The standard anesthesia method in intubated patients during thoracoscopic surgery is one-lung ventilation (OLV). Accumulated experience in video-assisted thoracoscopic surgery (VATS) has remarkably advanced minimally invasive techniques in thoracic surgeries, a progress that has prompted anesthesiologists to pursue different and alternative methods. The desire to avoid possible general anesthesia side effects, such as intubation-related airway trauma, mechanical ventilation-induced lung damage, residual neuromuscular blockade, and postoperative nausea and vomiting, has led to the introduction of nonintubated anesthesia techniques as an alternative anesthesia method in thoracic surgery. Nonintubated techniques are established to preserve the patient’s spontaneous breathing during iatrogenic pneumothorax created by the surgeon during VATS and the atelectasis on the side to be operated on, providing sufficient surgical field of view and allowing successful completion of the surgery. Although this does not compete with continuing traditional thoracic anesthesia, in the future, nonintubated techniques will gain greater acceptance for VATS with appropriate patient selection and increased experience. This article reviews nonintubated anesthesia techniques used in VATS, including their advantages, disadvantages, appropriate patient selection, and complications.

Objectives: This study aimed to compare Bretschneider’s histidine–tryptophan–ketoglutarate (BHTK) and blood cardioplegia in terms of postop-erative acute kidney injury (AKI) and outcome parameters in patients who underwent open-heart valve surgery.
Methods: A total of 94 patients who underwent open-heart valve surgery between January 2016 and November 2021 were retrospectively evaluated. According to the administration of BHTK and blood cardioplegia, patients were stratified into two groups. Postoperative Kidney Disease Improving Global Outcomes was compared in terms of development of AKI and outcomes according to staging.
Results: A total of 31 patients in the BHTK group and 63 patients in the blood cardioplegia group were evaluated. No statistical difference was found between the groups in terms of postoperative AKI (p>0.05). Postoperative 24 and 48 h blood urea nitrogen (BUN) was higher in the BHTK group (p=0.007 and p=0.023). This difference equalized on the 7th day. No statistical difference was found in the mechanical ventilation time, intensive care unit and hospital stay, and 30-day mortality.
Conclusion: Literature evaluating the systemic effects of BHTK solution is limited. In our study, although no difference was found between BHTK and blood cardioplegia in terms of AKI development, the increase in BUN in the BHTK group was remarkable. Further studies exploring the clinical impact of this finding are warranted.

Objectives: In cardiac surgery, a successful erector spinae plane (ESP) block has been demonstrated within the scope of multimodal analgesic approach. This study aimed to comparatively evaluate the effect of ESP block used in cardiac surgery on neutrophil-lymphocyte ratio (NLR).
Methods: Patients who underwent an ESP block and conventional analgesia technique for coronary artery bypass grafting surgery were retrospectively compared. Postoperative pain scores, analgesic consumption, extubation times, and intensive care unit (ICU) and hospital stays were recorded with patient and operative data. As the study’s primary outcome, NLR values were calculated from the hemogram as an indicator of inflammation during the preoperative period and 3 days postoperatively.
Results: A total of 97 patients who underwent coronary artery bypass graft surgery with cardiopulmonary bypass were investigated. The highest pain score (p=0.016), total opioid (p=0.008) and acetaminophen (p=0.009) consumption, extubation (p=0.024), and ICU stay (p=0.045) in the first 24 h after extubation were significantly lower in the ESP group. NLR (p=0.019, p=0.046, and p=0.038, respectively) was significantly lower in the ESP group in the first 3 days.
Conclusion: In addition to being associated with less opioid use in the first 24 h in the postoperative pain management of cardiac surgery, ESP block reduces NLR 3 days postoperatively.

Objectives: The use of cardiopulmonary bypass (CPB) in pediatric patients during open-heart surgery is associated with excessive inflammation, fluid leakage, and end-organ dysfunction. To reduce these effects, various ultrafiltration (UF) techniques are utilized. In this study, we aimed to compare the effect and early outcomes of modified UF (MUF) and conventional UF (CUF) in infants undergoing pediatric cardiac surgery.
Methods: A total of 232 infants who underwent open-heart surgery with CPB between February 2018 and January 2020 were retrospectively reviewed. Fifty-six patients weighing ≤15 kg with a history of any UF technique use were included. Patients were stratified into CUF (n=23) and MUF (n=33) groups. Preoperative patient characteristics and intraoperative and postoperative outcomes were recorded.
Results: The MUF group had a lower patient size (height, weight, and body surface area), with no statistical difference. Intraoperative parameters (CPB and cross-clamp time) and prime solution components were similar between groups. MUF significantly shortened the mechanical ventilation (MV) time (p=0.048) in contrast to intensive care unit stay, which showed no significant difference.
Conclusion: In our series, we demonstrated that the MV duration was shorter in the MUF group, which is consistent with prior literature. Additionally, although the lower weight of the patients in the MUF group showed no statistical significance, early hemodynamic effect and low mortality in this group support the potential benefits of MUF. With its cost-efficiency and early benefits, MUF is an effective UF method with a good safety profile, especially in low-weight infants.

