Demet Altun

Objectives: Shared airway management in endolaryngeal surgery conflicts surgical access with adequate ventilation. This study compared the effects of High‐Frequency Jet Ventilation (HFJV) and Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) via High‐Flow Nasal Cannula (HFNC) on perioperative oxygenation, arterial CO ₂ kinetics, and metabolic stability. Methods: In this prospective randomized controlled study, 36 patients (ASA I–II) undergoing elective endolaryngeal procedures were randomized into HFJV ( n = 18) or HFNC ( n = 18) groups. Both cohorts received standardized TIVA and neuromuscular blockade. Primary outcomes were longitudinal PaCO ₂ changes at five intervals: baseline (T0), 10 (T1), 20 (T2), 30 (T3) minutes post‐induction, and at surgical conclusion (T4). Secondary outcomes included PaO ₂ , pH, and lactate. Results: PaCO ₂ levels were comparable at T0 and T1. At 20 min (T2), PaCO ₂ was significantly higher in the HFNC group (55.5 vs. 44.5 mmHg; p = 0.002). At surgical conclusion (T4), median PaCO ₂ reached 66.5 mmHg in the HFNC group versus 44.5 mmHg in the HFJV group ( p < 0.001). Consequently, the HFNC group exhibited significantly lower pH (7.21 vs. 7.31; p < 0.001) and elevated lactate (3.4 vs. 2.5 mmol/L; p < 0.001) at T4. PaO ₂ levels at T3 and T4 were significantly superior in the HFJV group ( p < 0.001). Conclusion: While HFNC offers an ideal tubeless field for short interventions, its use is limited by time‐dependent hypercapnia and progressive respiratory acidosis. We propose a clinical “20‐min threshold” for HFNC; for longer endolaryngeal procedures, HFJV is preferred to maintain ventilatory and metabolic homeostasis. Trial Registration: This clinical trial was registered at ClinicalTrials.gov (registration number NCT05746949). Level of Evidence: 2.

Objectives: Prolonged intubation is a known risk factor of LTS. LTS related to COVID‐19 may result in a different phenotype: pronation affects the location of stenosis and COVID‐19 pneumonia can decline lung mechanics. Therefore, airway management in these patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow‐controlled ventilation (FCV) in the management of patients with COVID‐19‐related LTS undergoing laryngeal surgery.Methods: 20 patients suffering from COVID‐19‐related LTS, as diagnosed by CT, requiring endolaryngeal surgery, with or without CO₂ laser, were included. Ultrathin endotracheal tube Tritube, together with FCV was used for airway management and ventilation. Feasibility, ventilation efficiency, and surgical exposure were evaluated.Results: Median duration of mechanical ventilation during their ICU stay was 17 days, (range, 7–27), and all patients had been pronated. In 18/20 patients, endoscopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Surgeons’ satisfaction on the view was rated 9 out of 10 (range 7–10), where 0 was the worst view and 10 was the best view. Hemodynamic and respiratory variables were within the normal clinical range during the surgical procedure. One patient that had a SpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meeting the predefined requirement of “respiratory complication.”Conclusion: This study demonstrates the feasibility of using Tritube with FCV in patients with relatively unusual subglottic posterior location tracheal stenosis, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provides highly adequate ventilation especially in patients with compromised lung mechanics.Level of Evidence: IV, non‐comparitive prospective clinical trial with 20 patients.

Objective: To explore the effects of pharyngeal packing on antral cross-sectional area, gastric volume and post-operative complications.Methods: In this prospective, randomised, controlled study, 180 patients were randomly assigned to a control group or a pharyngeal packing group. Gastric antral dimensions were measured with pre- and post-operative ultrasound scanning. Presence and severity of post-operative nausea and vomiting and sore throat were recorded.Results: Post-operative antral cross-sectional area and gastric volume were significantly larger in the pharyngeal packing group compared to the control group. The incidence and severity of post-operative nausea and vomiting were significantly less in the pharyngeal packing group. More frequent and severe sore throat was observed in the control group within the ward. An increased Apfel simplified risk score and post-operative antral cross-sectional area were associated with post-operative nausea and vomiting during the first 2 hours, whereas septorhinoplasty and functional endoscopic sinus surgery, absent pharyngeal packing, and lower American Society of Anesthesiologists’ physical status were associated with post-operative nausea and vomiting within the ward.Conclusion: Regardless of operation type, pharyngeal packing use resulted in smaller gastric volume, which was associated with reduced post-operative nausea and vomiting frequency and severity, and lower sore throat incidence.

