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Purpose: The use of ultrasound in peripheral blocks has now become the gold standard. Ultrasound is a method that is easy to apply and most importantly does not carry any risk, and its only disadvantage is based on the skill and knowledge of the practitioner. Injury to vascular structures, which is the most common occurrence in peripheral block applications, has been significantly reduced by the use of ultrasound. The aim of this study is to determine the location of nerve branches and to determine the most common anthropometric parameters in the axillary fossa. In this way, the common anatomy of the axillary BP will be determined and will guide the practitioners while performing the axillary plexus block., Design: Observational Clinical Study., Methods: The patients were positioned with forearm abducted 90 degrees and elbow flexed 90 degrees. A high-frequency linear ultrasound probe was placed on the lateral border of the pectoralis major muscle in the transverse plane. Pulsation of the axillary artery was visualized and shifted slowly to view the nerves around the artery. The axillary vein was also visualized to facilitate the movement of the transducer and to find the nerve localization more easily. The regions on the prepared wheel were marked. At the same time, demographic information such as gender, age, weight, and height of the patients were also recorded., Findings: The sample was 248 patients, 61.3% female and 38.7% male. Our results showed that only 59% were compatible with the most common nerve locations in cadaveric dissections and the locations described in anatomy textbooks., Conclusions: Since there are many anatomical variations, validation of nerves with a nerve stimulator as well as simultaneous visual application under ultrasound guidance will increase the success chance of axillary brachial plexus block and protect it from unwanted complications., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19., Methods: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study., Results: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29)., Conclusion: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.

Background/aim: This study aimed to evaluate the effect of low- and high-pressure pneumoperitoneum pressures applied during robotic-assisted laparoscopic prostatectomy (RALP) using near-infrared spectroscopy (NIRS) on regional cerebral oxygenation saturation (rSO2)., Materials and Methods: The prospective, comparative, and observational study included patients aged 18–80 years, with the American Society of Anesthesiologists (ASA) physical status I-II, who would undergo elective RALP. The patients were divided into two groups (12 mmHg of pneumoperitoneum pressure group, n=22 and 15 mmHg of pneumoperitoneum pressure group, n=23). Patients’ demographic data, durations of anesthesia, surgery, pneumoperitoneum, and Trendelenburg position, intraoperative estimated blood loss, fluid therapy, urine output, hemodynamic and respiratory data, and rSO2 values were recorded at regular intervals., Results: The rSO2 values increased significantly during the pneumoperitoneum combined with steep Trendelenburg position (from t3 to t6) and at the end of the surgery (t7) in both groups, compared to the values 5 min after the onset of pneumoperitoneum in the supine position (t2) (P < 0.05), but no statistical significance was observed between the two groups. No cerebral desaturation was observed in any of our patients. Hemodynamic and respiratory parameters were preserved in both groups. The blood lactate levels were significantly higher in patients operated at high-pressure pneumoperitoneum, compared to those with low-pressure pneumoperitoneum (P < 0.05)., Conclusion: We believe that low-pressure pneumoperitoneum, especially in robotic surgeries, such as robotic-assisted laparoscopic prostatectomy (RALP), can be applied safely., Competing Interests: The authors have no funding, financial relationships, or conflicts of interest to disclose., (This work is licensed under a Creative Commons Attribution 4.0 International License.)