1. Course objectives

The immune system includes specific and non-specific immunity. The inherited immune response is a nonspecific immune defense present at birth. It is the first line of defense and refers to the protective mechanisms that are present even before the infection. Its main components are epithelial membranes (which block pathogenic inputs), phagocytic cells (neutrophils and macrophages), dendritic cells, killer (NK) cells, and several plasma proteins, including the complement system. The most important cellular reaction of innate immunity is inflammation - a process mediated by dendritic and NK cells, whereby phagocytic cells are recruited and activated to remove the intruder. Adaptive immunity, also called specific or acquired immunity, consists of mechanisms that have been created by recognizing specific pathogen antigens. The specific immune system is mediated primarily by lymphocytes and its function can be classified into two types: humoral immunity, mediated by B lymphocytes and their antibodies and cellular immunity, mediated mainly by T lymphocytes and their cytokines, which play an important role in immune cell activation, regulation and communication. Local anesthetics are substances which by reversible effect prevent the membrane depolarization by blocking the flow of sodium (Na +) ions while not influencing too much potassium (K +) ions. Therefore, the longer the frequency of stimulation, the greater the possibility of binding local anesthetic to the ion channel inside and its inactivation. They affect all the tissues but have a special affinity for nervous tissue. In order to understand well the effects of local anesthetics’ metabolic activity, we will clarify their pharmacodynamic and pharmacokinetic activity. We will try to explain how local anesthetics (intravenous, topical, infiltrative, regional) affect the number and activity of immune cells (NK cells, T lymphocytes, leukocytes, etc.) in the body. The aim is also to investigate the effect of local anesthetics on neurotransmitters and other systemic opioid and neopioid analgesics.

• General competencies :. 
  To know  general principles of local anesthetics on cellular and humoral immune response
• Specific competencies:

At the end of the course, the student is expected to be able to: independently analyze the effect of local anesthetics on the immune response, to see ways in which local anesthetics can be applied, and the influence of local anesthetics on individual organic systems To develop students' self-expanding knowledge through a database search (PubMed and Ovid) and the otheraddresses on the Internet, and for transferring new knowledge to other members of the group (presentation of the treated area). Encourage studentsto group work, discussion about the given topicand to draw conclusions based on presented facts.

Course content ;

• Local anesthetics and clinical pharmacology
• Types of local anesthetics
• The effect of local anesthetics on signal transmission
• Local anesthetic application methods
• The influence of the technique of application at the plasma concentration of local anesthetics
• Non-pharmacological factors that affect the activity of local anesthetics
• Changes in innate immunity caused by local anesthetics
• Changes in acquired immunity caused by local anesthetics
• The effect of local anesthetics on the immune system in various pathological conditions
• Influence of inflammatory tissue on the action of local anesthetics
• Side effects of local anesthetics

Student’s obligations :

Regular attendance to lectures and seminars and exercises. Preparation of course material to be discussed during seminars

Assessment  and evaluation of student’s work during classes and on final exam:

 Evaluation will be performed according to the Legal act of evaluation of University of Rijeka and of School of medicine.

Students' performance will be evaluated thorugh entire duration of the course ( 70% of the evaluation) as well as on the final exam ( 30% of the evaluation).

Literature:

1. Abbas Abul K., Lichtman Andrew H., Pillai S. Stanična i molekularna imunologija (skupina prevoditelja, ur. hrv. izdanja prof. dr. sc. Drago Batinić i doc. dr. sc. Vesna Lukinović-Škudar). 8. Izdanje, Medicinska naklada Zagreb 2017.

2. Andreis i suradnici. Imunologija, Medicinska naklada, Zagreb, 2010.

3. B. Katzung: Bazična i klinička farmakologija, 11. izdanje, McGraw Hill, New York, 2011.

4. Jukić M, Husedžinović I, Kvolik S, Kogler Majerić V, Perić M, Žunić J. Klinička anesteziologija. Medicinska naklada Zagreb, drugo, dopunjeno i izmjenjeno izdanje, Zagreb, 2013.

5. Medicinska fiziologija, A. C. Guyton i J. E. Hall, Medicinska naklada Zagreb, trinaesto izdanje, 2017. 

6. Delves PJ. Martin SJ, Burton DR, Roitt IM, Roitt's Essential Immunology, 13th edition. Wiley-Blackwell, 2017.

7. Murphy K., Weaver C. Janeway's Immunobiology, 9th edition. New York: Garland Publishing; 2016.

8. Rang HP, Dale MM, Ritter JM, Moore PK. FARMAKOLOGIJA, 5.izdanje,Churchill   Livingstone, London, 2003.

9. Hadzic A, Carrera A,editors.Hadzic's  peripheral nerve blocks and anatomy for  ultrasound – guided regional anesthesia. 2^nd ed. New York: McGraw – Hill,2012.

All content not covered by mandatory literature will be published on the course website.