Background and Objectives: The moment of birth represents a complex physiological process that is followed by adaptive changes in the vital systems of the newborn. Such reactions have their positive but also negative effects. The aim of this research was to determine the difference in laboratory values of stress indicators in newborn children delivered by cesarean section (CS) with general and spinal anesthesia. We attempted to make a recommendation about the optimal type of anesthesia based on our results. Materials and Methods: The study was performed on 150 healthy term newborns delivered by urgent or planned CS. Samples for adrenocorticotropic hormone (ACTH), cortisol, triglycerides, and interleukin-6 (IL-6) were analyzed. Results: Leukocyte numbers, triglycerides, and blood sugar values were normal for the newborns’ age, with statistically significantly lower values of blood sugar and triglycerides in newborns delivered by CS in spinal anesthesia (p < 0.005) compared to general anesthesia. There were no significant differences in ACTH, cortisol, and IL-6 levels between those newborns delivered via CS after spinal or general anesthesia. Conclusions: In cases where vaginal delivery is not possible, when CS is indicated, the use of well-controlled spinal anesthesia is followed by lower degrees of metabolic, inflammatory, and stress responses and better vitality of the baby upon birth.

Introduction. Dexmedetomidine is a potent and highly selective ?2-adrenergic agonist. Its sedative effects are mediated through the inhibition of neuronal activity in the locus coeruleus, which is rich in ?2A-adrenergic receptors. In pediatric patients, sedation or general anesthesia is often required for certain diagnostic procedures, such as magnetic resonance imaging, due to limited cooperation in children under six years of age and the intense noise during scanning, ensuring patient tolerance and procedural success. Case Report. We present the case of a five-yearold boy referred for magnetic resonance imaging due to headaches and dizziness. Premedication was administered intramuscularly 30 minutes before the procedure, consisting of atropine (0.0125 mg/kg) and midazolam (0.1 mg/kg). Simultaneously, an initial intravenous bolus of dexmedetomidine (2 ?g/kg) was infused over 15 minutes. The child was then transferred to the magnetic resonance imaging room, where sedation was maintained with a continuous intravenous infusion of dexmedetomidine at 0.25 ?g/kg/h via an infusion pump, without additional anesthetic agents or bolus doses. No adverse effects, including bradycardia, respiratory disturbances, or desaturation were observed. Conclusion. Despite the use of a subminimal continuous dexmedetomidine dose compared to recommended dosing regimens, an adequate depth of sedation was achieved, allowing for high-quality magnetic resonance imaging without complications.

Background: Laparoscopic appendectomy offers several advantages over open surgery, including shorter recovery time and less postoperative pain. However, it also poses some risks due to the creation of pneumoperitoneum. Understanding and mitigating this risk through the use of appropriate anaesthetic agents, antioxidant therapy, and optimised surgical techniques can improve patient outcomes. This study aimed to determine which of the two anaesthetics, propofol or sevoflurane, provides better suppression of oxidative, inflammatory and metabolic responses in children undergoing laparoscopic or conventional appendectomy. Methods: This randomised, clinical control trial enrolled 120 children aged 7 to 17 years with a diagnosis of acute appendicitis. Key parameters, including blood glucose, white blood cells, IL-6, oxidative stress markers, lactate, pH, and mean arterial pressure, were analysed. Results: A statistically significant change in lactate and mean arterial pressure values was observed over time in all four study groups. However, neither the type of surgical procedure nor the type of anaesthesia significantly influenced glucose, white blood cells or thiobarbituric acid levels. The postoperative values of IL-6 were lower in patients treated with balanced anaesthesia. Conclusions: Our study demonstrated that the type of anaesthesia affects hemodynamic changes, which are closely related to the occurrence of reperfusion injury. Although markers of tissue hypoxia and acidosis were elevated during laparoscopic surgery, their values quickly normalised in the immediate postoperative period.

