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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.

Massive hemorrhage in pediatric cranioplasty operations may necessitate blood transfusion, which may cause many complications. Radical-7 Pulse CO-Oximeter (Massimo Corporation, Irvine, CA) can provide continuous hemoglobin concentration (SpHb) measurements noninvasively. In this study, we aimed to evaluate the effects of SpHb measurement on perioperative transfusion management and postoperative patient outcomes. For this retrospective case-control study, we collected the data of pediatric patients undergoing fronto-orbital advancement surgery for plagiocephaly and trigonocephaly between 2018 and 2021. Perioperative SpHb monitoring was performed for patients in the SpHb Group. Other patients that were managed conventionally were considered as the control group (C Group). The data on patients\" demographic and clinical characteristics, intraoperative hemodynamic and laboratory variables such as blood gases, intraoperative blood losses, the amount of the transfused blood products, the length of postoperative intensive care unit (ICU) stay, and the duration of hospital stay were collected. The data of 42 patients were collected, and 29 of these patients were males (69%). In 16 of the patients, SpHb monitoring was performed. The demographic, clinical, and perioperative hemodynamic characteristics of the patients were comparable between the groups. Compared to the C Group, the SpHb Group had significantly lower perioperative packed red blood cell (PRBC) transfusion (136.3 +/- 40.1 vs. 181.5 +/- 74.8 mL, P = 0.015), less postoperative drainage (125.3 +/- 47.7 vs. 185.8 +/- 97.6 mL, P = 0.013), and shorter ICU stay (37.1 +/- 12.0 vs. 64.8 +/- 24.9 h, P < 0.001). There was a positive correlation between the amount of PRBC transfusion and the length of ICU stay (r = 0.459, P = 0.003). Patients with perioperative continuous SpHb measurement have lower intraoperative PRBC transfusion, less postoperative bleeding, and shorter ICU stay. When necessary, SpHb, together with clinical judgment and laboratory confirmation, can be used in decision-making for perioperative PRBC transfusion.

BACKGROUND: There were few prospective studies investigating the relationship between the burn injury and erectile dysfunction (ED). The aim of this study was to prospectively explore the alteration in erectile functions regarding major burn. METHODS: This study was conducted as a prospective survey in patients with major burn injury. The study group consisted of burn cases with at least 20% of body surface area affected according to the Wallace Rule of Nines. Initially International Index of ED-5 (IIEF-5) was administered to the patients in the burn unit, and it was repeated in the 2rd and 6th months. Burn types, the severity of burns, age of patients, and alteration in IIEF-5 scores were compared. RESULTS: The study included 63 male patients. The median age of the patients was 35 (20-73) years, and the median burn percent-age was 22 (20-60). The rate of ED was markedly increased during follow-up as 8%, 39.7%, and 25.4% at baseline, 3rd, and 6th month evaluation, respectively. The median initial IIEF-5 score of the patients was 23 (5-25). Subgroup analysis revealed that IIEF-5 score of patients with electrical and flame burn significantly decreased at 3rd month compared with the baseline values. The median IIEF-5 score of patients with electrical burn increased at 6th month compared with 3rd month (p=0.042). Binary logistic regression analysis showed that age and service period, and IIEF-5 Score at 3rd month and burn grade were all statistically significantly associated with the normal erectile function (IIEF-5>=18), at 3rd month and 6th month, respectively. CONCLUSION: The current trial demonstrated that IIEF-5 scores of patients with major burn can show significant impairment in long term, and it seems a time-dependent process. This is the first prospective trial showing that IIEF can be utilized to monitor erectile function of burn patients in a longer follow-up program.

