A 25-year-old female developed permanent, fluctuating sensorineural hearing loss (SNHL), disabling vertigo, and tinnitus following an uneventful spinal anesthesia for cesarean section. At her first visit to the ear-nose-throat (ENT) department approximately 2 months postoperatively, pure-tone thresholds revealed profound SNHL on the right side whereas thresholds were within normal limits on the left side. The recruitment score (SISI) was 95% at 2000 Hz on the right side. Directional preponderance towards the right and the right canal paresis were evidenced by bithermal caloric testing. At follow ups the pure tone thresholds have shown some improvement, but fluctuating SNHL, disabling vertigo attacks, and tinnitus have remained. These findings imply a cochlear pathology causing endolymphatic hydrops possibly induced by lumbar puncture for spinal anesthesia.

Vomiting is a common problem following strabismus surgery. We compared the effects of propofol-N2O and sevoflurane-N2O on the incidence of oculocardiac reflex and postoperative nausea and vomiting. Forty unpremedicated children, aged 3-15 years were randomly assigned to two groups of 20 patients. In group 1, anaesthesia was induced and maintained with propofol infusion (173 +/- 41 micrograms.kg-1.min-1). In group 2, anaesthesia was induced with N2O (66%) in O2 and incremental sevoflurane via face mask and maintained with sevoflurane. Both groups received 66% N2O in O2 throughout surgery. The overall incidence of vomiting and antiemetic requirement in the first 24 h was significantly higher in sevoflurane-N2O group than propofol-N2O group (P < 0.05). The propofol-N2O group had significantly more episodes of oculocardiac reflex than sevoflurane-N2O group (P < 0.05). Propofol-N2O anaesthesia results in a significantly lower incidence of postoperative vomiting, yet a significantly higher incidence of oculocardiac reflex.

TEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery.

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During TIVA without the use of muscle relaxants neither LMA insertion nor ET intubation increased the IOP, but ET extubation did.

The exact aetiology of vestibulocochlear dysfunction after spinal anaesthesia is unknown. Low-frequency hearing loss occurs after spinal anaesthesia. The aim of this study was to investigate the effects of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on vestibulocochlear dysfunction, using pure tone audiometry performed pre- and on the first and the second day postoperatively. Forty-five patients who were to undergo elective caesarean section were evaluated. In group I, CSE anaesthesia (18 G Tuohy, 25 G Whitacre pencil-point-design spinal needles) was performed in 15 patients. In group II, spinal anaesthesia was performed in 15 patients with 25 G Whitacre pencil-point-design spinal needles and, in group III, spinal anaesthesia was performed in 15 patients with 22 G Whitacre pencil-point-design spinal needles. In the pre- and on the first and the second day postoperatively, the pure tone audiogram was performed in the audiology laboratory of our hospital, using a calibrated Kamplex Diagnostic Audiometer AC 40 in a noise-free room. When the CSE anaesthesia group and 22 G spinal group were compared for change in hearing between the pre- and postoperative periods, a statistically significant difference was observed at R-right ear 125 Hz (P < 0.025) and at L-left ear 125 Hz (P < 0.023), and at L-left ear 1000 Hz (P < 0.036) and at R-right ear 1500 Hz (P < 0.006), and at L-left ear 1500 Hz (P < 0.022). At other frequencies, the difference was insignificant. When the CSE anaesthesia group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, no statistically significant difference was detected at any frequency tested. When 22 G spinal group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, there was some hearing loss at low frequency, although this difference did not reach statistical significance. The positive correlation of low-frequency hearing loss and increased pressure in the epidural space (which decrease the risk of cerebrospinal fluid leakage through the dura) suggests that cerebrospinal fluid leakage via the spinal puncture hole is not the only factor involved. Perioperative fluid replacement alone may not prevent hearing loss but CSF loss through the dural puncture site should also be prevented.

