Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, non-invasive blood pressure monitoring (NIBP) frequently leads to the missed hypotensive episodes. Our goal was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during 3 min intervals, starting from SA, by the end of the surgery. Results. In group E, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. CNAP detected 31 (81.6%) hypotensive patients in E group and significantly lower number 20 (52.6%) with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP, only 18 (47.3%), p = 0.001. CNAP detected significantly higher number of hypotensive intervals in E and P groups (p < 0.001). Umbilical vein pH was lower within hypotensive compared with normotensive patients in E and P groups, with CNAP and NIBP, respectively (p < 0.001, p = 0.027 in E, and p = 0.009, p < 0.001, in P group). Conclusion. CNAP is much more efficient in hypotension detection for CS during SA, which allows faster treatment of hypotension, thus improving fetal and maternal outcome.

Malignant hyperthermia is a hypermetabolic disorder of skeletal muscle that occurs in genetically susceptible individuals after exposure to anesthetic. Basic disorder is an increase of calcium ions inside the skeletal muscle, increasing metabolism and reducing cell energy supplies leading to development of acidosis, cell membrane destruction and cell death. Due to the increased metabolism occurs hypercarbia and strong stimulation of the sympathetic nervous system (tachycardia, hypertension, ventricular arrhythmia, tachypnea dropped for the neuromuscular blockade). Sweating, cyanosis, muscle rigidity and hyperthermia are also present.is work presents the case of a female patient aged 32 who was heterozygous for the mutation RYR1 gene and therefore has an increased risk of malignant hyperthermia. Per anamnesis we got data that patient's brother suff ers from central core disease (myopathy). Patient has no muscle disease, 41 st week of pregnancy and was admitted to the hospital for childbirth. Vaginal delivery in epidural analgesia was planned. Epidural catheter is placed in the space L3 -L4, through which she received 0.25% levobupivacaine 10 ml. Due to adverse obstetric fi ndings cesarean section underwent after two hours. Given the increased risk of malignant hyperthermia, the safest type of anesthesia for cesarean is epidural anesthesia. Over the epidural catheter has received 0.5% levobupivacaine 18 ml. Anesthesia machine was verifi ed, hoses were replaced with new ones, CO 2 absorber system was replaced, and whole system is fl ushed with pure oxygen, before surgery started. During the operation the patient had stable vital parameters that are monitored. She got a male child Apgar score of 9/10 and saw her child at birth. After the operation was transferred to the intensive care unit where we monitored the vital parameters, laboratory analysis, the amount and color of urine. Since all parameters were satisfactory, following day she was transferred to the ward, and she was discharged with a child on the fourth day after the surgery.

Introduction: Spinal anesthesia and peripheral nerve block anesthesia are used in total knee replacement. The main aim of the study was to examine whether peripheral nerve block anesthesia would provide a more stable hemodynamic profile and analgesic effect in elderly patients undergoing total knee replacement, as compared to spinal anesthesia.Methods: This is a single-center case-control trial, with patients from our prospectively followed registry. The patients were divided into two groups, those with peripheral nerve block anesthesia and spinal anesthesia. Propensity score analysis was performed in 1:1 ratio. The primary outcome was analgesia with total analgesic effect and the secondary outcome was intraoperative hemodynamic status.Results: The patients in peripheral nerve block anesthesia group had a longer length of analgesia (606.19±219.35 vs 359.48±106.82, P<0.01) and pain scores during 24h and 48h after the surgery were lower in the same group of patients (3.21±1.74 vs 5.02±2.23, P=0.037; 3.03±1.57 vs 5.67±2.51, P=0.028). Spinal anesthesia group had a larger number of patients with significant hypotension (3.84% vs 15.38%, P=0.01), as well as a larger number of patients who received vasopressors (0% vs 9.61%, P<0.01).Conclusion: Both anesthesia methods demonstrated sufficient analgesic efficacy in total knee replacement, although there was less pain severity and longer analgesic effect of peripheral nerve block anesthesia in patients who were 60 years old or older. Spinal anesthesia showed a significantly higher degree of hypotension than in those patients receivingperipheral nerve block anesthesia.