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Introduction The Plethysmographic Variability Index can be measured by both finger and forehead probes. Vasoconstriction may jeopardize the reliability of finger PVI measurements in pediatric patients undergoing surgery. However, forehead vasculature exhibits more marked resistance to alterations in the vasomotor tonus. Objective Our aim was to compare the Plethysmographic Variability Index measured via finger or forehead probes in mechanically ventilated pediatric surgery patients in terms of their ability to predict fluid responsiveness as well as to determine the best cut-off values for these two measurements. Materials and Methods A total of 50 pediatric patients undergoing minor elective surgery were included after provision of parental consent and ethics committee approval. Perfusion index measured at the finger or forehead and Plethysmographic Variability Index monitoring comprised the primary assessments. Hemodynamic parameters monitored included perfusion index, Plethysmographic Variability Index, and cardiac output. A >= 15% increase in cardiac output following passive leg raise maneuver was considered to show fluid responsiveness. Two groups were defined based on fluid responsiveness: Group R (responsive) and Group NR (non-responsive). Student\"s t-test, Mann-Whitney U test, DeLong test, and ROC were used for statistical analysis. Results The area under curve for finger and forehead Plethysmographic Variability Index prior to passive leg raise maneuver were 0.699 (p = .011) and 0.847 (p < .001), respectively. The sensitivity for finger and forehead measurements at a cut-off value of

© 2022 American Academy of Hospice and Palliative MedicineContext: The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19. Objectives: Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19. Methods: This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death. Results: We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5–2.19; 1.78, 1.15–3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35–2.32), and male sex (OR 1.16, CI 1.0–1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort measures only, and 29% received CPR, with non-White racial and ethnic groups less likely to receive comfort measures only and more likely to receive CPR. Conclusion: In this international cohort of patients with COVID-19, Full Code was the initial code status in the majority, and more likely among patients who were Black or Asian race, Hispanic ethnicity or male. These results provide direction for future studies to improve these disparities in care.

Objective Lumbar interventional pain procedures (LIPPs) are frequently used in low back pain and have shown an increasing trend in recent years. LIPPs are highly effective when performed by properly trained physicians. However, some adverse events are seen during interventional procedures. Our aim in this study is to determine the immediate adverse event rates of LIPPs and to inform our colleagues about possible adverse events. Study Design Retrospective, observational study. Setting A university hospital pain management center. Methods After approval by the institutional ethics committee, a retrospective evaluation of patients who received fluoroscopy-guided LIPPs between January 2015 and December 2020 was performed. This observational study was conducted with 4,209 patients who underwent LIPPs, including epidural steroid injection, sacroiliac and facet joint injection, medial branch block or radiofrequency ablation, application of pulsed radiofrequency to the dorsal root ganglion, epidural catheter placement, or spinal cord stimulator application. Results No major adverse events were detected during the procedures. Minor adverse events were detected in 60 patients, and the adverse events rate was found to be 1.4% (95% confidence interval: 1.0–1.8%). Minor adverse events rates varied between 0.7% and 2.3% according to the procedure type. The most common adverse events were determined to be vasovagal reactions (26/60). Facial numbness, cramps, and seizures were detected as rare adverse events. Conclusion No major adverse events were seen in 4,209 patients. The rate of minor adverse events was 1.4%, with no sequelae in any of the events. When evidence-based guidelines are followed, interventional pain procedures can be performed safely.

