Tapia's syndrome is due to extracranial involvement of the hypoglossal nerve and the recurrent laryngeal branch of the vagal nerve. The injury of these nerves is a rare complication of anesthetic airway management. We present a patient with a postoperative bilateral hypoglossal and recurrent laryngeal nerves palsy after uncomplicated orotracheal intubation. Corticosteroid therapy was started after diagnosis. Forty-eight hours later, the movements of the vocal cords started to recover and full recovery was achieved by the fourth day. Within 3 days, tongue mobility was gradually improved and the patient's symptoms resolved completely by 4 weeks.

Background: In Covid-19 pneumonia, high mortality rates reported in intubated patients have raised noninvasive methods of respiratory support. Objective: We aimed to evaluate the impact of HFNC application on intubation requirement, intensive care length of stay, and short-term mortality in patients with COVID-19 pneumonia. Material-method: Patients receiving oxygen by reservoir mask or HFNC therapy in our intensive care units due to COVID-19 pneumonia were included in the study. Group H consisted of patients who received HFNC, and Group K consisted of patients who received conventional oxygen therapy (COT). The number of patients intubated, duration of intensive care stay and short-term mortality were recorded. Results: 43 patients were included. The short-term mortality and the number of patients with intubation need was lower in Group H. There was no significant difference between the Groups in the length of intensive care stay. Conclusion: Administration of HFNC in respiratory failure secondary to COVID-19 pneumonia decreases the need for intubation and mortality.

Background We evaluated the effect of early awake prone position administration on oxygenation and intubation requirements and short-term mortality in patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) pneumonia. Methods This is an observational-cohort study. Patients receiving mask oxygen therapy in our intensive care units because of acute respiratory failure due to COVID-19 pneumonia were included. The Awake Prone Position (APP) group consisted of patients who were applied awake prone position, whereas non-APP group consisted of patients who were not applied awake prone position. PaCO 2 , PaO 2 , pH, SpO 2 values and PaO 2 /FiO 2 ratios were recorded at the beginning and 24th hour. Demographic data, comorbidities, intubation requirements, ventilator-free days, length of intensive care unit stay and short-term mortality of the patients were recorded. Results The data of total 225 patients were examined, and 48 patients who met our study criteria were included. At the 24th hour, the median SpO 2 value of the APP group was 95%, the median PaO 2 value was 82 mmHg, whereas the SpO 2 value of the non-APP group was 90% and the PaO 2 value was 66 mmHg. ( p = 0.001, p = 0.002). There was no statistically significant difference between the groups in length of intensive care unit stay and ventilator-free days, but short-term mortality and intubation requirements was lower in the APP group ( p = 0.020, p = 0.001) Conclusion Awake prone position application in patients receiving non-rebreather mask oxygen therapy for respiratory failure due to COVID-19 pneumonia improves oxygenation and decreases the intubation requirements and mortality.

Abstract. Background:The aim of this study is to evaluate the demographic and epidemiological data, clinical features and surgical outcomes of lacrimal canalicular lacerations. Methods: The charts of all patients who applied to our emergency department with eyelid laceration from 2008 to 2013 were reviewed retrospectively. Demographic and epidemiological data, clinical characteristics, treatment outcomes, simultaneous injuries and complications of patients who underwent canalicular laceration repair surgery were analyzed. Results: A total of 556 patients were identified with an eyelid laceration, and in 42 (7.55%) of these patients 44 lacrimal canalicular lacerations were detected. The average age was 26.16±18.42 (range 5 to 78) years and mean follow-up time was 17.62±6.62 months (range 12-42 months). The male-to-female ratio was 5.3-1. The lower canaliculus was involved in 33 patients (78.57%), the upper in 7 patients (16.6%), and 2 patients (4.76%) had bicanalicular involvement. The most common etiology of canalicular laceration was assault (n = 16, 38.1%) followed by traffic accidents (n = 8, 19.05%). In 28 patients (66.67%) surgery was performed within 24 hours and in 14 patients (33.33%) surgery was performed between 24 hours and 6 days. In 32 patients (76.2%) direct anatomosis and in 10 patients (23.8%) indirect anastomosis was performed. Tubes were removed after a mean time of 5.8±2.8 months. Anatomic success was 96.87%, while functional success was 92.85%. Complications were detected in 3 cases: two patients had early tube extrusions and in patient had punctal slits. Conclusion: Reconstruction of traumatic lacrimal canalicular lacerations with stenting gives good results at long-term follow up. The Mini-Monoka tube is a safe, simple, effective method with few complications.

