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    ANESTHETIC MANAGEMENT FOR PATIENT WITH TRACHER COLLINS SYNDROME SCHEDULED FOR ELECTIVE CESAREAN DELIVERY
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2018-12)
    Zlatkova, Milica
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    Ivanov, Emilija
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    Popovska, Rusanka
    Tracher Collins Syndrome is an autosomal dominant genetic disorder, as a result from mutation in TCOF1 gene. Other names for Treacher Collins Syndrome include Franceschetti- Zwalen-Klein syndrome, mandibulofacial dysostosis (MFD), zygo-auro-mandibular dysplasia and Treacher Collins Franceschetti syndrome. These changes cause deformities of the facial bones and occurrence at antimongoloid slant of the eyes, micrognathia and deformity of the ears. Complications may include breathing problems, seeing problems, cleft palate and hearing lost. Diagnosis of TCS is made through clinical evaluation, radiographic examination and molecular genetic analysis. Treatment is tailored to the specific needs of each individual by a multidisci- plinary craniofacial management team. We report a case of TCS with second twin pregnancy achieved with IVF. The first pregnancy ended with c-section (and death of the newborn after 23 days of delivery due to dysmorphia – TCS on the fetus). The patient was hospitalized at our clinic for evaluation and ending of pregnancy with elective section cesarean. The patient was managed successfully under regional anesthesia which is generally preferred technique to general anesthesia, in order to avoid potential complications associated to difficult airway management. The patient was left home on the fifth postoperative day with her two healthy children.
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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.
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    Influence of Spinal and General Anesthesia on Newborn’s Status
    (Македонско лекарско друштво / Walter de Gruyter GmbH, 2015-06-01)
    Ivanov, Emilija
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    Nikolovski, Sotir
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    Curlinov, Kiro
    The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied . Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.</jats:p><jats:p>Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.</jats:p><jats:p>Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO<jats:sub>2</jats:sub>and BE) did not affect the newborns’ Apgar score in the first and fifth minute.</jats:p>