Spinalna anestezija je jedna od najstarijih, najkorisnijih i do danas najčešće primenjivanih tehnika regionalne anestezije. Ubrizgavanjem lokalnog anestetika u subarahnoidalni prostor nastaje tranzitorni prekid sprovođenja nervnih impulsa u spinalnim nervnim korenovima i paraliza autonomnih, senzitivnih i motornih nervnih završetaka. Blokada simpatikusa, uzrokovana spinalnom anestezijom, dovodi do hemodinamskih promena. Hipotenzija i bradikardija su najčešći kardiovaskularni efekti viđeni kod simpatičke denervacije. Cilj rada: Cilj rada je bio da se utvrdi kakav uticaj hronična terapija beta-blokatorima ima na promene arterijskog krvnog pritiska tokom spinalne anestezije, s obzirom na to da su im efekti slični, te da se sagleda značaj hemodinamskog monitoringa (merenja arterijskog krvnog pritiska) pri izvođenju spinalne anestezije kod ove grupe pacijenata. Materijal i metode: Nakon odobrenja od strane Etičkog odbora Univerzitetskog kliničkog centra Banjaluka, sprovedena je prospektivna, case-control studija, koja je trajala od 01.06.2013. do 31.05.2016. godine na hirurškim klinikama ove ustanove. U studiju je uključeno 70 bolesnika podeljenih u dve grupe, starosne dobi od 35-65 godina. Grupu N1, radnu grupu, sačinjavalo je 35 pacijenata koji su zbog esencijalne hipertenzije upotrebljavali beta-blokator metoprolol u hroničnoj terapiji. Druga grupa je bila kontrolna grupa (N2) i nju je činilo 35 pacijenata iste dobne granice, ASA I statusa. Pacijenti su bili podvrgnuti spinalnoj anesteziji za "beskrvne" operacije preponske kile, tumora mokraćne bešike, operacije prostate, uretre i donjih ekstremiteta. U rad nisu bile uključene trudnice, te pacijenti sa dijabetesom, bu-Summary Introduction: Spinal anesthesia is one of the oldest, most useful and most commonly used techniques of regional anesthesia. The injection of local anesthetics into the subarachnoidal space creates a transient interruption of nerve impulses in the spinal nerve roots and paralysis of autonomic, sensitive and motor nerve endings. Sympathic blockade caused by spinal anesthesia leads to haemodynamic changes. Hypotension and bradycardia are the most common cardiovascular effects seen in sympathetic denervation. The goal of the work: Determine the effects of chronic therapy with beta-blockers on changes in arterial blood pressure during spinal anesthesia, since their effects are similar, and see the importance of hemodynamic monitoring (measurement of arterial pressure) in performing spinal anesthesia in this group of patients. Material and methods: After the approval by the Ethics Board of the University Clinical Center Banja Luka, a prospective, case-control study was conducted, which lasted from 01.06.2013. until 31.05.2016. at the surgical clinics of this institution. The study included 70 patients divided into two groups, aged 35-65 years. Group N1, a working group, consisted of 35 patients who, due to essential hypertension, used a beta-blocker, metoprolol, in chronic therapy. The second group was the control group, N2, and it consisted of 35 p...

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Introduction: Spinal anesthesia (synonyms: subarachnoidal nerve block, subdural nerve block, subdural anesthesia, lumbar anesthesia, subarachnoid anesthesia) occurs by injection of local anesthetics within the subarachnoid space in the lumbal interspace. 1 It is also called a neuroaxial blockade that represents the primary anesthetic technique in one-third of surgical procedures. 2 A local anesthetic, given in this way, transits blocking the transmission of sensory, motor and autonomic nerve impulses transiently, resulting in the desired effects, sensory and motor blockade, as well as the side effects due to blocking autonomic nerve fibers, when unwanted effects of spinal anesthesia, hyopotension, bradycaria, nausea, vomiting and retention of urine occur. In this paper we examined the effect of spinal anesthesia on cardiovascular functions in patients whose sympathetic tonus is partly suppressed due to the chronic use of β-blockers due to essential hypertension. We wanted to know whether spinal anesthesia is a safe anesthetics technique in this group of patients or their effects are summed up, which would lead to cardiovascular instability that would result in greater use of pharmacological agents for the treatment of hypotension and bradycardia. Aim of the Study: To examine cardiovascular stability during spinal anesthesia in patients on β-blocker therapy and determine the safety of its use in this group of patients. Patients and Methods: After approval by the Ethics Committee of UCC Banja Luka, a prospective, observation study was conducted on 70 patients divided into two groups, aged 35-65 years, and it lasted from June 1st, 2013. until May 31st, 2016. Group N1, a working group, consisted of 35 patients who used beta-blocker, Metoprolol, in chronic therapy due to essential hypertension. The second group was a control group, N2, and it consisted of 35 healthy patients of the same age limit. Patients underwent spinal anesthesia for "bloodless" surgery on the inguines, perineum, urinary bladder, prostate, urethrae and lower extremities. No pregnant women, diabetic patients, kidney, liver and heart disease were involved in the work. Results: The results showed that there were a significantly higher number of patients with a critical drop in blood pressure, in the group of patients undergoing therapy with beta-blockers, ≥30%, and alone with this more frequent use of vasopressor. Likewise, in the group of patients on beta-blocker therapy, significantly more patients developed bradycardia, i.e. a pulse of 50/min, which required the use of Atropine. Conclusion: Spinal anesthesia is not a safe anesthetic technique in patients on beta-blocking therapy

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Introduction: Acute pancreatitis in pregnancy is usually diagnosed in the third trimester. The most common etiology factors are cholelithiasa and choledocholithiasa. The most severe consequence is perinatal and maternal mortality. The lethal outcome is largely reduced due to the widespread use of the following: contemporary diagnostics (ultrasound, magnetic resonance imaging, endoscopy and laparoscopy) and multidisciplinary approach to problem solving.