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Surgery induces release of neuroendocrine hormones, cytokines and acute phase proteins. Study was to assess the effect of spinal and general anaesthesia on serum concentration of pro-inflammatory and anti-inflammatory cytokines, and cytokines which are secreted by Th1 helper lymphocytes. Surgery-related postoperative release of the pro-inflammatory cytokine IL-6 was increased in patients after spinal and general anesthesia. In this study, increased levels of the typical Th1 cytokine IL-2 were found in patients anesthetized by general anesthesia compared to spinal anesthesia. Serum concentrations of other pro-inflammatory cytokines, anti-inflammatory cytokines and cytokines which are secreted by Th1 helper lymphocytes showed no statistical difference before and after surgery under general and spinal anesthesia.

Uspostava suradnje i razvoja projekata u sklopu programa Erasmus+, mentorstva diplomskih i doktorskih disertacija, organizacija zajedničkih kongresa s prezentacijom rezultata istraživanja. Edukacija u simulacijskom centru Ljubljana iz područja primjene ultrazvuka u regionalnoj anesteziji, analgeziji i intenzivnoj medicini. Posebnost je primjena ultrazvuka u epiduralnoj analgeziji za bezbolni porod, s preeklampsijom, suspektnom plućnom embolijom ; spinalna anestezija za carski rez ; periferni nervni blokovi

Hemodynamic changes and cardiac arrhythmias are not uncommon in clinical practice, depending on including patient features, surgical treatment and drugs administered. We describe hemodynamic changes developed in young patients, soon after a local infiltration anesthesia in day surgery. Methods - We retrospectively assessed the hemodynamic effect of 2% lidocaine with 0,0125mg/ml adrenaline (Li & AD) administered for septorhinoplasty in 44 participants and combination of 0.5% bupivacaine and 2% lidocaine with 0.0125mg/ml adrenaline (BLi & AD) for breast augmentation in 48 participants. Blood pressure and heart rate were recorded before the introduction of general anesthesia, immediately 5.10 and 20 minutes after administration of local infiltration, anesthetic (LIA) and data were analyzed. Results - The mean systolic blood pressure (SBP) in all observed measurements before general anesthesia (0), immediately, 5 minutes, 10 minutes and 20 minutes after local infiltration anesthesia was higher among patients who underwent septorinoplasty (Li & AD), in relation to patients who underwent breast augmentation (BLi & AD) (p, Sažetak Hemodinamske promjene i aritmije srca nisu rijetkost u kliničkoj praksi, ovisne o osobinama bolesnika, kirurškom liječenju i primijenjenim lijekovima. Opisane su hemodinamske promjene koje su se razvile u mlađih bolesnika ubrzo nakon lokalne infiltracije anestezija u dnevnoj kirurgiji Metode Retrospektivno smo procijenili hemodinamski učinak 2% lidokaina s 0,0125 mg/ml adrenalina (Li & AD) primijenjenog za septorinoplastiku u 44 pacijenta i kombinacija od 0,5% bupivakaina i 2% lidokaina s 0,0125 mg/ml adrenalina (BLi & AD) za povećanje dojki u 48 sudionika. Krvni tlak i broj otkucaja srca bilježeni su prije uvoda u opću anesteziju 0, te poslije 5,10 i 20 minuta nakon primjene lokalne infiltracije anestetika (LIA) i podaci su analizirani. Rezultati Srednja vrijednost sistoličkog krvnog tlaka (SRR) u svim promatranim mjerenjima prije opće anestezije (0), odmah 5 minuta, 10 minuta i 20 minuta nakon lokalne infiltracije anestetika bila je viša kod pacijenata podvrgnutih septorinoplastici (Li & AD) u odnosu na pacijentice podvrgnute povećanju dojki, (BLi & AD) skupina (p

Complications associated with peripheral nerve blockade (PNBs) are relatively rare. Regardless, the neurologic consequences of complications with PNBs remain a significant source of concern for both the patient and the anesthesiologist. Auroy and colleagues1 prospectively evaluated serious complications after 21, 278 PNBs in a 5-month period in France. Using a 95% confidence interval, they estimated the po¬tential for serious complications per 10, 000 PNBs to be 0 to 2.6 deaths, 0.3 to 4.1 cardiac arrests, 0.5 to 4.8 neurologic injuries, and 3.9 to 11.2 seizures. Most complications are related to the use of upper extremity blocks and there is a paucity of reports of complications spe¬cifically associated with lower-extremity PNBs.

Poslijediplomski tematski tečaj stalnog medicinskog usavršavanja liječnika Kardiopulmonalna reanimacija hitnih stanja u nastavno zdravstvenoj ustanovi održati će se 9. I 10.rujna 2021 god. na Fakultetu za dentalnu medicinu i zdravstvo Osijek, Kabinet vještina, Ul.Cara Hadrijana 10C, 31 000 Osijek Obrazloženje tečaja: Kardiopulmonalna reanimacija (KPR) podrazumjeva privremene mjere dopreme kisika u mozak i srce, dok se kasnijim specifičnim postupcima uspostavljaju spontana cirkulacija i ventilacija. Akutne bolesti koje najčešće ugrožavaju život su poremećaji funkcije disanja i srca, krvarenje i ozljede. Prikazati će se: gubitak svijesti, postupci za provjeru gubitka svijesti, gušenje stranim tijelom u dišnom putu, metode izbacivanja stranog tijela iz dišnog sustava, prestanak disanja, provjera, metode ponovnog uspostavljanja disanja, prestanak rada srca, provjera, metode ponovnog uspostavljanja rada srca, masaža srca i uporaba defibrilatora su predmet edukacije u nastavno zdravstvenoj ustanovi. Vježbe: Usvojiti će se:održavanje dišnih putova i Ventilacija, Vježbe zabacibvanje glave i držanje brade, držanje mandibule, čišćenje dišnih putova sukcijom, postavljanje jednostavnih zračnih tubusa, ocjena veličine i postavljanje orofaringealnog zračnog tubusa, postavljanje nazofaringealnog tubusa i održavanje dišnog puta, ventilacija na masku, postavljanje laringealne maske, ventilacija ambu-valvula-maska, ventilacija – 2 osobe, ventilacija sa “Combi”tubusom, vježbanje insercije endotrahealnog tubusa, vježbe pritiska na krikoidnu hrskavicu, postavljanje igle ili tubusa pri krikotiroidotomiji, vježbe masaže srca i uporaba defibrilatora, krvožilni pristup i primjena lijekova. Obrazovni ciljevi: KPR je temeljna vještina koju mora svladati svatko tko propisuje i daje lijekove kao što su anestetici, sedativi i analgetici koji deprimiraju stanje svijesti, cirkulaciju i ventilaciju. Sudionici će tijekom tečaja dobiti stručne informacije o hitnim stanjima i obnoviti i svladati vještine osnovnog i naprednog održavanja života.

