Objectives: Anemia is prevalent in the surgical population. Since anemia and blood transfusion are associated with increased mortality, optimizing patient blood management and treating anemia may improve patient outcomes. This study aims to determine the impact of preoperative anemia on postoperative morbidity and mortality in patients undergoing open-heart surgery.
Methods: Our prospective observational study included 200 patients scheduled for elective open-heart surgery, divided into two groups: 100 with preoperative anemia and 100 without. The two groups were compared in terms of morbidity and in-hospital mortality.
Results: In our study, postoperatively, sepsis was observed in 11% of the anemia group, acute kidney injury (AKI) in 22%, and cerebrovascular disease (CVD) in 4%, while in the control group, sepsis was observed in 4%, AKI in 15%, and CVD in 2%. No significant association was found between the incidence of sepsis, AKI, and CVD in the two groups. Mortality rates were 7% in the anemia group and 4% in the control group, indicating that anemia was not a decisive factor in mortality.
Conclusion: Although the duration of MV was longer in the preoperative anemia group, there was no difference in ICU and hospital stay durations. Despite higher incidences of sepsis, AKI, CVD, and mortality in the anemia group, anemia was not found to be a determining risk factor. We conclude that managing anemia, a treatable condition, in elective cases such as high-mortality open-heart surgeries is essential to minimize risk factors.

Objectives: This study aims to examine the relationship between microcirculation and macrocirculation in the early period after extracorporeal circulation (ECC). Specifically, it investigates whether macrocirculation parameters such as Double Product (DP) and Shock Index (SI) can predict microcirculation by studying their correlation with lactate levels, a marker of microcirculation, in the early post-ECC period.
Methods: The study analyzed the demographic, hemodynamic, and laboratory data of 2039 patients who underwent isolated coronary bypass surgery with ECC at Acıbadem Kadıköy and Acıbadem Altunizade Hospitals between 1999 and 2023. The data included serum lactate levels, DP, and SI measurements taken before induction and after ECC for all patients, as well as for the subgroup with DP values above 12,000.
Results: The analysis did not find any correlation between plasma lactate levels and DP and SI during the post-ECC period; p=0.11, r=0.04 (-0.01; 0.08) and p<0.001, r=0.11 (0.06; 0.15), respectively. Similarly, no correlation was found between plasma lactate values and DP in patients with DP values >12,000 (n=284) (p=0.643, r=0.03 (-0.09; 0.14)).
Conclusion: Vital parameters do not fully capture circulatory disorders. It would be more appropriate for critically ill patients to assess microcirculation using parameters such as lactate directly. Therefore, further studies are necessary to evaluate microcirculation and develop independent parameters.

This multicenter study aims to investigate the incidence of chronic postsurgical pain (CPSP) after cardiac surgery, exploring the influence of various factors and their implications on patients' quality of life. The CPSP-Cardiac is a large, multicenter, observational study. The target population of 1176 cardiac surgery patients will be recruited from participating hospital sites. Patients undergoing cardiac surgery with median sternotomy for coronary surgery and all open-heart procedures will be eligible for the study. Patients between the ages of 18–80 years who have an American Society of Anesthesiologists Physical Status score of II–III will be included. The primary outcome of our study is to determine the incidence of chronic postsurgical pain in the third month following cardiac surgery, along with identifying the factors that influence it. Our secondary outcomes include assessing opioid consumption in the first 24 hours postoperatively, NRS scores, incidences of postoperative nausea and vomiting, side effects and complications, extubation time, length of stay in the intensive care unit and hospital, chronic pain status at 3 and 6 months, psychological assessments, quality of life, and postoperative complications at 3 and 6 months.

Objectives: The present study aims to evaluate the knowledge and awareness levels of pulmonologists regarding local anesthetic (LA) toxicity and the use of intravenous lipid therapy.
Methods: This study included research assistants, specialists, and faculty members working in the field of chest diseases in Türkiye, who agreed to participate. A survey consisting of 16 questions was prepared to assess physicians’ knowledge regarding local anesthetic toxicity and the use of intravenous lipid therapy for its treatment. The survey was used to obtain participants’ general knowledge of local anesthetic drugs, their toxicities, and general knowledge of toxicity treatment.
Results: A total of 109 physicians participated in this study. The highest participation was received from university hospitals (49.5%), and 47.7% of the participants had been working in this specialty for over 10 years. Lidocaine was the most commonly used agent (94.5%). Allergy (23.85%) and arrhythmia (21.1%) among the early signs of toxicity, and hepatotoxicity (34.86%) and cardiac arrest (33.94%) among the late signs, were frequently selected. While 21.1% of the physicians encountered toxicity, symptomatic treatment (54.13%) was the most frequently chosen method upon encountering toxicity. It was found that 57.8% of the physicians had not heard of lipid therapy for toxicity, and 6.4% used lipid therapy when encountering toxicity. Significant differences were found in the knowledge about treatment application among physicians by their roles in pulmonary clinics (p=0.00).
Conclusion: This study revealed a consistent lack of education and awareness among pulmonologists regarding local anesthetic toxicity and its treatment.

Objectives: The aim of this study was to retrospectively investigate the tracheal stenosis (TS) etiologies of patients with a diagnosis of TS after intubation who underwent rigid bronchoscopy balloon dilation/rigid bronchoscopy balloon dilatation+stent/tracheal resection and reconstruction at our clinic.
Methods: Medical records of all adult patients who underwent procedures for TS between March 1, 2020, and April 30, 2022, at our clinic were retrospectively reviewed. Age, gender, previous ASA score, comorbidities, etiology of TS, type of surgery performed, length of hospital stay after the surgical procedure, morbidity, and mortality data were recorded.
Results: It was determined that interventions were performed on a total of 101 patients due to post-intubation TS. Among these patients, it was observed that 37 (36.6%) had experienced intubation due to coronavirus, 19 (18.8%) due to neurological diseases, and 14 (13.9%) due to multiple traumas. Of the patients, 57 (56.43%) were male and 44 (43.57%) were female. The most common accompanying comorbidities were hypertension (25.7%) and diabetes (21.7%). The mean age was 50.3±17.2 years, and the mean duration of intubation was 25.4±17.8 days. Rigid bronchoscopy balloon dilatation was performed a median of 2 times per patient. Rigid bronchoscopy balloon dilatation+stent was performed in four patients, and tracheal resection and reconstruction was performed in 58 patients.
Conclusion: In the cross-sectional evaluation of the patients, it was determined that the most common cause of TS developing after intubation was coronavirus.

P2Y12 inhibitors, along with aspirin, are essential therapeutic agents in dual antiplatelet therapy, the most effective approach for preventing arterial thrombosis in patients with acute coronary syndrome and a history of stent implantation. This paper reports on two cases of a rare complication resulting in acute intraparenchymal hematoma triggered by ticagrelor. It also presents a discussion on the side effects of ticagrelor-related intracranial bleeding in light of the literature. Ticagrelor, a cyclopentyl-triazolopyrimidine antiplatelet drug, is the first reversible oral P2Y12 receptor antagonist. Its side effects include bleeding, liver failure, bradycardia, dyspnea, elevated creatinine, elevated uric acid levels in the blood, and thrombotic thrombocytopenic purpura. Ticagrelor is a potent, rapid-onset, backpropagating P2Y12 receptor inhibitor used in acute coronary syndrome. Ticagrelor is generally well tolerated. One of the most common side effects is bleeding. This paper presents two cases of bleeding in the parieto-occipital region following ticagrelor loading.