Postoperative pain management in pediatric patients remains a significant challenge despite improvements in perioperative care. Regional anesthesia techniques applied as part of multimodal analgesia strategies offer the potential to reduce opioid use, accelerate recovery, and minimize side effects such as respiratory depression, nausea, and delayed mobilization. This review examines the clinical applications, advantages, and limitations of regional anesthesia blocks in the context of common pediatric surgical procedures—appendectomy, inguinal hernia repair, circumcision, cholecystectomy, and pyloromyotomy. We provide procedural comparisons in terms of analgesic efficacy, opioid-sparing effects and suitability for ambulatory surgery. In conclusion, regional anesthesia techniques have significant potential to improve postoperative outcomes in pediatric patients. However, block selection should be individualized, considering the type of surgical procedure, patient characteristics, and operator experience. Increasing applicability and routinely implementing ultrasound-guided procedures will encourage the safer and more effective use of these techniques in pediatric anesthesia.

Amaç: Retrospektif çalışmada hastanemizde laparoskopik bariatrik cerrahi uygulanan hastalardaki anestezi deneyimimizin aktarılması ve perioperatif yönetimin literatür eşliğinde tartışılması amaçlanmıştır. Gereç ve Yöntem: Obezite cerrahisi geçiren ASA II-III olan 72 Hasta retrospektif olarak değerlendirilmiştir. Hastaların demografik özellikleri, cerrahi süresi, peroperatif dönemde görülen komplikasyonlar (akut kidney injury-AKI), yoğun bakım ihtiyacı kaydedilmiştir. Bulgular: Hastaların havayolu yönetiminde 7 (%10,3) hastada zor maske ventilasyon, 11 (%16,2) hastada zor entübasyon olduğu değerlendirilmiştir. İntraoperatif dönemde görülen komplikasyonlar arasında bradikardi, hipotansiyon görülmüştür. Ortalama cerrahi süre 135 dakika, cerrahi bitiminde 4 hasta yoğun bakım ünitesinde 24saat takip edilmiştir. Bu hastaların 2’sinde obstrüktif uyku apnesi sendromu (OSAS) tanısı vardı. Hastaların postoperatif 24 saatlik takiplerinde 1 hastada (%1,5) Akut kıdney injury (AKI) gelişmiştir. Sonuç: Laparaskopik obezite cerrahisinde oluşabilecek komplikasyonların önlenmesinde preoperatif hazırlık, uygun peroperatif sıvı yönetimi ideal anestezi için gereklidir.

Objective: After endotracheal intubation (ETI), the endotracheal tube cuff (ETTc) should be inflated at sufficient pressure to function, and high pressure should be avoided to prevent complications. In our study, the effect of professional experience on the estimation of ETTcP by palpation is investigated. Method: The study included 75 adult patients with physical status I-III of the American Society of Anesthesiology (ASA) scheduled for ETI. Anesthesia residents were divided into two groups of 20, each with 1 month to 1 year of experience (Group 1) and those with more than 4 years of experience (Group 2). After the ETI, one participant in both groups was asked to inflate the ETTc to an estimated 25 cm H2O by cuff palpation. Then the actual ETTcP was measured with a manometer. Results: The median ETTcP value was 42,00 cm H2O in Group 1 and 32,00 cm H2O in Group 2, (p=0.012). Although the data of both groups were significantly higher than the target value, the values obtained in Group 1 were further away from Group 2 (p<0.001, p<0.001). Conclusion: Professional experience has no effect on the correct estimation of the ETTcP. It is more convenient to measure the actual pressure to avoid undesirable effects of ETTcP outside the target.