Istaknuta je uloga, noviteti i mogućnosti regionalne anestezije u Hrvatskoj.

Many patients who present to the emergency department are in pain. Establishing the site and characteristics of this pain is often very important in diagnosing the underlying problem. Relief of pain is an essential and urgent part of treatment and is usually the initial top priority for patients. Pain and distress may prevent patients from giving important details of the history and may prevent them from cooperating fully with investigations or treatment

Globalna pandemija COVID-19 ima snažan utjecaj na zdravstvene sustave svih zemalja svijeta. Zbog nedovoljnog broja znanstvenih istraživanja većina preporuka za anesteziološko postupanje za vrijeme pandemije bazira se prvenstveno na mišljenju stručnjaka. Za vrijeme pandemije potrebno je odložiti sve planirane operacije, a izvode se jedino hitne operacije koje imaju za cilj spriječiti trajnu invalidnost i smrtni ishod bolesnika te zahvati kod zloćudnih bolesti. Opća anestezija je povezana s postupcima koji stvaraju aerosol, stoga se prednost daje regionalnoj anesteziji kad god je to moguće. Ovim radom obuhvaćene su preporuke za primjenu neuroaksijalne anestezije i perifernih živčanih blokova tijekom COVID-19 pandemije u Hrvatskoj, pri čemu su uvaženi trenutni stavovi europskog i američkog društva za regionalnu anesteziju i liječenje boli. Ove preporuke su usmjerene na pripremu i planiranje osoblja, potrebnih sredstava, lijekova i opreme, izbor odgovarajuće zaštitne opreme, prilagodbu kliničkog okruženja novonastalim uvjetima, odgovarajuću primjenu terapije kisikom, procjenu sigurnog izvođena postupaka regionalne anestezije i nadzor tijekom i poslije operacijskog zahvata. Primjena ovih praktičnih uputa od ključne je važnosti za sigurnost bolesnika te ujedno osigurava zaštitu zdravstvenih djelatnika od moguće zaraze.

Farmakološko liječenje ostaje glavni terapijski pristup pri liječenju karcinomske boli, a mogu se integrirati i druge strategije tijekom trajanja i liječenja bolesti. Kontrola boli može se postići s pomoću tehnika regionalne anestezije upotrebom trajno implantiranih katetera koji omogućuju prekidanje nociceptivnih putova odgovornih za transmisiju signala boli u središnji živčani sustav. Postavljanje katetera za primjenu analgetika na različitim mjestima u bolesnika s intraktabilnom neuropatskom karcinomskom boli omogućuje odgovarajuću analgeziju i treba biti predloženo prije eventualne primjene destruktivnih tehnika. Cilj je rada prikaz liječenja karcinomske boli s pomoću regionalnih invazivnih tehnika., Pharmacological therapy is the mainstay of treating cancer pain, but other strategies can also be integrated during the course of the disease. Control of pain can be achieved by regional anesthesia techniques using chronically implanted catheters providing interruption of nociceptive pathways responsible for pain transmission to the central nervous system. Placing catheters at different sites for administration of analgesics in patients with intractable (neuropathic) cancer pain provides adequate pain relief and has to be proposed before considering more destructive techniques. The aim of this review article is cancer pain management by using regional invasive techniques.

Imunosni sustav uključuje specifičnu i nespecifičnu imunost. Promjene imunosnog odgovora u perioperativnom razdoblju posredovane su ozljedom tkiva, strahom, lijekovima, hipotermijom, boli, transfuzijom krvi, hiperglikemijom, infekcijom i povećanim stresom. Anestezija može utjecati na stresni odgovor središnjom modulacijom (opća anestezija), aferentnom blokadom (regionalna anestezija) ili interakcijom s endokrinim sustavom. Također, izbor anestezioloških tehnika može imati mnogo šire značenje svojim utjecajem na karcinomske stanice i njihovo metastaziranje. Ciljevi ovoga preglednog članka bili su istražiti učinke regionalne anestezije u usporedbi s općom (intravenskom i inhalacijskom) anestezijom na promjenu kirurškog odgovora na stres, progresiju maligne bolesti i poslijeoperacijsko funkcioniranje organa. Dokazano je da primjena općih anestetika ima supresivni učinak na staničnu i humoralnu imunost djelujući na funkciju imunokompetentnih stanica te gensku ekspresiju upalnih medijatora i njihovu sekreciju. Opioidni analgetici ili njihov način primjene pokazuju drukčiji efekt na imunosni sustav: imunosupresivni, imunostimulacijski ili oba. Nasuprot tomu, primjena lokalnih anestetika djelotvorna je u liječenju akutne i kronične upale jer ti anestetici inaktiviraju upalne procese na različitim razinama djelujući na monocitno-makrofagni sustav, smanjuju proupalne funkcije poput stvaranja kisikovih metabolita, oslobađanja histamina, interleukina (IL-1α) i leukotrijena. Da bi se izbjegla ova imunosna reakcija, preporučuje se primjena regionalne analgezije koja je nadmoćna naspram drugim analgetskim metodama te reducira količinu poslijeoperacijskog krvarenja. Upravo zbog tih važnih prednosti danas je regionalna analgezija u širokoj primjeni kod kirurških zahvata na onkološkim bolesnicima., The immune system comprises both specific and non-specific immunity. The immune response during the perioperative period is modulated by tissue trauma, fear/anxiety, medication, hypothermia, pain, transfusion of blood products, glycaemia regulation, infection and increased stress. Anaesthesia can influence the stress response by central modulation (general anaesthesia), afferent blockade (regional anaesthesia), or by interaction with the endocrine system. The choice of anaesthetic technique seems to have an influence on cancer cells and their possible dissemination. The aims of this review article are to review the effects of regional anaesthesia in comparison to general anaesthesia (intravenous and inhalational) on the immune response to surgical stress, malignant disease progression and postoperative organ function. It is known that general anaesthesia can suppress cellular and humoral immunity by acting on immune-competent cells, gene expression and secretion of inflammatory mediators. Opioids and/or their mode of administration show a different effect on the immune system: immune suppression, immune stimulation or both. In contrast, local anaesthetics are efficient in treating acute and chronic inflammation because they deactivate inflammatory processes on different levels, including the monocyte macrophage system, decrease of oxygen metabolites and free radical formation, histamine liberation, release of interleukin (IL-1α) and leukotriens. To minimise or avoid immune reactions, the use of local and regional anaesthesia is recommended, as it is superior to other analgesic methods and also reduces postoperative blood loss. Because of these significant advantages, today the use of regional anaesthesia is widespread in oncological surgery.

