Purpose The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07169-7.

Background:Pre-operative evaluation includes determining the patient's physiological and psychological situation, taking information about pharmacological and therapeutic history, laboratory examinations, and identifying the anesthesia risks. The aim of this study is to learn the patients’, who planned for elective surgery, knowledge and perception about anesthesia, to determine the causes of fears, to investigate whether age, gender, education level, and history of operation affect the outcome of the survey.Methods:A questionnaire consisting of 21 questions was asked to fill by the patients who applied to the anesthesia clinic. In our study, totally 250 patients, aged between 16 and 75 were included. The questionnaire consists of two parts: The first part includes demographic data such as age, gender, education level, occupation; the second part includes the questions about anesthesia experience and knowledge.Results:Of the 250 patients studied, 59% were females and 41% were males. Of these patients, 37.6% had secondary education. As occupation, the highest percentage was belonging to the housewives (33.6%). In the second part of the questionnaire, it was showed that having an anesthesia experience and high education status statistically significantly affect the level of information about anesthesia (P=0.001; P=0.001).Conclusion:In this study, it was showed that there is an important relationship between education and past anesthesia experience and having information about anesthesia and anesthetists. But, generally it was also showed that the patients not having adequate information about anesthesia and anesthetists and to provide the public more informed about anesthesia, with hospital policies and studies of increasing education level, the individual attempts of anesthetists and continuous studies for anesthesia displaying are needed.

Background and Methods With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single‐blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US‐guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. Results In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. Conclusions It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

Introduction: The Blue Code practice provides increase in survival rates and decrease in the rate of permanent sequelae after cardiac arrest. There are issues that healthcare workers should pay attention to in the Code Blue practice. Aim The primary purpose of this survey study is to determine the knowledge levels of physicians and nurses about the Code Blue and cardiopulmonary resuscitation in 6 centres. The secondary aim is to determine the solutions that can be made to eliminate these deficiencies. Methods After the approval of the Faculty Ethics Committee, Mersin University Faculty of Medicine, Adana Baskent Turgut Noyan Training and Research Hospital, Dokuz Eylül Univ. Faculty of Medicine, Hacettepe University Faculty of Medicine, Gulhane Training and Research Hospital, Manisa Celal Bayar Univ. Faculty of Medicine, except for the doctors and technicians of the Department of Anaesthesiology and Reanimation and the healthcare professionals working in the intensive care units, the doctors and nurses working in other departments were asked to answer the questions in the questionnaire via the internet with the questionnaire form stated in Appendix 1. Results A total of 415 participants responded the survey. Of them, 45.8% were nurses, 24.8% residents, 23.3% faculty members, 5.4% specialist doctors and 0.7% general practitioners. Totally 86.6% of the participants knew the Code Blue number. To the question "What is the Code Blue?", 92.7% of the participants gave the correct answer to his question. "Do you hesitate to intervene when you encounter a patient requiring emergency intervention?" 25.9% of the participants answered "Yes" to the question. "Is there a form about Code Blue in your clinic?" 41% answered "No" to the question. Conclusion According to the results of the survey we conducted, we are of the opinion that healthcare workers have insufficient knowledge about the Code Blue. In order to solve these problems, it would be appropriate to direct healthcare professionals to both in-hospital and external training programs.

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Hastalara ait yaş, cinsiyet, hastanede kalış süresi, yatış tanısı, beslenme durumu ve taburculuk durumları değerlendirildi. Bulgular: Çalışmaya alınan 850 hastanın 450'si %53'si kadın, 400'ü %47'si erkek hasta idi. Palyatif Bakım biriminde yatan hastaların yaş ortalaması 69.3±17.6 olup, hastanede ortalama kalış süreleri 11.2±13.3 gün olarak belirlendi. Hastaların 242'si (%28) malignite ve maligniteye bağlı komplikasyonlar nedeni ile hastanede yatırıldı. 217 hasta (%25) serebrovasküler hastalıklar ve sekelleri nedeniyle yatırıldı. Bu tanılarla yatan hastaların 162'sine (%18) beslenme bozukluğu ve yatak yarası tanıları eşlik etmekteydi. Bu hastaların 423'ünün (%50) beslenmesi enteral ve parenteral yolla sağlandı. Hastaların 468'i (%55) başka bir branşa sevk edilirken, 282'si (%33) taburcu edildi, 100 (%11) hasta ex oldu. Sonuç: Dünyada Palyatif bakım birimleri yaygın olmakla birlikte ülkemizde birçok hastanede yeni açılmaktadır. Dünyanın her yerinde yaşlı nüfustaki ve kronik hastalıklardaki artış, palyatif bakım ihtiyacını artırmaktadır. Bunun için hasta profilinin belirlenip ona göre Palyatif Bakım Birimlerinin gerekli donamıma ve eğitimli personele sahip olması gerekmektedir.

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Background: The aim of this study was to evaluate the effect of serratus anterior plane block in addition to intrathecal morphine for early postoperative period after video-assisted thoracoscopic surgery on the amount of morphine consumption and the Visual Analog Scale scores. Methods: This single-blind, randomized-controlled study included a total of 64 patients (39 males, 25 females; mean age: 53.6±17.0 years; range, 20 to 89 years) who were scheduled for video-assisted thoracoscopic surgery in a tertiary hospital between September 2019 and March 2020. Postoperative pain control was achieved with intrathecal morphine 0.6 mg addition to serratus anterior plane block (Group ITM+SAPB) or with only intrathecal morphine (Group ITM) after an induction of anesthesia. The serratus anterior plane block was performed with a single injection of 0.4 mL/kg of 0.25% bupivacaine at the level of fifth rib with ultrasound guidance. Morphine consumption, pain scores, and side effects were recorded in the postoperative period. Results: The mean morphine consumption was significantly lower in the ITM+SAPB group at all time points. Compared to the control group, the Visual Analog Scale-resting and coughing scores were significantly lower in the first 12 h after surgery. Pain scores were significantly higher in the ITM+SAPB group in patients where the trocar was inserted at upper level of the fifth rib than the lower level (3-5 vs. 5-8) during the first 6 h after surgery. Conclusion: The use of serratus anterior plane block in addition to intrathecal morphine is a safe and effective way to improve pain control for early postoperative period after video-assisted thoracoscopic surgery. The serratus anterior plane block ensures better analgesia until the peak effect of spinal morphine occurs.