Objectives: To investigate the relationship between the SYNTAX score and inflammatory markers (CRP, RDW, PDW) in patients undergoing coronary artery bypass grafting (CABG) and to evaluate their independent predictive roles in in-hospital mortality.
Methods: This retrospective, single-center study included 160 consecutive patients who underwent elective isolated CABG between January 2024 and April 2025. Preoperative SYNTAX scores were calculated, and inflammatory markers (CRP, RDW, PDW) were measured within 24 hours before surgery. The primary endpoint was in-hospital mortality. Correlation analyses, subgroup comparisons, and multivariate logistic regression were performed.
Results: CRP, RDW, and PDW levels significantly increased across higher SYNTAX categories. Positive correlations were observed between SYNTAX and CRP (ρ=0.27, p=0.003), RDW (ρ=0.24, p=0.006), and PDW (ρ=0.22, p=0.010). Multivariate logistic regression analysis demonstrated that SYNTAX (OR=1.12, p=0.014), CRP (OR=1.06, p=0.021), RDW (OR=1.09, p=0.029), and PDW (OR=1.18, p=0.028) were independent predictors of in-hospital mortality. The combined model yielded the highest discriminative performance (AUC=0.88) compared with the SYNTAX score alone (AUC=0.71).
Conclusion: The combined evaluation of the SYNTAX score with inflammatory markers (CRP, RDW, PDW) provides complementary prognostic value and significantly improves the prediction of in-hospital mortality in CABG patients. This integrated approach may enhance preoperative risk stratification and aid in the early identification of high-risk individuals.

Objectives: This study aimed to identify perioperative predictors of early extubation and to evaluate its impact on postoperative outcomes in patients undergoing minimally invasive coronary artery bypass grafting (MICS-CABG).
Methods: This single-center retrospective cohort study included 95 adult patients who underwent isolated MICS-CABG between January 2021 and January 2024. Patients were categorized according to extubation time as early (≤6 hours, n=60) or late (>6 hours, n=35). Standard perioperative care was applied to all patients, and an early extubation protocol was implemented in eligible cases.
Results: Patients in the early extubation group were younger (58 vs. 67 years, p=0.0002), had higher ejection fractions (55% vs. 45%, p<0.001), and lower EuroSCORE II values (1.3% vs. 3.36%, p<0.001). Intraoperative blood transfusion (p=0.0001) and inotrope use (p=0.031) were more frequent in the late extubation group. Postoperative pneumonia (p=0.016) and arrhythmia (p=0.029) rates were also significantly higher among patients with delayed extubation. In multivariate analysis, EuroSCORE II (OR 0.20, 95% CI 0.08–0.51, p=0.0008), blood transfusion (OR 0.23, 95% CI 0.08–0.66, p=0.006), and inotrope use (OR 0.31, 95% CI 0.11–0.90, p=0.031) were identified as independent predictors. ROC analysis confirmed excellent discriminative ability of the model (AUC=0.95).
Conclusion: Early extubation following MICS-CABG is a safe and feasible approach in appropriately selected patients. EuroSCORE II was identified as the strongest predictor, while blood transfusion and inotrope use were associated with delayed extubation. These findings support structured risk assessment and intraoperative optimization as essential components of fast-track recovery protocols.

Objectives: Aortic dissection (AD) is a life-threatening condition requiring urgent intervention. Despite advances in anesthetic and perioperative management, surgical outcomes remain poor. Anesthesiologists play a critical role in managing hemodynamics, blood loss, and transfusions. This study aimed to share our experience in emergency AD surgery and identify factors associated with in-hospital mortality.
Methods: This retrospective study included 51 patients who underwent surgery for acute DeBakey type I or II AD. Clinical and perioperative data were obtained from hospital records.
Results: The mean age was 59.7±12.6 years, and 60.8% of the patients were male. Type I dissection was present in 82.4% of patients. The median anesthesia duration was 255 minutes. Packed red blood cell (PRBC) transfusions were administered to 70.6% of patients. In-hospital mortality occurred in 33.3% of cases. Non-survivors had longer cardiopulmonary bypass (CPB) times (p=0.014) and received more PRBC units (p=0.018). A significant correlation was observed between PRBC transfusion and total circulatory arrest duration (r=0.335, p=0.034). In multivariate analysis, both PRBC transfusion (OR: 2.10, 95% CI: 1.03–4.29, p=0.042) and CPB duration (OR: 1.03, 95% CI: 1.01–1.05, p=0.007) were identified as independent predictors of in-hospital mortality.
Conclusion: The number of PRBC units transfused and CPB duration were independent predictors of mortality in emergency AD surgery. PRBC transfusions were also correlated with circulatory arrest duration. These findings highlight the importance of careful transfusion management in this high-risk population.

Objectives: Delirium is a common acute brain dysfunction in critically ill patients and is associated with poor short- and long-term outcomes, yet it often remains under-recognized. This study aimed to determine the prevalence of delirium in adult ICU patients and to examine its association with clinical and laboratory risk factors.
Methods: In this prospective observational study, we evaluated 60 consecutive adults (≥18 years) admitted to a tertiary ICU with a Richmond Agitation–Sedation Scale (RASS) score between −3 and +4. Sedation was assessed using RASS; delirium using the Confusion Assessment Method for the ICU (CAM-ICU) and the Delirium Rating Scale–Revised-98 (DRS-R-98); organ dysfunction using the Sequential Organ Failure Assessment (SOFA); and illness severity using APACHE II. Demographics, comorbidities, basic laboratory tests, and sedative and analgesic drug use were obtained from medical records.
Results: The mean age was 65±18 years, and 59.4% of the patients were male. Delirium was diagnosed by CAM-ICU in 28 patients (46.7%). Compared with non-delirious patients, those with delirium were older (70±15 vs. 60±19 years) and had higher DRS-R-98, C-reactive protein, APACHE II, and SOFA scores, as well as lower platelet count, Glasgow Coma Scale (GCS), and RASS scores (all p<0.05).
Conclusion: Delirium is frequent among ICU patients and is associated with advanced age, greater disease severity, organ dysfunction, deeper sedation, and adverse inflammatory and hematological profiles. The combined use of CAM-ICU and DRS-R-98 appears reliable for identifying delirium and monitoring its severity in the ICU.

