Objective: We aimed to determine the safety and feasibility of general anaesthesia (GA) compared with local anaesthesia + Monitored Anaesthesia Care (LA+MAC) for One-Day Thyroid Surgery (ODTS); to assess patient and operator satisfaction with either of the anesthetic approaches. Material and Methods:We reviewed prospectively 130 patients who underwent ODTS from 2008 to 2011. 64 patients were operated on under GA and 62 -under LA+MAC. All variables of patient demographic characteristics, duration and type of operation, postoperative complications, difficulty in airway management and postoperative opiate consumption were recorded and analyzed.Results: There is no difference in respect to length of stay, discharge time and major/minor complications rate between two groups, but in the LA+MAC group, pain appears earlier and is more severe (56min; VAS 6, 5) than in GA patients (223 min; VAS 1, 5; p<0.001). Patient satisfaction was similar but the operator preference was greater for GA. Conclusion:In experienced hands LA with MAC for Thyroidectomy is a safe and wise choice, but GA is even more so!

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Introduction: Although vaccines are the safest and most effective means to prevent and control infectious diseases, the increasing rate of vaccine hesitancy and refusal (VHR) has become a worldwide concern. We aimed to find opinions of parents on vaccinating their children and contribute to available literature in order to support the fight against vaccine refusal by investigating the reasons for VHR on a global scale. Methodology: In this international cross-sectional multicenter study conducted by the Infectious Diseases International Research Initiative (ID-IRI), a questionnaire consisting of 20 questions was used to determine parents’ attitudes towards vaccination of their children. Results: Four thousand and twenty-nine (4,029) parents were included in the study and 2,863 (78.1%) were females. The overall VHR rate of the parents was found to be 13.7%. Nineteen-point three percent (19.3%) of the parents did not fully comply with the vaccination programs. The VHR rate was higher in high-income (HI) countries. Our study has shown that parents with disabled children and immunocompromised children, with low education levels, and those who use social media networks as sources of information for childhood immunizations had higher VHR rates (p < 0.05 for all). Conclusions: Seemingly all factors leading to VHR are related to training of the community and the sources of training. Thus, it is necessary to develop strategies at a global level and provide reliable knowledge to combat VHR.

Background:Stenosis in the area of the cricotracheal segment is still a challenging problem to be dealt with. Post-intubational cases mark an increase in recent years due to the advances in intensive care, thoracic surgery and neurosurgery departments.Case Report:This paper describes a case report of a patient with severe subglottic stenosis (grade III according to the Cotton-Myer scale), introduces a new option in cricotracheal resections - postoperative temporary non-cannulated tracheostomy and describes its advantages.Conclusion:This variation of classical operative techniques provides additional fixation of the trachea, thus relieving any transitory tension on the anastomosis; acts as a valve and decreases the air-pressure in the upper airways during coughing and sneezing in the post-operative period; and is an easy access point for video tracheoscopy of the anastomosis.

РезюмеТеоретични основи: наличието на ларингеален карцином налага прецизна оценка за възможността за осъществяване на ендотрахеална интубация. Трудната интубация изисква изготвянето на предварителен план за осъществяване на вентилация, ако интубацията се окаже невъзможна. Успешна употреба на супраглотични устройства се описва от някои автори, когато се очаква трудна интубация. От друга страна, неправилната употреба на същите може да доведе до тежки усложнения. Целта на обзора е да характеризира преимуществата и проблемите при осигуряване проходимост на ГДП при пациенти с карцином на ларинкса посредством ларингеална маска и ендотрахеална тръба. Резултати: при използването на ларингеална маска мъртвото пространство е по-голямо, отколкото при ендотрахеална интубация. При ендотрахеална интубация се повишава резистентността при вентилацията поради намаляване на диаметъра на дихателния път и рефлексната констрикция на дихателните пътища. При употребата на ларингеална маска се създава по-малко увеличение на резистентността, поради по-големия диаметър на тръбата на устройството в сравнение с ендотрахеалната тръба, освен това не се осъществява директно дразнене върху трахеята. Повишаването на артериалното налягане и сърдечната честота след въвеждането на ларингеалната маска е по-малко, отколкото при ендотрахеалната интубация. Вътреочното налягане се повишава в по-малка степен след въвеждане на ларингеалната маска в сравнение с ендотрахеалната интубация. Тонусът на долния езофагеален сфинктер може да бъде понижен при работа с ларингеална маска в сравнение с ендотрахеалната тръба. Не съществува консенсус за употребата на ларингеалната маска при туморни образувания в областта на ларинкса и шията. Изводи: в заключение можем да отбележим, че техниката за осъществяване на вентилация, използвана при различна степен на обструкция на горните дихателни пътища, остава дискутабилна.

Introduction: Successful anesthetic management of microlaryngeal cases requires a high degree of cooperation with the surgeon, a reciprocal understanding of the potential problems, and adequate preparation on both sides to meet the anticipated challenges that may arise. The Aim of the study is to determine the hemodynamic complications during microlaryngeal surgery. Materials and Methods: A 5-year prospective cohort study of 200 patients who underwent microlaryngeal surgery in the

Theoretical basis: Laser is an acronym for light amplification by stimulatedemissionofradiation-a highly collimated beam of photons at a single frequency. Lasers are ubiquitous in the modern world and are increasingly used in the operating room. The Aim of the study is to determine different anesthetic techniques and complications during laser surgery of the larynx. Results: Light has a biologic effect solely from absorption in tissue (Grotthus-Draper law), specifically by raising electrons to higher energy states that, in turn, can raise kinetic energy (heat) or cause chemical reactions. Boulnois categorized the biologic effects into four types: electromechanical effects, thermal effects, photoablative effects and photochemical effects. The same properties that give lasers their clinical value also pose threats to patient and provider safety. These risks fall into three categories: atmospheric contamination, gas embolism, and inappropriate energy transfer. Laser light, because of its special qualities of beam collimation, coherence, and high-energy density, poses optical safety hazards not associated with light from conventional sources. Conclusion: Lasers are increasingly used in the operating room. Understanding the technology is important to safe anesthetic practice.