Introduction and aim Postoperative cognitive dysfunction is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally studies have focused on major surgery, while there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare general and spinal anesthesia in terms of cognitive decline in elderly patients after elective minor surgery using the Mini-mental state examination and Montreal cognitive assessment. Material and methods This observational study was conducted June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The Mini-mental state examination and Montreal cognitive assessment scores were evaluated before and one day after the operation. Results The postoperative Mini-mental state examination scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) only in the general anesthesia group (p =0.003), while the postoperative Montreal cognitive assessment scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The Postoperative cognitive dysfunction incidence was 32.9% using the Montreal cognitive assessment and was not significantly different between anesthesia methods. Conclusion Early Postoperative cognitive dysfunction is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The Montreal cognitive assessment is an alternative tool that can be applied in a short time for screening cognitive functions in elderly patients. The cognitive screening of elderly patients perioperatively may be beneficial.

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Aim: Providing effective ventilation of the unconscious patient is an essential skill in every specialty dealing with airway management. In this randomized cross-over study aimed to compare intra-oral and classic face mask in terms of ventilation success of patients, practitioners’ workload and anxiety assessments. Also we analyzed potential risk factors of difficult mask ventilation for both masks. Methods: 24 anesthesiology residents and 12 anesthesiologists participated in the study. Each of the practitioners ventilated 4 patients with both masks at settled pressure and frequency. Practitioners rated their workload and anxiety related to masks with National Aeronautics and Space Administration Task Load Index score and State Trait Anxiety Inventory scale. Ventilation success was evaluated with Han scale, expiratory tidal volume and leak volume. We analyzed potential risk factors of difficult mask ventilation with anthropometric characteristics and STOP-BANG score. Results: Ventilation success rate was superior with intraoral mask comparing to classic face mask in terms of Han Scale (Easy mask ventilation percentage 84/144 (58.3%); 123/144 (85.4%); respectively) and tidal volume (481.92±173.99; 430.85±154.87mL; respectively). Leak volume in intraoral mask ventilation was significantly lower than classic face mask (71.50±91.17 /159.38±146.31 respectively). Diffucult mask ventilation risk factors were high weight, neck circumference, Mallampati score and STOP-BANG score>3 for classic face mask (at the utmost neck circumference 95% CI, OR=1.180, p= 0.002) Risk factors were high body mass index and Mallampati score for intraoral mask (at the utmost Body mass index 95% CI, OR=1.162 p=0.006). The anxiety ratings of practitioners were similar between two masks. The work-load rating is higher with intraoral mask comparing to classic face mask. Conclusion: Intraoral mask may be an effective alternative device for bag-valve mask ventilation.

The Aim: This prospective, randomised controlled study aimed to investigate the efficacy and respiratory effects of postoperative pain management with erector spinae plane block (ESPB) in patients undergoing percutaneous nephrolithotomy surgery. Methods: A total of 60 ASA I-II patients aged 18–65 years, scheduled to undergo percutaneous nephrolithotomy (PCNL) were included. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB with 15mL 0.5% bupivacaine at the T11 level was performed preoperatively using the in-plane technique in the ESP group. In both groups, 1gr of intravenous paracetamol was administered intraoperatively. Postoperative pain and agitation was evaluated using VAS, Dynamic VAS at 0, 6 and 24 hours and the Riker sedation-agitation scale at 0th Hours after surgery. Peak expiratory flow rate(PEFR) and SPO2 were measured in preoperative examination and at the 0th, 6th, 24th hours postoperatively. In the postoperative period, intravenous tramadol (100mg) was administered as a rescue analgesic when VAS ≥ 4. Time and number of the rescue analgesias, mobilization time and length of hospital stay were also recorded and analyzed. Results: A significantly lower VAS and DVAS were observed at 0th, 6th, 24th hours in the ESPB group (p < 0.05 for each timepoint). Also number of and time to rescue analgesia decreased in the ESPB group (p< 0.05 and 0.01 respectively). Postoperative/preoperative PEFR ratio was lower and there were more agitated patients in control group (p<0.05). Conclusion: ESPB may have additional clinical advantages while providing effective analgesia in patients who underwent PCNL comparing to intravenous analgesia.