Background This study aimed to measure the levels of anxiety and burnout among healthcare workers, including attending physicians, residents, and nurses, in intensive care units during the coronavirus disease 2019 (COVID-19) pandemic. Methods This is a cross-sectional survey analysis of healthcare workers in our institution. Data were collected on demographic variables, COVID-19 symptoms and test, disease status, anxiety level (assessed by the Beck Anxiety Inventory), and burnout level (measured by the Maslach Burnout Inventory). Subscales of the burnout inventory were evaluated separately. Results A total of 104 participants completed the survey. Attending physicians, residents, and nurses constituted 25%, 33.7%, and 41.3% of the cohort, respectively. In comparison to untested participants, those tested for COVID-19 had a lower mean age ( p =  0.02), higher emotional exhaustion and depersonalization scores ( p =   0.001, 0.004, respectively), and lower personal accomplishment scores ( p =  0.004). Furthermore, moderate to severe anxiety was observed more frequently in tested participants than untested ones ( p =  0.022). Moderate or severe anxiety was seen in 23.1% of the attending physicians, 54.3% of the residents, and 48.8% of the nurses ( p =  0.038). Emotional exhaustion, personal accomplishment, and depersonalization scores differed depending on the position of the healthcare workers ( p =  0.034, 0.001, 0.004, respectively). Conclusion This study revealed higher levels of anxiety and burnout in younger healthcare workers and those tested for COVID-19, which mainly included residents and nurses. The reasons for these observations should be further investigated to protect their mental health.

Purpose. This study aims at comparing two different types of drainage tubes in conjunctivodacryocystorhinostomy, which are used for upper lacrimal system obstruction or damage, with respect to their respective postoperative problems and solutions. Methods. Nineteen eyes of 17 patients who underwent conjunctivodacryocystorhinostomy (CDCR) or conjunctivorhinostomy (CR) surgery with a Medpor coated tear drainage tube or silicon tube placement between October, 2010, and February, 2014, were included in this retrospective comparative study. Results. In the initial surgery, Medpor coated tear drainage tubes were used in 11 eyes by CDCR, whereas silicon tear drainage tubes were implanted into 2 eyes by CR and 6 eyes by CDCR. In group 1, proximal and distal obstructions developed postoperatively in 4 eyes, while 1 eye showed tube malposition and 3 eyes developed luminal obstruction by debris 3 times. In group 2, tube extrusion developed in 4 eyes, whereas tube malposition developed in 6 eyes and luminal obstruction by debris developed in 6 eyes at different times, for a total of 20 times. Conclusions. In our study, the most significant complication we observed in the use of silicon tear drainage tubes was tube extrusion,whereas the leading complication related to the use of Medpor coated tear drainage tubes was tube obstruction.

Objective: To determine taste and smell impairment rates in patients with coronavirus disease 2019 (COVID-19) who were hospitalized in the intensive care unit (ICU). Methods: Between March 2020 and May 2020, patients with COVID-19 hospitalized in the ICU were enrolled in this study. Upon discharge, patients were telephoned and asked to complete a survey related to taste and smell impairment. Characteristics were compared between patients with and without taste and/or smell impairment. Results: Fifty-two patients were enrolled (mean age, 61.32 ± 12.53 years; mean ICU stay, 10.19 ± 10.24 days). Age, sex, type/number of comorbid diseases, most ICU support modalities, and ICU stay duration did not significantly differ between groups. Patients in group B required more high-flow nasal oxygen therapy than patients in group A ( P = .010). In total, 22 (42.3%) of 52 patients experienced taste and/or smell impairment. Three patients experienced isolated smell impairment and one patient experienced isolated taste impairment. Among the 21 patients who experienced smell impairment, 18 (85.78%) experienced hyposmia (mean visual analog scale [VAS] score: 6.33 ± 0.97), while 3 (14.28%) experienced anosmia. Among the 19 patients who experienced taste impairment, 16 (84.22%) experienced hypogeusia (mean VAS score: 6.43 ± 1.03) and 3 (15.78%) experienced ageuisa. Among 22 patients who experienced taste and/or smell impairment, 15 (68.18%) patients (n = 15/22) experienced smell and/or taste impairment before the ICU stay, while 7 (31.82%) patients (n = 7/22) experienced impairment during the ICU stay. Overall, 28.84% (n = 15/52) of the patients experienced taste and/or smell impairment before the ICU stay. Conclusions: Patients who were hospitalized in the ICU experienced lower rates of taste and/or smell impairment. Some patients experienced taste and/or smell impairment during the ICU stay.

This study investigated whether the addition of 25 microg intrathecal fentanyl to levobupivacaine spinal anaesthesia for outpatient inguinal herniorrhaphy allows a sub-anaesthetic levobupivacaine dose to be used. Forty patients were assigned to receive 5 mg levobupivacaine 0.5% mixed with 25 microg fentanyl (group LF) or 7.5 mg levobupivacaine 0.5% (group L). The highest sensory block levels achieved were T7 (range T5 - T9) and T6 (range T4 - T9) in groups LF and L, respectively. The times to two-segment regression, S2 regression, ambulation, urination and discharge were all significantly shorter in group LF than group L. These results indicate that, for outpatient inguinal herniorrhaphy, intrathecal fentanyl combined with low-dose levobupivacaine provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. This protocol is well suited for the outpatient setting because it features rapid recovery of full motor power, sensory function and bladder function.