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    IATROGENIC HYPERNATREMIA AFTER HYPERTONIC SALINE IRRIGATION OF SPLENIC HYDATID CYST –
    (Department of Anaesthesia and Reanimation Faculty of Medicine, “Ss. Cyril and Methodius” University, Skopje, R.N.Macedonia, 2020-10)
    Michunivikj Derebanova Lj
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    Leshi A
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    Jovchevski L
    Pediatric hypernatremia is a rare electrolyte abnormality. However, it can be a complication of hypertonic saline irrigation in hydatid disease. In our case report, we present a ten-year-old boy with splenic hydatid cyst who received operation treatment and developed electrolyte disturbances. Our aim is to emphasize the potential dangers of the use of hypertonic saline and the appropriate management of hypernatremia.
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    NOVEL INDICATION FOR ATORVASTATIN: CHRONIC SUBDURAL HEMATOMA
    (“Ss. Cyril and Methodius” University, Skopje, R.N.Macedonia, Department of Anaes thesia and Reanimation Faculty of Medicine, 2019-05)
    Angjushev D
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    Kotevska-Angjushev M
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    Leshi A
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    EPINEPHRINE AND DEXAMETHASONE AS ADJUVANS IN SUPRACLAVICULAR BLOCK IN PEDIATRIC PATIENTS: A CASE SERIES
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University Skopje, R.N.Macedonia, 2021-06)
    Mikjunovikj Derebanova Lj
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    Leshi A
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    Toleska M
    Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax, but they are considered to be one of the most effective anesthetic procedures for upper extremity surgeries. Ultrasound-guided approaches increase efficacy of blocks and may reduce the risk of complications associated with injection of large volumes of local anesthetic. Adjuvants are often used with local anesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anesthetics. This paper reports three cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery while applying different adjuvants (epinephrine and dexamethasone).
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    CARDIAC ARREST IN THE EARLY POSTOPERATIVE PERIOD
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University Skopje, R.N.Macedonia, 2021-03)
    Burmuzoska M
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    Toleska M
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    Leshi A
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    Grncharevski M
    In-hospital cardiac arrest (IHCA) is determined as acute circulatory loss which requires fast resuscitation with chest compressions and/or defibrillation. Despite that it is a common condition, little research is done in this area, and many data are extracted from out-hospital cardiac arrest guidelines and researches. Perioperative cardiac arrest patients are a subclass of surgical patients who need CPR on the day of surgery. In this article, through a case report about successful reanimation, the in-hospital and perioperative cardiac arrest characteristics are discussed. A young female patient presented with cardiac arrest, 30 minutes after arriving in PACU and acute pulmonary embolism was the most suspected cause of the arrest. She was reanimated for around 30 minutes and she recovered without any neurological impairment. Perioperative cardiac arrest must be distinguished from other cardiac arrests and ACLS guidelines should be targeted according to particular situations. These patients require rapid evaluation and quick management, because usually there is a potentially reversible cause. As quickly as the cause is identified, as much the chances of ROSC are bigger
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    ADDUCTOR POLLICIS MUSCLE THICKNESS MEASUREMENT – A RELIABLE METHOD FOR NUTRITIONAL STATUS ASSESSMENT IN CRITICALLY ILL PATIENTS
    (Department of Anesthesia and reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje Macedonia, 2017-11)
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    Nikolova-Todorova Z
    Introduction: Malnutrition in hospital patients is a worldwide problem which leads to increased morbidity and mortality rate. Nutritional assessment carried out immediately after admission of the patient allows to make a plan to start nutritional therapy in order to improve nutritional status and minimize the risk of complications. Among the different methods for nutritional assessment a new technique that enables a measurement of the thickness of adductor pollicis muscle has become popular in the last years. The objective of this study was to determine the validity of the measurement of the thickness of adductor pollicis muscle in correlation to other anthropometric measurements for nutritional status assessment in critically ill patients. Material and Methods: The pilot study included 24 patients treated at the Clinic for Anesthesiology, Reanimation and Intensive Care in the period from April to June 2017. The inclusion criteria were age older than 18 years and hemodynamically stable patients. Exclusion criteria were: pregnancy, current injury or deteriorated mobility from a previous injury, upper limb fracture in the last six months, and degenerative disease. The nutritional status was followed by: Weight and height, Body Mass Index, Mid Arm circumference, Triceps skinfold thickness, Mid Arm Muscle Circumference, Calf circumference, the thickness of Adductor pollicis muscle (TAPM) and Subjective Global Assessment. Results: The mean TAPM measured in mm was 16, 67±2,16 in male and 13,00±1,73 in female patients for dominant hand, and 15,24±2,11 in male and 11,70± 2,54 in female for non-dominant hand. The mean TAPM in patients younger than 45 years was the highest for both the dominant (17, 11±2,47) and the non-dominant hand (15,67 ±2,55). The smallest mean TAPMhand (14,47 ± 2,67). According to the subjective global assessment the mean TAPM was highest in well-nourished patients (16.93 ± 2.16) and smallest in patients with severe malnutrition (12.50 ± 2.56). The correlation between the TAPM and other anthropometric measures showed significance only with Mid Arm Muscle Circumference (p = 0.003) and Calf circumference (p = 0.046) for the dominant hand and with Mid Arm circumference (p = 0.017), Mid Arm Muscle Circumference (p = 0.002) and Calf circumference (p = 0.009) for the non-dominant hand. Conclusion: The measurement of the thickness of adductor pollicis muscle presents a reliable method for nutritional status assessment and it correlates to the other anthropometric measurements used in clinical practice in critically ill patients.