Faculty of Medicine

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    SPINAL ANESTHESIA IN PARTURIENT WITH SEVERELY SCOLIOTIC SPINE
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2018-12)
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    Ivanov, Emilija
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    Veninov, Filip
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    Spasovski, Sasho
    The choice of anesthesia in parturients with severe scoliosis undergoing an elective cesarean section (C-section) is associated with potential risks for both mother and fetus and presents a challenge for the anesthesiologist when considering the type of anesthesia that should be used. Alterations in the maternal physiology and potential perioperative complications associated with this comorbidity can cause difficulties when both general and spinal anesthesia are used. After reviewing all risk factors associated with both types of anesthesia, we consider that a single shot spinal anesthesia can be a successful type of anesthesia in severely scoliotic individuals, especially in those with pulmonary compromise. Here we present a successful case of parturient undergoing а spinal anesthesia for C-section performed at the University Hospital for Genecology in Skopje.
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    Epidural Anesthesia for Caesarean Section and Occurrence of Horner’s Syndrome
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2017-06-01)
    Spasovski, Sasho
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    Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.
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    Intravenous Remifentanil for Labor Analgesia - A Review
    (Medical Faculty Ss. Cyril and Methodius University in Skopje, 2016)
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    Ivanov, Emilija
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    In modern obstetrics there has been a need for safe, efficient, and easy-to-use systemic analgesia with a rapid and short onset, and without an effect on either mother or fetus. Although epidural analgesia remains the gold standard for labor analgesia, opioids applied intravenously can be very useful in cases when epidural analgesia is contraindicated, refused by the patient, or in the absence of skilled anesthesiologist. Closest to the ideal for systemic analgesia is remifentanil, a potent, ultra short-acting μ-1 agonist, which is rapidly metabolized in both mother and fetus. This article, through a literature review, will present the efficacy of remifentanil, its pharmacokinetics, the most effective dose, the safety for both mother and fetus and satisfaction for the mother. The results available show that remifentanil can be quite a satisfactory alternative to neuroaxial analgesia, hence taking its deserved place in modern obstetrics. A low number of reported side effects from mother and child are enough to open a field for future research.