Objectives: Previous studies have demonstrated that an elevated serum glucose-to-potassium ratio (GPR) is associated with poor prognosis in patients with subarachnoid hemorrhage, ischemic stroke, and pulmonary embolism. This study aimed to investigate the association between GPR and mortality among critically ill patients with COVID-19.
Methods: This retrospective study included patients with a confirmed diagnosis of COVID-19 who were admitted to the intensive care unit (ICU) of a tertiary-level hospital between March 2020 and January 2022. Laboratory data and 90-day survival status following ICU admission were recorded. The glucose-to-potassium ratio was calculated for each patient.
Results: The mean GPR was significantly higher in non-survivors than in survivors (45.8±17.0 vs. 38.1±15.1, p=0.006). A significant positive correlation was observed between GPR and mortality (r=0.247, p=0.002). Binary logistic regression analysis identified GPR as an independent risk factor for mortality (odds ratio=1.08, 95% CI 1.03–1.14, p=0.002). Receiver operating characteristic (ROC) analysis determined a GPR cut-off value of >32.1, yielding a sensitivity of 81.9% and specificity of 50.0% (AUC=0.647, 95% CI 0.565–0.723, p=0.002). The prevalence of kidney disease as a comorbidity was significantly higher among non-survivors (p=0.009).
Conclusion: Elevated glucose-to-potassium ratio and the presence of kidney disease at the time of ICU admission are associated with poor prognosis in patients with COVID-19.

INTRODUCTION: The aim of this study was to investigate the preliminary effects of different doses of dexmedetomidine (DEX) on cell viability and neurite growth, as well as the effects of pre- or post-treatment with DEX on oxygen and glucose deprivation/reoxygenation (OGD/R)-induced apoptosis and inflammation in mouse neuroblastoma (NB2a) cells.
METHODS: The effects of DEX on cell viability and toxicity were explored using the MTT and NNT methods at DEX concentrations of 0.1, 1, 3, 10, 30, 45, and 60 μM. To investigate the effects of DEX (10 μM) on OGD/R-induced apoptosis and inflammation, four experimental groups were established: Control group (C), in which cells did not undergo the OGD/R procedure; OGD/R group, in which cells were not treated with DEX; DEX+OGD/R group, in which cells were treated with DEX (10 μM) before the OGD/R procedure; and OGD/R+DEX group, in which cells were treated with DEX (10 μM) after the OGD/R procedure. Data were analyzed using one-way ANOVA (post hoc test: Tukey-b) and the Kruskal–Wallis test. Data were presented as mean±SD. P<0.05 was considered statistically significant.
RESULTS: Dexmedetomidine increased cell viability at all concentrations (0.1–45 μM) except 60 μM. H-scores for eNOS and TGFβ antibodies in the DEX+OGD/R and OGD/R+DEX groups were significantly decreased compared with the OGD/R group following treatment with DEX 10 μM (p<0.001). The apoptotic index in the DEX+OGD/R and OGD/R+DEX groups was also significantly decreased compared with the OGD/R group (p<0.001).
DISCUSSION AND CONCLUSION: Dexmedetomidine increased cell viability at almost all concentrations (0.1–45 μM) except 60 μM. Treatment with DEX 10 μM, either before or after injury, reduced apoptosis induced by OGD/R injury in NB2a cells. Pre-injury treatment with DEX also decreased both iNOS and eNOS antibody expression. The neuroprotective effects of DEX against OGD/R injury may be attributed to its antiapoptotic and antioxidative effects.

Hypoxemia during one-lung ventilation is uncommon in healthy patients. When standard measures fail, intracardiac shunts should be considered. A healthy 15-year-old girl underwent bilateral thoracic sympathectomy. Profound desaturation occurred during one-lung ventilation despite 100% oxygen. The tube position was correct, and oxygenation returned to normal with two-lung ventilation. Switching from sevoflurane to propofol-based total intravenous anesthesia provided partial improvement. Intraoperative transesophageal echocardiography revealed an atrial septal defect, which was later confirmed postoperatively. Refractory hypoxemia during one-lung ventilation may suggest hidden intracardiac shunting. Prompt intraoperative echocardiography is essential for diagnosis and safety.

Intraoperative hypoxemia is a common yet potentially life-threatening complication during general anesthesia, resulting from alterations in pulmonary physiology as well as mechanical or clinical factors. Mucus plug–related atelectasis often remains asymptomatic but may cause severe oxygenation impairment and hemodynamic instability if not promptly recognized and treated. We report a case of intraoperative left lung collapse caused by a mucus plug during open-heart surgery in a patient with aortic and mitral valve insufficiency. This case emphasizes the importance of considering mucus plug–induced airway obstruction in the differential diagnosis of intraoperative hypoxemia. Early recognition is essential to prevent catastrophic complications.