The number and complexity of endoscopic gastrointestinal diagnostic and therapeutic procedures is globally increasing. Procedural analgosedation during gastrointestinal endoscopic procedures has become the gold standard of gastrointestinal endoscopies. Patient satisfaction and safety are important for the quality of the technique. Currently there are no uniform sedation guidelines and protocols for specific gastrointestinal endoscopic procedures, and there are several challenges surrounding the choice of an appropriate analgosedation technique. These include categories of patients, choice of drug, appropriate monitoring, and medical staff providing the service. The ideal analgosedation technique should enable the satisfaction of the patient, their maximum safety and, at the same time, cost-effectiveness. Although propofol is the gold standard and the most used general anesthetic for endoscopies, its use is not without risks such as pain at the injection site, respiratory depression, and hypotension. New studies are looking for alternatives to propofol, and drugs like remimazolam and ciprofol are in the focus of researchers’ interest. New monitoring techniques are also associated with them. The optimal technique of analgosedation should provide good analgesia and sedation, fast recovery, comfort for the endoscopist, patients’ safety, and will have financial benefits. The future will show whether these new drugs have succeeded in these goals.

Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that helps red blood cells work properly; it participates in the production of antioxidants and helps to defend cells against oxidative damage. With all this in mind, patients with G6PD deficiency may be very sensitive and vulnerable to different oxidative stressors, because they can cause some serious medical conditions of which hemolytic anemia is common in adults and severe jaundice in newborns. The most common triggers of hemolysis in G6PD deficiency are infections, medications, metabolic conditions such as diabetic ketoacidosis, hypothermia, and a very important item—surgical stress. During the operative period, the anesthetic goal is to reduce stress and monitor if the hemolysis occurs, and of course, treat it if it occurs. In our case, the combination of sevoflurane inhalation anesthesia with the addition of sufentanil proved to be safe and effective in the management of a child with G6PD deficiency.

Chest trauma is one of the most serious and difficult injuries, with various complications that can lead to ventilation–perfusion (V/Q) mismatch and systemic hypoxia. We are presenting a case of a 53-year-old male with no chronic therapy who was admitted to the Intensive Care Unit due to severe respiratory failure after chest trauma. He developed a right-sided pneumothorax, and then a thoracic drain was placed. On admission, the patient was hemodynamically unstable and tachypneic. He was intubated and mechanically ventilated, febrile (38.9 °C) and unconscious. A lung CT showed massive non-ventilated areas, predominantly in the right lung, guiding repeated therapeutic and diagnostic bronchoalveolar lavages. He was ventilated with PEEP of 10 cmH₂O with a FiO₂ of 0.6–0.8. Empirical broad-spectrum antimicrobial therapy was immediately initiated. Both high FiO₂ and moderate PEEP were maintained and adjusted according to the current blood gas values and oxygen saturation. He was weaned from mechanical ventilation, and non-invasive oxygenation was continued. After Stenotrophomonas maltophilia was identified and treated with sulfamethoxazole/trimethoprim, a regression of lung infiltrates was observed. In conclusion, both ventilatory and antibiotic therapy were needed to improve the oxygenation and outcome of the patient with S. maltophilia pneumonia and V/Q mismatch.

Objective: Studies have suggested that pre-emptive analgesia may decrease postoperative pain and opioid consumption. This study was undertaken to determine whether pre-emptive analgesia reduces postoperative pain and total paracetamol and opioid consumption in children undergoing herniorrhaphy. Methods: In this retrospective study, medical records were analysed before and after the pre-emptive analgesia regimen was introduced. Demographic data, perioperative drug consumption and discharge time were recorded. In the first group, no pre-emptive analgesia (NA; year, 2011; n=60) was given and in the second group, the pre-emptive analgesia (PA) paracetamol 10-15 mg kg(-1) was given intravenously in the surgical ward at least 1 h before the surgical procedure (year 2013; n=60). Postoperative pain determining supplemental pain medications was scored using a Faces Pain Scale or visual analogue scale. Total paracetamol and opioid consumption during 24 perioperative hours was registered for all patients. The statistical analysis was performed using t test and Chi-square test. Results: The mean age of children was 69.6 +/- 49.9 and 58.7 +/- 32.4 months (p=0.157), and the mean body mass index (BMI) was 18.3 +/- 8.8 kg m(-2) and 16.4 +/- 3.7 kg m(-2) (p=0.125) in the NA and PA groups, respectively. Total paracetamol consumption was 1157.8 +/- 908.8 mg vs. 983.0 +/- 536.4 mg (p=0.202), and the total opioid consumption was 5.8 +/- 4.7 in the NA group and 7.0 +/- 4.6 morphine equivalents in the PA group (p=0.160). No differences in the discharge time between the groups were observed (2.1 +/- 0.3 vs. 2.0 +/- 0.3 days, p=0.13). Conclusion: PA was proven to be efficient in the terms of postoperative pain control but did not reduce the overall analgesic drug consumption in the children undergoing elective herniorrhaphy. Multimodal pain treatment may decrease the consumption of analgesic drugs.

The postoperative care unit at the Department of Urology has significantly improved treatment of patients undergoing surgical procedures and reduced admission of urologic patients to the Intensive Care Unit (ICU). We examined the characteristics of...