Introduction. Gastrointestinal endoscopic procedures are increasingly performed in pediatric populations; however, data on postprocedural pain and its determinants remain limited. Adequate sedation and effective pain management are essential for ensuring patient comfort and optimizing procedural outcomes. This study is aimed to evaluate intensity of postprocedural pain following gastrointestinal endoscopic procedures in children and to identify factors associated with increased pain perception. Material and Methods. This prospective clinical study included pediatric patients undergoing elective endoscopic procedures at the Pediatric Clinic in Novi Sad between May and July 2025. Pain intensity was assesses 30 minutes after the procedure using age-appropriate validated scales: the Numerical Rating Scale for children aged ≥9 years, the Wong-Baker Faces Pain Rating Scale, and the Face, Legs, Activity, Cry, Consolability scale for younger children. Patient demographics, procedural characteristics (type and duration), and overall satisfaction were analyzed. Statistical analysis was performed using SPSS version 23. Results. A total of 39 patients were included (16 boys and 23 girls). The most frequently performed procedure was combined esophagogastroduodenoscopy and colonoscopy (61.5%). The mean pain score was 2.69 (SD = 1.73), ranging from 0 to 6. Female patients reported higher pain scores (mean = 3.08) compared to males (mean = 2.12), with the difference approaching statistical significance (p = 0.086). No statistically significant associations were observed between pain intensity and age, type or duration of the procedure, or prior endoscopic experience. The mean satisfaction score was 4.64 (SD = 0.58), with significantly higher satisfaction reported among younger patients (p = 0.03). Conclusion. Identification of individual risk factors for postprocedural pain may facilitate optimization of sedation protocols and support more patient-centered approach in pediatric endoscopy.

Introduction: Idiopathic adolescent scoliosis (IAS) is commonly managed non-surgically; however, patients with a Cobb angle >45° before skeletal maturity often require posterior spinal fusion. Because this procedure carries a risk of neurological complications, intraoperative neurophysiological monitoring (IONM) is essential for early detection of spinal cord compromise. Case report: We present a 13-year-old girl with rapidly progressing scoliosis (Cobb angle 78°) who developed intraoperative changes in motor evoked potentials (MEPs) during posterior fusion from L4 to Th2. Total intravenous anesthesia without muscle relaxants was used, and standard multimodal IONM with somatosensory evoked potentials (SSEPs), MEPs, and spontaneous/triggered electromyography was applied. After induction of general anesthesia and surgical exposure, pedicle preparation at Th8–Th9 was followed by increased bleeding from the vertebral bodies and an abrupt loss of MEPs in both lower limbs, most prominently in the tibialis anterior muscles, whilst SSEPs remained unchanged. Intraoperative radiography confirmed correct screw placement, and anesthetic variables were reassessed with no reversible cause identified. Because MEPs remained absent, a wake-up test was performed and demonstrated intact voluntary movement, allowing the surgery to continue. By the end of the procedure, MEPs recovered fully on the left side and partially on the right. The patient awoke without any postoperative motor deficit. Conclusion: It is well known that motor responses can show variability during surgery, including a gradual decrease due to prolonged anesthesia. After excluding anesthetic and mechanical factors, one of the hypothetical explanations for the transient MEP loss was temporary venous congestion and retrograde flow within the intravertebral and epidural/intraspinal venous networks, resulting in reversible spinal cord drainage impairment. Another hypothetical possibility was transient vasospasm from surgical manipulation without direct neural or vascular injury. This case highlights the critical role of continuous multimodal neuromonitoring in detecting reversible spinal cord dysfunction and guiding safe decision-making during complex scoliosis surgery.

Introduction. During pregnancy, approximately 1-2% of patients undergo non-obstetric surgical interventions. Pregnant women are considered at increased risk in the perioperative period, due to anatomical and physiological changes that occur during gravidity. Anatomical and physiological changes. Changes in the respiratory tract are especially pronounced towards the end of pregnancy. These changes include swelling of the oropharyngeal tissues and reduced caliber of the glottis, which can lead to difficulty during ventilation and intubation. Perioperative anesthesiological considerations. Carefully titrating anesthetics is essential, as drug requirements are usually reduced during pregnancy. Medications and toxicity. Drugs administered during pregnancy may have a harmful effect on the fetus depending on dosage, method of administration and time of exposure. Despite years of animal experiments and observational studies in humans, no anesthetic has been shown to be clearly dangerous to the human fetus. Fetal monitoring. Accurate interpretation of fetal heart rate patterns and understanding of the effects of anesthetics enable effective monitoring of fetal well-being and informed decision-making regarding intraoperative care for the safety of both mother and fetus. Non-obstetric surgical conditions. Appendicitis and cholecystitis are the two most common surgical conditions that require treatment during pregnancy. Other more common conditions are chronic inflammatory bowel diseases and pancreatitis. Traumatic injuries of pregnant patients are a special topic. Conclusion. Comprehensive preoperative preparation should performed before every surgical intervention. Pregnant women should never be denied an emergency indicated surgical procedure, regardless of the current trimester of pregnancy.