Amaç: Bu çalışma; tıpta uzmanlık eğitimi alan klinik branş araştırma görevlilerinin havayolu yönetimi ile ilgili deneyimlerini ve bu deneyime Anesteziyoloji ve Reanimasyon staj ve rotasyonunun katkısını belirlemeyi amaçlamaktadır.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi’nde, dahili ve cerrahi branşlarda uzmanlık eğitimi alan araştırma görevlileri üzerinde, havayolu yönetiminde teorik bilgi ile pratik deneyimlerini ve Anesteziyoloji ve Reanimasyon staj ve rotasyonunun bu deneyime katkısını ölçmek için 26 sorudan oluşan bir anket çalışması yapıldı. Anket sorularına verilen cevapların değerlendirmesinde tanımlayıcı istatistiki analizler kullanıldı.Bulgular: Anket sonuçlarının cevapları değerlendirildiğinde; katılımcıların %95,7’si havayolu gereçleri ve kullanımları ile ilgili eğitim aldıklarını, %82,2’si bu eğitimi ilk olarak anestezi stajında aldıklarını, %56,7’si ilk endotrakeal entübasyonu anestezi stajında yaptığını, %59,2’si airwayi ilk anestezi stajında kullandığını, %34,2’si laringeal mask airway kullandığını, %50’si laringeal mask airwayi ilk olarak anestezi stajında kullandığını belirtmiştir. Anesteziyoloji ve Reanimasyon rotasyonu yapmayan katılımcıların %61’i bu durumu uzmanlık eğitimleri açısından bir eksiklik olarak görmektedir. Katılımcıların %70’i rotasyon sonrası kendilerini havayolu yönetimi açısından yeterli bulmaktadır. Kendini yeterli bulmayan katılımcılar ise pratik uygulamaların artırılması gerektiğini ve sürenin az olduğunu belirtmişlerdir. Sonuç: Anket sonuçlarımıza göre havayolu yönetimi eğitiminde Anesteziyoloji ve Reanimasyon stajı önemli bir yer tutmaktadır. Farklı branşlarda uzmanlık eğitimi alan hekimlerin Anesteziyoloji ve Reanimasyon rotasyonunun gerekliliğini belirtmeleri rotasyon programlarının yeniden gözden geçirilmesini gündeme getirebilir. Verilen eğitimlerin özellikle pratik bölümündeki eksiklikler gözardı edilmemelidir. Çalışmamızın havayolu yönetimi eğitimi ile ilgili düzenlemelere katkı sağlayacağı kanaatindeyiz., Background: The aim of this study was to assess the airway management experiences of residents and to determine the contributions of job rotations in Anesthesiology-Reanimation.Material and Method: A 26-question survey was conducted at Necmettin Erbakan University Meram Faculty of Medicine, on the medicine and surgery residents to evaluate their theoretical knowledge and practical experiences in airway management and to determine the contribution of job rotations in Anesthesiology-Reanimation. The responses to the questionnaire were evaluated with descriptive statistical analyses.Results: The results revealed that 95.7% of the participants were trained about the airway management instruments; 82.2% took this training during their internship period in anesthesia; 56.7% performed endotracheal intubation for the first time during their anesthesia internship; 59.2% used airways for the first time in their anesthesia internship; 34.2% had previously used laryngeal mask airways; and 50% used laryngeal mask airways for the first time during their anesthesia internship. Of the participants who did not have a job rotation in Anesthesiology-Reanimation, 61% perceived it as the incompleteness of the specialty training. Of the participants, 70% considered themselves competent for airway management after the job rotation. The participants, who considered themselves incompetent, reported that the duration of the training was short and that practical training should be promoted. Conclusion: The results of our survey demonstrated that Anesthesiology-Reanimation internship is important in airway management training. The residents in different specialty areas have reported that a rotation in Anesthesiology and Reanimation is necessary, possibly raising the issue that a revision in the job rotation schedules is needed. Any incompleteness in practical training should not be overlooked. We believe that our study will contribute to regulations about airway management training.

Amaç: Örgütsel sinizm, çalışanların kurumlarına karşı geliştirdikleri kuşkucu ve olumsuz tutumları ifade eden, iş tatminlerini ve performanslarını olumsuz yönde etkileyen bir kavramdır. Çalışanların örgütsel sinizm düzeylerinin saptanması ile olumsuz etki eden faktörlerin nedenlerinin ortaya çıkarılması etkin ve tatmin edici bir yapının kurulmasına olanak sağlayacaktır. Bu çerçevede araştırmanın amacı, bir eğitim ve araştırma hastanesi bünyesinde yer alan anestezi bölümünün çalışanlarının örgütsel sinizm düzeylerinin incelenmesidir. Yöntem: Araştırmanın evrenini Ġstanbul'da faaliyet gösteren bir eğitim ve araştırma hastanesinin anesteziyoloji bölümünde çalışan sağlık personeli oluşturmuştur. Araştırmada basit örneklem yöntemi kullanılarak 53 çalışan çalışma kapsamına alınmıştır. Verilerin toplanmasında Örgütsel Sinizm Ölçeği kullanılmıştır. Veriler SPSS programı ile değerlendirilmiştir. Bulgular: Yapılan analiz sonucunda, bölüm çalışanlarının örgütsel sinizmi orta düzeyde bulunmuş, cinsiyet, kıdem, çalışma süresi, bölümde çalışma süresi ve çalışma şekli değişkenlerinde istatistiksel olarak anlamlı farklılıklar tespit edilmiştir. Sonuç: Çalışmanın demografik verilerinin analizi, çalışma süresi, bölümde çalışma süresi ve çalışma şekli gibi işe yönelik değişkenlerin, örgütsel sinizm düzeyini belirlemede kişisel özellikler kadar önemli olduğunu göstermiştir. Çalışanların hizmet koşullarının düzeltilmesi ve yöneticilerin çalışanların beklentilerini doğru şekilde tespit etmesi örgütsel sinizmi ve yaratacağı olumsuz etkileri azaltacaktır., Aim: Organisational cynicism, described as the negative attitude towards the employing organization, can have negative outcomes in job satisfaction and work performance, which in turn may also have unintended and serious results. Determining the levels and underlying factors of cynicism in workplace has become an important issue in health service. In this context, the study aimsto investigate the effects of demographic variables on organizational cynicism levels. Method: The population of the research was created by medical personnel working in the anesthesiology department of a training and Research Hospital in Istanbul. 53 employees were included in the study using a simple sampling method. The scale of organizational cynicism was used in the collection of data. The data were evaluated with the SPSS program. Findings: The result of the study revealed a moderate degree of organizational cynicism among employees with statistically significant differences between the organisational cynicism and demographic variables of age, gender, work status and years in the department. Conclusion: Analysis of the demographic data of the study showed that the variables related to work such as working time, working time in the department and working style were as important as personal characteristics in determining the level of organizational cynicism. Correcting the service conditions of the employees and correctly determining the expectations of the employees will decrease the organizational cynicism and its negative effects

