Tracheal resection is a technically challenging procedure due to altered airway anatomy and the requirement for shared airway management. Anesthetic planning involves comprehensive preoperative evaluation, including pulmonary function tests, flow–volume loops, CT scans, and bronchoscopy to define the site and degree of stenosis. Stenosis severity determines the induction and airway management method, ranging from inhalational induction with spontaneous ventilation to awake fiberoptic intubation. Total intravenous anesthesia (TIVA) is employed for maintenance due to its stability and versatility. Intraoperative ventilation modalities include cross-field ventilation, jet ventilation, high-flow nasal oxygenation, and, in some cases, ECMO. Each is selected based on the surgical stage and patient considerations. Operating room extubation is performed safely to protect the tracheal anastomosis, and postoperative care involves careful monitoring, airway protection, and pulmonary support. Overall, successful outcomes rely upon careful planning, multidisciplinary teamwork, and airway plans tailored to the individual patient, focused on both surgical and anesthetic requirements.

Effective hemodynamic management is fundamental in anesthesia practice to ensure adequate organ perfusion and stability of organ function during and after major surgical procedures or in critically ill patients. The advent of advanced monitoring techniques has expanded the understanding of arterial hemodynamic parameters, enhancing decision-making in fluid management and the use of vasoactive agents. However, similar advancements in understanding the venous system—comprising 70% of the total blood volume—remain limited. The venous system's compliance, characterized by its unstressed and stressed volumes, plays a critical role in determining venous return and cardiac output. Central venous pressure (CVP), a routine clinical parameter, provides insights into venous return but has limitations when used in isolation. Advanced concepts such as mean systemic filling pressure (Pmsf ) offer a more comprehensive understanding of venous hemodynamics. Techniques like Pmsf(hold), involving inspiratory hold maneuvers, and Pmsf(analog), based on mathematical modeling, have been developed to measure Pmsf in clinical settings. These approaches highlight the dynamic interplay between venous return, stressed volume, and right atrial pressure under various clinical conditions, including hypovolemia, cardiogenic shock, and septic shock. Recent studies suggest that combining CVP analysis with Pmsf evaluations improves fluid management and individualized hemodynamic control. However, clinical application of these measurements remains challenging, necessitating further validation through experimental and clinical studies. This review underscores the importance of an integrated approach to venous and arterial systems in optimizing hemodynamic management, paving the way for more precise and evidence-based patient care.

Minimally invasive cardiac surgery (MICS) has emerged as an alternative to conventional median sternotomy, offering benefits such as reduced trauma, faster recovery, and decreased postoperative complications. However, MICS presents unique challenges for anesthetic management, including airway control, one-lung ventilation (OLV), hemodynamic stability, pain management, and postoperative recovery. This article provides a structured anesthesia protocol for MICS, focusing on preoperative assessment, perioperative management, and postoperative care.

Objectives: Inflammation plays a crucial role in postoperative outcomes following coronary artery bypass grafting (CABG) surgery. Readily available hematological markers, such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), have been increasingly recognized as indicators of systemic inflammation. However, their relationship with postoperative mortality in coronary artery bypass grafting (CABG) surgery remains uncertain. This study aims to evaluate the effect of postoperative PLR and NLR on mortality in patients undergoing CABG surgery.
Methods: This retrospective observational study included 470 patients who underwent CABG surgery between March 2020 and June 2022. Postoperative blood samples were analyzed to assess PLR and NLR levels. The primary outcome of the study was postoperative mortality. Logistic regression models were used to evaluate the association between these inflammatory markers and mortality risk.
Results: Preoperative PLR and NLR values were not significantly associated with postoperative mortality (p>0.05). However, postoperative NLR was found to be a significant predictor of mortality (p<0.05), with each unit increase in postoperative NLR correlating with a 1.05-fold increase in mortality risk (95% CI: 1.02–1.09). Although postoperative PLR levels were elevated, they did not show a statistically significant relationship with mortality.
Conclusion: This study demonstrates that postoperative NLR is significantly associated with mortality in patients undergoing CABG surgery, while postoperative PLR does not show a significant correlation. Regular monitoring of postoperative NLR may help identify high-risk patients early and enable timely interventions to improve outcomes. Given its accessibility and cost-effectiveness, incorporating NLR into routine postoperative monitoring could enhance patient management. Further multicenter studies are needed to validate these findings and refine the clinical implications of NLR and PLR in CABG patients.

