Peri-operative management of infants with trisomy 18 syndrome is challenging due to various congenital cardiac and facial anomalies.

Cross-sectional area,gastric volume,ultrasonography

Cancer is one of the most important health problems that deeply affects all humanity and will have groundbreaking consequences in human history with its elimination. Gastrointestinal cancers, including colon and rectum, stomach, liver, pancreatic, and esophageal, account for 26% of the global cancer incidence and 35% of cancer-related deaths. Unfortunately, it is estimated that today’s high incidence and mortality rates will increase by 58% and 73% by 2040, respectively. Although the treatment process includes novel options such as immunotherapy in addition to classical options with a multidisciplinary approach, surgical treatment under general anesthesia remains the leading option. Considering a long-lasting cancer process, it is quite surprising that a very short-term anesthetic administration can have various effects on cancer cell behavior. Various anesthetic approaches such as regional blocks used in pain management, the use of anesthetic adjuvants such as β-adrenoceptor antagonists, nonsteroidal anti-inflammatory drugs, and intravenous lidocaine, and the choice of anesthetic drugs seem to have potential effects on long-term cancer outcomes. Propofol is an intravenous anesthetic drug that is used for both induction and maintenance of general anesthesia. Many in vitro and clinical studies examining the effects of propofol comparatively with other anesthetic agents on tumor recurrence and metastasis revealed possible effects on tumor cell signaling, the immune response, and the modulation of the neuroendocrine stress response. However, the evidence from all these in vitro and clinical studies is different, complicated, and inconsistent. The general effects of propofol on the behavioral patterns, growth, and metastasis of gastrointestinal tumor cells, as well as the clinical features and consequences resulting from these effects, constitute the subject of this review.

In vitro vasoactive effects of dexmedetomidine on isolated human umbilical arteries

In this editorial, we comment on the article by Hu et al entitled “Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”. We wanted to draw attention to the general features of postoperative delirium (POD) as well as the areas where there are uncertainties and contradictions. POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery. It is a severe postoperative complication, especially for elderly oncology patients. Although the underlying pathophysiological mechanism is not fully understood, various neuroinflammatory mechanisms and neurotransmitters are thought to be involved. Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD. As delirium is considered a preventable clinical entity in about half of the cases, various early prediction models developed with the support of machine learning have recently become a hot scientific topic. Unfortunately, a model with high sensitivity and specificity for the prediction of POD has not yet been reported. This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.

Background: Continuous non-invasive hemoglobin monitoring (SpHb) may provide real-time information during surgery, but its accuracy in neurosurgery remains uncertain. We evaluated the agreement, trending ability, and diagnostic performance of SpHb compared with arterial blood gas hemoglobin during elective intracranial neurosurgery. Methods: In this prospective observational study, 60 adults undergoing elective neurosurgery with invasive arterial monitoring were included. SpHb (Masimo Radical-7) was compared with paired arterial hemoglobin values. Agreement was assessed using repeated-measures Bland–Altman analysis and mixed-effects modeling. Trending ability was evaluated using four-quadrant concordance with an exclusion zone of ±0.5 g/dL. Discrimination for severe anemia (Hb < 8 g/dL) was assessed using ROC analysis with patient-level cluster bootstrapping. Results: A total of 190 paired measurements were analyzed. Mean bias was +0.23 g/dL, with wide limits of agreement (−3.26 to +3.72 g/dL). Agreement was worse under low-perfusion-index conditions. Trending performance was preserved, with an overall concordance rate of 85.5%. SpHb showed moderate discrimination for severe anemia (AUC 0.78; 95% CI 0.61–0.93), although severe anemia events were infrequent. Conclusions: SpHb showed limited reliability for absolute hemoglobin quantification during neurosurgery but provided useful trend information. SpHb should not replace invasive hemoglobin measurements for clinical decision-making.