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In this retrospective cohort study, we aimed to evaluate the incidence, risk factors and outcomes of amikacin-induced acute kidney injury (AKI) in critically ill patients with sepsis. A total of 311 patients were included in the study. Of them, 83 (26.7%) had amikacin-induced AKI. In model 1, the multivariable analysis demonstrated concurrent use of colistin (OR 25.51, 95%CI 6.99-93.05, p0.001), presence of septic shock during amikacin treatment (OR 4.22, 95%CI 1.76-10.11, p=0.001), and Charlson Comorbidity Index (OR 1.14, 95%CI 1.02-1.28, p=0.025) as factors independently associated with an increased risk of amikacin-induced AKI. In model 2, the multivariable analysis demonstrated concurrent use of at least one nephrotoxic agent (OR 1.95, 95%CI 1.10-3.45; p=0.022), presence of septic shock during amikacin treatment (OR 3.48, 95%CI 1.61-7.53; p=0.002), and Charlson Comorbidity Index (OR 1.12, 95%CI 1.01-1.26; p=0.037) as factors independently associated with an increased risk of amikacin-induced AKI. In conclusion, before amikacin administration, the risk of AKI should be considered, especially in patients with multiple complicated comorbid diseases, septic shock, and those receiving colistin therapy.

Objective: The primary aim of this study is to evaluate the knowledge, perception, and attitudes of residents working in intensive care unitsfrom different disciplines about local anesthetic systemic toxicity (LAST).Methods: Residents from anesthesiology and reanimation, internal medicine, cardiovascular surgery, thoracic surgery, and cardiology wereenrolled in the study after they obtained written informed consent. The participants answered 41 questions about local anesthetics and LAST.Results: A total of 148 residents [median age 28 (24-44) years, 56.1% male] were enrolled in the study. Of them, 34.5% stated that theyreceived education on local anesthetics, and 22.3% declared that their education on this subject was sufficient. The most used methods forpreventing LAST were the use of appropriate doses (74.3%), pre-injection aspiration (65.5%), and monitoring (63.5%). Of the participants, 59.5%indicated that they did not know whether there was 20% lipid-emulsion in their hospital and 72.3% in their unit. The participants had a lowknowledge rate of early and late symptoms of LAST. They also gave rarely correct answers about the loading, maintaining, and maximumdoses of 20% lipid emulsion. The basic principles of cardiopulmonary resuscitation in LAST were generally well known by participants, butthe optimal length of the follow-up duration after convulsion and cardiovascular instability was not.Conclusion: Prevention, recognition, management of the LAST, and the following of the patients with LAST are essential for patient safety inthe intensive care unit. Residents working in intensive care units should be educated about LAST regardless of their branch.

Background/aim: Acute kidney injury is strongly associated with mortality in critically ill patients with coronavirus disease 2019(COVID-19); however, age-related risk factors for acute kidney injury are not clear yet. In this study, it was aimed to evaluate the effectsof clinical factors on acute kidney injury development in an elderly COVID-19 patients.Materials and methods: Critically ill patients (≥65years) with COVID-19 admitted to the intensive care unit were included in the study.Primary outcome of the study was the rate of acute kidney injury, and secondary outcome was to define the effect of frailty and otherrisk factors on acute kidney injury development and mortality.Results: A total of 132 patients (median age 76 years, 68.2% male) were assessed. Patients were divided into two groups as follows: acutekidney injury (n = 84) and nonacute kidney injury (n = 48). Frailty incidence (48.8% vs. 8.3%, p < 0.01) was higher in the acute kidneyinjury group. In multivariate analysis, frailty (OR, 3.32, 95% CI, 1.67–6.56), the use of vasopressors (OR, 3.06 95% CI, 1.16–8.08), andthe increase in respiratory support therapy (OR, 2.60, 95% CI, 1.01–6.6) were determined to be independent risk factors for acute kidneyinjury development. The mortality rate was found to be 97.6% in patients with acute kidney injury.Conclusion: Frailty is a risk factor for acute kidney injury in geriatric patients with severe COVID-19. The evaluation of geriatricpatients based on a frailty scale before intensive care unit admission may improve outcomes.Key words: Frailty, COVID-19, acute kidney injury, intensive care

