In recent years, research has shown the involvement of free radicals in the development of the pain that accompanies many pathological conditions. In the treatment of acute and chronic pain, the most effective therapies are natural and synthetic opioid alkaloids. Their metabolism in itself may contribute to the formation of free radicals and thus affect body system load and the perception of pain. Long-term treatment with opioids is a tool of choice for the treatment of medium and severe pain. Opioids stimulate the effect of endogenous opioids, endorphins, by binding to multiple subtypes of opioid receptors (µ,?,s) in spinal, supraspinal and peripheral tissues. Morphine is a typical, natural opioid analgesic utilised in practice in the treatment of severe chronic pain. In addition, similar effects can be expected from semisynthetic opioids such as oxycodone and hydromorphone. However, during treatment with opioids some adverse effects can appear regardless of whether treatment is short-term or long-term. One potentially serious side effect is the induction of oxidative stress. The purpose of this present work is to determine the main sources of reactive oxygen and nitrogen in the development of infl ammatory and neuropathic pain, and the manner in which metabolism of morphine contributes to oxidative stress alone.

I experienced the case of an elderly patient with dementia who had recurrent respiratory failure due to the abuse of a transdermal fentanyl patch. Opioids have been recently used in patients with moderate-to-severe chronic non-cancer pain and in those with cancer pain in palliative care [1]. A transdermal fentanyl patch has been reported effective for the treatment of chronic cancer and non-cancer pain [2]. However, previous reports showed the life-threatening toxicity of respiratory repression from the use of a fentanyl patch. It usually occurred when the dosage or absorbed amount was excessive either by accident or design [3,4].

Recently, there has been increased interest and concern regarding the safety of anesthetics on the long-term impairment of the central nervous system (CNS). The field of anesthesia-related toxicology, therefore, has engaged multiple scientific disciplines in attempt to identify the basic characteristics of the anesthetic agents that produce harmful acute and/or chronic effects on the nervous system. Currently, the clinical relevance of anesthetic neurotoxicity is an urgent matter of public health.

This case report describes an unusual presentation and anesthesia management of a rare genetic association. The MURCS association, a variant of Mayer-Rokitansky-Küster-Hauser syndrome is a rare (1/4500-1/50,000) congenital syndrome, of unknown etiology, consisting of mullerian duct (MU) aplasia, renal (R) aplasia, and cervicothoracic somite (CS) dysplasia.

The bisphosphonate related osteonecrosis of the jaws (BRONJ) is defined as a drug-adverse reaction that involves the maxillary bones. It develops during or after a long-term bisphosphonate therapy in absence of radiotherapy [1]. The clinical pattern was described for the first time by Marx RE in 2003, who observed the development of jaws osteonecrosis in patients underwent to Multiple Myeloma and Mammary Cancer therapy [2]. Bisphosphonates (BF) pharmacokinetics consist in the osteoclast function interruption, angiogenesis inhibition, as well as blocking any cancer cell line activity together with the interruption of signal transduction [3]. In this way the bone regeneration is interrupted and osteonecrosis is more probable.

Aims: As old paracervical block using Kobak needle was abondoned developing fetal bradycardia, new safe vaginal submucosal anesthesia was tried to safely remove labor pain. Methods: Three ml local anesthetics was injected to vaginal submucosal tissue with 2 mm exposed 22G 14 cm long Cathelin needle, and 5 mm exposed needle injecting 7-10ml anesthetics to block pudendal nerve. Results: Analgetic and relaxation effects were sufficient, despite no fetal and maternal damage was experienced among 4,070 cases of anesthesia in 6,976 births. Local anesthesia was repeated if it was necessary.

The use of brain stimulation either without drugs at all or with ones that are currently obsolete for the promotion of general anesthesia [1]. Furthermore, different intensities and time durations of stimulation were reported, making it difficult to compare between studies. In the past few decades, there has been an intensive development in the techniques of neurostimulation [2], including the use for chronic pain management [3]. Although it has not been assessed for general anesthesia anymore, current data on brain stimulation suggests that low intensity electric currents may have mechanisms that could be useful as an add-on therapy in anesthesia; this supports ethical and well-designed experimental and clinical studies focusing on their anesthetic and analgesic effects.

Introduction: There are many different analgesic methods used for children undergoing inguinoscrotal surgery. Research suggests that caudal analgesia reduces the need for postoperative pain relief in these children compared with regional techniques but may increase the risk of motor block and urinary retention. This can be problematic given that these procedures are commonly performed as day cases.