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Using local anaesthetics in daily practice, particularly by anaesthesiologists and dentists, is related to the risk of adverse reactions. Therefore, monitoring of such reactions, carrying out detailed documentation (according to the chart proposed in this study) and conducting specialist examinations is of the greatest importance. There is a variety of adverse reactions that may occur during local anaesthesia procedures, with the intensity ranging from clinically insignificant to life-threatening reactions. The majority of concerns reported by clinicians are linked to the appearance of various hypersensitivity reactions, including anaphylaxis. Healthcare providers responsible for the administration of local aneasthetics should be able to detect hypersensitivity reactions in order to implement appropriate treatment and then choose diagnostic procedure. The final diagnosis should be based on detailed history, medical record, including a case description and measurements of tryptase activity, skin tests and provocation trials. Screening tests are not currently recommended in individuals without hypersensitivity to local anaesthestics in history.Key words: hypersensitivity; local anestehtics; local Słowa kluczowe: znieczulenie miejscowe, środki znieczulające, nadwrażliwość; znieczulenie miejscowe, środki znieczulające, testy skórne Anestezjologia Intensywna Terapia 2016, tom 48, nr 2, 135-141Wprowadzenie do praktyki klinicznej leków znieczu--lających miejscowo zrewolucjonizowało procedury zabiegowe. W 1884 roku austriacki lekarz Carl Koller skutecznie znieczulił powierzchniowo kokainą rogówkę oka do zabiegu okulistycznego. Obecnie leki znieczulenia miejscowego (LZM) są szeroko stosowane w wielu dziedzinach medycyny z różnymi możliwościami ich aplikacji. Częste stosowanie znieczuleń miejscowych nie może pozostać bez wpływu na zwiększenie prawdopodobieństwa wystąpienia działań niepożądanych środków tej grupy, w tym także reakcji nadwraż-liwości [1]. Efekty niepożądane leków, które wynikają z ich farmakologicznego mechanizmu działania lub z nasilenia objawów zależnych od dawki są zazwyczaj dobrze poznane i stąd możliwe do przewidzenia. W odróżnieniu do nich, reakcje nadwrażliwości na leki ciągle wywołują dyskusje, a ich diagnostyka stanowi ogromne wyzwanie dla klinicystów. W ostatnich dwóch latach poczyniono jednak pewne postępy. Opublikowano międzynarodowe wytyczne ekspertów [2−5], które próbują uporządkować zagadnienie nadwrażliwości na leki, problem będący jednym z najbardziej enigmatycznych tematów alergologii [6]. Zawarte w nich zalecenia odnoszą się również do nadwrażliwości na LZM.

Background: Dexmedetomidine and propofol are commonly used sedative agents in non-invasive ventilation as they allow for straightforward arousal and are easily controllable to a relative degree. Moreover, dexmedetomidine is associated with a low risk of respiratory depression. However, both agents are associated with significant haemodynamic side effects. The primary aim of this study is to compare the influence of both drugs on haemodynamic effects in patients after thoracic surgical procedures receiving dexmedetomidine or propofol for non-invasive postoperative ventilation. Methods: A prospective, randomised, observational study conducted in a university hospital. Interventions: Continuous sedation with dexmedetomidine or propofol for six hours of postoperative non-invasive ventilation after thoracic surgery, with concomitant use of continuous epidural analgesia. results: A total of 38 patients (20 on dexmedetomidine and 18 on propofol) were included in the analysis. The primary findings of this study were that although the heart rate, along with the systolic and mean arterial blood pressure did not differ significantly between the groups (P = 0.87; P = 0.42; P = 0.13, respectively), diastolic arterial blood pressure was significantly higher in the propofol group (P = 0.02). A comparative analysis of epinephrine usage did not reveal significant differences between the groups. Although cardiac output (P = 0.36) and cardiac index (P = 0.36) analyses did not show significant differences between the groups, there is a clear tendency toward lower values of CO/CI in the group receiving propofol. While we also observed a similar tendency in the stroke volume index and stroke volume variation values, these differences did not reach statistical significance either (P = 0.16; P = 0.64, respectively). Despite systemic vascular resistance index values being higher in the propofol group, exceeding reference values, similarly, the difference between the groups was not significant (P = 0.36). Conclusions: The main finding of this study is that dexmedetomidine and propofol provide similar advantages in haemodynamic stability during short-term sedation for non-invasive ventilation after thoracic surgical procedures in patients receiving continuous epidural analgesia.

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Background: Selective spinal anaesthesia is the practice of employing minimal doses of intrathecal agents so that only the nerve roots supplying a specific area and only the modalities that require to be anaesthetised are affected. . The study is based on the hypothesis that small dose lidocaine spinal anaesthesia may be adequate for elective surgical procedures, providing limited motor and sensory block, and thus enabling earlier patient's discharge. The aim of this study was the comparison of the low and the conventional dose of lidocaine spinal anaesthesia discharge time. Methods: The study was a prospective, randomized controlled single-blind trial, with 84 patients enrolled. Patients in study group (SS-L, Selective Spinal Lidocaine) were administered 3 mL of a 0.8% lidocaine solution containing 24 mg of lidocaine and 15 μg of fentanyl into the subarachnoid space. Patients in the control group (CD-L, Conventional Dose Lidocaine) received 5 mL of a 1% lidocaine solution containing 50 mg of lidocaine and 25 μg of fentanyl into the subarachnoid space. Discharge time was evaluated. Results: In the SS-L group time to discharge were shorter (P < 0.01) compared to the CD-L group. Conclusion: Selective spinal anaesthesia with low dose of lidocaine decreases the time of patient discharge compared with conventional lidocaine dose spinal anaesthesia.