The most appropriate ventilatory mode during fiberoptic bronchoscopy is still not yet known clearly for patients with acute respiratory distress syndrome. Airway pressure release ventilation is used as a recovery treatment for patients with severe acute respiratory distress syndrome. In this study, the aim was to evaluate the safety of the fiberoptic bronchoscopy process in patients with severe acute respiratory distress syndrome ventilated with airway pressure release ventilation mode and its effect on gas exchange and respiratory mechanics.Single-center retrospective observational study was performed in the intensive care unit of a tertiary referral center from September 2018 to November 2019. Patients with severe ARDS ventilated with APRV mode and undergoing FB were included. Fiberoptic bronchoscopy was performed by an expert intensivist-pulmonologist. All ventilator parameters set by the clinician were kept stable, and no change was made other than O2 concentration. The mechanical ventilation parameters and arterial blood gas values before and after the procedure and fiberoptic bronchoscopy-related complications were recorded for the first 24 hours.A total of 14 acute respiratory distress syndrome patients who were ventilated with airway pressure release ventilation were enrolled. No significant deteriorations were detected in gas exchange, pulmonary compliance, and airway resistance values in our case series. It was observed that a small reduction in PaO2 and an increase in PaCO2 were present after the 1st hour; however, both were returned to baseline values in the 24th hour. Only 1 patient developed fiberoptic bronchoscopy-induced hypoxemia (7.1%). Complications, such as fiberoptic bronchoscopy-induced barotrauma, pneumothorax, hemodynamic deterioration, and bleeding, were not detected.According to our preliminary findings, performing fiberoptic bronchoscopy under airway pressure release ventilation mode by an experienced bronchoscopist does not bring additional complication risks in patients with severe acute respiratory distress syndrome.

PurposeThe aim of this study is to visualize the effect of a high flow nasal cannula (HFNC) in patients with the diagnosis of COVID-19 acute respiratory distress syndrome (C-ARDS) followed up in intensive care unit (ICU) with the use of electrical impedance tomography (EIT). Methods Two different flow rates oxygen therapy in supine and prone positions were applied to the patients with HFNC. Patients’ EIT-based parameters (global inhomogeneity index (GI index), Center of Ventilation (CoV), Regional Ventilation Delay index (RVD index), Region of Interest Ratio (ROI ratio)), respiratory and hemodynamic parameters were recorded from the database.ResultsTwenty patients were included in this retrospective observational study.When the flow rate gradually increased from baseline to 50 L/min and prone position; a significant and consistent descreasing trend of GI index: 0,55±0,02 (p < 0.0001), CoV: 42,98±0,93 (p 2/FiO2. ratio (partial arterial oxygen pressure/fraction of inspired oxygen): 203,1±33,44 ((p < 0.0001) were observed. ConclusionIt was found that lung homogeneity in following C-ARDS patients in the prone position increases according to the evaluation of EIT parameters, respiratory and hemodynamic parameters.

The effects of fiberoptic bronchoscopy are not elucidated in different mechanical ventilation modes. The present study aimed to evaluate the effects of fiberoptic bronchoscopy on lung mechanics, ventilation parameters, and gas exchange in 2 often-used modes, volume control and pressure control, in invasively ventilated patients followed up in the intensive care unit.Eligible patients were screened and included in the study after intensive care unit-fiberoptic bronchoscopy database search. Patients who underwent fiberoptic bronchoscopy under volume control and pressure control mechanical ventilation modes were compared. The primary outcome was the occurrence of any complication within the first 24 hours after the procedure, and secondary outcomes were changes in lung mechanics (dynamic lung compliance and airway resistance) and gas exchange (arterial partial pressures of oxygen and carbon dioxide).A total of 61 patients (median age: 69 years, 60.7% male) were included. Twenty-nine (47.5%) patients were ventilated in volume control mode and 32 (52.5%) in pressure control mode during the fiberoptic bronchoscopy procedure, and the median (interquartile range) duration of the procedure was 9 [8-11] minutes. Baseline dynamic lung compliance, airway resistance, arterial partial pressures of oxygen and carbon dioxide, and the fraction of inspired O2 were similar in both groups. After fiberoptic bronchoscopy, dynamic lung compliance decreased in both groups, and airway resistance and peak airway pressures increased but reached pre-fiberoptic bronchoscopy values at the 1st hour after the procedure. No significant differences were detected in both groups in terms of blood gas values and lung mechanics in the 1st and 24th hours after the procedure. In both groups, the 24th hour fraction of inspired O2 was the same as the pre-fiberoptic bronchoscopy values, but the ratio of arterial partial pressure of oxygen and the fraction of inspired O2 improved. No complications developed in patients within 24 hours after the procedure.No differences were detected in terms of gas exchange and pulmonary mechanics, and complications in volume control and pressure control modes in critically ill intubated patients.