Öz Kardiyak Cerrahi Sonrası Postoperatif Bilişsel Fonksiyon Bozukluğu; Görülme sıklığı ve Risk Faktörleri Amaç: Çalışmamızın amacı merkezimizde kalp cerrahisi sonrası kognitif bozulma görülme sıklığını ve risk faktörlerini araştırmaktır. Yöntem: 01-01-2021 ve 31-12-2021 tarihleri arasında kalp cerrahisi planlanan 18-70 yaş arası ASA II-III hastaları çalışmaya dahil edildi. Ameliyat sonrası bilişsel bozukluk (POBB) tanısı mini mental durum testi (MMDT) ile konuldu. MMDT ameliyat öncesi ve ameliyat sonrası 7. gün ve 8. haftada yapıldı. MMDT puanı <23 olan hastalar bilişsel işlev bozukluğu olan POBB (+) olarak tanımlandı. Bulgular: Bu süre içerisinde uygun görülen 231 hastadan 73'ü çalışma dışı bırakıldı, çalışmaya dahil edilen 158 hastadan 54'ü çalışmayı tamamlayamadı ve geri kalan 104 hastanın verileri analiz edildi. POBB (+) görülme sıklığı 7. günde %38,46, ameliyat sonrası 8. haftada ise %22,11 olarak belirlendi. Yaş, ameliyat öncesi MMDT skorunun düşük olması, ameliyat öncesi Euroscore skorunun yüksek olması, 7. günde yoğun bakımda kalış süresinin uzun olması, yaş, ameliyat öncesi ve ameliyat sonrası 7. günde MMDT skorunun düşük olması 8. hafta için POBB risk faktörleri olarak belirlendi. Sonuç: Kalp cerrahisi sonrası POBB hala ciddi bir sorundur ve bunu en aza indirmek için risk faktörlerinin bilinmesi önemlidir.

Laparoscopic surgery offers several advantages such as reduced postoperative pain and faster recovery; however, the establishment of pneumoperitoneum has the potential to transiently increase intracranial pressure (ICP). Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) provides a reliable noninvasive indicator of ICP changes. This study aimed to evaluate ONSD measurements, which may reflect intraoperative ICP changes during laparoscopic upper abdominal surgery performed in the reverse Trendelenburg position, and to assess the specific effects of pneumoperitoneum. Fifty-five patients with ASA physical status I-III who undergoing elective laparoscopic upper abdominal surgery were prospectively enrolled. Bilateral ONSD measurements were performed at four time points: after induction of anesthesia (T₀), 10 min (T₁), and 60 min (T₂) after the establishment of pneumoperitoneum, and 10 min after desufflation (T₃). Respiratory and hemodynamic parameters were recorded simultaneously. Mean ONSD values increased significantly at both 10 and 60 min of pneumoperitoneum compared to baseline (p < 0.001) and remained elevated even after desufflation (p < 0.01). No significant difference was observed between T₁ and T₂. Peak and plateau pressures increased while compliance decreased during pneumoperitoneum (p < 0.001). Pneumoperitoneum during laparoscopic upper abdominal surgery causes a significant yet transient increase in ONSD. Although ONSD values showed a partial decrease after desufflation, they remained higher than baseline measurements but within clinically acceptable and non-critical ranges. Continuous intraoperative ultrasonographic ONSD monitoring may provide real-time insight into intracranial dynamics, particularly in patients at risk for elevated ICP. Further studies are warranted to clarify the underlying multifactorial mechanisms and determine the clinical significance of ONSD alterations. NCT06209034, Registered January 6, 2024. (Retrospectively registered). GOKAEK-2023/19.12. The online version contains supplementary material available at 10.1186/s12871-026-03764-5.

Background: Cardiopulmonary bypass (CPB) causes disruption of the blood-brain barrier and cerebral autoregulation for many reasons. The resulting cerebral edema causes an increase in intracranial pressure. Ultrasonographic optic nevre sheath diameter (ONSD) measurement is one of the non-invasive methods that provides information about intracranial pressure. Numerous studies have demonstrated a correlation between ONSD and intracranial pressure (ICP). We aimed to investigate ONSD changes during CPB and the relationship between these changes and CPB duration.Methods: Twenty six patients aged between 18-75 years, with an ASA score of II or III, which underwent cardiac surgery with CPB are included to the study. ONSD measurements were made throughout surgery and data were recorded.Results: ONSD values increased significantly at 45 and 90 min of CPB and end of the surgery compared to pre-CPB values for both eyes. There was no significant difference between 45 and 90 min. during CPB. A critical ONSD value was detected in 12 patients during CPB. No patient developed neurologic adverse events in the postoperative period.Conclusion: ONSD increased during CPB regardless of duration. With the data obtained from our study, we cannot say that the increase in ONSD will be a predictor of postoperative neurological complications.