BackgroundWhile actual figures are still lacking, this incidence of laryngotracheal stenosis (LTS) is expected to increase because of the high COVID-19 patient numbers requiring (prolonged) invasive mechanical ventilation. While prolonged intubation is a known risk factor of LTS, LTS related to COVID-19 may be result in a different phenotype: pronation affects the location of stenosis and COVID-19 pneumonia can decline lung mechanics. Therefore, airway management in patients with COVID-19 related LTS has unique challenges for both anesthesiologists and surgeons for its location and severity. This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow_controlled ventilation (FCV) in the management of patients with LTS secondary to COVID-19 related LTS undergoing laryngeal surgery.Methods20 patients suffering from COVID-19 related LTS, as diagnosed by CT, requiring endolaryngeal surgery were included. Ultrathin endotracheal tube Tritube, together with FCV was used for airway management and ventilation. Feasibility, ventilation efficiency and surgical exposure were evaluated.ResultsMedian duration of mechanical ventilation during their ICU stay was 17 days, [range (7-27] and the prone position was used in all patients. In 18/20 patients endoscopic diagnosis, confirmed the initial CT diagnosis: posterior subglottic stenosis. Visual Analogue Scale (VAS) score was 9 out of 10 (range 7-10). FCV ventilation was performed with or without CO₂laser. All hemodynamic and respiratory variables were within the normal clinical range. In 1 patient a respiratory complication occurred, meaning that the SpO₂temporarily dropped to 89 %. Note that this patient had SpO₂of 90 % before induction of anesthesia.ConclusionThis study shows that it is feasible to use Tritube with FCV in patients with unusual location of tracheal stenosis, namely a subglottic posterior location, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provided highly adequate ventilation especially in patients with compromised lung mechanics.Trial registrationClinical trial registration was done prospectively (NCT05317923) on 08/04/2022.

Amaç: Kalça kırıkları geriatrik hasta grubunda önemli bir sağlık sorunudur. Malnütrisyonun saptanması, perioperatif tedavi planının oluşturulması, prognozun belirlenmesi ve böylece morbidite ve mortalitenin azaltılması açısından önemlidir. Prognostik beslenme indeksi (Prognostic nutritional index, PNI), hastaların beslenme durumunun bir göstergesi olan basit, uygun maliyetli ve kolay uygulanabilir bir parametredir. Bu çalışmanın amacı, postoperatif kalça kırığı hastalarında preoperatif PNI ile mortalite arasındaki ilişkiyi incelemektir. Gereç ve Yöntem: Bu prospektif gözlemsel çalışmaya, kalça kırığı sonrası ilk 48 saat içinde ameliyat edilen, Amerikan Anesteziyoloji Derneği skoru I-IV arası olan, 65-95 yaş arası 183 hasta dahil edildi. Hastalar PNI’nın 37,25 eşik değerine göre 2 gruba ayrıldı. Toplamda 172 hasta çalışmayı tamamladı: 53’ü grup düşük PNI’da ve 119’u grup yüksek PNI’da sınıflandı. Bulgular: Hastanede kalış süresi grup düşük PNI’da anlamlı olarak daha yüksekti (p=0,035). Postoperatif deliryum grup düşük PNI’da anlamlı olarak daha yüksek bulundu (p=0,001). Üç aylık mortalite grup düşük PNI’da anlamlı olarak daha yüksekti (p=0,0001). Sonuç: Rutin taramalarda kullanılabilecek kolay hesaplanabilen, objektif ve ucuz bir biyobelirteç olan PNI ile kalça kırıklarında malnütrisyon tanısı konarak optimize bir tedavi planı oluşturmak ve mortaliteyi azaltmak mümkün olabilir.

