Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068-1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623-0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182-3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232-2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004-1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761-2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

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According to the report, COVID-19 infection was confirmed in 10000 patients followed with 2% mortality rate in Serbia, compared with 7% global mortality rate reported by WHO. Team work and multidisciplinary therapy approach is crucial in COVID-19 management. According to the current organizational plan, the anesthesiology teams were assigned to the ICU of the Clinic for Infectious and Tropical Diseases for treatment of patients with moderate to severe form of SARS CoV-2 infection. The each work shift of anesthesiology team is scheduled for 4 hours with personal protective equipment (PPE) available. In addition to anesthesiologists, health-care providers in other fields of medicine also took part in management of patients with most severe forms of infection (infectologist, pulmologist, hematologist, cardiologist, gastroenterologist, nephrologist). The anesthesiologist-coordinator coordinated the work of different specialists. In the "red zone", the principle of treatment was organized according to the current recommendations: respiratory, hemodynamic and nutritional support, tromboprophylaxis. At the beginning of the epidemic, 90.5% were intubated, and later 25-30%. We applied several non-invasive respiratory support methods: NIV 11.1%, HFNC 13.3%, oxygen mask 15.6%. Doses of sedative agents need to be individually adjusted as COVID-19 patients require higher doses than usual. But, the most important is to follow instructions related to PPE use for safe work in the "red zone". Recommendations based on experience: always respect the recommended layered arrangement of PPE, do not apply additional protective equipment "for safety", it is necessary that the order of wearing PPE is always the same, it is more practical to wear a spacesuit for more than ideals.

Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.