Cardiopulmonary arrest, which is seemingly uncommon with an estimated incidence of 1 in 20,000 pregnant women, can occur at any time. Therefore, clinicians should be prepared to respond immediately. Maternal resuscitation is performed with only a few minor adjustments due to the anatomic and physiologic changes of pregnancy. Anesthesiologists, obstetricians and neonatologists should work as a team to ensure appropriate treatment of both mother and newborn. This review article will address the management of cardiac arrest in pregnancy and the use of perimortem cesarean delivery.

INTRODUCTION: Carotid endarterectomy (CEA) under regional anesthesia provides real-time neurological assessment and is the preferred approach. We aimed to compare the effects of different sedative agents on hemodynamic parameters and anesthesia related complications CEA under cervical plexus block (CPB).
METHODS: After ethical committee approval, patients undergoing CEA with CPB between January 2011 and December 2014 were included in this retrospective clinical study. Subsequent to midazolam premedication, all subjects had CPB. Depth of sedation was adjusted between Ramsay scale II or III. Group I was under dexmedetomidine sedation with an infusion rate of 0.4-0.7 μg/kg/h/; whereas Group II had a bolus of 1-2 μg/kg fentanyl subsequent to initial midazolam dose and additional doses if required. Group III had an infusion of remifentanil of 1.5-3 μg/kg/h Complications (hemodynamic, respiratory or neurological), cross-clamp time, shunt requirement were all registered.
RESULTS: We enrolled 80 patients in this study with 33 (41%) in GI, 35 (44%) in GII and 12 (15%) in GIII. Systolic blood pressures and heart rate were comparable between groups (p>0.05) and there was no statistical difference within group analysis in time intervals (p>0.05). Hemodynamic complications or interventions did not show any difference between groups. Hypotension was seen in 4 patients in GI, 2 in GII and 1 in GIII. Bradycardia was present in 4 patients in GI, 2 in GII whereas hypertension was noted in only 1 within GII.
DISCUSSION AND CONCLUSION: During CEA operations under regional anesthesia, dexmedetomidine, midazolam+fentanyl or remifentanyl provide safe sedation with similar minimal side effects without affecting patients' cooperation.

Ýntroduction:
Valvular aortic stenosis (AS) is one of the major mortality and morbidity reason in geriatric patients. The conventional therapy for serious AS is surgical aortic valve replacement. But most of the geriatric patients are considered non-operable due to anesthetical and surgical high risks. Recently, transcatheter aortic valve replacement (TAVR) is the evolving new alternative therapy option for these high risk AS patients. In this study, we aimed to share our experience in patients undergoing TAVR procedure under general anesthesia (GA).

Method:
Sixty-seven patient with serious symptomatic AS (29 male, 38 female, mean age 78.3 ± 6.44 years) undergoing TAVR procedure under GA were evaluated retrospectively and included in this study.

Results:
The mean duration of the procedure and anesthesia was 159 ± 38 min and 193 ± 41 min, respectively. Blood products were transferred to 28 patients (% 41). Vasopressor medication was infused to 4 patients intraoperatively (% 0.5). The median values of length of stay in the intensive care unit was 2 (1-7) days and hospital stay was 7 (4-60) days.

Conclusion:
TAVR is a challeging procedure for anesthesiologists due to the complexity of the procedure itself and also the high risk of the patient population. Anesthesiologists have to stabilize the hemodynamics to protect the vital functions. Optimal perioperative evaluation is important for rapid and safe approach to possible complications. The growing experience in TAVR procedures will result in increased procedure success.

INTRODUCTION: Delirium is the most common neurological complication after heart surgery. Studies have reported different prevalence results due to factors as varying detection tools, diagnostic criteria. Our aim was to investigate the prevalence of delirium, predisposing factors and the effect of dexmedetomidine on therapy.
METHODS: After the ethic commitee approval, 30 patients who were diagnosed with delirium were selected as the study group and 1165 patients as the control, who had undergone heart surgery in first 7 months of 2013. The Confusion Assessment Method (CAM-ICU) was used as assesment tool and dexmedetomidine therapy was started. Patient’s demographics, length of surgery, the amount of blood and fluid, inotrophic therapy, length of stay in ICU and hospital were recorded. Statýstýcs: Kolmogorov – Smirnov test was used for normal distribution, Pearson Chi-Square test and Fisher’s Exact test were used for qualitative datas. Mann Whitney U test was used for the quantitave parameters.
RESULTS: After dexmetodomine, regression of symptomes were observed in 80% patients. Age, inotropic drugs, duration of surgey and cross-clamp time, the amount of blood were predisposing factors.The length of ICU and hospital stay was longer in Group D (7,5± 8 > 2,9±1days ICU, 14,7± 9 >9,6 ±3 HLOS)
DISCUSSION AND CONCLUSION: We found the prevalance of delirium as 2.5%.Hypertension, duration of surgery and cross-clamp, amount of blood products were found as risk factors. We concluded that; addition of CAM-ICU to daily routine monitoring may provide early diagnose and appropriate therapy of delirium after heart surgery. Dexmedotomidine is a convinient and useful choice for therapy of delirium.

INTRODUCTION: Antihypertensive drugs have effects on hemodynamics during anesthesia. We aimed to compare the effects of antihypertensive drugs and medication withdrawal time on intraoperative hemodynamics in our study.
METHODS: Patients using antihypertensive drugs who were admitted to anesthesiology clinic were taken into the study by taking hospital approval and written informed consent. Antihypertensive drugs used by ASA I-III patients aged 18-75 years who underwent elective abdominal operation, withdrawal time and intraoperative hemodynamics were recorded. Frequently used angiotensin converting enzyme inhibitors (ACEI), calcium channel blockers (CCB) and angiotensin receptor blockers (ARB) are divided into 3 groups as ACEI or ARB (group 1), CCB (group 2) and ACEI + CCB or ARB + CCB (group 3). According to time of drug withdrawal, groups were divided into two subgroups: 24 hours before and the morning of operation. 124 of the 156 patients were taken into the study. 32 patients were excluded due to the inconvenience of using compulsory medication or withdrawal time. There was no significant difference in demographic data between the groups (p> 0,05). There was no significant difference between ACEI or ARB group and CCB group in mean arterial pressures service, before induction, intraoperatively and after extubation (p> 0.05). There was a significant difference in mean arterial pressures between these two groups and ACEI + CCB or ARB + CCB group, which was significantly lower in the ARB + CCB group (p <0.01).
RESULTS: Heart rate was significantly higher in the CCB group compared to the other two groups after extubation (p <0.05). In all three groups, the mean arterial pressure was found to remain at the normal limit compared to the group that was interrupted 24 hours before the morning of the operation (p <0,05).
DISCUSSION AND CONCLUSION: In the ACEI + CCB or ARB + CCB groups, medication was given concomitantly and the interruption of medication on the morning of surgery allowed the intraoperative hemodynamics to remain more stable.

Prolonged residual neuromuscular blockade which is unresponsive to cholinesterase inhibitors is frequent in obese patients. In this case report, we present a obese and diabetic old women patient who was diagnosed and treated for extended revival and recovery time because of prolonged neuromuscular blockade after coronary artery bypass grafting surgery.

Invasive arterial pressure monitorization is used very often at cardiovascular surgery perioperatively. It is also used at cardiovasculary by-pass surgery for every patient. At this case report we aimed to present our management the patient who is administrated propofol and midazolam through intraarterial route unintentionally during anestetic induction for cardiovascular surgery in light of current literatures.