The first case of coronavirus disease 2019 (COVID-19) was defined as unexplained pneumonia on December 8, 2019, and then it rapidly caused a pandemic and affected transplantation rates negatively. Organ donation processes got more complex because the exclusion of the disease in a short period became more difficult than normal. The exclusion of the disease is vital not only for recipients but also for the medical staff, transplantation teams, and intensive care professionals to reduce the transmission risk. The main steps for diagnosis of COVID-19 are investigation of symptoms, recollection of travel and physical contact history, and testing using the real time polymerase chain reaction (RT-PCR) test. Although it has limitations such as false negative results, RT-PCR is the most accurate method to detect COVID-19, and it is mandatory before donation processes in many countries. In this case report, we aim to share our experience about the first organ donation during the COVID-19 pandemic in Turkey.

OBJECTIVE: Drowning is a process of submersion and can lead to respiratory failure. Annually, there are an estimated 320 000 deaths worldwide due to drowning, in addition to nonfatal drowning events. There are limited data for respiratory failure due to drowning and its prognosis in Turkey. The aim of this study was to identify the therapeutic modalities used for acute respiratory failure (ARF) due to drowning, and its prognosis in hospitalized patients. MATERIAL AND METHODS: All adult drowning cases (according to the International Classification of Disease (ICD) diagnosis code) who were admitted to either the emergency department (ED) or the intensive care units (ICU), or the pulmonology inpatient clinics between 2008 and 2018 were included in the study. Data for demographic characteristics, radiologic evaluations, respiratory support and mechanical ventilation, hospital stay duration, and hospital mortality were retrospectively collected from hospital records. RESULTS: A total of 117 patients (47 females, 70 males, mean age: 57.3 years) were included in the study. The drowning accidents most commonly occurred in summer (86.3%). Of them, 31 victims (26.4%) were admitted to ICU due to severe respiratory failure. The mean pH was 7.32, and PaO(2) was 69.13 mmHg in the arterial blood gas at admission. Invasive and noninvasive mechanical ventilation were performed in 24.7% and 25.6% of the patients respectively. The PaO(2)/FiO(2) of 106 patients (who had accessible FiO(2) values) were >300 in 12 (11%), 201-300 in 32 (30%), 101-200 in 49 (46%), and

To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19.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.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; p0.001), albumin levels2.92g/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).The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels2.92g/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.Avaliar a incidência de fatores de risco para hipotensão pósintubação em pacientes críticos com COVID-19.Foi realizado um estudo retrospectivo com 141 pacientes com COVID-19 que foram intubados na unidade de terapia intensiva. Hipotensão pós-intubação foi definida como a necessidade de qualquer dose de vasopressor a qualquer momento em até 60 minutos após a intubação. Pacientes com parada cardiorrespiratória relacionada à intubação e hipotensão antes da intubação foram excluídos do estudo.Dos 141 pacientes incluídos, 53 pacientes (37,5%) e 43,6% dos pacientes (n = 17) eram do sexo feminino. A idade mediana do grupo com hipotensão pós-intubação foi de 75 anos (amplitude interquartil: 67,0 - 84,0). Na análise multivariada, índice de choque ≥ 0,90 (RC = 7,76; IC95% 3,14 - 19,21; p0,001), níveis de albumina2,92g/dL (RC = 3,65; IC95% 1,49 - 8,96; p = 0,005) e níveis de procalcitonina (RC = 1,07, IC95% 1,01 - 1,15; p = 0,045) foram fatores de risco independentes para hipotensão pós-intubação. A mortalidade hospitalar foi semelhante em pacientes com hipotensão pós-intubação e pacientes sem hipotensão pós-intubação (92,5% versus 85,2%; p = 0,29).A incidência de hipotensão pós-intubação foi de 37,5% em pacientes críticos com COVID-19. Um índice de choque ≥ 0,90 e níveis de albumina2,92g/ dL foram independentemente associados à hipotensão pós-intubação. Além disso, índice de choque ≥ 0,90 pode ser uma ferramenta do leito antes da intubação endotraqueal. Neste estudo, a hipotensão pós-intubação não esteve associada ao aumento da mortalidade hospitalar em pacientes com COVID-19.