Objectives: This study aimed to evaluate the effects of previous coronavirus disease 2019 (COVID-19) infection on mortality, factors influencing mortality, and potential postoperative complications in on-pump cardiac surgery.
Methods: This single-center, retrospective, observational study included 233 adult patients who underwent on-pump cardiac surgery between June 2021 and February 2022. Patients with preoperative history of COVID-19 infection confirmed by nasopharyngeal swab polymerase chain reaction (PCR) test were compared to those without COVID-19 history.
Results: Patients’ mean age was 60.12±11.26 years (range, 23–81 years), and 77.3% were male. The mean time from PCR positivity to surgery was 191.11±169.9 days (median, 108 days). No between-group differences were observed in anesthesia, cross-clamp time, pump time, operative time, extubation time, length of intensive care unit and hospital stay, or mortality (p>0.05). The post-COVID-19 group had higher rates of preoperative acute neurologic events and arrhythmias, pump lactate levels, and intraoperative inotropic scores (p<0.05). These factors were not associated with survival. Postoperative pneumothorax was more frequent in the post-COVID-19 group (p=0.002) and associated with longer length of hospital stay. No significant difference was observed in preoperative, postoperative, or changes in neutrophil/lymphocyte ratio (NLR) between groups.
Conclusion: Patients with and without COVID-19 history had similar outcomes after open-heart surgery. Nevertheless, the former had increased frequency of postoperative pneumothorax and prolonged length of hospital stay. Open-heart surgery seems safe after COVID-19. However, larger, prospective studies including inflammatory markers other than NLR are needed to further investigate the potential complications.

Objectives: This study aimed to review the characteristics and outcomes of children with congenital heart disease requiring tracheostomy after cardiac surgery.
Methods: Medical records of 65 out of 2814 consecutive patients who required tracheostomy after congenital heart surgery between March 2018 and March 2023 were retrospectively reviewed. Outcomes such as hospital survival, long-term survival, and weaning from positive pressure ventilation were elucidated.
Results: During the 5-year period, a total of 65 of 2814 (2.3%) patients required tracheostomy in the pediatric intensive care unit after surgery. The median patient age was 5 (range, 0.6–24) months and the median weight was 4.3 kg (range, 3.3–11). A total of 23 (35.5%) patients demonstrated a single-ventricle physiology while 42 (64.5%) patients manifested with biventricle physiology. A total of 11 (16.9%) patients were syndromic, including Down syndrome in 6 patients, Di George syndrome in 3 patients, and Williams syndrome in 2 patients. In the whole cohort (65 patients), the mean time to tracheostomy from cardiac surgery was 30±16 days. In-hospital mortality was noted in 20 of the patients (30.8%) who underwent tracheostomy. Twenty-six patients (40%) were decannulated and discharged without a tracheostomy, and 14 patients (22%) were discharged with a tracheostomy cannula and home-type mechanical ventilator (HMV).
Conclusion: Tracheostomy is a viable option for pediatric patients with prolonged mechanical ventilation after heart surgery for congenital heart disease. It creates an opportunity to discharge patients on HMV, if repeated attempts of extubation and decannulation fail, albeit with potential risks.

Objectives: Multidisciplinary cardiac care is well known to lead to improved outcomes. In this study, two different organizational models (surgeonled and team-based units) for pediatric cardiac intensive care unit (ICU) located in a developing country setting and their early postoperative out-comes for patients with pediatric congenital heart disease were compared.
Methods: A total of 246 infants and children who underwent surgery for congenital cardiac diseases were retrospectively analyzed. The correlations between the perioperative patient data of both models were analyzed and compared. The predictive factors for morbidity were calculated. Results: No significant difference was observed in the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STS-EACTS) mortality category and estimated mortality rate between groups. However, a statistically significant difference was observed in the STS-EACTS estimated postoperative length of stay and estimated major complication rate between groups. The extubation time and length of ICU stay varied significantly between groups.
Conclusion: Compared with the surgeon-led model, the team-based model resulted in superior postoperative patient outcomes in terms of morbidity, shorter extubation time, and ICU length of stay. Thus, in developing countries, higher morbidity rather than mortality may be anticipated when undertaking congenital heart surgery in non-neonatal age groups without a multidisciplinary team to support the surgeon. Therefore, higher major complications can be expected when congenital heart surgery programs have to be established despite the lack of experienced staffing.

Tetralogy of Fallot is a cyanotic congenital heart disease involving hypoxic episodes. We herein present a case of a patient who underwent the Duhamel operation for Hirschsprung’s disease. The patient had hypoxic seizure triggered by surgical stimulation, anesthesia effect, and postoperative agitation and was diagnosed with Tetralogy of Fallot via echocardiography postoperatively.