INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

Objectives:To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey.Methods:This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods.Results:The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%).Conclusion:Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.

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We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

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Objective: In our study the factors related to anesthesia and peroperative variables associated with postoperative mortality among patients aged ≥65 years who had undergone orthopedic surgery were assessed. Methods: Reports on patients aged ≥65 years who had undergone orthopedic surgery between 2015 and 2017 were investigated retrospectively. Results: A total of 135 patients were included in the study. The operations comprised implantations of total hip prosthesis in 26%, total knee prosthesis in 18%, fixation of lower extremity fractures in 24, and upper extremity fractures in 14%, and amputation surgery in 17% of the patients. The postoperative mortality rates were highest (76.9%) among patients who underwent amputation surgery (p<0.05). It was found that anesthesia type, whether regional or general, was not related to mortality. Mortality was found to be associated with increasing age, ≥3 ASA score, emergency surgery, ≥3 accompanying diseases, prolonged preoperative hospital stay and low preoperative hemoglobin (Hb) values (p<0.05). Patients developing postoperative complications, those who were monitored in intensive care unit (ICU) and required mechanical ventilator (MV), and patients with prolonged ICU and hospital stay had higher mortality rates (p<0.05). 9% of all patients were determined dead. Conclusion: Among geriatric orthopedic surgery patients, apart from gender and anesthesia method, increasing age, high ASA scores, emergency surgery, the number of accompanying diseases, duration of preoperative hospital stays, low preoperative Hb values, postoperative complications requiring ICU-MV and prolonged ICU and hospital stays were all factors that affected postoperative mortality. We believe that detailed preoperative assessment and perioperative clinical management are essential if postoperative prognosis after geriatric orthopedic surgery is to be improved.

This study aims to investigate the effect of McCoy, Macintosh laryngoscope, and C-MAC videolaryngoscopes on optic nerve sheath diameter (ONSD) and hemodynamic responses to laryngoscopy and intubation. Methods: This prospective randomized study was conducted in Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey, between July 2019 and January 2020. Informed written consent was obtained from all patients. Patients with previous intracranial/ ocular surgery or glaucoma were excluded from the study. The patients were randomized to use McCoy, Original Article Macintosh, and C-MAC (30 per group). Intubations were performed by the same person. Mean arterial pressure, heart rate (HR), and ONSD were recorded before the induction and repeated in 1, 3, 5, and 10 minutes after the intubation. Results: The effects of laryngoscopy and intubation on hemodynamic responses and ONSD were similar between groups (p>0.05). While the comparison within groups showed ONSD increase in McCoy group and HR and ONSD increase in the Macintosh group compared to baseline 1 min after the intubation, no change was observed in hemodynamic responses and ONSD measurements in the C-MAC® group (p>0.05). Conclusions: In this study, there was no significant difference between the groups in terms of ONSD and hemodynamic responses to laryngoscopy and intubation. It was observed that there were no significant changes in ONSD values just in C-MAC® video-laryngoscope group. Therefore, intubations with C-MAC® videolaryngoscope are thought to be more appropriate for patients with an increase in intracranial pressure.