We present a case of a severe anaphylactic reaction to diclofenac, administered as an intravenous infusion in a 45-year-old patient, during intravenous anesthesia for in vitro fertilization. During the preoperative clinical examination and obtaining of anamnestic data, the patient denied symptoms of allergies to medicines and other substances. The dominant clinical manifestations of anaphylactic reaction were: hypotension, tachycardia, angioedema, bronchospasm, and delayed awakening following anesthesia. No visible changes in the appearance of the skin, such as erythema or urticaria have been observed. Proper clinical observation and adequate intraoperative monitoring led to rapid diagnosis and significantly reduced the time interval from the onset of anaphylaxis to the beginning of treatment and reanimation procedures.

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Introduction. Sedation is the reduction of irritability or agitation by the use of certain drugs mostly to facilitate therapeutic or diagnostic procedures. Scales for evaluation of the depth of sedation. Riker Sedation-Agitation Scale and Richmond Agitation-Sedation Scale are the most commonly used scales. Drugs. Sedation is generally produced by using medications from the group of opioids, benzodiazepines, intravenous and inhalation general anesthetic agents, neuroleptics, phenothiazines, α-agonists and barbiturates. Adverse effects of sedatives. Sedation is often associated with hypotension, prolonged mechanical ventilation and longer time on respiratory support, higher frequency of delirium, immunosuppression, deep vein thrombosis, increased risk for development of nosocomial pneumonia, all of which leads to the prolonged recovery time. Conclusion. Sedatives currently used in intensive care units are widely used, but they have limitations. The goal is to get the desired level of sedation with as few side effects as possible.

Introduction/Objective. Stanford type A aortic dissection is a surgical emergency associated with high mortality. The aim of this study was to determine which group of patients and which characteristics were associated with postoperative, in-hospital mortality. Methods. The retrospective study included 116 patients with type A aortic dissection surgically treated over a five-year period. The association between postoperative, in-hospital mortality and patient characteristics was examined. Results. Total postoperative, in-hospital mortality was 22.4% (26 out of 116 patients). The variables that, after multivariate analysis, showed a direct correlation with mortality were: admission creatinine value (OR 1.026 [1.006-1.046], p = 0.009), C-reactive protein (CRP) > 10 mg/L (OR 4.764 [1.066-21.283], p = 0.041), and stroke (OR 6.097 [1.399-26.570], p = 0.016). The ROC curve showed that creatinine could be a good predictor of mortality (Area Under the ROC curve = 0.767; p <0.0005). The cut-off point was 124.5 ?mol/L. The sensitivity was 65% and the specificity was 80%. The cut-off point for CRP was 14.5 mg/L - sensitivity 71.4%, specificity 75% (Area Under the ROC curve = 0.702, p = 0.021). Conclusion. Surgery for type A aortic dissection is still associated with relatively high mortality. A lower chance of survival may be indicated by elevated admission creatinine and CRP values, as well as stroke.

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