that causes the most concern among clinicians. Numerous factors related to anesthesia, surgery and the patient play a role in the development of these complications. Therefore, the combined assessment of all these factors is the most significant factor influencing early diagnosis, adequate treatment and, consequently, improved prognosis.
The aim of this review is to comprehensively discuss the pathophysiological and aetiological factors underlying neurological complications that may arise following a peripheral nerve block, and to offer a new perspective on strategies to prevent complications through safer regional anesthesia practices.

Objective: This prospective randomized parallel-group study compared sevoflurane consumption in pediatric patients undergoing general anesthesia with high initial concentration and gradual induction techniques in pediatric patients undergoing general anesthesia. The primary objective was to measure the volume of sevoflurane used until loss of eyelash reflex (V-LOER). Secondary objectives included time to loss of eyelash reflex (T-LOER), time to intravenous (IV) cannulation, volume of sevoflurane used until IV cannulation, end-tidal sevoflurane at LOER (EtSevo-LOER) end-tidal sevoflurane at IV cannulation (EtSevo-IV) concentration, hemodynamic changes and induction-related complications.
Method: Seventy children aged 2–8 years were randomized into two groups. Group A received high initial concentration of 8% sevoflurane in 6 L min⁻¹ oxygen from the onset, while Group B underwent incremental sevoflurane induction, starting at 1% and increasing by 1% every 10 seconds until 8% was reached. Sevoflurane consumption was measured using agent monitoring system of GE Aisys CS² anesthesia workstation. The T-LOER and time for IV cannulation, EtSevo-LOER and EtSevo-IV, hemodynamic parameters, and complications were statistically analyzed.
Results: Group A required lesser V-LOER (1.88±0.41 mL) than group B (2.91±1.40 mL). Group A required shorter time T-LOER (47.11±10.13 seconds) compared to group B (87.69±35.02 seconds). Sevoflurane consumption till IV cannulation was lower in group A compared to group B although not statistically significant. The EtSevo-LOER was similar in both groups. The EtSevo-IV cannulation was lower in group B.
Conclusion: High initial concentration induction of sevoflurane achieves faster induction at lower agent consumption compared to incremental induction technique of general anesthesia in pediatric patients.

Objective: This study aimed to compare intraoperative mechanical power (MP) between patients with obesity and patients without obesity undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Mechanical power reflects the ventilatory energy load and may influence postoperative pulmonary complications (PPCs). In the current study, we hypothesise that patients with obesity would be associated with significantly higher MP values.
Method: This retrospective study included male patients who underwent elective RALRP between January 2023 and June 2023. Obesity was classified according to World Health Organization criteria. The intraoperative data included measurements taken at three specific time points: 10 minutes after inducing anesthesia (T1), 10 minutes after establishing pneumoperitoneum (T2), and 10 minutes after placing the patient in the Trendelenburg position (T3). The primary outcome of this study is the measurement of intraoperative MP at T3.
Results: A total of 56 patients’ data were included in the analysis. The primary outcome, MP at T3, was 13.7 J min⁻¹ in the group with obesity and 12 J min⁻¹ in the group without obesity (p = 0.001). At the other time points, MP, peak inspiratory pressure, and driving pressures were also significantly higher in the group with obesity. Overall PPC incidence was 19.5%, with 38.1% in the group with obesity and 8.6% in the group without obesity.
Conclusion: During RALRP, MP and airway pressures were significantly higher in patients with obesity. Although complications were more frequent in this group, the majority were mild, and there were no significant differences in intensive care unit or overall hospital stay between the groups.