Objective:This study aimed to determine and compare the effects of two different gastric residual volume (GRV) thresholds, 200 mL and 400 mL, on target calories and gastrointestinal intolerance in intensive care patients receiving enteral nutrition.Materials and Methods:Prospective data of 56 patients over 18 years of age who were expected to stay in the intensive care unit for more than three days were included in the study. Patients were randomized into two groups as GRV threshold 200 mL (group 1) and GRV 400 mL (group 2). Enteral Measurement of GRV was done every six hours. The feeding was initiated at a rate of 20 mL/h and was increased by 10 mL/h to reach the goal rate.Results:There was no significant difference between two groups regarding gender, age, APACHE II score, body mass index, length of stay in intensive care unit, admission reason, and co-morbidities. There was also no significant difference in the incidence of GRV, vomiting, diarrhea and intolerance. Time to target calories was 24 hours in group 1 and 26 hours in group 2, and no significant difference was found between the two groups.Conclusion:In this study, there was no significant difference between 200 mL and 400 mL GRV regarding time to target calories and incidence of gastrointestinal complications in critical intensive care unit patients.

Background: To date, the coronavirus disease 2019 (COVID-19) caused more than 2.6 million deaths all around the world. Risk factors for mortality remain unclear. The primary aim was to determine the independent risk factors for 28-day mortality. Materials and Methods: In this retrospective cohort study, critically ill patients (>= 18 years) who were admitted to the intensive care unit due to COVID-19 were included. Patient characteristics, laboratory data, radiologic findings, treatments, and complications were analyzed in the study. Results: A total of 249 patients (median age 71, 69.1% male) were included in the study. 28-day mortality was 67.9% (n = 169). The median age of deceased patients was 75 (66-81). Of them, 68.6% were male. Cerebrovascular disease, dementia, chronic kidney disease, and malignancy were significantly higher in the deceased group. In the multivariate analysis, sepsis/septic shock (OR, 15.16, 95% CI, 3.96-58.11, p < 0.001), acute kidney injury (OR, 4.73, 95% CI, 1.55-14.46, p = 0.006), acute cardiac injury (OR, 9.76, 95% CI, 1.84-51.83, p = 0.007), and chest CT score higher than 15 (OR, 4.49, 95% CI, 1.51-13.38, p = 0.007) were independent risk factors for 28-day mortality. Conclusion: Early detection of the risk factors and the use of chest CT score might improve the outcomes in patients with COVID-19.

Background Mortality in critically ill patients with coronavirus disease 2019 (COVID‐19) is high, therefore, it is essential to evaluate the independent effect of new‐onset atrial fibrillation (NOAF) on mortality in patients with COVID‐19. We aimed to determine the incidence, risk factors, and outcomes of NOAF in a cohort of critically ill patients with COVID‐19. Methods We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID‐19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID‐19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID‐19 patients. Results NOAF incidence was 14.9% (n = 37), and 78% of patients (n = 29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5‐84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, P = .019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40‐5.09, P = .582). Conclusions The incidence of NOAF was 14.9% in critically ill COVID‐19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID‐19., The incidence of NOAF is high in critically ill COVID‐19 patients. Hospital mortality is high in severe COVID‐19 patients with NOAF. Patients with NOAF are older and have co‐existing comorbidities.

Background/aim: Bevacizumab is a chemotherapeutic drug, which selectively binds to vascular endothelial growth factor (VEGF) and mainly inhibits angiogenesis and neovascularization. We aimed to study the possible effects of bevacizumab on right ventricular pressure (RVP), right ventricular hypertrophy, and VEGF, in hypoxia -induced pulmonary hypertension (PH) rat model. Materials and methods: 24 adult Wistar Albino rats were randomly divided into four groups: control group -saline; Bevacizumab Group; PH Group; PH + Bevacizumab Group. In hypoxia -induced model, 10% oxygen and 90% nitrogen were applied in a plexiglas box for eight days to PH Group and PH + Bevacizumab Group. On day eight, RVPs were measured directly from the heart, and then animals were sacrificed. Heart and lung tissues were examined, and Fulton index was measured. Results: RVP, Fulton index, and tissue VEGF scores were significantly lower in PH + Bevacizumab group than PH group: median (ranges), RVP, mmHg, 37.8 (33.0-39.0) and 32.3 (28.0-35.0), p: 0.01; Fulton index: 0.30 (0.29-0.33) and 0.25 (0.24-0.26), p: 0.003; tissue VEGF scores: 5.1 (4.8-5.3) and 4.0 (3.8 4.1), p: 0.004, respectively. Conclusion: Bevacizumab, which is indeed an antineoplastic agent, might have a favorable effect on hypoxia -induced pulmonary hypertension.

