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The prevalence of congenital heart disease is about 8 to 10 case per 1000 live births and is a major cause of increased mortality and morbidity in pediatric patients undergoing noncardiac surgery. Therefore safe anesthesia and adequate recovery should be provided. It is important to determine the patient's risk score in the preoperative period. However, the risk assessment tools have a limited prediction for increased mortality and morbidity of non-cardiac surgery. The most important point in determining the anesthesia method is to be aware of the latest situation both anatomically and physically about the circulation of patient and to create the specifi c planning. In these patients, the aim of maintenance of anesthesia is to increase arterial oxygen saturation by increasing pulmonary blood fl ow. Thus the use of appropriate anesthesia and monitoring methods through multidisciplinary decision-making and planning, as well as the identifi cation of high-risk patients based on risk classifi cation, may reduce mortality and morbidity in the pediatric patients with congenital heart disease.

Prevention and minimizing serious complications during difficult airway management is an important goal for anesthesia providers. Using the high flow cannula oxygenation systems it is possible to improve the clinical outcomes, increase patient safety and reduce the rate of complications. A possible mechanism of this method can be explain by 'Aventilatory Mass Flow' which is a physilogical phenomenon. Several methods can be used to implement apneic oxygenation such as nasopharyngeal catheter, nasal cannula, face mask, Venturi mask, transtracheal endobronchial catheters, dual blade laryngoscopes and High Flow Nasal Cannula Oxygenation (HFNCO) systems. However each method has some restrictions. In this review we aim to focus on the important features of HFNCO systems including the indications, contraindications and possible complications.

Objective: We aimed to investigate the effect of low and minimal flow desflurane anesthesia on hemodynamic parameters, cerebral oxygenation, blood gas values, and gas consumption amounts in patients undergoing Single Lung Ventilation (SLV).Methods: 60 ASA I-III patients scheduled for elective thoracic surgery with single lung ventilation were randomly divided into 2 groups as low-flow (LF) and minimal flow (MF). After applying 4 L/min of fresh gas flow for the first 10 minutes in both groups, 1 L/min (80% oxygen + 20% air) with 4-6% desflurane to LF group (n = 30) and 0.5 L/min (80% oxygen + 20% air) with 6-8% desflurane to MF group (n = 30) was applied. The patient was set with the Dräger Perseus anesthesia device to have a tidal volume of 4-6 ml/ kg, respiratory frequency of 16-18/min, and an Inspiration: Expiration (I:E) ratio of 1:2 [End tidal carbondioxity (EtCO 2 ) 35-45 mmHg].Results: There was no significant difference between the groups in terms of demographic data, single lung ventilation (SLV), and operation duration, desflurane intake, and consumption amount, perioperative heart rate, systolic and diastolic arterial pressure. SpO 2 , EtCO 2 and cerebral oximetry mean values were found to be lower in the minimal flow group. pH, HCO 3 , peripheral oxygen saturation (SpO 2 ), carboxyhemoglobin, and lactate values were high in the minimal flow group and the PCO 2 value was low. Conclusion:Low and minimal flow anesthesia applications can be applied safely in patients with SLV, especially with cerebral oximetry and blood gas monitoring, with an anesthesia device with sufficient equipment and close monitoring, and even increase patient safety due to the need for closer monitoring of the patient.