Objective: This study aimed to compare the sedation efficacy, adverse effect profile, incidence of lower extremity movements, and surgeon and patient satisfaction across three different ketamine–propofol (ketofol) ratios in short gynecological procedures.
Method: In this prospective, randomized, double-blinded trial, 90 female patients aged 18–65 years, classified as ASA I–II and scheduled for elective gynecological procedures lasting ≤30 minutes, were included. Participants were randomly assigned to receive ketofol at a ratio of 1: 1 (Group 1), 1: 2 (Group 2), or 1: 3 (Group 3). Sedation depth was assessed using the Ramsay Sedation Score (RSS). The primary outcomes were the incidence of involuntary lower extremity movement and surgeon satisfaction. Secondary outcomes included patient satisfaction, time to achieve RSS > 4, recovery time, time to Modified Aldrete Score (MAS) ≥ 9, and adverse events.
Results: Surgeon and patient satisfaction scores were significantly higher in Groups 2 and 3 compared to Group 1. Although the incidence of lower extremity movement did not differ significantly between groups, it was lowest in Group 3 (16.7%). Time to achieve RSS > 4 was significantly longer in Group 1. The total volume of administered drugs was significantly lower in Group 3. No significant differences were observed in recovery time or time to MAS ≥ 9 among the groups. However, desaturation rates and the need for chin lift maneuvers were significantly higher in Group 3.
Conclusion: The 1: 2 ketofol ratio demonstrated an optimal balance between sedation quality and respiratory safety, making it a favorable choice for short gynecological procedures.

Objective: Total hip arthroplasty (THA), a commonly performed major surgical procedure, is associated with significant postoperative pain and epidural analgesia is an effective method for postoperative pain management. Inflammation is known to play a role in the development and progression of postoperative pain. Despite reports of the use of neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker in various diseases, in-depth investigations of the impact of NLR on postoperative pain associated with acute inflammation are limited. While recent studies on NLR have increased, data on the association of preoperative NLR with postoperative pain and outcomes in THA remain scarce.
Method: We retrospectively reviewed the medical and anesthesia records of 81 patients who underwent THA under general anesthesia with epidural catheter. For each patient, we recorded the preoperative NLR, demographic information, comorbidity status, length of hospital stay, amount of intraoperative blood transfusion, occurrence of intraoperative hypotension, analgesic consumption, postoperative complications, and pain level. The patients were stratified into two groups according to their NLRs, based on a threshold NLR of 4.
Results: We found statistically significantly higher 9, 12, 18, and 24 h Visual Analog Score (VAS) scores in the NLR>4 group than in the NLR≤4 group (p<0.05). The additional local anesthetic administration rates at 9, 12, 18, and 24 h were also significantly higher in the NLR>4 group (p<0.05).
Conclusion: The measurement of preoperative NLR in patients indicated for total hip arthroplasty can be considered an objective method for predicting postoperative pain and may facilitate preoperative analgesic planning.

Objective: Transforaminal lumbar epidural steroid injection (TFESI) has been extensively used for treating lumbar radiculopathies. Intradiscal platelet rich plasma (PRP) is a novel treatment modality in patients of lumbar degenerative disc diseases (LDDD). We aimed to compare TFESI alone and with PRP in patients with LDDD with radicular pain.
Method: This was a prospective, randomized, single centre interventional study. After obtaining institute ethical committee clearance and written informed consent, 40 patients aged between 18 to 65 years, with LDDD and radicular pain were randomly allocated in 2 groups of 20 each: Group S and group P. Both groups received fluoroscopy guided TFESI triamcinolone 20 mg in 2 ml of 0.5% bupivacaine at the corresponding level. The group P additionally given intradiscal injection of 3 ml of autologous PRP at the same level. The primary outcome was assessment of pain relief by change in the numeric rating scale (NRS) score at 3 months. Secondary outcomes assessed were NRS after procedure and at 1-month, modified Oswestry disability index (MODI) and complications of procedures.
Results: At three months, group P had a mean decrease in NRS of 3.8 ± 0.69 vs 2.75 ± 0.63 in group S (p<0.0001). The decrease in NRS after treatment was 4.55 ± 0.6 and 3.35 ± 0.74, p<0.0001 and at one month, 4.1 ± 0.64 and 3.1 ± 0.78, p=0.0001, respectively, in groups P and S. The decrease in MODI was also significantly lower in group P compared to S (at 1 month 32.5 ± 3.66 vs 20.9 ± 4.96 and at 3 months 31.4 ± 4.05 vs 19.7 ± 5.36, p<0.0001). No serious complications were reported in either of the groups.
Conclusion: Addition of intradiscal PRP to TFESI leads to better pain relief and disability improvement in patients with LDDD in comparison to TFESI alone.