Cilj: Transuretralna resekcija predstojne žlijezde (prostate) (TURP) često se izvodi kao jednodnevni kirurški zahvat. Iako je procedura relativno sigurna, ipak su moguće teške perioperativne komplikacije. Sindrom TURP-a rijetka je komplikacija, ali potencijalno opasna za život. Cilj su ovog rada trenutačni klinički pregled i analiza učestalosti, patofiziologije i kliničke prezentacije sindroma TURP-a temeljem najnovije objavljene medicinske literature. Metode: Pretraženi su medicinski podatci s pomoću bazâ PubMed, Ovid Medline® i Google Scholar za razdoblje od 1. siječnja 2017. do 1. siječnja 2020. godine. Rezultati: Više čimbenika ima ulogu u patofiziologiji sindroma TURP-a. Klinički simptomi variraju od blagih do teških, a ovise o brzini i količini intravaskularne apsorpcije i vrsti otopine za ispiranje te o čimbenicima koji se odnose na bolesnika i operaciju. Akutno povećanje cirkulacijskog volumena može dovesti do plućnog edema i srčanog zastoja, dok promjene u koncentraciji otopljenih tvari u plazmi poput hiponatremije te hipotoničnosti i hipoosmolalnosti plazme mogu dovesti do poremećaja središnjega živčanog sustava (SŽS). Rane kliničke simptome teško je otkriti u anesteziranog bolesnika, ali rano prepoznavanje presudno je za pravodobni tretman. Liječenje treba biti u skladu s težinom kliničkih simptoma i znakova. Spinalna anestezija ima prednosti pred općom anestezijom jer su olakšani nadzor i rano prepoznavanje simptoma središnjega živčanog sustava kada je bolesnik pri svijesti. Zaključci: Ovaj narativni pregledni članak iznosi novije činjenice u vezi sa sindromom TURP-a, s naglaskom na sadašnja stajališta o prevenciji, ranoj dijagnozi i liječenju ove ijatrogene komplikacije. Bolje razumijevanje etiologije i preventivnih mjera, novije kirurške tehnike i intenzivni nadzor bolesnika pridonose daljnjem sniženju rizika od nastanka sindroma TURP-a., Objectives: Transurethral resection of the prostate (TURP) is often performed as a day case surgery. Although it is considered a safe procedure, serious perioperative complications could occur. TURP syndrome is a rare but potentially life-threatening complication.The objective of this clinical update, based on recently published literature, was to discuss the incidence, pathophysiology and clinical picture of TURP syndrome. Methods: A comprehensive review of medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from January 1st 2017 to January 1st 2020 was performed. Results: Pathophysiology of TURP syndrome is multifactorial. Clinical symptoms vary from mild to severe and they depend on the rate and amount of intravascular absorption of the irrigation solution into the circulation, type of the irrigation solution, and patients and surgical factors. Acute volume load into the circulation could lead to pulmonary edema and cardiac arrest, whilst solute changes in plasma like hyponatremia ,as well as hypotonicity and hypoosmolality of plasma may cause central nervous system (CNS) disturbances. Early detection of clinical symptoms in anesthetized patients is difficult but crucial for early treatment. The treatment must be in accordance with the severity of clinical symptoms and signs. Spinal anesthesia has advantages over general anesthesia because it allows monitoring and early detection of CNS symptoms in conscious patients. Conclusions: This narrative review provides an update on TURP syndrome with an emphasis on prevention, early diagnosis and treatment of this iatrogenic complication.Improved understanding of etiology, preventive measures, newer surgical techniques, and intensive monitoring facilitate further risk reduction of TURP syndrome.

Purpose of this review is a postpartum hemorrhage (PPH) as a leading cause of maternal morbidity and mortality in worldwide. Recognition of PPH is challenging, but once hemorrhage is recognized, management needs to focus on achieving adequate uterine tone and maintaining maternal hemodynamic stability. Recent findings indicate in the understanding of at-risk parturients, and the use of hemorrhage protocols and safety bundles to improve patient outcomes. There are many new advances in transfusion management (e.g. fibrinogen concentrate, prothrombin complex concentrate, tranexamic acid) that can compliment traditional component therapy. Although postpartum hemorrhage itself may not be preventable, early identification of blood loss, and mobilization of resources may prevent adverse outcomes.

An inevitable consequence of medical practice and damage can not be completely avoided. However, by developing a comprehensive, consistent and practical approach to the teaching and practice of general and regional anaesthesia, every anaesthetic department should ensure that all its members adopt high standards of practice and use appropriate levels of care when performing anaesthesia. Each institute should develop a pathway where the safety of the patient with the safe practice of regional anesthesia is maintained. Research and training in regional anaesthesia require a deliberate strategy and promoting their implementation into perioperative pathways.

Health care management can refer to cost rationalisation and proper allocation of resources, managed by qualified professionals within the health institution. In light of financial constraints and new approaches that threaten traditional organisational structures, it is important pressure to embrace the interdisciplinary approach in healthcare institutions in order to maximize the quality of service.

7th Croatian Congress of Regional Anaesthesia and Analgesia with international participation, held on June 14-15, 2019 in Zagreb, Croatia. The Congress was organized by the Croatian Society of Regional Anaesthesia and Analgesia in collaboration with the European Society of Regional Anaesthesia & Pain Therapy and School of Medicine, University of Zagreb under the auspices of the Croatian Academy of Science and Arts. Regional anaesthesia specialists and enthusiasts have a mission to improve the current state-of- the-art of regional anaesthesia in orthopaedics, obstetrics and day surgery as well as to advance the therapy of postsurgical pain, pains in adults and in children, and of any kind of severe pain that can be helped by sensible administration of drugs and other pain therapies. In addition to education on current pain research and therapy through conferences and publications, we must promote education on the management of pain for both medical students and health professionals. Postoperative pain has been poorly managed for decades. Regional anaesthetic techniques are the most effective methods to treat postoperative pain. Th e role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging.