A 58-year-old man (weight 55 kg, body surface area 1.58 m 2 ) had end-stage dilated cardiomyopathy. A left ventricular ejection fraction of 20% was measured by two-dimensional echocardiography. Cardiac catheterization documented severe pulmonary hypertension with pulmonary arterial pressures of 86/40 mmHg (mean, 48 mmHg), pulmonary capillary wedge pressure of 29 mmHg, and pulmonary vasculary resistance of 7.3 Wood units, which decreased to a level of 4.0 Wood units with multiple drug manipulations (isoproterenol, prostoglandin E 1 , nitroprusside, and oxygen inhalation). Cardiac output and cardiac index were 2.4 l·min Ϫ1 and 1.51 l·mm Ϫ1 ·m Ϫ2 , respectively. Coronary angiography was normal, but left ventriculography confirmed moderate mitral regurgitation and dilated cardiomyopathy. The patient was placed on our waiting list and the decision was made to repeat right heart catheterization at the time of transplantation for the definitive operative procedure. Since the patient had NYHA class IV congestive heart failure, he was hospitalized for high-dose inotropic support with (dopamine 10 µg·kg Ϫ1 ·min Ϫ1 , dobutamine 10 µg·kg Ϫ1 ·min Ϫ1 , and isoprenaline 0.5 µg·kg Ϫ1 ·min Ϫ1 ), During his hospitalization, a young female donor (52 kg body weight and 1.50 m 2 body surface area) was referred to us. The patient received premedication with midazolam 5 mg intramuscularly 30 min preoperatively. In the operating room, the patient was monitored with a five-lead ECG, and ST segment analysis, SpO 2 , ETCO 2 , invasive radial artery blood pressure, and rectal and esophageal temperature were measured. In the operating room, a pulmonary artery catheter was placed. The pulmonary artery pressure and calculated pulmonary vascular resistance were 80/38 (mean, 46 mmHg) and 6.4 Wood units, respectively. Anesthesia was induced with 5 mg midazolam, 1 mg fentanyl, and 0.1 mg·kg Ϫ1 vecuronium to facilitate tracheal intubation. Anesthesia was maintained with a

The primary aim of the current study is to analyze the clinical, laboratory, and demographic data comparing the patients with Coronavirus Disease 2019 (COVID-19) admitted to our intensive care unit before and after the UK variant was first diagnosed in December 2020. The secondary objective was to describe a treatment approach for COVID-19. Between Mar 12, 2020, and Jun 22, 2021, 159 patients with COVID-19 were allocated into 2 groups: the variant negative group (77 patients before December 2020) and the variant positive group (82 patients after December 2020). The statistical analyses included early and late complications, demographic data, symptoms, comorbidities, intubation and mortality rates, and treatment options. Regarding early complications, unilateral pneumonia was more common in the variant (−) group (P = .019), whereas bilateral pneumonia was more common in the variant (+) group (P < .001). Regarding late complications, only cytomegalovirus pneumonia was observed more frequently in the variant (−) group (P = .023), whereas secondary gram (+) infection, pulmonary fibrosis (P = .048), acute respiratory distress syndrome (ARDS) (P = .017), and septic shock (P = .051) were more common in the variant (+) group. The therapeutic approach showed significant differences in the second group such as plasma exchange and extracorporeal membrane oxygenation which is more commonly used in the variant (+) group. Although mortality and intubation rates did not differ between the groups, severe challenging early and late complications were observed mainly in the variant (+) group, necessitating invasive treatment options. We hope that our data from the pandemic will shed light on this field. Regarding the COVID-19 pandemic, it is clear that there is much to be done to deal with future pandemics. Abbreviations: ARDS = acute respiratory distress syndrome, ARF = acute respiratory failure, CMV = cytomegalovirus, CoV = Coronavirus, COVID-19 = Coronavirus disease 2019, CPAP = continous positive airway pressure, ECMO = extracorporeal membrane oxygenator, HFNC = high flow nasal cannula, ICU = intensive care unit, MAS = macrophage activating syndrome, MOF = multi-organ failure, nCPAP = nasal continous positive airway pressure, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, VV-ECMO = veno venous extracorporeal oxygenator.