The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.

Objective: Endotracheal intubation of patients is an effective method for controlling airway and breathing. However, laryngoscopy and endotracheal intubation is not easy in every case. There is a recent abundance of equipment used for controlling ventilation and intubation. Airtraq is one of those equipments. In this study, our main objective is to compare the success rates of the Airtraq and Macintosh (direct and classic) laryngoscopes in endotracheal intubation. Methods: In this single-center, prospective, randomized, clinical study was performed on 80 patients who were operated under general anesthesia, ASA I-II, 18-65 years old. Patients were intubated using two different endotracheal intubation tools. Group A was intubated using the Macintosh (direct and classic) laryngoscope, meanwhile Group B was intubated using the Airtraq laryngoscope. Patients' snoring complaints, modified Mallampati scores, sternomental distances, thyromental distances, interincisor distance measurements and Cormack-Lehane (C-L) laryngoscopic classification, upper lip bite test results, intubation time, number of intubation attempts, maneuvers and techniques used for facilitating intubation and complications arising from intubation were recorded. Results: There was a statistically significant difference between the groups in terms of C-L scores (p=0.041). In all, 8 patients in the Macintosh group, and 2 patients in the Airtraq group were C-L grade III. In intubation of the Airtraq group, only 3 patients required facilitating techniques, meanwhile in intubation of the Macintosh group 15 patients we had to use one or more facilitating maneuver. The rate of Mallampati scoring "difficult" was 4/6 in the Macintosh and 2/11 in Airtraq laryngoscopy groups (p=0.553). Conclusion:In cases with seemingly difficult intubations, we believe the Airtraq laryngoscope has an advantage over the Macintosh laryngoscope, owing to its better view of the oropharyngeal and glottic areas in addition to facilitating intubation in patients with limited head extension.Keywords: Airtraq, laryngoscope, intubation success Amaç: Anestezi uygulanacak hastanın endotrakeal entübasyonu, havayolu ve solunumun kontrol edilebilmesi için en etkin yöntem-dir. Laringoskopi ve endotrakeal entübasyon her vakada aynı kolaylıkla gerçekleştirilememektedir. Son zamanlarda, ventilasyon ve entübasyon için kullanılan ekipmanlarda çeşitlilik artmıştır. Airtraq da bu ekipmanlardan bir tanesidir. Biz bu çalışmada, Airtraq laringoskop ile Macintosh (doğrudan, klasik) laringoskopun gerçekleşti-rilen endotrakeal entübasyon başarısını karşılaştırmayı amaçladık. Yöntemler: Bu tek merkezli prospektif, randomize, klinik çalışma, genel anestezi altında ameliyat olan, 18-65 yaş arası, Amerikan Anesteziyolojistler Derneği (ASA) risk grubu I-II olan ve araştırmaya dahil olmayı kabul eden 80 hasta üzerinde gerçekleştirildi. Hastalar iki farklı endotrakeal entübasyon aracı kullanılarak entübe edildi. Grup A'da Macintosh (direk, klasik) laringoskop, Grup B'de Airtraq laringoskop ile endotrakeal entüba...

Aim:The aim of this study is to determine the prevalence of medical device-related pressure injuries in COVID-19 patients. Material and Method:This study was conducted with a cross-sectional and retrospective design. The data of 436 patients who were followed up and treated in the Anesthesia and Reanimation Intensive Care Unit with the diagnosis of COVID-19 disease between 11.03.2020-31.02.2021 in a Training and Research Hospital in İstanbul were included in the study. The sample of the study consisted of 32 patients out of 436 patients who met the sampling criteria. The data obtained by retrospective reviewing of the patient records were analyzed through the "Patient Information Form" and "Pressure Injury Stage" forms.Results: Medical device-related pressure injury developed in 32 (7.3%) of 436 patients examined in the study on the specified dates. 90.6% of these patients were male, and the average age was 67.5. 43.7% had comorbid diseases. According to the Braden Risk Assessment Scale, 25% of these patients had medium and 71.8% high risk. Medical devices that cause pressure injury were continuous positive airway pressure mask (n=13), intubation tube (n=7), nasogastric tube (n=5), nasal cannula (n=3), gel pads (n=3), and oxygen mask (n=1). Conclusion:In this study, the potential factors in the study that may have led to the incidence of medical device-related pressure injury specific to COVID-19 disease include the rapid increase in the need for respiratory support, ischemia caused by this infection, and the use of prone position.

