The aim of this study was to describe whether or not spinal anaesthesia with bupivacaine versus levobupivacaine has any effects on the QTc interval during caesarean section. Sixty healthy pregnant women scheduled for elective caesarean section were randomized to spinal anaesthesia with either bupivacaine (the bupivacaine group) or levobupivacaine (the levobupivacaine group). ECG recordings were performed prior to spinal anaesthesia at baseline (T1), 5 min. after spinal anaesthesia, but before uterine incision (T2), and after skin closure (T3). QT intervals were calculated and corrected with the patients' heart rate according to the Bazett formula. Compared with baseline values, mean maximum QTc intervals at T2 and T3 were significantly longer in the levobupivacaine group, but only at T2 in the bupivacaine group. In addition, compared with the bupivacaine group, the QTc maximum interval at T3 was significantly longer in the levobupivacaine group. At T2, the QTc maximum intervals were longer than baseline in both groups. By the end of the surgery, the prolongation of the QTc interval had disappeared in the bupivacaine group but not in the levobupivacaine group.The QT interval is defined as the measurement of time between the start of the Q wave and the end of the T wave in the heart's electrical cycle. The QT interval represents the total period of the left ventricle's depolarization and its repolarization. QT prolongation is associated with increased risk of ventricular arrhythmias, leading to polymorphic ventricular tachycardia (Torsades de Pointes) and ventricular fibrillation [1]. The myocardial conduction changes (prolongation of PQ or QT intervals or QRS widening) are assumed to be early signs of drug-related cardiac toxicity and might be determined even in the absence of any significant changing in contractility [2]. Prolongation of the QT interval can be either hereditary or acquired. It is associated with different medications, as well as cardiac, neurological and electrolyte disorders. Several cardiac and non-cardiac medications, including anaesthetics [3], can also interfere with cardiac repolarization and prolong the QT interval, and sometimes may cause drug-induced Torsades de Pointes and even sudden cardiac death [4][5][6][7].Spinal anaesthesia is commonly used in emergency and elective caesarean section because it provides rapid and adequate anaesthesia. Regional anaesthesia techniques eliminate the increased catecholamine levels that result from laryngoscopy and intubation. Increased plasma catecholamine concentrations and sympathetic activity are related with increased incidence of ventricular arrhythmias and even sudden death because of prolonged QT interval [8,9]. In addition, regional techniques eliminate or decrease the need for induction agents, volatile anaesthetics, opioids, muscle relaxants and neuromuscular reversal intra-operatively and postoperatively, all of which have variable effects on QT intervals [5,10,11]. Both bupivacaine and levobupivacaine (both the L-form and the S ...

Because intubation becomes a long procedure as potential, arterial oxygen (O 2) desaturation should be taken into account during the intubation. Since oxygen reserves are not always sufficient to meet the duration of intubation, preoxygenation should be routine before anesthetic induction and tracheal intubation. Surveys show that maximal preoxygenation increases oxygen reserves in the body and significantly delays arterial hemoglobin desaturation and hypoxia. In cases of respiratory insufficiency oxygenation can be improved by positive end expiratory pressure (PEEP) or pressure support. Effective technique and FeO 2 monitoring can increase the effectiveness of preoxygenation and thus increase the safety margin. Preoxygenation failures have to be identified and alternative oxygenation methods must be readily available in order to be applied quickly and easily. Although genetic and environmental factors play a role in diseases such as heart attack, stroke and cancer, which have become the cause of the worst death in the twenty-first century, the underlying problem in the development of these pathological conditions is hypoxia. Better understanding of hypoxic areas in ischemic tissues or growing tumors as well as increased knowledge of hypoxia cellular and molecular responses will allow possible applications in the treatment of major diseases associated with tissue hypoxia.

In this chapter, we scope the importance of functional anatomy and physiology of the upper airway. The upper airway has an important role in transporting air to the lungs. Both the anatomical structure of the airways and the functional properties of the mucosa, cartilages, and neural and lymphatic tissues influence the characteristics of the air that is inhaled. The airway changes in size, shape, and position throughout its development from the neonate to the adults. Knowledge of the functional anatomy of the airway in these forms the basis of understanding the pathological conditions that may occur. The upper airway extends from the mouth to the trachea. It includes the mouth, the nose, the palate, the uvula, the pharynx, and the larynx. This section also describes the functional physiology of this airway. Managing the airway of a patient with craniofacial disorders poses many challenges to the anesthesiologist. Anatomical abnormalities may affect only intubation, only airway management, or both. This section also focuses on the abnormal airways in obesity, pregnancy, children and neonate, and patients with abnormal facial defects.

Purpose: Acute kidney injury diagnosed patients are in need of renal replacement therapy (RRT). Continuous RRT is believed to be safer because the rates of fluid and solute removal are slower than with intermittent hemodialysis. In many centers, CRRT is preferred in special conditions such as increased cranial pressure, sepsis, burns, heart and liver failure. In our study, we present one year data of CRRT usage in our ICU. Materials and methods: This study included the patients who admitted to the Internal Medicine Intensive Care Unit of our university between January 2019 and June 2020. Among these patients, those over 18 years of age and those who had acute renal failure during their hospitalization and received continuous renal replacement therapy were included in the study. Results: Mean SOFA scores at admission were 2.7 which is an indication for severe disease. Lengths of ICU stay were long and approximately 77 percent of these patients died in ICU. When the comorbid conditions of the patients were examined, it was seen that oncological diseases were the most common. It was followed by hypertension, diabetes mellitus and heart diseases. Considering the KDIGO scores of the patients diagnosed with AKI, it was seen that 60 percent of them were grade 5. Treatment could be applied for an average of 25 hours. Conclusion: Indications, timing and benefits of CRRT are the questions that need to be research and yet remained unsolved. With evolving of technology, CRRT will be our most useful helper in ICUs.

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