ECMO is a mechanical support system applied in cases of severe heart and/or lung failure unresponsive to all treatments. The use of ECMO is increasing. Technological advancements in ECMO systems (oxygenator, pump, cannula systems, and cannulation techniques), careful patient selection, and the use of echocardiography (ECHO) contribute to improving survival rates. Additionally, the establishment of ECMO teams and increased experience in this field have also enhanced its applications. Knowledge of ECMO indications and contraindications, technical and intraoperative anesthesia management, and potential complications necessitates collaborative implementation in the operating room, intensive care unit, or during the e-CPR process. This review emphasizes the importance and guidance of transthoracic and transesophageal echocardiography (TTE and TEE) in peripheral or central ECMO applications, including ECMO cannulation, hemodynamic monitoring, and separation processes.

Objectives: This study aimed to determine whether follow-up with standard base excess (SBE) and anion gap (AG) aids in the differential diagnosis of early postoperative hyperlactatemia, specifically in distinguishing between low cardiac output and lactate washout.
Methods: The study involved 1203 patients who underwent isolated coronary bypass surgery with the help of Extracorporeal Circulation (ECC). These patients were divided into two groups based on their cardiac index (CI): Group 1 consisted of 1162 patients with CI ≥ 1.8 L/min/m², while Group 2 had 41 patients with CI<1.8 L/min/m². Blood gas measurements were taken at five different time points to examine the correlation between lactate, SBE, and AG.
Results: The correlation between lactate and SBE in Group 1 was weak (r=-0.07, p<0.001). Similarly, the correlation between lactate and anion gap was weak (r=0.08, p=0.005). On the other hand, in Group 2 (CI<1.8 L/min/m²), a much stronger correlation was observed between lactate and SBE (r=-0.49, p<0.001). However, there was no correlation between lactate and anion gap (r=-0.007, p=0.964).
Conclusion: Relying solely on SBE (standard base excess) and anion gap to distinguish hyperlactatemia is limited because they depend on various variables. Therefore, we recommend assessing hyperlactatemia by examining the patient's clinical condition, other tissue perfusion parameters, flow measurements, plasma chloride, and albumin values.

Objectives: This study evaluates the analgesic effects of intrathecal morphine (ITM) and ultrasound-guided erector spinae plane block (ESPB) in managing postoperative pain following video-assisted thoracoscopic surgery (VATS).
Methods: This retrospective observational study examined hospital records and anesthesia documents of 40 patients who underwent VATS at a university hospital between January 2021 and January 2022. The patients were divided into two groups: ITM and ESPB. The comparative analysis included cumulative morphine consumption within the initial 12/24 h after VATS, Numeric Rating Scale (NRS) resting/activity scores, rescue analgesic requirements, and the side effect profile.
Results: During the first 12 h postoperatively, the ITM group exhibited lower median morphine consumption than the ESPB group (ITM: 1.9 mg [0.85–3] vs. ESPB: 3.65 mg [3–4.23], p=0.003). Further, within the initial 24 h postoperatively, the ITM group also exhibited lower median morphine consumption compared to ESPB (ITM: 4 mg [1.54–5.38] vs. ESPB: 10 mg [10–10], p<0.001). The NRS resting/activity scores were consistently lower in the ITM group than in the ESPB group at all measurement times (p<0.001). The number of patients receiving rescue analgesic medication was lower in the ITM group than in the ESPB group (ITM, n=6 [30%] vs. ESPB, n=20 [100%]; p<0.001). The side effect profiles of both groups were comparable.
Conclusion: ITM reduced morphine consumption, pain scores, and the requirement for rescue analgesia compared with ESPB, with a comparable side effect profile after VATS.

Objectives: Central venous catheterization (CVC) of the internal jugular vein (IJV) has been performed with landmark techniques for many years. In recent years, ultrasound (US) guidance has become the preferred method. In this observational study, we aimed to obtain the durations of IJV puncture and catheterization during US-guided CVC in patients undergoing cardiovascular surgery.
Methods: After ethics committee approval, patients over the age of eighteen who underwent cardiovascular surgery were included. Central venous catheters were inserted via the right IJV with the aid of US guidance after standard anesthesia induction. Demographic data, characteristics of surgical interventions, number of attempts for IJV puncture, duration of puncture, success rate of puncture, duration of catheterization, success rate of catheterization, and complications were recorded. Data were presented as mean±SD (min-max) and/or number (%).
Results: Fifty patients (31 M, 19 F) were included. The mean age was 64.22±11.02 years, the mean weight was 77.12±11.81 kg, and the mean height was 166.48±9.53 cm. Coronary artery bypass grafting surgery (64%), valve replacement (VR) surgery (24%) [single VR (10%), double VR (12%), and triple VR (2%)], coronary artery bypass grafting surgery with mitral VR surgery (4%), Bentall procedure (4%), Bentall procedure with aortic VR surgery (2%), and ASD repairment surgery (2%) were performed on the patients. The mean number of puncture attempts was 1.0±0.00, the mean puncture duration was 5.08±3.85 (1-16) seconds, and the mean catheterization duration was 92.86±30.85 (68-232) seconds. Vein puncture and catheterization were both successfully performed in all patients. No complications were observed.
Conclusion: The anatomical relationship and variation of IJV and CA could be easily detected with the use of US. Thus, catheterization of the IJV can be performed successfully with the aid of US guidance. Our results are in accordance with the results of studies present in the literature.

Rib fractures are a significant cause of morbidity and mortality due to potential respiratory complications. Pain is one of the most critical factors affecting respiratory functions. Therefore, pain management is a crucial component of treatment. The erector spinae plane block, a newly defined technique, has been used for postoperative acute pain control and chronic pain syndromes. Its use has become widespread in rib fractures due to its ability to provide effective analgesia and its safe application under ultrasound guidance. Data is needed to determine if it is the best method compared to other techniques. In this article, we aim to review the literature through our case series.