General principles of the anesthetic management for the operations non-related to pregnancy have been presented. Additionally key points for specific conditions like laparoscopic surgery and breast cancer requiring surgery during pregnancy have been also addressed and revisited.

Key words: Surgery, anesthesia, pregnancy, laparoscopy, breast cancer

Objective: The difference between bupivacaine and levobupivacaine would potentially be created during regional block techniques at low concentrations. In this study we aimed to compare the interscalene brachial block (ISB) properties of 0.25 % bupivacaine and levobupivacaine by comparing the dermatomal sensorial and motor block onset time and durations.
Material and Methods: ASA I-III, 64 patients who will receive ISB application because of  shoulder surgery were included in this  prospective double-blind study. Patients were randomly assigned to receive ISB with either 40 mL 0.25 % bupivacaine (Group B, n=32) or 0.25 % levobupivacaine (Group L, n=32). Sensory block was assessed with pinprick test applied on C4 to T1 dermatomes and motor function was assessed by Bromage scale. The time of onset of sensory and motor blocks, time to recovery from sensorial and motor blocks, and pain scores were  recorded.
Results: Patient characteristics were similar between groups. The mean onset time of sensory block in all  dermatomes was significantly faster in Group L (7.13±4.57 min in Group B and 4.03±2.37 min in Group L) (p=0.002). The time to onset of  sensory and motor block in all  dermatomes, duration of sensory and motor blocks were comparable between groups.
Conclusion: Application of ISB with 40 mL 0.25 % concentration of levobupivacaine provides clinical advantage over bupivacaine with shorter  time to onset of sensorial blockade in each dermatome.

Key words: Interscalene brachial plexus block, bupivacaine, levobupivacaine

Objective: Fentanyl is commonly used as a pre-induction adjunct, but can sometimes elicit cough. The existing literature about the incidence of fentanyl-induced cough (FIC) is extremely diverse and the results of clinical trials are conflicting. The purpose of our study was  to investigate the effects of intravenous pre-induction doses (2 µg/kg) of fentanyl given with different injection velocities  on the incidence and severity of FIC in Turkish population.
Material and Methods: Following local ethical approval and obtaining written informed consents of the patients, 210 ASA I-III, 18-75 year- old patients undergoing general anesthesia for elective surgery were enrolled into this randomized placebo- controlled study. The exclusion criteria included, history of bronchial asthma or chronic obstructive lung disease, upper respiratory tract infection, smoking, and angiotensin converting enzyme inhibitor use. No premedication was used before surgery. Patients received either 2 µg/kg fentanyl injected over 2 sec, 20 sec or the same volume saline placebo (NaCl % 0.9) injected over 2 sec in  Groups I, II, and III respectively. After completion of injections, the onset time and intensity of coughing was recorded by a blinded observer for 1 minutes. Severity of coughing was graded based on the number of coughs  as  mild (1-2), moderate (3-5), severe (?5). Statistical analyses were performed with chi- square and independent sample t tests. P<0,05 was regarded as statistically significant.
Results: The mean onset time of coughing was 21±7,71 seconds after the injections. The frequencies of coughing  were 11.4 %, 8.6 %, 0 % in  Groups I,II, and III respectively.
Conclusion: According to our study, the mean incidence of coughing  in the study participants after 2 µg/kg intravenous fentanyl was 10 % which is  in-between European and Far East-Asiatic populations.

Key words: Fentanyl, coughing

A patient with tracheobronchial mucosal injury secondary to tracheal suctioning, and safe suctioning protocols for ICUs have been discussed.
A 70-year old patient with chronic obstructive pulmonary disease was on mechanical ventilation due to pulmonary insufficiency after coronary artery bypass grafting. On the 15th day of intubation, percutaneous tracheostomy was performed, and tracheobronchial tree was evaluated with flexible bronchoscope. Diffuse bleeding areas on tracheal mucosa extending to carina and mucosal injury located in the carina, seems to be related to tracheal suctioning catheter were observed. One week after modification of the aspiration protocol, mucosal injury reevaluated with bronchoscope, and significant recovery was observed.
In conclusion, endotracheal suctioning is necessary to prevent air way obstruction, but it is not a totally innocent procedure. It is decided that, specialists should be informed about suctioning related tracheal mucosal injury, and clinics should formulate endotracheal suctioning protocols.

Key words: Endotracheal suctioning, tracheal injury, mechanical ventilation

Supraventricular arrhythmias and ventricular extrasystoles might occur as a result of guide-wire tip contact to atrial or ventricular wall during central venous catheterization. The rhythm might recover by drawing back the guide-wire whereas arrhythmias triggered during catheterization would require resuscitation. In this report, we present our experience with successful resuscitation of torsades de pointes rhythm occurred due to catheterization.

Key words: Subclavian venous catheterization, torsades de pointes

Superior vena cava syndrome (SVCS) is an anesthetic challenge because of its symptomatic cardiovascular, respiratory and neurologic pathophysiology. Decreased venous return to the heart, potential negative outcome of positive pressure ventilation in the presence of an intrathoracic mass complicate the anesthetic management. If this syndrome develops during pregnancy, this condition becomes more dreadful because of already existing pressure on inferior vena cava by gravid uterus. In this case report, we aimed to present anesthetic management of a parturient with SVCS and endobronchial tumour.

Key words: Superior vena cava syndrome, cesarean, epidural anesthesia

Different regional anesthetic techniques and several local anesthetics have been widely used for extremity surgeries. We may occasionally encounter some complications due to block technique or local anesthetics ranging from minimal to serious, even fatal outcomes. In this case, we report two incidents of convulsive attacks caused by two different types of regional blocks in the same patient at separate occasions which were alleviated with pharmacotherapy.

Key words: Local anesthetics, convulsion