Faculty of Medicine

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    COMPARISON OF THE EFFECTS OF DESFLURANE AND SEVOFLURANE IN AWAKENING AND COGNITIVE FUNCTION AFTER A GENERAL ANESTHESIA
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024)
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    Leshi, Albert
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    Angjusev, Darko
    Introduction: The pharmacokinetics of desflurane and sevoflurane favour improved intraoperative control of anaesthesia and led to faster postoperative recovery. These anaesthetics have a lower blood/gas coefficient than isoflurane and halothane. (1) The low fat/gas coefficient and low brain/blood coefficient of desflurane lead to faster elimination of and faster awakening from anaesthesia. This leads to a quicker return of cognitive functions and speedier discharge from the Post Anaesthesia Care Unit (PACU). Objectives The purpose of this study is to compare the emergence time and time of return of cognitive functions in patients with general inhalation anaesthesia (general anaesthesia) maintained with inhalant anaesthetics desflurane and sevoflurane, respectively, under standardized conditions. Material and methods: This study included ASA I and II patients undergoing colorectal abdominal surgery who were randomly assigned into two groups: the first group received the inhalation anaesthetic desflurane in combination with the analgesic remifentanil for anaesthesia maintenance, while the second group was kept under using sevoflurane in combination with fentanyl. We used standard hemodynamic monitoring, the Train of Four (TOF) and the Bispectral Index System (BIS) to determine the depth of the anaesthesia. We recorded the time required for extubation, the opening of the eyes, verbal response, the modified Aldrete score of 9, the Mini Mental State Examination (ММSE) of 25 and the Short Orientation-Memory-Concentration Test (OMCT). Results: The results, expressed in minutes and obtained in both patient groups, demonstrate a significantly shorter time for regaining cognitive functions in the patients who received a desflurane inhalation anaesthetic with remifentanil compared to the patients who received a sevoflurane inhalation anaesthetic with fentanyl. This is thought to be due to the faster pharmacokinetic profile of desflurane, leading to an accelerated elimination in the patients. Desflurane, in combination with remifentanil, a short-acting opioid, further shortens the recovery time of cognitive functions. Conclusion: This study underscores that the time required for early recovery from anaesthesia is markedly shorter in patients receiving desflurane compared with patients given sevoflurane when administering general anaesthesia. This finding emphasizes the potential benefits of desflurane in optimizing perioperative outcomes, including faster emergence from anaesthesia and cognitive recovery.
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    SLEEP PROBLEMS AMONG PATIENTS ON METHADONE MAINTENANCE TREATMENT
    (Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2022-12-20)
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    Elizabet Miceva Velichkoska
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    Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Subjective sleep complaints occur in 75-84% of methadone-maintained patients, and more than 50% of methadone-maintained patients reported use of medications to improve their sleep cycle. Studies of insomnia support a female predominance. The Aim of this study was to evaluate insomnia and gender differences in insomnia among methadone-maintained patients in the Department for prevention and treatment of drug abuse and dependence, Psychiatric Hospital Skopje. This was a cross-sectional study. Two groups of methadone-maintained patients were included: 73 males and 14 females. Participants were evaluated with Bergen Insomnia Scale (BIS), and Insomnia Severity Index. The evaluation of subjects with BIS showed that 87.3% of subjects reported some sleep problems. There were significant differences between the groups related to item 3 on BIS with higher mean score for females. The total score for the Insomnia Severity Index scale showed that a larger number of females than males had moderate and severe insomnia. More females than males reported use of medications (90.5% used benzodiazepine), to help them with their sleep problems. Last month 36.8% of subjects used some substances and in 75% of cases it was alcohol, cannabis or both. This study provided evidence that sleep disturbance and use of alcohol, cannabis, and benzodiazepines was highly prevalent among methadone-maintained patients. Female patients reported a significantly worse sleep cycle than males. Use/abuse of benzodiazepines in methadone-maintained patients does not resolve the problem of insomnia.
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    Unintentional Opioid Overdoses Treated at University Clinic of Toxicology-Skopje in a Nine-Year-Period
    (Faculty of Medicine, Hradec Králové Charles University, 2021-07-30)
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    Background: The aim of this study was to assess the epidemiological profile of unintentional opioid overdoses, the prevalence and number of psychotropic substances involved in opioid overdoses. Methods: This was a descriptive study, in which 180 participants were enrolled, and covered a nine-years-period. For collecting data was used the National patient electronic system “My term”. The variables as gender, age, duration of opioid dependence, number of overdoses, type of substance, number of antidote ampoules, duration of hospitalization were analyzed. Severity of poisoning was made by using the Poison severity score. Results: Opioid overdose cases were significantly higher among males than females. Mean age with standard deviation (SD) was 32.23 ± 6.71 years. Mean years (±SD) of duration of opioid use disorder was 11.60 ± 5.89 years. The most commonly used primary substance was methadone in 68.89% and heroin in 31.11% cases. Twenty patients were treated with mechanical ventilation because of the severe respiratory depression. Poison severity score was moderate in 51.11%, severe in 45.56% and fatal in 3.33% of the cases. Conclusion: Most of the cases, predominantly males used one or two substances. The combination of methadone and benzodiazepine was most frequently used and the most common way was by injecting the abused substances. In most of the subjects PSS score was moderate and severe with no differences between genders.