PREAMBLE Articles published in this issue of the Acta Clinica Croatia had been prepared for oral presentations at the 7th Croatian Congress of Regional Anaesthesia and Analgesia with international participation, held on June 14- 15, 2019 in Zagreb, Croatia. Th e Congress was organized by the Croatian Society of Regional Anaesthesia and Analgesia in collaboration with the European Society of Regional Anaesthesia & Pain Th erapy and School of Medicine, University of Zagreb under the auspices of the Croatian Academy of Science and Arts. Prior to acceptance and publication, all articles had undergone double review process, CrossRef similarity check and language editing. Regional anaesthesia specialists and enthusiasts have a mission to improve the current state-of- the- art of regional anaesthesia in orthopaedics, obstetrics and day surgery as well as to advance the therapy of postsurgical pain, pains in adults and in children, and of any kind of severe pain that can be helped by sensible administration of drugs and other pain therapies. In addition to education on current pain research and therapy through conferences and publications, we must promote education on the management of pain for both medical students and health professionals. By recognizing the dominant role of the brain, which generates our subjective experiences and activates our defense systems, we are now able to get a bit closer to the interlinked relationship between pain and stress. Th ese relationships among stress, gender, the immune system, and chronic pain syndromes reveal the need to study pain in a biological context far broader than a pain pathway. Postoperative pain has been poorly managed for decades. Regional anaesthetic techniques are the most eff ective methods to treat postoperative pain. Th e role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging.

Background and aims Emergency patient with fractured left shin bone ASA status 3 was enrolled for emergency osteosynthesis. The patient ate 2 hours before acceptance and received 10 mg metoclopramide and 50 mg ranitidine intravenously. Cardiac murmur 4/6 was found during physical examination over praecordium of which the patient had no knowledge. Other known comorbidities were hypertension, hypothyreosis and overweight. Due to unspecified cardiac murmur and the notion patient ate before the accident we excluded spinal anaesthesia as an option. Methods We successfully performed a combination of ultrasound-guided femoral, distal sciatic and saphenous block using in-plane technique. Time from the performed blocks to the start of surgical procedure was half an hour. We used propofol via TCI pump for light sedation during the surgical reposition. Results Patient was stable the whole time during the procedure with stable blood pressure and pulse, breathing spontaneously with SpO2 100% via oxygen facial mask 4 l/min. Intraoperative blood loss was about 150 ml. Conclusions The blocks were successful, and no block-related complications were noted. No opioid requirements after surgery were noted in postoperative period as well. Ultrasound-guided peripheral nerve blocks are a good option of anaesthesia and analgesia for emergency patients.

The manuscripts is this issue were presented at the joint 7th Croatian congress of regional anaesthesia and analgesia with international participation held on June 14.-15, 2019, School of Medicine University of Zagreb, Croatia. Content of Supplement are: Holistic Approach to the Immunobiology of Aging (view on the turn of millenium), Dexamethasone - Intrathecal Minimiser of Simple Haemathologic Stress Biomarkers in Hip Fracture, Comparison of Plexus Brachial Blockade Effect by Supraclavicular and Axillary Approach - our Experience, Influence of Local Infiltration Analgesia on Postoperative Pain in Abdominoplasty Patients, The Anatomy of Orofacial Innervation, The Role of Paravertebral Blocks in Ambulatory Surgery: Review of the Literature, Regional Anaesthesia for Neurosurgery, Local Anesthetics and Steroids: Contraindications and Complications. (Over) view of the clinical problems, Impact of Local Infiltration Anesthesia on Postopertive Pain Management after Rhinoplasty in Day Care Surgery, Comparison of Different Surgical Procedures with Local Infiltration Analgesia in Day Surgery, Ultrasound Skills in Lower Extremity Traumatology and Orthopedics – Regional Anesthesia and Beyond, Spinal Anaesthesia-induced Hypotension in Obstetrics: Prevention and Therapy, Regional Anaesthesia in Thoracic and Abdominal surgery, Regional Analgesia Modalities in Abdominal and Lower Limb Surgery - Comparison of Efficacy, Applications and Critical Evaluation of Fascia Iliaca Compartment Block and Quadratus Lumborum Block for Orthopaedic Procedures, Medico - Legal Responsibility in Management of Acute and Chronic Pain in Obstetric.Epidural Analgesia in Multipy Injured Patients with Severe Chest Trauma: -Two Case Reports and Literature Review

Proksimalni prijelomi bedrene kosti su najčešći uzrok prijma u bolnicus visokim poslijeoperacijskim morbiditetom. Hipoteza je da jedna intratekalna doza deksametazona s levobupivakainom za kiruršku korekciju prijeloma proksimalnog dijela bedrene kosti smanjuje kirurški stres sa kvalitetnijim boravkom u bolnici. U istraživanje je bilo uključeno šezdeset pacijenata starije dobi s prijelomom proksimalnog dijela bedrene kosti, ASA status 2 i 3, te su bili randomizirani u dvije skupine. Trideset pacijenata je primilo 8 mg deksametazona i 12, 5 mg 0, 5% levobupivakaina intratekalno, DLSA skupina, trideset pacijenata u usporednoj skupini je primilo 12, 5 mg 0, 5% levobupivakaina intratekalno, LSA skupina ; tijekom anestezije za kiruršku korekciju. Plazmatske koncentracije kortizola i glukoze mjerene su prije i poslije kirurškog zahvata, intenzitet boli je određivan zbrojem VAS, te je analizirano trajanje hospitalizacije. Rezultati istraživanja su prikazali smanjene koncentracije kortizola, dulje trajanje analgezije te kraće trajanje hospitalizacije u DLSA skupini u usporedbi sa LSA skupinom. Koncentracije serumske glukoze nisu se značajnije razlikovale između skupina. Rasvjetljavanjem skupljenih rezultata, jedna intratekalna injekcija deksametazona u spinalnoj anesteziji za kiruršku korekciju prijeloma proksimalnog dijela bedrene kosti snižava stresni odgovor smanjenjem plazmatske koncentracije kortizola s duljim analgetskim učinkom te boljim mogućnostima rehabilitacije, skraćujući time hospitalizaciju što opravdava ovaj anesteziološki obrazac kao metodu izbora.

Negative patient outcomes are an inevitable consequence of medical practice and it is unrealistic to assume that damage can be completely avoided. However, by developing a comprehensive, consistent and practical approach to the teaching and practice of general and regional anaesthesia, every anaesthesia department should ensure that all its members adopt high standards of practice and use appropriate levels of care when performing anaesthesia. Regional anaesthesia can influence a reduction in surgical morbidity and mortality, length of hospital stay, and other markers of improved outcome from surgery. Each institute should develop a pathway where the safety of the patient with the safe practice of regional anaesthesia is maintained. Our goals must be realistic, patient safety requires tools and practice and health care.