To validate the utility and performance of the gastro-laryngeal tube (GLT) in terms of cardiologist and patient satisfaction levels, incidence of and attempts at successful transesophageal echocardiography (TEE) probe placement, perioperative and postoperative hemodynamics, and adverse events related to the TEE procedure.In this randomized prospective clinical study, forty-four patients undergoing TEE and aged 20 to 80 years old scheduled for TEE were randomly allocated to two study groups: Group SA (sedation and analgesia) and Group GLT. Cardiologist and patient satisfaction levels, TEE probe placement performance, hemodynamics, adverse events related to the TEE procedure, demographic characteristics, and TEE procedure data were recorded.The cardiologist satisfaction level was significantly higher in Group GLT (P = .011). The TEE probe was successfully placed at the first attempt in all the patients in Group GLT and at the first attempt in 11 patients, at the second attempt in 8 patients, and at the third attempt in 3 patients in Group SA. The TEE probe placement success was significantly higher in Group GLT (P .001), and TEE probe placement was significantly easier in Group GLT (P .001). There were no significant differences in patient satisfaction, heart rate, mean arterial pressure, oxygen saturation, adverse events related to the TEE procedure between the groups.The present study revealed that GLT use elicited a higher cardiologist satisfaction level and resulted in more successful and easier TEE probe placement. We thus conclude that the use of the recently developed GLT may ensure airway management safety and a comfortable TEE experience.

Giriş: Bu çalışmamızda, anestezi uygulanan hastaların ameliyat sonrası anestezi memnuniyetini ve anestezi bilgisini araştırmayı amaçladık. Gereç ve Yöntem: Ameliyat sonrası birinci gün, 140 kadın ve 104 erkek olmak üzere toplam 244 hastanın prospektif olarak demografik verileri kayıt edildi ve hastalardan hasta memnuniyet anketini doldurmaları istendi. Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 45.72±17.23 idi. Hastaların 188’i genel anestezi (%77), 50’si (%20.5) spinal anestezi, 4’ü epidural anestezi (%1.6) uygulanarak ameliyat oldu. Kadın hastaların eğitim seviyesinin, genç hastaların endişe düzeyinin daha yüksek olduğu tespit edildi. Ameliyat sonrası bulantı-kusma şikayeti, kadınlarda erkeklere göre daha fazla olduğu; yaş ve eğitim düzeyinin yükselmesiyle paralel olarak bulantı-kusma şikayetinde artış olduğu saptandı. Sonuç: Sağlık hizmetlerinin iyi bir şekilde sunulabilmesi, anestezi kalitesinin artırabilmesi ve hasta memnuniyetini en üst düzeye çıkarılabilmesi için hasta memnuniyet anketleri bize faydalı sonuçlar verebilmektedir., Introduction: In the present study, we aimed to evaluate the anesthesia quality and knowledge of the patients in the postoperative period. Material and Methods: Demographic datas of 244 patients consisting of 140 females and 104 males, were recorded prospectively in the postoperative first day and patients were asked to complete the patient satisfactory questionnaire. Results: The mean age of the patients that included in the study was 45.72±17.23. One hundred and eighty-eight of the patients (% 77) were operated under general anesthesia, 50 (% 20.5) under spinal anesthesia, 4 (% 1.6) under epidural anesthesia. It was shown that female, higher educated and younger patients have a higher anxiety level. Postoperative nausea and vomiting complains have a higher rate in females rather than males; nausea and vomiting complians were rising concurrently with age and education. Conclusion: Patient satisfactory questionnaires have provided us beneficial results for sustaining a good health care services, increasing quality of anesthesia and going patient satisfactory through a higher level