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Vallecular cyst (VC) can cause difficult intubation. If a double-lumentube (DLT) has to be placed, difficulty in tracheal intubation becomes more complicated. The gum elastic bougie (GEB) is a widely used device for facilitating tracheal intubation.However, there is not enough study with DLT to make a predictionfor success of GEB-guided intubation. Here, we aimed to describe our approach during unexpected difficult intubation due to VC in a patient required DLT insertion. We emphasize that, in case of confronting a patient with asymptomatic VC as a cause of difficult intubation, a successful DLT intubation is possible by sliding endobronchial lumen of DLT over pediatric GEB.

Cannulation of the internal jugular vein (IJV) may be diffucult because of anatomical variations. A 66-year-old female patient, who was in the intensive care unit, underwent ultrasound-guided cannulation of the right IJV. The right IJV could not be visualized by ultrasonography despite positional changes of the patient and Valsalva maneuvre. The left IJV was easily determined by ultrasonography and cannulated. Although the landmark technique may be sufficient for most of the central vein cannulations, the rate of anatomical variations and related complications is quite high. We point out that even if ultrasound cannot be used in real-time, the ultrasonographic confirmation during the pre-insertion period may be crucial for successful central vein cannulation.

Kartagener sendromu bronsektazi, sinuzit ve situs inversusla karakterize otozomal resesif gecisli bir hastaliktir. Bu yazida kombine genel ve torakal epidural anestezi altinda pulmoner rezeksiyon yapilan Kartagener send- romu ve bronsektazisi olan hastamiz sunuldu. Bu nadir hastalikta akciger izolasyon teknikleri; hastaya ve anesteziste gore degismektedir. Olgumuz- da; sol orta ve alt lobektomi icin sag ana bronsa, sol cift lumenli tupun bronsiyal lumeni sagda olacak sekilde yerlestirildi. Toraks cerrahisi geciren KGS'li hastada sevofluran ile kombine genel ve torakal epidural anestezi- nin avantajlari ve uygun anestezik yaklasimlar tartisildi.

As a rare procedure, massive bronchoalveolar lavage (MBAL) is a large-volume lavage which necessitates general anesthesia and one-lung ventilation (OLV). During MBAL isotonic saline is instilled into one lung and drained through one lumen of a double-lumen tube. MBAL is the most effective treatment for symptomatic pulmonary alveolar proteinosis (PAP). A 27-year-old male with PAP was scheduled for therapeutic MBALs. After standard preoxygenation, monitoring and anesthesia induction, a double-lumen tube was placed. Tube position was verified by a fiberoptic bronchoscope. The internal jugular vein, radial and pulmonary arteries were cannulated. A temperature probe and foley catheter were inserted. The nonventilated lung was filled with 1000 mL saline and then drained in each session. The left and right lung were lavaged with an interval of 2 weeks. A total of 20 L saline was used in each MBAL without retention. MBALs were terminated after the effluent became clear. Duration of the left and right MBALs were 325 and 275 minutes, respectively. Despite increased shunt fraction, oxygenation was within acceptable limits during OLV. The trachea was extubated in the operating room uneventfully after each MBAL. The patient's clinical and laboratory findings were evidently improved. Consequently, if proper conditions are provided, MBAL is safe and beneficial despite its risks and the long duration. Turkish Baslik: Nadir Gorulen Bir Hastalik Icin Nadir Bir Girisim: Bir Pulmoner Alveolar Proteinosis Hastasinda Masif Bronkoalveolar Lavaj Anahtar Kelimeler: Bronkoalveolar lavaj, pulmoner alveoler proteinoz, genel anestezi Nadir bir islem olan masif bronkoalveolar lavaj (MBAL) genel anestezi ve tek akciger ventilasyonu (TAV) gerektiren genis hacimli lavajdir. MBAL sirasinda, bir akcigere, cift lumenli tupun bir lumeni araciligiyla, izotonik salin infuze edilip drene edilir. MBAL, semptomatik pulmoner alveolar proteinosis (PAP) icin en etkin tedavi yontemidir. PAP tanisi olan 27 yasinda erkek hastaya terapotik MBAL planlandi. Standart preoksijenasyon, monitorizasyon ve anestezi induksiyonunu takiben cift lumenli tup yerlestirildi. Tup pozisyonu fiberoptik bronkoskopla dogrulandi. Internal juguler ven, radiyal ve pulmoner arter kateterizasyonu uygulandi. Ozafageal isi probu ve foley sonda yerlestirildi. Her seansta ventile olmayan akciger 1000 ml serum fizyolojik ile doldurulup, serbest direnajla bosaltildi. Sol ve sag akciger 2 hafta arayla yikandi. Sivi retansiyonu olmayan her bir MBAL sirasinda toplam 20 L serum fizyolojik kullanildi. Yikama sivisi berrak geldiginde islem sonlandirildi. Sol ve sag MBAL sureleri sirasiyla 325 ve 275 dk idi. TAV sirasinda arteriyel oksijenasyon, artmis santa ragmen, kabul edilebilir sinirlarda idi. Her bir islem sonunda, hasta ameliyathanede ekstube edilerek, sorunsuz olarak yogun bakim unitesine transfer edildi. Hastanin klinigi ve laboratuvar bulgularinda belirgin duzelme gozlendi. Sonuc olarak, MBAL uzun suresine ve risklerine ragmen, uygun kosullar saglandiginda guvenli ve yararlidir.