Svrha studije je procjena djelovanjalokalne infi ltracijske analgezije (LIA) s levobupivakainom na promjene akutne poslijeoperacijske boli i ishod za pacijente podvrgnute rinoplastici i abdominoplasticiu općoj anesteziji. Istraživanje je provedeno na 60 pacijenata, od kojih je 30 pacijentabilo podvrgnutoabdominoplastici i 30 pacijenata podvrgnuto rinoplastici sa LIAu općoj anesteziji u Poliklinici Bagatin u vremenskom periodu od 01.01.2014. i 01.01.2017. U 85% bolesnika podvrgnutih abdominoplastici zabilježena je poslijeoperacijska primjena analgetika, te u 45 % bolesnika podvrgnutih rinoplastici. Pacijenti podvrgnuti abdominoplastici otpušteni su iz poliklinike unutar 48 satinakonkirurškog zahvata, a svi pacijenti koji su podvrgnuti rinoplastici otpušteni su na isti dan kirurškog zahvata. Tijekom prvog poslijeoperacijskog dana bolesnici podvrgnuti rinoplastici nisu imali potreba za analgeticima, dok je u 3 % bolesnika podvrgnutih abdominoplastici bila potrebna dodatna doza analgetika. Rezultati su studije pokazali da uz primjenu LIA-e poslijeoperacijska bol i povraćanje nakon kirurškog zahvata nisu utjecali na duljinu boravka u ustanovi u kojoj je zahvat učinjen.

Background and Aims: Cognitive dysfunction is a common complication after surgically treated hip fracture in spinal anesthesia. We hypothesized that intrathecal applied dexamethasone could effectively attenuate post-spinal pain and cognitive dysfunction following surgically treated hip fracture. Methods: Sixty male and female patients, ASA II-III, 50-95 years old were included in this prospective and randomized double-blind study. Patients were divided into two equal groups ; group DLSA received 8 mg dexamethasone, group LSA did not receive dexamethasone, each in addition to intrathecal isobaric levobupivacaine 0.5%. Cognitive dysfunction incidence, intensity and recurrence and adverse events were recorded for 10 days after the start of spinal anesthesia. Results: Regression model was statistically significant and it explains 27% variance of dependent variable and it classifies correctly 79% of patients. The exception is the PPBK group without dexamethasone, LSA group, which in comparison to DLSA group, increases probability of cognitive dysfunction occurrence for 7, 67 times (95% CI: 1, 39- 42, 36 ; P=0, 019). Sixty male and female patients, ASA II-III, 50-95 years old were included in this prospective and ran- domized double- blind study. Patients were divided into two equal groups ; group DLSA received 8 mg dexamethasone, group LSA did not receive dexametha- sone, each in addition to intrathecal isobaric levobupivacaine 0.5%. Cognitive dysfunction incidence, intensity and recurrence and adverse events were recorded for 10 days after the start of spinal anesthesia. Conclusions: Intrathecal applied dexamethasone was effective in attenuation of cognitive dysfunction compared to placebo in patients scheduled for surgically treated hip fracture under spinal anesthesia with less adverse events.

Each institute should develop a pathway where the safety of the patient with the safe practice of regional anesthesiais maintained.Hip fracture occur most commonly in elderly individuals with many other risk factors.Administration of local anaesthetics was designed to provide intraoperative anaesthesia and prolog postoperative analgesia with significant impact on outcome of major surgical procedure by modulating stress/ immune response.

Proximal femur fractures are the most common cause of emergency admission to hospital with high postoperative morbidity. The hypothesis is that one single shot of dexamethasone with levobupivacaine in spinal anesthesia reduces postoperative pain and cognitive disturbances. The study included 60 patients with proximal femur fracture, ASA status 2 and 3 who were randomized into two groups. DLSA group received 8 mg of dexamethasone and 12.5 mg of 0.5% levobupivacaine intrathecally. LSA group received only levobupivacaine. The postoperative cognitive disturbance was evaluated with CAM-ICU score scale, the pain intensity was measured with VAS scale and cortisol and glucose samples were taken before and after surgery. Surgical correction was made in 63% of patients in 48 hours after admission. Ephedrine was used in LSA group, P=0,044. We found shorter hospitalization in DLSA group (P=0,045), shorter duration from surgery to discharge (P=0,044), there was lower occurrence of delirium and POCD (P=0,043), longer analgesia (P

Proksimalni prijelomi bedrene kosti (PPBK) najčešći su uzrok prijma u bolnicu za kiruršku rekonstrukciju kuka s visokim poslijeoperacijskim morbiditetom. Hipoteza je da jedna intratekalna doza deksametazona u spinalnoj anesteziji s levobupivakainom snižava poslijeoperacijsku bol i kognitivne promjene svijesti. U istraživanje je uključeno 60 pacijenata s PPBK, ASA statusa 2 i 3 randomiziranih u dvije skupine: DLSA skupina je primila 8 mg deksametazona tijekom uvođenja spinalne anestezije sa 12.5 mg 0.5%-tnog levobupivakaina. LSA skupina primila je samo levobupivakain. Poslijeoperacijska kognitivna promjena svijesti procijenjivana je CAM-ICU bodovnom ljestvicom, intenzitet boli zbrojem VAS te su mjerene vrijednosti kortizola i glukoze u krvi prije i poslije operacije. Kirurška korekcija poslije 48 sati od prijma učinjena je kod 63% pacijenata. U skupini LSA koristio se efedrin (P=0,044). U skupini DLSA zabilježeno je kraće trajanje hospitalizacije (P=0.045), kraće vrijeme od operacije do otpusta (P=0,044), manji udio POKD i delirija (P=0,043), kraći nastup bloka(P=0,005), dulje trajanje analgezije (P, Proximal femur fractures are the most common cause of emergency admission to hospital with high postoperative morbidity. The hypothesis is that one single shot of dexamethasone with levobupivacaine in spinal anesthesia reduces postoperative pain and cognitive disturbances. The study included 60 patients with proximal femur fracture, ASA status 2 and 3 who were randomized into two groups. DLSA group received 8 mg of dexamethasone and 12.5 mg of 0.5% levobupivacaine intrathecally. LSA group received only levobupivacaine. The postoperative cognitive disturbance was evaluated with CAM-ICU score scale, the pain intensity was measured with VAS scale and cortisol and glucose samples were taken before and after surgery. Surgical correction was made in 63% of patients in 48 hours after admission. Ephedrine was used in LSA group, P=0,044. We found shorter hospitalization in DLSA group (P=0,045), shorter duration from surgery to discharge (P=0,044), there was lower occurrence of delirium and POCD (P=0,043), longer analgesia (P

