Prevalence and Causes of Elective Surgery Cancellations After Patients are Taken to the Operating Room: A Prospective, Cross-Sectional Study.

Objective: This study aimed to investigate the causes and prevalence of elective surgery cancellations in the operating room, and the clinical outcomes of affected patients. Methods: This prospective, cross-sectional study assessed the prevalence and causes of elective surgery cancellations once patients are in the operating room. A tertiary academic referral center hosted the study between January 2022 and January 2023. The study sample consisted of 7,482 adult patients scheduled for elective surgeries and taken to the operating room. The 7,415 completed procedures were in Group 2, whereas the 67 cancelled surgeries were in Group 1. Patients were divided into two groups on the basis of whether their surgeries were completed or cancelled. Factors such as age, American Society of Anesthesiologists (ASA) status, and surgical department were analyzed. The two groups were compared on the basis of age, ASA status, surgical department, and surgery time (month and day). Results: Elective surgery cancellations occurred in the operating room at a rate of 0.9%. Group 1 was substantially older than Group 2 (p<0.001). Group 1 had a larger number of ASA III patients (p<0.001). The department with the highest cancellation rate was ophthalmology (2.5%), followed by general surgery (2.1%), urology (1.5%), and ear, nose, and throat (1.4%). It was possible to avoid 59.7% of cancelations. Conclusion: The study revealed a 0.9% prevalence rate of elective surgery cancelations in the operating room. Older age and higher ASA status greatly influenced these cancellations. Optimized surgery scheduling and patient assessment processes may prevent many of these cancellation.

The effect of ozone treatment on remote organ myocardial injury in an aortic ischemia-reperfusion model.

BACKGROUND: This study aims to investigate the effect of ozone on myocardial ischemia-reperfusion injury occurring after occlusion - reperfusion of infrarenal abdominal aorta in rats. METHODS: Thirty-two Wistar albino rats (weighing 200-250 g) were randomized into four equal groups. The control (sham) group underwent laparotomy and dissection of the infrarenal abdominal aorta without occlusion. Intraperitoneal ozone was applied for 10 days 1 mg/kg/day in the control+ozone group. Afterwards, control+ozone group underwent laparotomy and dissection of the infrarenal abdominal aorta without occlusion. Aortic ischemia-reperfusion and aortic ischemia-reperfusion+ozone groups underwent dissection of the infrarenal abdominal aorta, followed by achieving ischemia and reperfusion by cross-clamping the infrarenal abdominal aorta for 60 minutes and removing the cross-clamp for 60 minutes, respectively. The tissue levels of malondialdehyde and activity levels of superoxide dismutase, catalase, and myeloperoxidase were measured in the myocardial specimens. The tumor necrosis factor, interleukin-6 and troponin-I levels were measured in the plasma. A histopathological examination of the myocardial specimens was undertaken. RESULTS: Biochemical analysis showed that aortic ischemia-reperfusion significantly increased (p<0.05 vs. control) while ozone significantly decreased (p<0.05 vs. aortic ischemia-reperfusion) the myocardial tissue levels of superoxide dismutase and catalase and level of plasma troponin-I. Histologically, in the aortic ischemia-reperfusion group, myocardial disorganization, myofiber swelling and myofiber eosinophilia in the myocardial tissue samples were significantly increased compared to the control group (p<0.05 vs. control). However, histopathological changes in the aortic ischemia-reperfusion+ozone group decreased compared to the aortic ischemia-reperfusion group. CONCLUSION: The results of this experimental study indicate that ozone attenuates myocardial injury and oxidative stress that develop after infrarenal aortic ischemia-reperfusion through three markers; (i) decreased tissue superoxide dismutase and catalase levels, (ii) d ecreased p lasma t roponin-I l evels, a nd (iii) reduced histopathological changes, albeit not statistically significant.

Frequency of development of aspirin resistance in the early postoperative period and inadequate inhibition of thromboxane A2 production after coronary artery bypass surgery.

BACKGROUND: This study aims to investigate the frequency of the development of aspirin resistance, whether or not this resistance was reversible, and to evaluate the efficiency of the mechanism of incomplete inhibition of thromboxane A2 in development of aspirin resistance in the early postoperative period in patients who had undergone coronary artery bypass grafting. METHODS: Eighty patients (55 males, 25 females; mean age 63.1±9.2 years; range 51 to 75 years) who underwent coronary artery bypass grafting between February 2009 and March 2010 at our clinic were prospectively evaluated. Venous blood samples were collected from all patients and evaluated by a platelet function analyzer in the preoperative period and on postoperative days 7 and 15. Aspirin resistance diagnosis was defined as collagen-epinephrine closure time less than 186 seconds. The urine levels of 11-dehidro thromboxane B2 were also measured on postoperative day one. RESULTS: Aspirin resistance was found in 23 patients (28.75%) in the preoperative period, in 31 patients (38.75%) on the postoperative seventh day and in 25 patients (31.25%) on the postoperative 15th day. The urine levels of 11-dehidro thromboxane B2 in patients with aspirin resistance on the postoperative seventh day were significantly higher than those in patients without aspirin resistance (p<0.001). The mean aortic cross-clamping time (p=0.003) and cardiopulmonary bypass time (p=0.029) in the patients with aspirin resistance on the postoperative seventh day were significantly higher than those in patients without aspirin resistance. CONCLUSION: The results of this study suggest that aspirin resistance develops within the first seven days after coronary artery bypass grafting and is highly reversible, and that the mechanism of inadequate inhibition of thromboxane A2 by aspirin has a role in the development of aspirin resistance in the early postoperative period.