Background and objectives: In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. Methods: After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second–third year (Group I) and fourth year (Group II) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. Results: Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05). Change of needle insertion level was statistically higher in Group II (p = 0.008), whereas paresthesia was significantly higher in Group I (p = 0.007). Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents’ experience (p 0,05). A alteração do nível de inserção da agulha foi estatisticamente maior no Grupo II (p = 0,008), enquanto que a parestesia foi significativamente maior no Grupo I (p = 0,007). As taxas de cefaléia durante e após punção dural foram maiores no Grupo I. Um índice de massa corporal (IMC) maior e o nível do local de inserção foram fatores significativos para o fracasso do CET e para as taxas de complicações no pós-operatório, mas independentes da experiência dos residentes (p

BACKGROUND: Transbronchial needle aspiration using endobronchial ultrasonography (EBUS-TBNA), a new minimally invasive diagnostic procedure, has been used to evaluate intrathoracic lymph nodes. It has been reported that EBUS-TBNA can be performed safely under sedation and provides a high level of patient satisfaction. We aimed to describe perianesthetic data, and compare results regarding the agents of subjects undergoing EBUS-TBNA under deep sedation. METHODS: After ethics committee approval, perianesthetic data of 571 subjects undergoing EBUS-TBNA were analyzed retrospectively. Data were collected from anesthesia evaluation and observation forms. Four groups received anesthesia in the operating room as follows: propofol-midazolam (group PM), propofol-ketamine (group PK), propofol-ketamine-midazolam (group PKM), or propofol (group P). Dosage, number of anesthetic injection, hemodynamic variables, recovery time, complications, and patient satisfaction were also recorded. RESULTS: Propofol consumption was higher in groups P and PM compared with groups PK and PKM. Midazolam requirement was higher in group PM than in group PKM. Recovery time was shorter in group P compared with groups PK, PM, and PKM. It was also shorter in groups PK and PM compared with group PKM. All of these differences were statistically significant. Temporary desaturation ( n = 41; 7%) and increased blood pressure (n = 78; 14%) were predominant complications. In groups PK and PKM, risk of developing hypertension was higher than in groups PM and P ( P < .001). The percentage of subjects satisfied with the procedure was 99%. CONCLUSIONS: Independent from the sedative agent, deep sedation can be safe, and provide high patient satisfaction during EBUS-TBNA. The combination of ketamine with propofol or midazolam required lower doses of these anesthetics. However, the incidence of increased blood pressure was higher in groups administered ketamine. Recovery time was the shortest in group P, and the longest in group PKM. There was no relation between recovery time and total dose of anesthetics or presence of chronic disease.