Objectives: Thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) are widely utilized regional analgesia techniques for video-assisted thoracoscopic surgery (VATS). However, evidence comparing their analgesic efficacy remains inconclusive. This study aimed to compare postoperative opioid requirements, pain scores, rescue analgesic requirements, and perioperative outcomes between TPVB and ESPB in patients undergoing VATS.
Methods: Patients who underwent VATS between January 2021 and December 2025 were retrospectively evaluated. A total of 424 patients were analyzed (TPVB group, n=247; ESPB group, n=177). The primary outcome was additional postoperative intravenous (IV) morphine consumption in the post-anesthesia care unit (PACU). Secondary outcomes included rescue tramadol requirements, Numerical Rating Scale (NRS) pain scores, perioperative hemodynamics, and complications.
Results: Additional PACU IV morphine consumption was significantly lower in the TPVB group compared with the ESPB group (4.02±0.97 mg vs. 4.48±1.16 mg, p<0.001). The proportion of patients requiring rescue tramadol was also lower in the TPVB group (21.1% vs. 31.6%, p=0.014). Patients in the TPVB group had significantly lower NRS scores on arrival at the PACU and at 1, 2, and 12 hours postoperatively, with no difference at 24 hours. No significant differences were observed regarding PACU stay, length of hospital stay, postoperative or block-related complications, or perioperative hemodynamic parameters.
Conclusion: TPVB was associated with lower PACU opioid consumption, reduced rescue analgesic requirements, and lower postoperative NRS scores compared with ESPB; however, the absolute differences were relatively small, and their clinical relevance may be limited.

Objectives: One-lung ventilation (OLV) is used during thoracic surgery to protect the healthy lung from contamination while providing optimal surgical exposure. This study evaluated successful lung isolation and the time to lung collapse using the Univent blocker in patients undergoing thoracoscopic surgery.
Methods: Patients requiring lung isolation between November 2014 and February 2016 were prospectively enrolled. Demographic data, ASA physical status, Mallampati and Cormack–Lehane scores, and the need for airway adjuncts were recorded. Placement time was defined as the interval between laryngoscopy and bronchoscopic confirmation of blocker position. Lung collapse was assessed by the surgeon at 5, 10, 15, and 20 minutes after blocker inflation. Airway pressures (peak, plateau, and PEEP), dynamic compliance, inspired oxygen fraction (FiO₂), and end-tidal carbon dioxide (EtCO₂) were monitored throughout surgery.
Results: Twenty-eight patients completed the study. The right lung was isolated in 17 (61%) patients and the left lung in 11 (39%). At 5 minutes, lung collapse was graded as poor in 11%, fair in 64%, and excellent in 25% of patients; at 20 minutes, 50% were graded as fair and 50% as excellent. Blocker placement times were similar between right- and left-sided isolation (134±107 s vs. 117±77 s). However, the time to lung collapse was significantly longer for right-sided isolation (222±148 s vs. 142±56 s, p<0.05). Respiratory mechanics were comparable between groups.
Conclusion: The Univent blocker provides effective lung isolation. Although adequate lung collapse requires a certain amount of time, respi-ratory mechanics remain preserved during OLV.

Objectives: During cardiopulmonary bypass (CPB), temperature, lactate, and NIRS-derived cerebral oxygen saturation (rSO₂) are recorded simultaneously; however, whether they provide complementary or interchangeable information remains unclear. In adults undergoing elective on-pump coronary artery bypass grafting (CABG), we examined their within-patient relationships across consecutive CPB phases and tested whether temperature and lactate remained independently associated with rSO₂ after adjustment for hematocrit, mean arterial pressure (MAP), and PaCO₂. Methods: This prospective, single-center, observational study included 85 adults undergoing elective isolated on-pump CABG. MAP, esophageal temperature, bilateral frontal rSO₂, lactate, hematocrit, and PaCO₂ were recorded simultaneously at seven CPB-related phases, yielding 595 phase-level observations. Within-patient associations were evaluated using repeated-measures correlation. Adjusted associations were assessed with a linear mixed-effects model and supported by active-CPB, hemisphere-specific, and interhemispheric-agreement analyses.
Results: Cerebral rSO₂ decreased after CPB onset, lactate increased progressively, and hematocrit declined. Within-patient correlations among temperature, lactate, and rSO₂ were statistically significant but negligible (all r²≤0.025). In the mixed-effects model, hematocrit (standardized β=1.66), MAP (β=1.05), and PaCO₂ (β=0.85) were independently associated with cerebral rSO₂ (all p≤0.003), whereas temperature and lactate were not. This pattern was preserved in active-CPB and hemisphere-specific analyses. Interhemispheric agreement was high, supporting the use of the bilateral mean for this population-level analysis.
Conclusion: During CPB in elective CABG, temperature, lactate, and cerebral rSO₂ behaved as complementary, non-redundant signals rather than interchangeable perfusion indices. Cerebral oxygenation was independently associated with hematocrit, MAP, and PaCO₂, supporting cautious multiparameter interpretation and multicenter outcome-based confirmation.

