As the patients’ sensitivity to neuromuscular blocking (NMB) agents differs, the patients who take neuromuscular blockers, must be monitorized. Neuromuscular stimulatör is used in the determination of the onset of the NMB effect, as a guide for titration of neuromuscular (NM) blockade, and the prediction of the most suitable time for reversing NMB by agents and demonstration of the adequacy of this antagonistic effect. Electrical stimuli are generally used to determine the degree of neurumuscular function. Usually the muscular response or its clinical manifestation in reaction to neuronal stimulation is evaluated by inspection or other examination tools. Today commercialy available acceleromyography which is a simple and reliable method is used in clinics for this aim.

Since the muscles around the eye globe i.e.“orbicularis oculi” and “corrugator supercili” reflect the relaxation status of the laryngeal muscles more accurately., they may be a good choice for determining the adequacy of conditions of intubation. M.adductor pollicis longi and upper respiratory tract muscles are the most sensitive muscles to neuromuscular blockers and the block reversal is extremely prolonged. Monitorization of this muscle is more suitable for extubation.

In the last 20 years, many important advances have been achieved in cardiac surgery. The improvements in anesthesia frequently depends on the alteraions in the surgical conditions. The situations in cardiac surgery where monitorization of NMB plays a crucial role in the induction, and maintenance of neuromuscular blockade are as follows: 1) In the patients who receive frequently administered muscle relaxants or repetitive infusions or high doses of neuromuscular blocking agents because of application of single lung ventilation for the mandatory requirement of completely paralysed diaphragm, 2) For the cases who were scheduled for rapid extubation within 1-6 hours following cardiac surgery 3) To find out and prevent delayed extubation because of residual paralysis during postoperative period.

OBJECTIVE: In one-lung ventilation (OLV), use of same tidal volumes (TV) as in two-lung ventilation (TLV) is recommended. However, lower TVs are recently found to be associated withrelatively reduced inflammatory response. The aim of this study is to compare the effects of conventional ventilation using higher tidal volumes with those of the reduced TV application during OLV on the oxygenation.
METHODS: Thirty-one patients scheduled for elective lung resection were randomly assigned to two ventilation strategies in two different sequences using pressure-controlled ventilation (PCV) during OLV. During TLV, ventilation pressures were adjusted to obtain a TV required for the maintenance of normocapnia. During OLV, TVs were adjusted either by increasing the ventilation pressure to obtain the same TV as in TLV (normocapnic stage: StN) or artificial respiration was maintained by remaining in the same ventilation pressure as in TLV and allowing a hypercarbic state (hyypercapnic stage: StH). In each patient, both methods of the study were applied in two stages. At the end of every stage, PaO2, PaCO2, TV, and Qs/Qt were recorded.
RESULTS: There was a significant difference in TV (569±180 mL vs 399±136 mL; p<0.001) and in PCO2 (39.1±6.2 mmHg vs 46±7.6 mmHg; p<0.001) between StN and StH, respectively. In other words in our study TV values were significantly lower in StN, while PaCO2 measurements were found to be significantly higher in StH. There was a slight but insignificant decrease in PaO2 and a slight but insignificant increase in Qs/Qt during StH compared to StN (StN vs StH: 192±56 mmHg vs 176±50 mmHg; and 28.7±8.8 % vs 31.4±8.4 %).
CONCLUSION: Since lower TVs do not result in any important clinical change in oxygenation during OLV, ventilation with lower TV can be used without any hesitation

One-lung ventilation is a generally performed technique during thoracic surgical procedures. In this case report, left endobronchial intubation which was performed with a reshaped right-sided double lumen tube (DLT) was presented. Right upper lobectomy was planned for a 60-year-old man because of his pulmonary tumour. On the day of surgery, since an appropriate size of a left-sided DLT was not available in the operating room, right-sided DLT was reshaped like a left-sided one with a maneuver including two steps and left endobronchial intubation was performed with this reshaped right-sided DLT. The surgery was completed uneventfully. The patient was transferred to the intensive care unit while breathing spontaneously. He spent one day at the intensive care unit, then he was discharged to the ward.

Introduction: Bronchogenic cysts are lesions that occur as a result of abnormal development of the tracheobronchial system during embryological life, and they are usually localized on lung parenchyma or mediastinum.

Case reports: Three male and two female cases radiologically diagnosed as bronchogenic cysts were followed-up in our clinic. Bronchogenic cysts were localized in the mediastinum (n=3), within parenchyma (n=1), and subcutaneous layers at jugulum (n=1). Cystic structures were totally resected together with their walls and epithelia through standard posterolateral thoracotomy incision under single lung ventilation in four cases and a horizontal jugular incision was used under local anesthesia in one case. An efficient patient- controlled analgesia was provided for thoracotomy patients during the postoperative period. All patients histopathologically diagnosed as bronchogenic cyst were discharged without any problem. The cases were followed-up for 6 month and 2 years, and any long-term complication and recurrence did not observed.

Conclusion: Complete surgical resection of bronchogenic cysts allows for the establishment of definitive pathological diagnosis and absolute cure in cases with bronchogenic cysts. Efficient anesthetic management and postoperative patient- controlled analgesia improve patient comfort and shorten recovery period.

Chronic obstructive pulmonary disease (COPD) is one of the important risk factors for anesthetic applications in non-thoracic surgical procedures. This risk is significantly increased in thoracic surgery. Since in patients with COPD, complications such as atelectasis, and pneumonia are frequently seen during the operation and the postoperative period, anesthetic approach is very important Here, we reported a 70-year-old male patient with right emphysema and pneumothorax at the right hemitorax and impaired cardiac function who had undergone resection of bullae under thoracic epidural anesthesia.