Each institute should develop a pothway uhere the safety of the patient with the safe practice of regional anesthesia is maintained.Relief from pain is a worthwhile humanitarian and clinical goal and there is good evidence that regional anaesthesia and analgesia offer a superior quality of analgesia. We need to examine the currently available evidence for both the risks and benefits associated with major regional techniques to strike a balance, which can inform our clinical practice

Anesteziologija dijeli odgovornost za kvalitetu i sigurnost u anesteziji, intenzivnoj medicini, urgentnoj medicini i liječenju boli odnosno cijelokupnom perioperacijskom procesu i mnogim drugim situacijama u bolnici i izvan nje, kad su bolesnici vitalno ugroženi ( Helsinška deklaracija, 13.06.2010.) Anesteziologija je specijalistička znanstvena grana izrasla iz striktnih specijalistčkih potreba u operacijskoj dvorani koja snosi odgovornost različitih područja medicine. Tradicionalna joj je uloga kao medicinske specijalnosti s inicijalnim ciljem ocjene i evaluacije, održavanje funkcije organa, analgezija i amnezija svih pacijenata koji se podvrgavaju dijagnostičkim, terapeutskim ili kirurškim procedurama. Danas stremi promjenama prema većim, dubljim i više holističkim kompetencijama u perioperacijskom tijeku, u jedinici intenzivne medicine, hitne medicine i medicine boli koji su u mnogim zemljama integrirani dijelovi ove kliničke specijalnosti. Dakle, edukacija zahtijeva nove generičke kompetencije i opće principe u definiranju budućeg Europskog specijaliste Anesteziologije. Minimum trajanja specijalizacije ostaje 5 godina s najmanje 1 godinom intenzivne medicine/hitne medicine s stjecanjem 4 najvažnije kompetencije kao medicinski ekspert, voditelj, istraživač i profesionalac. Ekspert u anestheziologiji će steći sve potrebite kompetencije i funkcije u multidisciplinarnom pristupu u anesteziji, intenzivnoj i hitnoj medicini, te medicini akutne i kronične boli. Specialist anaesteziolog ima kompetencije u komunikaciji u različitim aspektima humanih odnosa, organizaciji i managementu tijekom profesionalnih aktivnosti. Odgovoran je za istraživački razvoj i održavanje visokog stupnja profesionalnih kompetencija, olakšavanje napredovanja kolega i drugih skupina profesionalaca u promotivnom razvoju iste specijalnosti. Diferentni aspekti sadrže: cijeloživotno učenje i razmišljanje o recentnim informacijama relevantnim u kliničkoj anesteziologiji i intenzivnoj medicini ; stjecanje temeljnih alata za učenje (uključujući superviziju), vještina za istraživanje i edukaciju za prezentiranje rezultata, podučavanje mladih kolega, specijalizanata i drugih zdravstvenih djelatnika ; odgovoran je za doprinos u istraživanju, razvoju i implementaciji/transmisiji novih medicinskih spoznaja kao i njihovom nadzoru ; te doprinos edukaciji pacijenata, studenata i drugih zdravstvenih djelatnika. Časopis sadrži sažetke prijave završnih specijalističkih radova iz poslijediplomskog specijalističkog studija , znastvena grana anesteziologija, reanimatologija i intenzivna medicina, polje Kliničke medicinske znanosti u znanstvenom područuju Biomedicine i zdravstva.

Local infiltration anesthesia (LIA) technique to obtain regional anesthesia and vasoconstriction of the skin and subcutaneous tissues is routinely adopted for primary subglandular breast augmentation. This series evaluates advantages and disadvantages of LIA in elective augmentation breast surgery as well as patients' response to this procedure. 60 patients underwent bilateral primary breast augmentation under preoperative LIA, combinations of 5 ml 0.5% levobupivacaine and 4 ml 2% lidocaine with epinephrine on each side and compared to only Ketolorac groups respectively. Midazolam 0.05 mg/kg IV were given as premedication. Surgery was performed under sevoflurane anesthesia. Postoperative pain was assessed by visual analogue scale(VAS) treating with Ketolorac and Tramadol. 60 patients were included in the LIA and only Ketorolac groups respectively. Postoperative pain was lower at 2 and 4 hour after surgery in theLIA group. Recovery room time 1 to 2 in 76, 6% vs 4-6 in Ketorolac group of patients. Vomiting were found in aaveraged 125 minutes. VAS in LIA group weretotal of 9 (5.3%) patients without complications such as hematoma or seroma formation. 86, 7% of patients discharge same day. Single shot infiltration with levobupivacaine improves postoperative pain control after breast surgery. Perioperative physicians should consider delivering LIA earlier during the procedure as opposed to solely at the time of wound closure.

Neki lijekovi upotrijebljeni u kombinaciji s lokalnim anesteticima mogu ubrzati nastup djelovanja živčanoga bloka, produljiti trajanje bloka ili smanjiti toksičnost. Međutim, loše odabrani ili nepotrebni adjuvantni lijekovi mogu imati neželjene učinke te izložiti bolesnika nepotrebnim rizicima. Ovo je pregledni članak o neopioidnim adjuvansima u neuraksijalnoj anesteziji i blokovima perifernih živaca koji se upotrebljavaju u kliničkoj praksi: vazokonstriktori, klonidin, antagonisti NMDA receptora, midazolam, glukokortikoidi, nesteroidni protuupalni lijekovi i neostigmin. Opisani su mehanizam i mjesto djelovanja svakoga od njih. Slijedi rasprava o eksperimentalnim i kliničkim podacima objavljenima u literaturi., Some medications used in combination with local anaesthetics can hasten the onset of nerve block, prolong block duration or reduce toxicity. On the other hand, poorly selected or unnecessary additives may not have the desired effect and may even expose patients to unnecessary risks. This is a review article on non-opioid adjuvants to neuraxial anaesthesia and peripheral nerve blocks used in clinical practice: vasoconstrictors, clonidine, NMDA antagonists, midazolam, glucocorticoids, non-steroidal anti-inflammatory drugs, and neostigmine. Mechanism and site of action of each of them is described. It is followed by a discussion of experimental and clinical data published in literature.