Objectives: Double-lumen endobronchial tubes (DLTs) are often used in one-lung ventilation (OLV). However, there is no optimal guide or parameter to estimate the accurate size of a DLT. The aim of this study was to investigate the role of ultrasonographic measurements—including tracheal width (TW), cricoid width (CW), lung offset, pulmonary pulse, and diaphragmatic motion—in selecting the correct DLT size.
Methods: Thirty-four patients undergoing thoracic surgery requiring OLV were included in the study. In the selection of DLT size, a scale based on sonographic tracheal width (TW) and the patient’s height was used. Sonographic lung measurements (SLM), including lung offset, pulmonary pulse, and diaphragmatic motion, were also used to confirm the location of the DLT, as compared to fiberoptic bronchoscopy (FOB).
Results: The mean DLT size was 39 Fr, while the mean BCV was 2.5 mm. BCV was found to be suitable (successful intubation) in 29 patients (85.3%) and non-suitable (failed intubation) in 5 patients (14.7%). The three SLMs—lung shift, pulmonary pulse, and diaphragmatic movement—were 100% compatible with intubation and OLV.
Conclusion: The sonographic TW- and height-based scale had an 85.3% success rate in determining the appropriate DLT size. Sonographic measurements of the lung were also found to be 100% compatible with intubation and OLV. Despite these promising results, sonographic measurements seem unlikely to replace FOB in DLT positioning. However, they may be helpful for selecting DLT size and confirming its placement, especially in the absence of FOB, in the presence of mucous plaque, or during emergency surgery.

Objectives: Cardiac disease complicates 1–4% of pregnancies, necessitating careful management and birth planning. This retrospective study examines anesthesia practices and outcomes in pregnant women with heart disease undergoing cesarean section (C/S) and emergency surgery at our cardiac center.
Methods: This retrospective study included all pregnant women with heart disease who underwent C/S or emergency surgery. Electronic and medical records of the patients were reviewed.
Results: The study included 74 pregnant patients, all of whom received general anesthesia. The most common cardiac condition was mitral valve replacement, followed by isolated pulmonary hypertension. Emergency C/S was performed in 23 patients, and one required emergency cardiopulmonary bypass. Maternal hospital mortality was 8.1%, with 72 live births. Extubation in the operating room was achieved in 24% of cases, while 22% remained in the ICU for more than a day. Two patients required ECMO, one of whom died postoperatively.
Conclusion: Close monitoring of pregnant women with cardiac disease throughout pregnancy is essential. Multidisciplinary management in specialized centers can significantly reduce perioperative morbidity and mortality.

Objectives: In infants hospitalized in neonatal intensive care units due to prematurity, respiratory distress syndrome (RDS) and its complications represent the leading causes of morbidity and mortality. Although surfactant deficiency is the primary cause of RDS, various endogenous hormones—such as prolactin, cortisol, and thyroid hormones—may also influence fetal lung maturation. This study aimed to investigate the risk factors for RDS and to evaluate the relationship between blood levels of prolactin, cortisol, and thyroid hormones and RDS in premature infants.
Methods: The study included 117 premature infants, 56 with RDS and 61 without RDS.
Results: Infants with RDS had significantly lower gestational ages and birth weights. A fifth-minute APGAR score of ≤7 was associated with a higher incidence of RDS. Neonates delivered via cesarean section had a lower risk of RDS than those born vaginally. A significant association was observed between preterm premature rupture of membranes and RDS. Total T4, cortisol, and prolactin levels were significantly lower in infants with RDS. Both TSH and prolactin levels showed a decreasing trend with lowering gestational age in neonates with RDS. Notably, hospital stays were longer and mortality rates were higher in the RDS group.
Conclusion: The inverse correlation between cortisol levels and RDS supports the hormone’s protective role in pulmonary development. Furthermore, serum prolactin levels decreased proportionally with gestational age in infants with RDS, suggesting a potential role of prolactin in lung maturation. The findings also highlight the contribution of thyroid hormones in promoting surfactant synthesis and pulmonary function in preterm neonates.

Critical pulmonary stenosis (CPS) is a life-threatening congenital heart defect in neonates, requiring prompt intervention. Percutaneous balloon pulmonary valvuloplasty (BPV) has emerged as the treatment of choice, but perioperative anesthetic management remains complex. We report the anesthetic management of a 17-day-old, 3020 g neonate with CPS, a secundum atrial septal defect, and a small ventricular septal defect. Anesthesia was induced with midazolam, fentanyl, and rocuronium, and maintained with continuous midazolam and fentanyl infusion. Normocapnia and moderate FiO₂ were ensured. The patient remained hemodynamically stable throughout the procedure, and BPV was successfully performed without complications. The postoperative course was uneventful. This case illustrates the importance of individualized anesthetic strategies in neonates with CPS. A balanced opioid-based approach, combined with careful respiratory and hemodynamic control, contributed to a safe perioperative course. Recent literature emphasizes the growing safety of BPV when accompanied by vigilant anesthetic care.