Objectives: Thoracic surgery consultation is frequently required in intensive care unit (ICU) patients. However, the clinical characteristics and consultation burden of these patients have not been well defined. This study aimed to evaluate the profile and consultation burden of patients requiring thoracic surgery consultation in the ICU and to compare trauma and non-trauma populations.
Methods: This retrospective cohort study included 3,955 adult ICU patients hospitalized between January 2021 and December 2025. Patients were grouped according to thoracic surgery consultation status. Among consulted patients, trauma and non-trauma groups were identified and compared. Consultation burden was defined as the number of consultations per patient.
Results: Thoracic surgery consultation was requested in 695 patients (17.6%). Patients requiring consultation were younger and had longer ICU stays (p<0.001 for both), while mortality rates were similar (p=0.395). Among consulted patients, non-trauma patients were older and had higher mortality rates (61.1% vs. 29.0%, p<0.001). Consultation burden differed significantly. The median number of consultations was higher in non-trauma patients (2.0 vs. 1.0, p<0.001), whereas the mean number was higher in trauma patients, indicating a skewed distribution. Temporal analysis demonstrated lower consultation rates in 2021 and 2022, followed by a progressive increase, partly influenced by higher ICU admissions during the pandemic period.
Conclusion: Thoracic surgery consultation burden reflects clinical complexity beyond diagnosis. Although the consultation burden was higher among non-trauma patients, a subgroup of trauma patients required substantial consultation. Temporal variations indicate the influence of healthcare system dynamics. Assessing consultation burden may improve multidisciplinary management, clinical outcomes, and resource utilization.

Objectives: The prognostic value of inflammatory and immunonutritional indices in intensive care unit (ICU) pneumosepsis remains uncer-tain. We evaluated eight routinely calculable indices for predicting invasive mechanical ventilation (IMV) and 30-day mortality.
Methods: This retrospective single-center cohort included consecutive adults with Sepsis-3-defined pneumosepsis admitted from the emergency department to the ICU between 2022 and 2024. Indices were calculated from complete blood count, albumin, and C-reactive protein values obtained within six hours of presentation. Discrimination was assessed by receiver operating characteristic analysis. Multivariable logistic and Cox regression models evaluated independent associations with IMV and mortality, respectively.
Results: Among 284 patients, 167 (58.8%) required IMV, and 112 (39.4%) died within 30 days. Non-survivors had higher Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index, Aggregate Index of Systemic Inflammation, and neutrophil-to-lymphocyte ratio values but lower Prognostic Nutritional Index, C-reactive protein-albumin-lymphocyte (CALLY) index, and Hemoglobin-Albumin-Lymphocyte-Platelet scores. CALLY showed the highest discrimination for 30-day mortality (area under the curve [AUC], 0.821), followed by SII (AUC, 0.798). SII (AUC, 0.784) and the neutrophil-to-lymphocyte ratio (AUC, 0.762) performed best for IMV. After adjustment for age, Sequential Organ Failure Assessment score, and Charlson Comorbidity Index, SII >2,156 (hazard ratio, 2.14; 95% confidence interval, 1.42-3.22) and CALLY <1.12 (hazard ratio, 2.67; 95% confidence interval, 1.78-4.01) independently predicted mortality (both p<0.001).
Conclusion: Admission inflammatory indices provide early prognostic information in ICU pneumosepsis. CALLY and SII may complement established severity scores and support early risk stratification. These inexpensive biomarkers may facilitate triage, resource allocation, and escalation of care while awaiting comprehensive clinical assessment.