Objective: Rapid postoperative recovery is of great importance in children who undergo elective surgery, but the complications encountered in the process of recurarization in these cases are crucial. The present study aims to compare the effects of sugammadex and neostigmine on the reversal of neuromuscular block and recovery in infants.
Method: A total of 50 patients aged between 1 month and 12 months, American Society of Anesthesiologists (ASA) I-II class, who were to undergo elective operation were included in the study. Patients under general anesthesia were administered rocuronium IV at induction and monitored with train of four (TOF). At the end of surgery, 2 mg kg⁻¹ sugammadex was administered to patients in sugammadex group (Group S) and 0.05 mg kg⁻¹ neostigmine + 0.02 mg kg⁻¹ atropine to patients in neostigmine group (Group N). Intraoperative and postoperative hemodynamic changes, extubation times, time to reach TOF 90%, recovery times, and complications were recorded.
Results: The time of TOF 90%, onset of spontaneous respiration, and extubation times after antidote administration were found to be significantly lower in group S. No significant difference was found between the groups in postoperative complications.
Conclusion: In the present study conducted in infants, in Group S, the use of sugammadex as an antidote provided both rapid reversal compared to neostigmine, and similar adverse effects were observed, which is consistent with the literature.

Objective: Central venous catheterization (CVC) is a frequently conducted in anesthesia and intensive care environmets. This study aims to assess CVC procedures performed using either ultrasound (US) guidance or palpation,focusing on metrics such as puncture time, first-attempt success, overall success rate and the number of attempts.
Method: This prospective, observational, controlled study comprised 52 patients, who were allocated into two groups: US group (CVC group with US guidance) and P group (CVC group with palpation). The clinical characteristics and demographic data of the patients were recorded. The two groups were compared in terms of puncture time, first-attempt success, success rate, and number of attempts.
Results: The demographic data and clinical characteristics of the patients were similar between the groups. No difference was found between the groups in terms of internal jugular vein diameter. The number of successful first-attempt cannulations was 23 (88.5%) in the US group and 17 (65.4%) in the P group with this difference being statistically significant (p = 0.013). The puncture time was shorter in the US group compared to the P group (p = 0.015), and the number of successful cannulations was higher. There were 0 and 2 unsuccessful cannulations in the US group and P group, respectively. Although there was no statistical difference between the two groups in terms of the number of attempts, it was observed that US guidance showed success with fewer attempts.
Conclusion: This study demonstrates that CVC performed under US guidance provides shorter procedure time, higher first-attempt success rate, and lower number of attempts compared to the palpation method. It is believed that the use of US will reduce the number of invasive procedures, shorten the procedure time, and increase patient satisfaction.

Objective: Elevated body mass index (BMI) complicates nerve block procedures and exacerbates postoperative pain. This study evaluated the association between BMI and pain outcomes in lumbar disc herniation (LDH) surgery.
Method: This prospective observational study included 75, ASA I-III patients undergoing LDH surgery. Patients were assigned to three groups based on their BMI: Group-I (18-24.9 kg m⁻²), Group-II (25-29.9 kg m⁻²), and Group-III (30-40 kg m⁻²). An erector spinae plane block was performed under ultrasound guidance at the lumbar transverse process level (15 mL of 0.25% bupivacaine per side). Compared parameters included age, BMI, gender, perioperative complications, anesthesia and surgery duration, postoperative pain scores (Visual Analog Scale; VAS), and additional analgesic consumption.
Results: A total of 75 patients were included. In Group-III, remifentanil consumption, block duration, failed attempts, and additional analgesia were significantly higher than in Group-I (p < 0.05). VAS pain scores differed significantly among the three groups at all assessed postoperative time points (all p < 0.001). Group-II and Group-III had significantly higher VAS-Rest (VAS-R) and VAS-Cough (VAS-C) scores at the 1ˢᵗ, 2ⁿᵈ, 6ᵗʰ, 12ᵗʰ, and 24ᵗʰ hours compared with Group-I. Similarly, VAS-R and VAS-C scores at the 1ˢᵗ, 6ᵗʰ, 12ᵗʰ, and 24ᵗʰ hours were significantly higher in Group-III than in Group-II. Additional analgesia was required in 35 patients (46.7%), significantly more frequent in obese patients (Group-III) (72%).
Conclusion: Higher BMI was associated with elevated pain scores, greater analgesic requirements, increased remifentanil consumption, more failed attempts, and prolonged block times. Obese patients should therefore be evaluated more carefully for postoperative pain management.