The aim of this research is to establish the effect of intrathecal dexamethasone administration in spinal anesthesia with levobupivacaine on postoperative cognitive dysfunction and the hospital length of stay for trauma patients with femur fracture. A total of 60 patients ASA2 and ASA3 status, scheduled for surgical procedures were sorted into two groups and underwent surgery. One group had spinal anesthesia with levobupivacaine, SA group, and the other study group had spinal anesthesiawith addition of dexamethasone, DSA group. The primary outcome measure was the occurrence of postoperative cognitive dysfunction (POCD). Length of hospitalization were secondary outcome measures. Postoperative cognitive dysfunction was a state of mental confusion in ten days after surgery. Length of hospitalization was the duration of hospital stay. Postoperative cognitive dysfunction was defined by using Confusion Assessment Method (CAM) criteria. Average age of DSA group was 81.63 (SD 6, 94) years and average age of SA group was 79, 67 (SD 10, 17) years (P=0, 370). CAM criteria showed that, 7 DSAvs 17 SA patients (23% vs 56, 7%) experienced postoperative cognitive dysfunction. Mean hospital length of stay of DSA group was 15, 90 (SD 6, 00) vs. SA was 17, 40 (SD 4, 00) days (P=0.045). There was apparent difference in POCD in DSAvs. SA group (P = 0.046). Our analysis confirmed that POCD was common but more than in SA vs. DSA patients and has influence on hospital length of stay. We concluded that spinal anesthesia with dexamethasone in comparison to the spinal anesthesia alone can facilitate rehabilitation and can reduce hospital stay.

Background and purpose:Cognitive side-effects often complicate postoperative care especially in elderly and fragile patients.The aim of this research is to establish the influence of intrathecal dexamethasone administration in spinal anesthesia with levobupivacaine on postoperative pain, consciousness and values of cortisol levels for patients with femur fracture. Methods:The study is planned as a prospective, interventional, randomized clinical trial. A total of 60 patients ASA2 and ASA3status, scheduled for surgical procedures will be sorted into two groups and undergo surgery. One group will have spinal anesthesia with levobupivacaine, SA group, and the other study group will have spinal anesthesia with addition of dexamethasone, DSA group. The primary outcome measure is the occurrence of postoperative disturbance of consciousness and plasma cortisol levels. As a secondary outcome measure, we are following pain intensity, blood glucose levels and recovery. Cortisol and glucose are analysed in five measurements. Peripheral venous blood samples are collected before anesthesia, one hour after surgery, third, fifth and on the tenth day after surgery. Postoperative cognitive dysfunction is defined by using Confusion Assessment Method (CAM) criteria. Visual analogue scale (VAS) is used to record pain severity among patients. Results:We collected data for 28 patients so far. Data presented as median(min-max) measured variables. Preoperative cortisol levels were 713, 25 nmol/L, pain intensity (VAS score) 8, 3. Postoperative cortisol plasma levels in 17 patients in DSA group were significantly lower 384(184-511) nmol/L in comparison to 11 patients in SA group with postoperative cotisol plasma levels 551(397-753) nmol/L. The duration of analgesia in DSA group was 428(350-510) minutes and in SA group 212(183-254) minutes. According to CAM criteria, postoperative cognitive disturbances were seen in 8 (72%) patients in SA group, and 3 (17%) patients in DSA group. Conclusion:The addition of dexamethasone to the local anesthetic has proven so far that it significantly prolongs the duration of sensory block and, thus, decreases opioid requirements and postoperative cognitive disturbances.

Background and purpose: Cognitive side-effects often complicate postoperative care especially in elderly and fragile patients.The aim of this research is to establish the influence of intrathecal dexamethasone administration in spinal anesthesia with levobupivacaine on postoperative pain, consciousness and values of cortisol levels for patients with femur fracture. Methods: The study is planned as a prospective, interventional, randomized clinical trial. A total of 60 patients ASA2 and ASA3 status, scheduled for surgical procedures will be sorted into two groups and undergo surgery. One group will have spinal anesthesia with levobupivacaine, SA group, and the other study group will have spinal anesthesia with addition of dexamethasone, DSA group. The primary outcome measure is the occurrence of postoperative disturbance of consciousness and plasma cortisol levels. As a secondary outcome measure, we are following pain intensity, blood glucose levels and recovery. Cortisol and glucose are analysed in five measurements. Peripheral venous blood samples are collected before anesthesia, one hour after surgery, third, fifth and on the tenth day after surgery. Postoperative cognitive dysfunction is defined by using Confusion Assessment Method (CAM) criteria. Visual analog scale (VAS) is used to record pain severity among patients. Results: We collected data for 28 patients so far. Preoperative cortisol levels were 713, 25nmol/L, pain intensity(VASscore) 8, 3. Postoperative cortisol plasma levels in 17 patients in DSA group were significantly lower 384(184-511) nmol/L in comparison to 11 patients in SA group with post- operative cotisol plasma levels 551(397-753) nmol/L. The duration of analgesia in DSA group was 428(350-510) minutes and in SA group 212(183- 254) minutes. According to CAM criteria, postoperative cognitive disturbances were seen in 8 (72%) patients in SA group, and 3 (17%) patients in DSA group. Conclusion: The addition of dexamethasone to the local anesthetic has proven so far that it significantly prolongs the duration of sensory block and, thus, decreases opioid requirements and postoperative cognitive disturbances.

Background and Purpose: A high risk cardiac patient, ASA IV, was planned for inguinal hernia repair. Since general anaesthesia presented a high risk, anaesthesia was conducted with a transversus abdominis plane (TAP) in combination with ilioinguinal-iliohypogastric (ILIH) block. Material and Methods: A 70-year old male patient with severe CAD and previous LAD PTCA, AVR, in situ PPM and severe MR and TR 3+, was planned for elective inguinal hernia repair. The preoperative ECHO showed IVS dyskinesis with apicoseptal hypokinesis, global EF 42% and grade III diastolic dysfunction. The patient also suffered from hypertension, diabetes mellitus and had severe stenosis of both femoral arteries. Preoperative preparation included IBP monitoring while the TAP block was carried out under ultrasound guidance using an 8 Hertz linear probe. The ilioinguinal and iliohypogastric nerves were identified with ultrasound and peripheral nerve stimulator. Local anaesthetic [0.5% levobupivacaine (Chirocaine®, Abbott Laboratories) ] was applied in two locations: in the upper right fascia of the transversus abdominis muscle (15 ml) and around the right ilioinguinal and iliohypogastric nerves (10 ml), totalling a volume of 25 ml. Skin infiltration was performed with 5 ml 2% lidocaine [Lido- caine®, Belupo] and 5 ml of normal saline. Results: Sensory block onset was at 28 minutes after administration and lasted for approximately 18 hours. There were no haemodynamic disturban- ces and the perioperative course was uneventful. Conclusion: During the first 18 postoperative hours, the patient was comfortable and satisfied with the anaesthetic procedure.

