One-lung ventilation (OLV) in thoracic anesthesia poses dual challenges: preventing hypoxemia and minimizing ventilator-associated lung injury (VALI). Advances such as fiberoptic bronchoscopy and improved anesthetic techniques have reduced hypoxemia, yet optimal management strategies remain uncertain. Protective ventilation, involving low tidal volumes (4–6 mL/kg), individualized PEEP, and selective alveolar recruitment maneuvers (ARM), seek to balance oxygenation and lung protection. However, questions persist regarding the ideal application of PEEP and ARM, as well as their integration into clinical practice. As for PEEP and ARM, further research is needed to address key questions and establish new guidelines.

Postoperative neurocognitive disorders (PNDs) are highly prevalent among the elderly population. Identifying an ideal biomarker for postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) remains a significant challenge. This study aimed to investigate the relationship between these syndromes and various biomarkers, including S-100β, neuron-specific enolase (NSE), interleukin-6 (IL-6), and high-mobility group box-1 (HMGB-1). The study included patients aged 60 years and older who underwent surgery for primary urologic malignancies. POD was evaluated in the recovery room using the Confusion Assessment Method (CAM). POCD was assessed preoperatively and at the first week (POCD1) and third month (POCD3) postoperatively using Addenbrooke's Cognitive Examination-III (ACE-III). Biomarker levels of S-100β, neuron-specific enolase (NSE), interleukin-6 (IL-6), and high-mobility group box-1 (HMGB-1) were measured using enzyme-linked immunosorbent assay (ELISA). A total of 54 patients completed the study. POD was diagnosed in 12 patients (22.2%), while POCD1 and POCD3 were identified in 17 (31.5%) patients and 12 (22.2%) patients respectively. The mean age of the participants was 73.8 ± 7.1 years. Preoperative levels of NSE were significantly higher in patients with POD compared to those without (p = 0.04). Additionally, preoperative and postoperative IL-6 levels, as well as preoperative and postoperative S-100β levels, were significantly elevated in patients with POCD1 compared to those without (p < 0.01, p = 0.01, p < 0.01, and p = 0.03, respectively). Furthermore, preoperative IL-6 and S-100β levels were higher in patients with POCD3 compared to those without (p = 0.01 and p = 0.03, respectively). In major urologic oncologic surgeries among geriatric patients, IL-6 and S-100β were found to be associated with both POD and POCD, while NSE was specifically associated with POD.

Background and Objectives: Metabolic-flow (<0.35 L/min) anesthesia is practiced more often as manufacturers provide newer technologies, yet the benefits of metabolic-flow anesthesia have not been fully investigated. This study aimed to investigate the feasibility and safety of automated gas control (AGC^®) mode, which provides metabolic-flow anesthesia, in a pediatric population. Materials and Methods: Pediatric surgery patients between 1 and 10 years of age were included in this prospective observational trial. After intravenous induction and safe orotracheal intubation, AGC^® was initiated, and total sevoflurane consumption (mL) and wash-in speed-based sevoflurane consumption data were collected to measure feasibility. For safety, inspired (F_iO₂), alveolar (F_AO₂), and expired (F_EO₂) oxygen concentration data, and inspired and alveolar sevoflurane (F_iSevo and F_ASevo, respectively) concentration data, were recorded. Changes in fresh gas flow (FGF) throughout the procedure and postoperative recovery data were also compared. Results: A total of 130 patients were eligible for this study, and 121 patients were included in the analyses; 30 patients had a wash-in speed of 4 (WI4) and 91 patients had a wash-in speed of 8 (WI8) at follow-up. The total mean sevoflurane consumption was 9.35 ± 4.93 mL for a median surgery duration of 100 min. WI8 patients consumed more sevoflurane (9.92 ± 5.08 mL vs. 7.79 ± 4.19 mL, p = 0.04). At the 15th and 30th minutes, the FGF dropped under minimal flow and metabolic flow limits, respectively (p < 0.001). The times to extubation and obeying commands were shorter in WI8 patients (8 (5–10) vs. 11 (5–15) p = 0.03, and 9.5 (5–10.5) vs. 13 (9–17) p < 0.01). Conclusions: Maintenance with AGC^® may offer up to 40 h of anesthesia, considering that the volume of a sevoflurane bottle is 250 mL, reflecting exceptional savings compared to conventional anesthesia management. Metabolic flow anesthesia driven by AGC^® is feasible and safe in pediatric anesthesia practice.

Background: Upper abdominal surgeries exceeding two hours and operated in a lateral decubitus position present an “intermediate” risk for pulmonary complications. The objectives of this study were to observe the sonographic and clinical changes during and after surgeries with one recruitment maneuver (RM) performed intraoperatively before extubation. Methods: Laparoscopic nephrectomy patients were randomized into pre-extubation single RM (Group RM) and control (Group NoRM) groups. The LUS (Lung Ultrasound Score) was evaluated after intubation (T1), at the end of surgery before the RM (T2), after the RM but before extubation (T3), and 30 min after arrival to the Post-Anesthesia Care Unit (T4) in Group RM; in Group NoRM, it was evaluated at the T1, T2, and T4 time points. The primary outcome was the effect on the pre-extubation LUS (T2 in Group NoRM versus T3 in Group RM). The secondary outcomes included the effects on the T4 LUS, PPC occurrence, and PaO₂/FiO₂ ratios, and the sensitivity and specificity of the LUS in predicting PPCs. Results: The data of 54 patients were analyzed. The pre-extubation LUS was significantly lower in Group RM (16 (12.5, 17) vs. 18 (17, 20), p < 0.001). The T4 LUS was only different in the upper zones in the dependent lung (2 (1, 3.5) in Group RM vs. 4 (3, 4.5) in Group NoRM, p = 0.01). The perioperative PaO₂/FiO₂ ratios were similar (p > 0.05). The pre-extubation LUS exhibited 91% sensitivity (p = 0.04), whereas the T4 LUS sensitivity was 82% (p = 0.01). The PPC risk was 10-fold higher in patients with a pre-extubation LUS exceeding 19. Conclusions: A pre-extubation single RM instantly increases the LUS. However, this does not persist postoperatively or diminish respiratory complications. More importantly, the LUS was found to be a sensitive tool for predicting PPCs when performed just before extubation.