Purpose The standard procedure for low-flow anesthesia usually incorporates a high fresh gas flow (FGF) of 4-6 L/minute during the wash-in phase. However, the administration of a high FGF (4-6 L/min) increases the inhaled anesthetic agent consumption. This study was designed to compare the sevoflurane consumption at 2 rates of flow and vaporizer concentration during the wash-in period. Methods Patients were randomly enrolled into high FGF (HFGF) (n = 30) and low FGF (LFGF) (n = 30) groups. During the wash-in, the HFGF group received 4 L/minute FGF with a sevoflurane vaporizer setting of 2.5%, and the LFGF group received 1 L/minute FGF with a vaporizer setting of 8%. Once the wash-in was complete, anesthesia maintenance was performed with 0.5 L/min FGF with a vaporizer setting of 2.5-4.5% in both groups. The patient demographic data, bispectral index values, hemodynamic variables, wash-in time, sevoflurane consumption during the wash-in phase, and total sevoflurane consumption were analyzed. Results The median sevoflurane consumption in the wash-in phase was 8.2 mL (7.1-9.3) in the HFGF group and 2.7 mL (2.2-3.1) in the LFGF group (p = 0.001). The mean total sevoflurane consumption was 17.41 +/- 3.58 mL in the patients who received HFGF and 14.93 +/- 3.57 mL in the LFGF group (p = 0.001). The mean wash-in completion time was 12.49 +/- 2.79 min in the HFGF group and 3.35 +/- 0.67 min in the LFGF group (p = 0.001). Conclusions The anesthetic agent consumption during the wash-in phase was approximately 3 times lower with the administration of sevoflurane at 1 L/minute FGF than the use of 4 L/minute FGF.

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.

© 2022, American Society of Interventional Pain Physicians. All rights reserved.Background: Central sensitization (CS) is a hyperexcitability that is manifested by the increased response of the central nervous system to sensory stimuli. It has been shown that the presence of CS may have a negative effect on the clinical picture in some musculoskeletal diseases and also have a negative effect on spinal procedures. Objectives: To investigate the effect of CS on interlaminar epidural steroid injection (ILESI) treatment outcomes in patients with cervical disc herniation (CDH). Study Design: An observational study. Setting: A university hospital pain management center. Methods: Patients, who underwent ILESI between 2020-2021 due to CDH, were included in the study. The Numeric Rating Scale (NRS-11), Neck Pain and Disability Scale (NPDS), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and Short Form-12 (SF-12) were used for evaluation of patients. Patients were assessed before the procedure, at the first hour, and 3 months after the procedure. The presence of CS was investigated by the Central Sensitization Inventory (CSI). Results: A total of 51 patients were included in the study. Twenty-three of the patients had CS, as assessed by the CSI. Although, patients who underwent ESI, had significantly lower NRS-11, S-LANSS, and NPDS scores, and higher SF-12 scores at all follow-up points. The first and third months, NRS-11, S-LANSS, and NPDS were significantly higher, and SF-12 scores were lower in the CS group compared to patients without CS. Limitations: The short follow-up period and relatively low number of patients can be considered as a limitation. The fact that CS is not evaluated with a more objective method, such as Quantitative Sensory Testing (QST), can be considered as another limitation. Since most clinicians use CSI, so from a \"real world\" perspective the lack of QST may be observed as a strength of the study. The third limitation is that we did not evaluate the patients’ pre-and posttreatment analgesic consumption. Finally, we did not include patients with a history of psychiatric illness, but not evaluating the current psychiatric conditions of the patients could be considered a limitation. Nevertheless, the main strengths of this study are its prospective design and, to our knowledge, it is the first study to explore the effects of CS on cervical ESI treatment. Conclusions: The presence of CS has a negative effect on pain scores, disability, and quality of life in patients undergoing cervical ESI due to CDH.

On behalf of the EAMS President, the Scientific Committee of the 6th European Airway Congress, and the Board of Directors of the European Airway Management Society, we would like to provide the readers of our journal and all other airway enthusiasts with further information about this important airway management event. The congress will be held at Pine Beach Belek Resort in Antalya, Turkey from the 28th of September till the 1st of October 2022 [1]. This conference will be organized under the motto: “Breathing again!“, which may fully describe the situation after more than two years of COVID-19 pandemics. The conference website at: https://www.eac2022.org is fully functional at the moment and provides detailed information about the venue, scientific program, abstract submission rules, accommodation, and social events associated with the conference. The congress is as usual preceded by the “Teach the airway teacher” course on Thursday, September 28th. The scientific program itself is balanced into theoretical lectures and hands-on sessions. Keynote lectures are devoted to the presentation of new guidelines such as PUMA (Project for Universal Management of Airways) [2] and ASA 2022 Guidelines [3], novel concepts of videolaryngoscopy, flow-regulated ventilation in the Intensive Care Unit, controlled ventilation with minimal or no device in the airway or recommendations how to teach airway management in the online era.