[The results of greater occipital nerve block applied for migraine headache]. / Migren basagrisinda büyük oksipital sinir blogu uygulama sonuçlarimiz.

OBJECTIVES: The aim of this study was to evaluate the efficacy of greater occipital nerve (GON) block in the treatment of migraine patients. METHODS: This study included 28 patients diagnosed with migraine between 2014 and 2015. The GON block procedure was applied by administering 1.5 ml of 2% lidocaine 2 cm lateral and 2 cm inferior to the external occipital protuberance. The patients were evaluated in respect of VAS scores, attack frequency, attack duration and the need for analgesia before the procedure. These parameters were evaluated again at 1 week, 1 month and 3 months after the procedure. RESULTS: The mean age of the patients was 42.21±10.13 years. The mean VAS score was 9.28±0.72 before the procedure and 2.96±2.16 at 1 week, 2.60±1.96 at 1 month and 1.75±1.37 at 3 months. The frequency of attacks was 9.42±4.51 before the procedure and, 5.42±3.30 at 1 month and 3.57±3.14 at 3 months. CONCLUSION: GON block with 1.5 ml of 2% lidocaine is a safe, simple and effective treatment method for migraine headache.

The genicular nerve: radiofrequency lesion application for chronic knee pain.

BACKGROUND/AIM: We investigated the short- and medium-term effectiveness of genicular nerve radiofrequency (RF) applied in patients with chronic knee pain due to osteoarthritis. MATERIALS AND METHODS: Radiofrequency was performed in 49 patients with a diagnosis of knee osteoarthritis. VAS and WOMAC were measured at baseline and at 1, 4, and 12 weeks postprocedure. Under fluoroscopic guidance, the cannula was advanced percutaneously towards the area connecting the shaft to the epicondyle. The RF electrode was inserted through the cannula and the electrode tip temperature was raised to 80 °C for 90 s. One RF lesion was made for each genicular nerve. RESULTS: Mean patient age was 64 ± 10.6. VAS score before the procedures was 8.9 ± 0.8, while 1, 4, and 12 weeks after the procedure it was 4.73 ± 3.23, 3.89 ± 2.9, and 3.93 ± 2.95, respectively. WOMAC score before the procedures was 64.26 ± 7.29, while 1, 4, and 12 weeks after the procedures it was 44.93 ± 13.18, 42.81 ± 13.15, and 43.04 ± 13.36, respectively. CONCLUSION: RF neurotomy of genicular nerves led to significant pain reduction and functional improvement in a subset of elderly patients with chronic knee osteoarthritis pain, and thus may be an effective treatment in such cases.

A 27-kg mucinous cystadenoma of the ovary presenting with deep vein thrombosis.

Giant ovarian adenomas are rarely observed today because of early diagnosis and treatment. Mucinous cystadenomas is a kind of tumor that mostly causes the ovary to enlarge. Theu can present with various and non-specific clinical manifestations such as deep vein thrombosis. The primary symptoms of giant ovarian tumors are abdominal enlargement and distension. Therefore, making the correct preoperative diagnosis is sometimes difficult. The appropriate treatment must include oncologic procedures and a multidisciplinary approach to minimalize complications and save the patient's life. Herein, we report a woman aged 53 years with a 27-kg ovarian mucinous cystadenoma that presented as a left popliteal vein thrombosis.

The application of epidural anesthesia in pregnant woman with uncorrected tetralogy of Fallot: a case report.

Tetralogy of Fallot is the most common cyanotic congenital cardiac disease. The hemodynamic changes which are present immediately after abdominal delivery may be resulted with serious, life-threatening multiorgan complications. Therefore the choice of anesthesia is very difficult. We describe the case of pregnant, 33 weeks gestation, with uncorrected tetralogy of Fallot who underwent caesarian section. The epidural anesthesia was performed uneventfully. After having stabile vital signs and a good general condition patient was followed up at the intensive care unit for 4 days. She was transferred to the obstetric service. We think that application of epidural anaesthesia with fragmented and increasing doses of slow levobupivacain in pregnant women with tetralogy of Fallot is safe. Nonetheless, this data of ours will grow stronger with the increase of the clinical application amount.