Despite improvements in medical and surgical treatment, aneurysmatic subarachnoid hemorrhage (SAH) remains one of the main causes of early mortality. Cardiac and pulmonary complications are the main causes of mortality. One of the most severe cardiac complications is neurogenic stress cardiomyopathy. Left ventricular dysfunction which is seen in neurogenic stress cardiomyopathy, although it is usually reversible within a few days, can cause severe hypotension, pulmonary edema and cardiogenic shock. Traditional treatment of heart failure after SAH is based on the use of noradrenaline, dobutamine and high volume of fluids. However, it is difficult to treat reduced cardiac output in SAH. Because, myocardial cells are already under stress due to increased adrenergic stimulation. The use of exogenous catecholamines may cause additional neurocardiogenic damage in myocardial cells, excessive calcium burden, decreased cerebral blood flow, and delayed cerebral ischemia. By reducing the use of exogenous catecholamines with levosimendan, the vicious circle of cardiotoxicity induced by catecholamines can be broken. Levosimendan is a nonadrenergic inotropic calcium sensitizer that allows rapid recovery of cardiac output and optimizes cerebral perfusion without increasing myocardial oxygen consumption. If we consider that reduction in left ventricular systolic function plays a role in the pathogenesis of delayed cerebral ischemia, the risk of developing neurological complications may be reduced by administration of levosimendan in these patients. Moreover, new evidence from experimental studies also indicates that levosimendan may have neuroprotective effects in the SAH. In this review, the use of levosimendan in the treatment of hemodynamic disorders which develops in the course of SAH has been discussed in company with current literature.

Objective:Intensive care units (ICU) are multidisciplinary structures dealing with potentially life-threatening diseases. Trauma patients are among some of the patients treated in ICU. In this study, we aimed to investigate the causes of mortality and morbidity in trauma patients treated in our ICU.Materials and Methods:The data of trauma patients hospitalized in anesthesia ICU between January 2014-2016 were evaluated retrospectively. Patients’ age, gender, concomitant disease, trauma etiology, clinical diagnoses, APACHE-2 revised trauma score (RTS) and injury severity scores, duration of stay in ICU, duration of mechanical ventilation, duration of hospital stay, mortality rates, discharge status from ICU and discharge Glasgow Coma Scale score, hemodialysis requirement during follow-up, enteral nutrition status within 48 hours after admission to ICU and lactate levels at admission to ICU were evaluated.Results:A total of 954 patients were treated in the ICU and 106 patients (11.1%) were followed up for trauma. Regarding 28-day and 90-day mortality, the mean lactate levels, duration of mechanical ventilation and APACHE-2 scores were significantly higher in non-survivors (p

The nocturnal peak of melatonin can be altered after anesthesia and surgery. We aimed to examine the melatonin levels during the day and night after anesthesia with three commonly used inhalational anesthetics. Forty-eight male Wistar albino rats were randomized into eight groups. Rats were administered anesthesia between 7:00 AM and 1:00 PM (day groups) or 7:00 PM and 1:00 AM (night groups) for 6 hours. At the end of the anesthesia, blood samples were collected for assessing melatonin levels. Mean values of melatonin levels after 6 hours of anesthesia during daytime were 43.17 +/- 12.95 for control, 59.79 +/- 27.83 for isoflurane, 50.75 +/- 34.28 for sevoflurane and 212.20 +/- 49.56 pg/mL for desflurane groups. The night groups' mean melatonin levels were 136.12 +/- 33.20 for control, 139.85 +/- 56.29 for isoflurane, 117.48 +/- 82.39 for sevoflurane and 128.70 +/- 44.63 pg/mL for desflurane groups. Desflurane anesthesia between 7:00 AM and 1:00 PM significantly increased melatonin levels (p < 0.001). Sevoflurane and desflurane anesthesia between 7:00 PM and 1:00 AM decreased the melatonin levels but there were no significant differences (pZ0.904 and p > 0.99, respectively). Isoflurane anesthesia did not significantly change melatonin levels during day or night (p = 0.718 and p > 0.99, respectively). Our results demonstrate that during daytime desflurane anesthesia can alter melatonin levels. Altered melatonin rhythm following inhalational anesthesia can be related to sleep disorders observed after anesthesia. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.