Background and aims: The aim of this research is to establish the influence of intrathecal dexamethasone administration in spinal anesthesia with levobupivacaine on postoperative pain, consciousness and values of cortisol levels for patients with femur fracture. Methods: The study is planned as a prospective, interventional, randomized clinical trial. A total of 60 patients ASA2 and ASA3 status, scheduled for surgical procedures will be sorted into two groups and undergo surgery in spinal anesthesia with 12, 5mg of levobupivacaine (SA) group and with addition 8mg of dexamethasone (DSA) group. The primary outcome measure is the occurrence of postoperative disturbance of consciousness and plasma cortisol levels. As a secondary outcome measure, we are following pain intensity, blood glucose levels and recovery. Cortisol and glucose are analyzed in five measurements. Peripheral venous blood samples are collected before anesthesia, one hour after surgery, third, fifth and on the tenth day after surgery. Postoperative delirium is defined by using Confusion Assessment Method (CAM) criteria. Visual analogue scale (VAS) is used to record pain severity among patients. Results: We collected data for 16 patients so far. Postoperative cortisol plasma levels in 8 patients in DSAgroupwere significantly lower 210(184-262) nmol/L in comparison to 8 patients in SA group with postoperative cortisol plasma levels 713(354-794) nmol/L. The duration of analgesia in DSA group was 428±72.57minutes and in SA group 212±34.76 minutes. According to CAM criteria postoperative cognitive disturbances were seen in 5(31%) patients in SA group. Conclusions: The addition of dexamethasone to the local anesthetic significantly prolongs the duration of sensory block and decreases opioid requirements and postoperative cognitive disturbances.

The aim of this research is to establish the influence of intrathecal dexamethasone administration in spinal anesthesia with levobupivacaine on postoperative pain, consciousness and values of cortisol levels for patients with femur fracture. The study is planned as a prospective, interventional, randomized clinical trial.A total of 60 patients ASA2 and ASA3 status, scheduled for surgical procedures will be sorted into two groups and undergo surgery in spinal anesthesia with 12, 5mg of levobupivacaine (SA) and with or without 8mg of dexamethasone (DSA). The primary outcome measure is the occurrence of postoperative disturbance of consciousness and plasma cortisol levels. As a secondary outcome measure, we are following pain intensity, blood glucose levels and recovery. Cortisol and glucose are analyzed in five measurements. Peripheral venous blood samples are collected before anesthesia, one hour after surgery, third, fifth and on the tenth day after surgery. Postoperative delirium is defined by using Confusion Assessment Method (CAM) criteria. Visual analogue scale (VAS) is used to record pain severity among patients. We collected data for 16 patients so far. As expected, cortisol plasma levels (preoperative mean values 715 nmol/L and postoperative 210 nmol/L) were significantly lower in all patients having spinal anesthesia with levobupivacaine and dexamethasone in comparison to patients in spinal anesthesia with only local anesthetic(preoperative mean values 807 nmol/L and postoperative 713 nmol/L).According to CAM criteria postoperative cognitive disturbances were seen in 5 patients after spinal anesthesia with only local anesthetic. The addition of dexamethasone to the local anesthetic significantly prolongs the duration of sensory block and decreases opioid requirements and postoperative cognitive disturbances.

Patient safety is a relatively new concept in the health care system, which is related to the prevention of errors and adverse events in medicine and to the activities toward building a culture of safety in order to protect patients from adverse events in the process of diagnosis and treatment. Pain relief is a worthwhile humanitarian and clinical goal and there is good evidence that regional anaesthesia and analgesia offer a superior quality of analgesia compared to opioid-based analgesia . Regional anaesthesia can influence a reduction in surgical morbidity and mortality, length of hospital stay, and other markers of improved outcome from surgery. In recent years, there has been a marked growth in the use of both neuraxial and peripheral nerve regional anaesthesia techniques and concerns have been raised about the potentially serious adverse events associated with this increased use. Each institute should develop a pathway where the safety of the patient with the safe practice of regional anesthesia is maintained.

Patient safety is a relatively new concept in the health care system, which is related to the prevention of errors and adverse events in medicine and to the activities toward building a culture of safety in order to protect patients from adverse events in the process of diagnosis and treatment. Pain relief is a worthwhile humanitarian and clinical goal and there is good evidence that regional anaesthesia and analgesia offer a superior quality of analgesia compared to opioid-based analgesia . Regional anaesthesia can influence a reduction in surgical morbidity and mortality, length of hospital stay, and other markers of improved outcome from surgery. In recent years, there has been a marked growth in the use of both neuraxial and peripheral nerve regional anaesthesia techniques and concerns have been raised about the potentially serious adverse events associated with this increased use. Studies have demonstrated a diminished stress response, fewer episodes of hypoxia, greater cardiovascular stability, faster return of gastrointestinal function, a reduced need for postoperative ventilation and a shorter stay in intensive care of children who have had surgery performed under regional anaesthesia. But really new aspects of regional anaesthesia in children during the last couple of years are the use of continuous peripheral nerve blocks and ultrasonography guidance to perform the blocks. Our training should be modified in order to introduce these new aspects into our daily clinical practice. The practice of regional anesthesia is getting more popular after the introduction of ultrasound technology in anesthesia practice. Each institute should develop a pathway where the safety of the patient with the safe practice of regional anesthesia is maintained.

Mortality after hip fracture has remained relatively unchanged for the last two decades. Currently, 8.4% of patients die within 30 days of surgery. However, it has been suggested that up to half of postoperative deaths are potentially preventable. Thirty-day mortality is increased for older, sicker, male patients. Up to 15–30% of patients die within a year of surgery. There is sufficient data that the effective pain mana- gement may reduce postoperative cognitive disturbances. The addition of dexamethasone to the local anesthetic administered intrathecally significantly prolongs the dura- tion of sensory block and decreases opioid requirements in postoperative management. Therefore, effective analgesia and the impact on the hypothalamic- pituitary-adrenal axis may reduce post- operative delirium in patients with femur fracture.

Purpose: The aim of study was to analyze costs of regional versus general anesthesia techniques at hip and knee surgery through a retrospective study. Using an interdisciplinary approach of cost management in health care institutions, independent financial analysis of costs of surgical procedures and resource utilization was conducted. Materials and Methods: 181 patient’s medical records were analyzed during different surgical procedures performed under regional or general anesthesia. Data such as duration of operation and anesthesia, incidence of moderate hypotension, total costs of physician and material used during the procedure, cost of blood transfusion during surgery as well as anesthesia technique were extracted from the records and elaborated. Results: Ratio of regional to general anesthesia was 61%:39% in the observed 4 month period. Average total cost of regional anesthesia operation, calculated from the surgical lists for the observed four month period, was 11, 6€, while average total cost of general anesthesia was 44, 8€. Thereby costs of anesthesia technique were lower (p