Background: Epidural fibrosis (EF) is one of the leading causes of post lumbar surgery syndrome (PLSS). Although there are studies in the literature suggesting that lumbar epidural steroid injections are an effective method in the pain management of PLSS caused by EF, no study is available comparing the effectiveness and safety of caudal and transforaminal approaches. Objectives: To investigate the efficacy of caudal epidural steroid injection (CESI) versus transforaminal epidural steroid injection (TFESI) in patients with PLSS. Study Design: A prospective, randomized, assessor-blind study. Setting: Interventional pain management center at a tertiary care center. Methods: Patients with low back and radicular pain related to EF following single-level lumbar discectomy were included. The patients were randomly divided into 2 groups: a CESI group and a TFESI group. All patients were assessed before the procedure (baseline) and at one hour, 3 weeks, and 3 months after the procedure using the Numeric Rating Scale (NRS-11) and at baseline, 3 weeks, and 3 months using the modified Oswestry Disability Index (mODI). Treatment success was defined as a ≥ 50% decrease in the NRS-11 scores compared to baseline. Results: A total of 56 patients (n = 26 CESI group; n = 30 TFESI group) were included. NRS-11 and mODI scores showed a significant decline in both groups at all follow-ups (P < 0.001). At 3 weeks, the improvement in the mODI scores was significantly higher in the TFESI group (P = 0.020). In all follow-ups, the NRS-11 scores were similar between the groups. At 3 weeks, the rates of patients with a ≥ 50% decrease in NRS-11 scores were 53.8% and 60% in the CESI group and TFESI group, respectively, while these rates were 30% and 26.7%, respectively, at 3 months. Limitations: This study had no placebo-control group and a relatively short follow-up. Conclusion: Both CESI and TFESI are effective and safe methods in the treatment of PLSS caused by EF following lumbar discectomy. These methods can reduce pain and disability. Although both methods have similar treatment success rates, TFESI seems to be a more effective treatment method in reducing disability at 3-week follow-up. Keywords: Post lumbar surgery syndrome, failed back surgery syndrome, post laminectomy syndrome, epidural fibrosis, epidural steroid injections, transforaminal, caudal, radiculopathy, back pain

Background: Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians’ experience, procedure time, patients’ body mass index (BMI), imaging techniques, and the type of procedure performed. Objective: The purpose of this study is to report procedure times and calculate the radiation doses for 4 different approaches of fluoroscopy-guided epidural injections per procedure and BMI to provide radiations doses for potential use in future dose reduction strategies. Study Design: Retrospective, observational study. Setting: A university hospital, pain management center. Methods: A retrospective evaluation was performed of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center. This observational study was conducted with patients aged ≥ 18 who underwent 3,711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal, and caudal approaches. If more than one level or bilateral injections were performed, total dose and times were divided by the number of sites injected to attain procedure time and mean dose per injection. Provided doses for each patient were also divided by patients’ BMI to obtain dose per BMI. Results: The highest radiation dose per procedure was found in caudal epidural injection with 0.218 mGy·m2 , and the lowest dose was found in cervical interlaminar epidural injection with 0.057 mGy·m2 . The radiation dose per procedure was 0.123 mGy·m2 for lumbar transforaminal and 0.191 mGy·m2 for lumbar interlaminar epidural injection. The shortest procedure time was determined in transforaminal (37.3 seconds) injections, and the longest was in lumbar interlaminar (46.7 seconds) injections. Caudal epidural injection also had the highest radiation dose per BMI which was 0.00749, and cervical interlaminar epidural injection had the lowest radiation dose per BMI, which was 0.00214. Limitations: Firstly, injections were performed by first- or second-year fellows in pain medicine. Moreover, patient-related factors (previous surgery, scoliosis, etc.) affecting radiation exposure were ignored. Conclusions: Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.

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.

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.