Objective: Emotional and physical burden is heavy in the intensive care unit (ICU) employees, and the risk of burnout has significantly increased. The purpose of this study is to determine the frequency of burnout and depression in nurses serving in tertiary ICUs in a university hospital by questionnaire.

Objective The aim of this study is to investigate the effect of day and night administration of desflurane anaesthesia on melatonin levels in rats. Methods Twenty-four 15-day-old rats were included in the study and were divided into four groups. The rats were anaesthetised between 19:00-01:00 (night group) and 07:00-13:00 (day group) with 5.7% desflurane concentration in 6 L min-1 100% oxygen. 6 L min-1 oxygen was administered to the control groups. At the end of 6 h of anaesthesia, blood samples were taken, and rats were sacrificed. Blood samples were centrifuged and melatonin levels from plasma samples were measured with radioimmunoassay. Results There was a statistically significant difference between the groups (p=0.007). Between group day control and group night control there was a statistically significant difference (p=0.042). Further, there was a significant difference between group day control and night desfluran as well (p=0.024). We could not find any difference between other groups. Conclusion This study showed that 6 hours of 5.7% desflurane anaesthesia during day and night hours did not significantly change melatonin levels.

Introduction: Sugammadex (Bridon ®) (SUG) is a recently developed neuromuscular block reversing agent. SUG can reverse also deep neuromuscular blockages in a short time period unlike other existing agents. SUG passes across blood brain barrier (BBB) in a very low ratio in normal patients. However SUG may pass the BBB in a higher ratio in patients whom BBB integrity is decreased. Since SUG passes BBB in a low ratio in normal patients there are only a small amount of studies investigating effects of this agent on central nervous system (CNS). In this study we aimed to assess the effects of SUG administered directly to intracerebroventricular space on CNS system of rats. Materials and Method: A total of 36 Wistar-Albino rats with normal motor activity weighting between 250-280 g were included in this study. Anesthesia was achieved with intraperitoneal 50 mg/kg sodium thiopental. The rats were divided into 6 equal groups randomly as one group being the control group. The experiment groups were received 2,4,8,16 and 32 mg/kg sugammadex via intracerebroventricular cannula. Effects of the SUG on CNS were assessed based on a 5 point scale. Results: Intracerebroventricular SUG administration did not result in any changes in behavioral status, locomotor activity or posture at any doses (2,4,8,16 and 32 mg/kg). There was no tonic clonic convulsion or seizure development following the sugammadex administration. Discussion: SUG barely passes the BBB in normal patients. However it was stated that this drug can pass BBB in higher ratios in certain patients. Therefore investigating the effects of SUG on CNS is an emerging subject of experiments. In our study we could not find any adverse effect of SUG on CNS even at high doses administered directly to intracerebroventricular space. However presence of a study indicating an increase in apoptotic cell death in cell cultures in presence of SUG makes it difficult to make a statement that SUG does not have any adverse effect on CNS. The authors of the aforementioned study stated a connection between decrease in cholesterol levels and apoptosis. It can be speculated that some mechanisms in live animals may restore this decrease in cholesterol levels occurring in presence of SUG therefore prevents the cells from apoptosis. Conclusion: In our study SUG did not cause any adverse effect on CNS in rats. Further studies assessing the relationship between SUG and cholesterol control mechanisms in neurons are necessary in order to make a certain statement.

The aim of our study was to examine the effects of the use of Transcutaneous Electrical Nerve Stimulation (TENS) in patients who had undergone spinal surgery on pain, functionality, depression and consumption of analgesic agents.Fifty-Four patients were randomized and placed into two groups, patient-controlled analgesia (PCA) plus TENS and only PCA. To assess the pain levels of the patients, the Visual Analog Scale (VAS) was used. In the assessment of their functional levels, the Timed Up and Go test (TUG) was utilized and in the assessment of their depression, the Beck Depression Inventory (BDI) was used. The measurements were performed before the operation and on the first and second postoperative days. The side effects were recorded from the analgesic agents.During the first and second days after the operation, a decrease in the pain levels was noticed in the TENS group (p0.05. In the TENS group, the consumption of analgesic agents also decreased and thus side effects were less frequent. From the viewpoint of functional and depression levels, no significant difference between the groups was noticed (p0.05).TENS was effective in reducing analgesic agent-related side effects and in reducing analgesic consumption. In addition, TENS also decreased activity related pain.