Introduction: The problem of intraoperative awareness concerns about 0.1%–0.2% of patients .The perfect method to evaluate the depth of sleep should be objective, so that the response is quick and precise – to increase or decrease the depth of anaesthesia. More scales originated in order to detect cases of intraoperative awareness. Also, new equipment was built so that anaesthesiologists could properly monitor the depth of anaesthesia. Aim: The aim is to describe methods and devices monitoring the depth of anaesthesia. Material and methods: This work was based on the available literature and the experience of the authors. Results and discussion: Recently a few devices were constructed, all of which can be divided into passive and active systems. Passive systems assess the collected data, while active ones first stimulate and then receive and process data. Passive systems use computer analysis of electroencephalographic signal, and some of them additionally evaluate alterations of frontal electromyogram. According to some, monitors currently available on the market show around 80% effectiveness in preventing intraoperative awareness. Other researchers showed that evidence of their effect on intraoperative awareness is limited. Conclusions: It seems that when it comes to the effect of anaesthetic agents on such a precise organ as the brain, there is still much to discover. As long as we do not fully know what awareness is and what mechanisms influence the state of staying awake and of anaesthetic sleep, and on which levels it happens, we will not be able to prevent intraoperative awareness effectively.

Introduction: The gas in the vessels of the portal system and arterial vessels is a very disturbing symptom and life-threatening condition. Aim: The aim of this study is to present a case of gas in the left ventricle (LV), ascending aorta (Ao), superior mesenteric vein (SMV) and hepatic portal vein (HPV) as a complication of gastric ulcer perforation (GUP). Case study: A 78-year-old male patient, who had undergone a laparotomy due to gas in the HPV, SMV, Ao, and both chambers of the heart with concomitant GUP and critical pyloric stenosis. Laparotomy revealed perforation of the gastric wall with limited wall necrosis and critical pyloric stenosis. The patient died on postoperative day 1 due to multiple organ failure. Results and discussion: The presence of gas in HPV (HPVG) and systemic circulation is a rare pathological condition associated with various abdominal diseases. GUP with a gas in the HPV, MV and Ao is very rare. While the mechanism of gas entry into the portal veins of the portal system is better understood, the paths of gas entry into the arterial vessels are still not fully understood and their descriptions are casuistic. Conclusions: The treatment of patients with air in the HPV and systemic vessels is extremely difficult and has a very high risk of failure.

Background Hepatocellular carcinoma (HCC) is a primary liver tumor that generally develops in a marsh-altered liver. Local ablation using radio frequency waves is the first-line treatment for patients with early onset of this cancer who cannot undergo radical surgery. This is a painful procedure and must be performed under deep intravenous analgosedation or general anesthesia. The method that appears to meet the anesthesiological and surgical requirements is thoracic paravertebral block.Aim of the study The main purpose of the study was to determine the efficacy and safety of paravertebral block compared to local perioperative anesthesia in patients who had percutaneous thermoablation as a treatment for HHC.Methods 30 patients enrolled in the treatment of hepatocellular carcinoma by percutaneous thermoablation were enrolled in the study. Two groups of patients were compared: group PVBpatients under paravertebral block anesthesia, group BB -patients under local anesthesia, without paravertebral block. ResultsThe use of paravertebral blockade (PVB) did not significantly reduce the patient's concerns about the postoperative period, the ability to ask questions to the doctor, receive understandable information about anesthesia, reduce stress levels or increase the level of satisfaction with pain therapy in the postoperative period (p> 0.05). Patients significantly more often experienced pain during surgery without paravertebral block (p <0.001). Side effects of anesthesia occurred in both compared groups. They mainly concerned nausea and vomiting, which significantly more often occurred in the group without blockade (BB) and affected up to 60% of the respondents (p = 0.008).Significantly more often any painkillers were used among BB patients compared to PVB, respectively: immediately after surgery 53% vs 13% (p = 0.02), 1 hour after surgery 80% vs 27% (p = 0.003), 3h after surgery 80% vs 14% (p <0.001), 6h after surgery 60% vs 14% (p = 0.008), after 24h 47% vs 20% (p = 0.12). ConclusionsThe paravertebral block has proved to be a safe and well-tolerated and effective method of treating postoperative pain in patients with liver cancer treated by percutaneous thermoablation.Patients with PVB during the surgery and in the postoperative period had significantly less pain than HCC -Hepatocellular Carcinoma -hepatocellular carcinoma PEI -Percutaneous Ethanol Injection -percutaneous ethanol injection RA -Regional Anaesthesia -regional anesthesia RFA -Radiofrrequency Ablation -ablation using radio frequency waves PRFA -Percutaneus Radiofrrequency Ablation -transcutaneous ablation using radio frequency waves SBP -Systolic Blood Pressure SpO2 -Oxygen Saturation -oxygen saturation of arterial blood TPVB -Thoracic ParaVertebral Block -chest block Declarations Ethics Approval and Consent to Participate -all patients gave written consent for participation, in addition, Consent of the Bioethics Committee: Resolution No. 46/2017 of 9/11/2017 issued by the LG -collecting clinical materials; clinical material analysis; substantive supe...