Objective: Despite vaccine and drug studies, convalescent plasma (CP) therapy remains an alternative treatment for coronavirus disease 2019 . In this study, we aimed to reveal the efficacy of CP therapy on mortality and the factors affecting it for the patients diagnosed with COVID-19 and acute respiratory distress syndrome (ARDS) which were followed in our intensive care unit (ICU). Material and Method:The data (demographic characteristics, the amount of CP used, PaO2/FiO2, leukocyte, neutrophil, lymphocyte, D-Dimer, C-reactive protein (CRP), procalcitonin, ferritin values, and the clinical findings) of the patients who were hospitalized in the ICU with the diagnosis of COVID-19 and received CP treatment between 20 March and 20 October 2020 were analyzed retrospectively. Data of deceased patients (n=29) and survivors (n=50) were compared with each other and logistic regression analysis was performed to investigate the relationship with mortality. Results: 79 patients who received 166 units of CP therapy after a mean of 13.45±3.6 days symptom onset, were identified. 96.2% of the patients had at least one concomitant disease. Mortality was observed in 29 (36.7%) of the patients. Mortality (5.1%) was less common in those receiving CP therapy within the first 14 days after the onset of symptoms. Patient age (p=0.041), neutrophil/lymphocyte ratio (p=0.004), CRP values (p=0.002), the number of comorbidities (p<0.001), PaO2/FiO2 ratio before CP (p=0.005), and the period when CP was first infused from symptom onset (p<0.001) had a statistically significant effect on mortality. Conclusion:CP can be safely used to treat COVID-19. However, its positive effect is less observed in patients with the advanced stage of the disease, progressive deterioration of oxygenation, and a high number of comorbidities. For this reason, starting CP treatment at an early stage may increase its effectiveness.

Introduction: There are few randomized controlled trials examining the effectiveness of bilateral Erector Spinae Plane Block (ESP) with patients undergoing cardiac surgery. The effect of bilateral ESP block on postoperative pain levels and analgesic consumption for patients undergoing open-heart surgery was examined in this single-blind, randomized, controlled trial.Material and Method: 54 patients who underwent cardiac surgery with open median sternotomy under general anesthesia between May 2020 and June 2021 were included in the study. Patients were randomized into two groups, each consisting of 27 patients, one with 40 ml of 0.25% bupivacaine and bilateral ESP block, the other with no block implementation (control group). Demographic data, operation type, length of stay in the Intensive Care Unit (ICU), numerical rating scale (NRS) values in the first 24 hours after extubation, and morphine consumption values of the patients were recorded for the study.Results: In the study, 4 patients were excluded from follow-up due to prolonged intubation in the postoperative period. The data of a total of 50 patients (ESP group n=25; Control group n=25) were analyzed. The duration before first analgesic (mean±SD: 459.2±92.8 min.) of the ESP group was statistically longer than those in the control group (mean±SD: 142.0±56.6 min.) (p<0.001). The total length of stay in the ICU and rate of nausea-vomiting were lower for the ESP group than for the control group (p<0.05). Total morphine consumption (mean±SD: 5.1±3.1 mg) of the ESP group in the first 24 hours was statistically lower (p<0.001) compared to the consumption of the control group (mean±SD: 14.8±4.2 mg). NRS scores were significantly lower for the ESP group at postoperative 1st, 2nd, 4th, 6th, and 8th hours compared to the control group (p<0.05). Conclusion:ESP block applied bilaterally in adult cardiac surgeries decreased postoperative pain scores and morphine consumption. At the same time, it was observed that the length of stay of the patients in the ICU was reduced and there were no complications.

Background/aim: Currently, the elderly population in the world is rapidly increasing due to technological developments and convenient access to health services. Due to comorbidities in elderly patients, hip fractures are frequently observed after exposure to environmental trauma. To reduce pain during positioning in spinal anesthesia, fascia iliaca compartment block (FICB) can be applied easily and reliably.In our study, we aimed to compare the analgesic effects and duration of fascia iliaca compartment blocks performed with USG guidance or the landmark approach methods for relieving spinal anesthesia position pain. Materials and methods:Our study included 100 patients undergoing operations due to hip fracture and administered spinal anesthesia after FICB. The group with USG-guided FICB (USG) had the blockage needle advanced to the compartment under the fascia iliaca, and 15 mL bupivacaine + 10 mL 2% lidocaine was administered. They were placed in sitting position for spinal anesthesia 20 min later and procedure duration and numerical rating scale (NRS) scores were recorded. In the group with landmark approach FICB (LAND), the spina iliaca anterior superior (SIAS) and pubic tubercle were connected with a line. The same amount of local anesthetic was administered to the external 1/3 portion of this line with the double pop technique. Procedure duration and NRS scores were recorded.Results: There was no statistically significant difference between the two groups in terms of NRS scores (p: 0.073). There was a statistically significant difference in duration of FICB administration between the two groups (p < 0.001). Conclusion:Both USG-guided and landmark approach FICB methods provide adequate and similar analgesia for positioning in spinal anesthesia. However, in cases where there is no problem with access to the ultrasound device or time, safer blockage can be provided by imaging neurovascular structures with ultrasound.

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The anesthesia method to be administered during emergency surgical procedures for COVID-19 (Coronavirus Disease 2019) pneumonia patients carries great importance for both patient and surgical team. Regional blocks are generally used to ensure postoperative analgesia after abdominal surgery with general anesthesia. In this case, involving a patient receiving anticoagulant treatment due to COVID-19 pneumonia with planned emergency operation, the aim was to present the anesthesia management with rectus sheath and transversus abdominis plane block combination for the ileostomy operation. Due to the administered blocks, the patient was not given general anesthesia. Hence, transmission was reduced by minimizing aerosol formation in terms of protecting health personnel and worsening of the patient’s pneumonia was prevented. The case is discussed in terms of regional anesthesia techniques offering a good alternative in appropriate cases for both employee and patient safety in the present day, when the whole world is affected by the COVID-19 pandemic.