Objective: Spinal anesthesia is widely used for lower limb surgeries because of its rapid and effective onset; however, its postoperative duration is limited. Clonidine and dexmedetomidine are used as adjuvants to enhance and prolong the duration of spinal anesthesia. This study aimed to compare the effects of intravenous clonidine and dexmedetomidine as premedication for spinal anesthesia using 0.5% hyperbaric levobupivacaine in lower limb orthopaedic surgeries.
Method: A prospective, randomised, controlled study was conducted on 100 adult patients undergoing planned lower limb orthopaedic surgeries. Patients were randomly divided into two groups receiving either intravenous clonidine or dexmedetomidine before spinal anesthesia. The parameters assessed included the onset and duration of the block, sedation levels, pain scores, and side effects.
Results: Dexmedetomidine produced a faster onset of sensory (3.45±0.84 min) and motor block (4.97±0.69 min) than clonidine. It also provided longer pain relief, with consistently lower pain scores over 24 h, the lowest being 2.47±0.90 at 4 h (p < 0.05). Sedation was deeper with dexmedetomidine, with higher Ramsay Sedation Scores throughout, peaking at 60 min (p < 0.0001). Heart rate (HR) and blood pressure remained stable in both groups, although HR was consistently lower in the dexmedetomidine group (p < 0.05), and mean arterial pressure was significantly reduced after dural puncture (p < 0.05). Hypotension occurred in 36% of the patients in both groups, whereas bradycardia occurred in 26% of the dexmedetomidine group and 18% of the clonidine group (p = 0.47).
Conclusion: Dexmedetomidine provided better block characteristics, longer pain relief, and deeper sedation with stable vital signs, making it a preferable premedication agent.

Objective: This study aimed to determine the prevalence of burnout syndrome among physicians undergoing intensive care specialty training in Türkiye, identify contributing factors, and explore potential solutions.
Method: After obtaining ethical approval, an online questionnaire was made available to physicians undergoing intensive care specialty training. The survey included sections on demographic characteristics, lifestyle habits, working conditions, and job satisfaction. Burnout levels and associated factors were assessed using the Maslach Burnout Inventory.
Results: A total of 69 physicians in intensive care specialty training participated in the study, including 22 residents. Primary specialties were distributed as follows: anesthesiology and reanimation (68.1%), internal medicine (11.6%), pulmonology (8.7%), and emergency medicine (11.6%). During their primary specialty training, 47.8% of participants reported experiencing burnout. Although 73.9% of the participants stated that they had voluntarily chosen intensive care specialty training, high levels of emotional exhaustion (58.0%) and depersonalization (59.4%) were observed in more than half of the participants, while 58.0% demonstrated low personal accomplishment. Overall, 42.0% of participants were classified as having a high level of burnout. When the Maslach Burnout Inventory subscales were considered, approximately 58-59% of the sample was found to be at high risk in at least one subscale, indicating a substantial risk of burnout. Regardless of primary specialty, physicians receiving intensive care specialty training who worked more than 80 hours per week had significantly higher levels of emotional exhaustion (p = 0.023).
Conclusion: Burnout syndrome is common among physicians in intensive care specialty training and constitutes a significant problem. Regulation of working hours is necessary to reduce and prevent burnout. Preventing burnout among physicians specializing in intensive care is essential to improve patient care standards in intensive care units.

Spinal anesthesia is generally considered safe and effective; however, its failure may occasionally indicate an underlying spinal pathology. We present the case of a 79-year-old female who experienced repeated unsuccessful attempts at spinal anesthesia despite the use of appropriate technique and drug administration. Postoperative thoracic-lumbar magnetic resonance imaging revealed a thoracic vertebral mass causing spinal cord compression. This case underscores the importance of considering asymptomatic vertebral lesions as a potential cause of spinal anesthesia failure and highlights the critical role of imaging in such scenarios.