The importance of regional anesthesia techniques is increasing as part of multimodal analgesia strategies for managing postoperative pain in pediatric hip and femur surgeries. We aim to present two cases, aged 10 years and 18 months, scheduled for surgery due to femoral neck fractures. As part of multimodal pain management, ultrasound-guided PENG + LFCN blocks were performed in both cases. Postoperative pain was assessed using VAS and FLACC scales. Our observations in these two cases suggest that the combined administration of PENG and LFCN blocks may serve as a valuable adjunctive strategy in the multimodal analgesia management of pediatric femoral neck fractures. Nevertheless, further large-scale clinical studies are warranted to more clearly delineate the efficacy and safety profile of this combination in routine clinical practice.

Accurate preoperative prediction of difficult intubation is essential for perioperative safety. Ultrasonographic airway evaluation has emerged as a promising adjunct. However, heterogeneity in study populations has limited the identification of population-specific predictors. This study aimed to evaluate the diagnostic performance of four ultrasonographic airway parameters in non-obese, non-obstetric adult female patients. This prospective, single-center, single-blinded observational study included adult women undergoing elective surgery. Preoperative airway ultrasonography was performed to measure tongue thickness, skin-to-hyoid bone distance, skin-to-epiglottis distance, and skin-to-anterior commissure of the vocal cords distance. Tracheal intubation was conducted using direct laryngoscopy by anesthesiologists blinded to ultrasonographic findings. Difficult intubation was defined as a restricted composite outcome: a Cormack-Lehane grade III-IV view on initial laryngoscopy plus either failed first-attempt intubation or requirement for adjunct techniques. Diagnostic performance was assessed using receiver operating characteristic analysis and multivariable logistic regression. A total of 379 patients were analyzed, of whom 45 (11.9%) met the criteria for difficult intubation. Tongue thickness was significantly greater in patients with difficult intubation and demonstrated the highest predictive accuracy (AUC 0.92, 95% CI 0.87-0.98). Skin-to-anterior commissure distance showed moderate discriminatory ability (AUC 0.71), whereas other measurements had limited or poor performance. In multivariable analysis, tongue thickness emerged as the strongest independent predictor of difficult intubation. Within this specific cohort, tongue thickness showed the highest discriminatory performance among the evaluated ultrasonographic parameters. Population-specific airway assessment using targeted ultrasonographic parameters may enhance preoperative risk stratification and support safer anesthetic practice. NCT07343557 (retrospectively registered).

Postoperative delirium (POD) is a common complication of cardiac surgery with cardiopulmonary bypass (CPB), and it is associated with systemic inflammation and gut-brain axis dysregulation. This study investigated the intestinal microbiota dynamics in patients with POD undergoing CPB to identify microbiota-related biomarkers and associated mechanisms. This observational study included 48 patients who underwent cardiac valve surgery with CPB. Faecal samples were collected preoperatively and postoperatively. POD was diagnosed using the Confusion Assessment Method for the Intensive Care Unit and 3-minute Diagnostic Confusion Assessment Method within 7 days of surgery. The intestinal microbiota composition was analysed using16S rRNA sequencing, and the alpha/beta diversity, taxonomic groups, and functional pathways were then evaluated. Perioperative variables and microbiota differences between the POD and non-POD (NPOD) groups were evaluated. In patients with POD, the postoperative intestinal microbiota exhibited reduced alpha diversity (e.g., observed amplicon sequence variants, P < 0.001) and altered beta diversity (unweighted or weighted UniFrac, P < 0.001) than those in preoperative samples. Linear discriminant analysis Effect Size analysis identified 25 differentially expressed species that served as biomarkers (linear discriminant analysis score > 4). Preoperatively, no significant differences in the microbial communities were found between the POD and NPOD groups (unweighted UniFrac, P = 0.171; weighted UniFrac, P = 0.085). Postoperatively, patients with POD exhibited distinct beta diversity (unweighted UniFrac, P = 0.004; weighted UniFrac, P < 0.001), and Lactobacillaceae was identified as a protective biomarker. Further, CPB period was an independent risk factor for POD (Odds ratio, 1.06 [95% confidence intervals, 1.01-1.14]) . This study demonstrates significant alterations in the intestinal microbiota composition following cardiac valve surgery with CPB and reveals that Lactobacillaceae is a potential protective biomarker for POD.