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Papers by Nikola Boskovski

Local anaesthetic agents belong to a surprisingly homogenous family of drugs that are able tempor... more Local anaesthetic agents belong to a surprisingly homogenous family of drugs that are able temporarily to interrupt impulse trnasmission along nerves in a relatively predictable and reuersible manner. During the past hundred years, more efficacious, safer, and uaried types of local anaesthetic agents haue been developed. Since the mechanisms by which these drugs block impulse conduction are becoming better understood, many responses to nerue block can be readily explained in physiologic terms 4 • Such basic understanding is important to the clinician, especially when complications arise or his block is only partly successful. The purpose of this paper is to summarize current knowledge regarding the areas of drug deuelopment, basic mechanism of local anaesthesia, clinical pharmacology of local anaesthetic drugs, and comparatiue effects of regional and general anaesthesia. It is emphasized that the bibliography is not a complete list of the vast literature but merely intends to list major reviews on the subject. Key Words slow releasing anaesthetic preparation. lt has been Local anaesthetics shown that dextran could extend the duration of Current trends conventional local anaesthetics by a few hours although conflicting data exist. 3 '4 Areas of Drug Development There is no doubt that the local anaesthetic drugs currently available are highly effective for the majority of surgical and obstetrical procedures in which regional anaesthesia is .indicated.

T en critically-ill patients with prolonged hypotension or unrecordable systolic blood-pressure, ... more T en critically-ill patients with prolonged hypotension or unrecordable systolic blood-pressure, impaired mental status and respiratory depression (n this study. Naloxone, 0.8-1.2 mg was injected intravenously in all patients. in six hypotensive patients, systolic blood-pressure rose in range of 26-35%, within 5-15 minutes following the naloxone injection. lnfour patients systolic blood-pressure was unrecordable .and after naloxone injection rose to a value of 100-120 mm Hg. Naloxone was effective in three patients in which dopamine could not maintain the systolic blood-pressure at optimal renal perfusion level. lt seems that naloxone had a lesser effect in three patients treated with high doses of corticosteroids. The therapeutic effect of naloxone is suggested on the assumption that endorphins are mainly responsible for the hypotension and respiratory depression in critically-ill patients.

Association of Anaesthesiologists in Malta, Nov 1, 1983

Regional Anesthesia & Pain Medicine, 1984

The effects of epidural versus general anesthesia on perioperative renal excretory function were ... more The effects of epidural versus general anesthesia on perioperative renal excretory function were studied in two comparable groups of 30 patients each. Epidural anesthesia was associated with significantly greater water and electrolyte excretion, which could be beneficial in preventing early postoperative complications associated with overhydration.

In the Maltese Islands there is a fear of T etanus as its fatality has been as high as 55% (Stati... more In the Maltese Islands there is a fear of T etanus as its fatality has been as high as 55% (Statistics 1966). This was well before the Intensive ward was opened i.e. five years ago. All cases of supsected T etanus are immediately refered to St Luke's Hospital: the Islands' main hospital. The total number of cases admitted during this five year study was 37 but T etanus spores or bacilli were only isolated in 26. None of these cases had ever had T etanus T oxoid Injection though 4 had had Tetanus Serum (ATS). Out of these 37 cases there were 8 deaths less than 20%.

Intravenous administration of narcotic analgesic drugs provides effective pain relief in patients... more Intravenous administration of narcotic analgesic drugs provides effective pain relief in patients with Qcute myocardial infarction. Thalamonal, a premix of 50: 1 droperidol and fentanyl, was given intravenously in dose of 2 ml. to 20 patients with acute myocardial infaction. Effective pain relief, haemodynamic stability and low incidence of cardiac dysrhythmias were noticed in the patients studies.

Journal of Clinical Anesthesia, 1991

Anesthetic experience with three cases of the resection of glucagonoma, a rare tumor of alpha cel... more Anesthetic experience with three cases of the resection of glucagonoma, a rare tumor of alpha cells of pancreatic islets, is presented. Marked increases of blood glucagon and glucose levels, with the potential for clinically significant metabolic and myocardial dysfunction, did not occur during anesthesia and surgery. Associated tumors of other endocrine cell types also were absent in the three study patients. Strategies for anticipating and managing other perioperative problems associated with glucagonoma also are discussed.

Journal of Clinical Anesthesia, 1992

A 6%year-old white female presented for cornea1 transplant, but her numerous medica, problems pla... more A 6%year-old white female presented for cornea1 transplant, but her numerous medica, problems placed her at unacceptably high risk for prolonged general anesthesia. Routine monitored anesthesia care measures would not have provided her or the surgeon the comfort and repose necessary ,for a successful outcome. We describe anesthetic management for ophthalmic surgery, using epidural anesthesia in conjunction with retrobulbar block, in an elderly patient at high risk for general anesthesia whose intractable back and leg pain would have otherwise precluded her cooperation in maintaining a motionless operative field.

Anesthesia & Analgesia, 1989