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Neurological disorders have increasing prevalence. Patients who come for surgery and anesthesia are more common with neurological comorbidities. This comorbidity, which has significant consequences for the behavior, psychological and physical characteristics of patients, has a need for numerous medications. When meeting these patients, anesthesiologists want answers to the following questions: the duration of the disease and the degree of illness, used therapy, the quality of life, the influence of anesthetics on the disease and the effect of therapy on the performance of anesthesia, the continuation of therapy after intervention and postoperative recovery. Still there are two dilemmas, whether and when before anesthesia and surgical interventions to stop the use of drugs that allow the function of patients and what are the possible interactions of drugs with anesthesia? The most common neurological diseases with which the anesthesiologist face as comorbidities are: Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, circulatory disorders, and lately increases the likelihood of coma patients. Answering on the questions above will help a doctor to decide on the type of anesthesia and which dosage of drugs he will use. If a patient is without restrictions in work and habits, then anesthesia in this case is the same as in a person without this comorbidity. The therapy for the existing disease should be carried out until surgery or anesthesia, and should be continued immediately after surgery. Due to the significant influence of used drugs and the nature of the disease, it is necessary to use lesser doses of relaxants, opioids and sedatives. The use of regional anesthesia has its place, and it is used when the degree of illness is such that it allows the patient to cooperate.

Critically ill patients during the treatment in the intensive care units (ICU) are exposed to various interventions and stressors from the environment that represent a significant source of discomfort. Sedative and analgesic medications are commonly administered to provide comfort and improve tolerance of ICU management. It has been recognized that pain and delirium, coupled with oversedation, are associated with increased morbidity and mortality if not properly addressed. Routine monitoring with reliable tools enables early detection of agitation and pain, thus avoiding excessive sedation and harsh consequences of delirium. Individual approach implies selection of medications that meet patient's needs while taking into account the presence of organ dysfunctions that may influence drug metabolism and predispose a patient to severe side effects of sedation. The current evidence reveals that a deep sedation should always be avoided as long as there is no mandatory clinical indication. The newest guidelines also suggest the use of non-benzodiazepine (either propofol or dexmedetomidine) sedation whenever feasible to improve clinical outcomes in mechanically ventilated patients. Aside from specific situations (increased intracranial pressure, the administration of muscle relaxants, seizures) the required goal should be an alert, cooperative patient who can tolerate necessary interventions in the ICU. It has been demonstrated that daily interruption of sedation and sleep promotion are beneficial in decreasing the duration of mechanical ventilation and decreasing the incidence of cognitive impairments. Further studies are needed to elucidate the association of non-pharmacological interventions with long-term psychological outcomes.

Introduction: Chronic pain in the abdomen occurs as a consequence of malignancy in these parts of the body, surgical, of radiological and chemotherapy treatments. It may also be as a result of relapse of the basic process. Non-invasive therapy of oral and transdermal analgesic was successful for some time, where necessary applies and epidural catheter. Case Report: The patient had a diagnosis of chronic postoperative pain malignant etiology. He is already used transdermal fentanyl and Nonsteroidal Anti-Inflammatory Drugs, but without success (VAS score 8-10). We increased doses of analgesics, but without success. In order of pain therapy, peridural catheter placed in the level L3 - L4. 5 ml of a solution of 8 ml of 0.25% bupivacaine, 2 ml (100 micrograms) of fentanyl and 10 ml of saline was administered every 6 hours through epidural catheter. The former chronic non-invasive treatment of pain did not stop. The first three to five days of pain relief was quite satisfactory in this way. Then the pain intensified but the peridural catheter had to be removed due to local infection. New peridural catheter was placed in the level L2 -L3. Then, 5 ml of the solution: of 8 ml 0,25% bupivacaine, 2 ml (100 micrograms) of fentanyl and 10 ml of saline is administered through peridural catheter. Peridural catheter was total used for 45 days. We had a need for more and more frequently administering analgesics through a catheter during use. The patient was using transdermal fentanyl and Nonsteroidal Anti-Inflammatory Drugs, all the time. The patient soon died due to progression of the underlying disease. Conclusion: After long-term administration of opioids, it is necessary to change the type and route of administration of the drug to achieve the success of the therapy. In this case it was the use of analgesics and local anesthetics through the peridural catheter.

Nutritional support of surgical patients is a necessary part of the treatment. It alone cannot cure the disease but it significantly affects the recovery of patients and supports surgical interventions. Patients in malnutrition have shown to have significantly more postoperative infectious and non-infectious complications. This significantly prolongs treatment time and increases costs. However, there is one fact that cannot be expressed in money, which is the patient's impression of the surgical intervention. Adequate preoperative patient support, based on the intake of liquid nutritive solutions, reduces preoperative stress and deflects the metabolic response. Now, it is recommended for adults and children older than one year to drink clear liquid up to 2 hours before induction in anesthesia. Appropriate enteral nutrition has a significant place in the postoperative recovery of patients. Enteral nutrition is reducing complications, mainly infectious complications because the function of the digestive system as one large immune system is preserved. Perioperative enteral nutrition is a necessary part of the modern treatment of surgical patients. In addition to the significant effect on the occurrence of postoperative complications, it is also important that this type of diet improves the psychological status of patients.

Introduction: Chronic pain in the shoulder and the shoulder joint is a very common pathology in modern human population. The etiology of chronic pain is often unknown, although the trauma, degenerative diseases, inflammation, tumors and neurological disease appear as common etiologic factors. Patients with this pain had a significantly reduced quality of life.1,2 Method: During the two years, twelve patients diagnosed painful shoulder syndrome. Eleven of the twelve patients involved in the study had started physical therapy. Under the physical treatment pain intensity decreased, but not completely. Hand had reduced mobility. We applied a suprascapular block. We used 1 ml (7 mg) betamethasone. Results: Suprascapular block was applied to the eleven patients in physical therapy. After three days of application, the pain was significantly reduced, by 50% in seven patients. Mobility of the hand was greatly improved. In three of the remaining four patients the block was repeated after one month. The pain was significantly smaller after that. Physical therapy is done all the time. Conclusion: The treatment of chronic pain in the shoulder and the shoulder joint is multidisciplinary. In some cases, the use of corticosteroids suprascapular block is very useful.