Objectives: To characterize the clinical profile and outcomes of pediatric patients receiving rescue levosimendan for refractory circulatory failure after congenital heart surgery rather than to evaluate treatment efficacy.
Methods: This retrospective single-center cohort study included pediatric patients who received postoperative levosimendan between January 2023 and December 2024 for persistent circulatory failure despite optimized conventional inotropic therapy. Demographic, operative, and postoperative variables, including vasoactive-inotropic score (VIS) at levosimendan initiation and extracorporeal membrane oxygenation (ECMO) requirement, were analyzed. Multivariable logistic regression was used to explore factors associated with in-hospital mortality.
Results: Thirty-nine patients received rescue levosimendan; one was excluded because of interhospital transfer before final outcome assessment, leaving 38 patients for analysis. Most procedures were of high complexity (STAT Mortality Category 4–5, 71.1%). In-hospital mortality was 34.2% (13/38). Non-survivors had higher VIS at levosimendan initiation (median, 22 vs. 17; p=0.048) and more frequently required ECMO support (84.6% vs. 20.0%; p<0.001). Delayed sternal closure was performed in 36.8% of patients. In multivariable analysis, ECMO requirement remained strongly associated with mortality (OR, 17.8; 95% CI, 3.4–92.1; p=0.001), whereas VIS was not statistically significant after adjustment. Conclusion: Pediatric patients receiving rescue levosimendan after congenital heart surgery represent a high-risk subgroup with advanced circulatory failure and substantial mortality. Rescue levosimendan use may therefore serve as a clinical marker of severe postoperative hemo-dynamic deterioration rather than an isolated determinant of outcome.

Objectives: Central line–associated bloodstream infections (CLABSIs) remain an important source of morbidity and mortality in pediatric cardiac intensive care units (PCICUs). Although evidence-based prevention bundles can reduce infection rates, sustaining low CLABSI rates in high-acuity settings remains difficult. To evaluate longitudinal trends in CLABSI rates in a pediatric cardiac intensive care unit over a three-year period.
Methods: A retrospective analysis of prospectively collected infection surveillance data was conducted for the period between January 1, 2023, and January 1, 2026. CLABSI rates were calculated as infections per 1,000 central line-days and analyzed quarterly. Observed infection rates were compared with institutional targets and external benchmark data from the Pediatric Cardiac Critical Care Consortium (PC⁴).
Results: A total of 1,800 patients and 24,100 central line-days were evaluated during the study period. Overall, 72 CLABSI episodes were identified, corresponding to a rate of 3.0 infections per 1,000 central line-days. CLABSI rates ranged from 0.5 to 6 infections per 1,000 catheter-days, with the lowest rates observed during 2024 and transient increases during early 2025. Periods with higher infection rates coincided with increased catheter utilization, prolonged catheter dwell time, greater ECMO exposure, and a higher proportion of complex surgical proce-dures. Gram-negative microorganisms predominated (66%), particularly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. CLABSI-related mortality was 6.9%.
Conclusion: CLABSI rates in this pediatric cardiac intensive care unit showed substantial temporal variability over the three-year surveillance period. Although periods of near-benchmark performance were achieved, sustaining consistently low infection rates remained challenging, particularly during periods of increased patient acuity and device utilization.

Objectives: Port catheter implantation is a commonly performed minimally invasive procedure that may still cause intraoperative discomfort and require supplemental analgesia. The serratus posterior superior intercostal plane (SPSIP) block is a recently described regional anesthesia technique for thoracic analgesia. This study evaluated the analgesic efficacy of the SPSIP block during port catheter implantation.
Methods: In this prospective randomized study, 66 patients undergoing elective port catheter implantation were allocated to either the SPSIP block group (n=33) or the local infiltration (LI) group (n=33). The primary outcome was pain intensity during port pocket creation, measured using the Numeric Rating Scale (NRS). Secondary outcomes included maximum intraoperative pain score, supplemental local anesthetic requirement, total tramadol consumption within the first 24 hours, patient and surgeon satisfaction, and procedure-related complications.
Results: Pain intensity during port pocket creation was significantly lower in the SPSIP group than in the LI group (median [IQR]: 1 [1–2] vs. 2 [1–3]; p=0.038). Maximum intraoperative pain scores and supplemental local anesthetic requirements were also significantly lower in the SPSIP group (p=0.038 and p=0.014, respectively). Although 24-hour tramadol consumption was lower in the SPSIP group, the difference was not statistically significant (p=0.154). Patient and surgeon satisfaction scores were significantly higher in the SPSIP group (p=0.026 and p=0.002, respectively).
Conclusion: The SPSIP block provides effective intraoperative analgesia during port catheter implantation, reduces supplemental local anesthetic requirements, and improves patient and surgeon satisfaction.

Hoarseness may rarely indicate cardiovascular pathology and have important anesthetic implications. We report a 67-year-old man with preoperative hoarseness, a saccular aortic arch aneurysm, and radiological tracheal deviation. Although conventional airway assessment was unremarkable, a potentially difficult airway was anticipated. Videolaryngoscopy revealed reduced left vocal cord mobility in a paramedian position, and tracheal intubation was achieved without technical difficulty. This case emphasizes preoperative hoarseness as a warning sign of altered airway anatomy in cardiovocal syndrome and highlights the importance of careful airway assessment, preparation, and anesthetic planning.