Perioperative fluid therapy is used to avoid dehydration and hypovolemia. Optimum perioperative fluid administration may improve postoperative outcomes after major surgery, and the optimal strategy remains controversial and uncertain. The primary outcome was the total amount of intraoperative fluids given between perioperative goal-directed fluid therapy (GDFT) guided by a hemodynamic monitoring system and standard fluid therapy based on “mean arterial pressure-diuresis” data in patients undergoing head and neck surgery. The secondary outcomes were the hemodynamics and laboratory variables, postoperative complications, length of mechanical ventilation, intensive care unit and hospital stay. A randomized controlled study. Sixty patients were scheduled and randomized into two groups of 30 patients each: in the study group, an arterial pressure catheter was inserted and connected to the FloTrac system, whereas in the control group, an arterial pressure catheter was inserted and integrated into the hemodynamic monitoring system with a special transducer. The control group had fluids administered at the discretion of the anesthesiologist according to the mean arterial pressure >65 mmHg and diuresis >0.5 ml/kg/h. In the study group, fluid management was administered to achieve a target value of ≤13% through the stroke volume variation. The total amounts of fluid in the intraoperative period were different between the groups, with the study group receiving significantly more fluids (P = 0.0455). The length of hospital stay was significantly longer in the study group than in the control group (P = 0.012), but prolonged oxygen demand was significantly more frequent in the control group than in the study group (P = 0.017). No difference was found in hemodynamics, lactate kinetics, and vasoactive agent requirements. The standard fluid therapy guided by conventional circulatory parameters appears sufficient for patients with low-to-moderate risk during head and neck surgery.

After congenital cardiac surgery, the duration of mechanical ventilation (MV) is related to the clinical status, type of operation, and the sedative-analgesic agents used postoperatively. This study aims to examine the effects of dexmedetomidine and morphine on the fast-track extubation (FTE) and ultra-fast-track extubation (UFTE) protocol after congenital cardiac surgery. A total of 251 pediatric patients were divided into two groups: 118 patients in the morphine group (Group M) and 133 patients in the dexmedetomidine group (Group D). We retrospectively reviewed medical data including hemodynamic parameters, duration of MV and cardiovascular intensive care unit (CICU), additional sedative/analgesic requirement, adverse events, the need for reintubation, and noninvasive MV, sedation, and pain scores. The mean mechanical ventilation duration of Group D was significantly shorter than Group M (3.74 ± 0.83 h in Group D, 5.72 ± 1.54 h in Group M, respectively) (p = .001; p < .05). In Group D, the success rate of FTE was 92.5% (n = 123) and UFTE was 7.5% (n = 10) (p = .001). In Group M, the success rate of FTE was 72.9% (n = 86) and UFTE was 0% (n = 0) (p > .05). Dexmedetomidine and morphine have clinical benefits which encourage their use for FTE protocol. Dexmedetomidine has more benefits compared to morphine. It can be used in UFTE protocol, besides its use in FTE protocol with fewer side effects.

Background and Aim of the Study Transfusion-associated hyperpotassemia is a serious complication of packed red blood cell (PRBC) transfusion after congenital cardiac surgery. Our study aimed to identify risk factors and potential preventive measures of transfusion-associated hyperpotassemia in neonates and infants after congenital cardiac surgery. Methods Pediatric patients who underwent congenital cardiac surgery and need transfusion were enrolled in this prospective study. The potassium concentration of PRBC was checked from the sample taken from the segment. The volume of transfusion, age of PRBC, potassium concentration of unit were recorded. The estimated increment of potassium level in patients after PRBC transfusion was calculated. Results Seventy-four individual patients, 95 distinct transfusions, 112 blood products were evaluated. The mean age of the blood unit was 3.8 ± 1.4 days. The mean potassium concentration in the PRBCs was 9.9 ± 2.4 mmol/L. A weak correlation was observed between the potassium value of the PRBC and the age of PRBC (p = 0.049, r = 0.2, y = 0.24 × x + −0.68). There was a weak correlation between the potassium value of PRBCs and the age of the unit (p < 0.001, r = 0.37, y = 2.8 × x + −3.6). Conclusions Before transfusion, even PRBC is fresh, measuring the potassium level of PRBC and the potassium that will be given to the pediatric patient with transfusion can prevent transfusion-related hyperpotassemia and related complications. Otherwise, high potassium levels, which may be overlooked despite being fresh, may cause serious complications, even cardiac arrest, especially in neonates and infants.