Faculty of Medicine

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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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    ANKLE BLOCK AN ALTERNATIVE OF ANESTHETIC MANAGEMENT OF MYASTHENIA GRAVIS (CASE REPORT)
    (Department of Anesthesia and Reanimation, Faculty of Medicine, Ss.Cyril and Methodius University, Skopje Macedonia, 2018-12)
    Burmuzoska M
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    Myasthenia gravis (MG) is a chronic autoimmune disease characterized by a decrease in acetylcholine receptors at the neuromuscular junction, secondary to destruction or inactivation by circulating antibodies. In patients with MG, perioperative issues remain unclear, especially the use of regional anesthetic techniques, while the perioperative and postoperative complications are numerous. Preoperative evaluation is crucial for choosing the modality. CASE REPORT: A 52 years old female patient with 16 years history of myasthenia gravis was admitted for Lisfranc amputation. Preoperative examination was made, and many comorbidities were noted (Myocardial infarction with stenting, CVI, Diabetes mellitus type II, many respiratory infections). The severity was estimated by Osserman classification as type III B, a severe stadium with ptosis, respiratory dysfunction and generalized weakness. According to all preoperative evaluations, treatment regiment and in collaboration with the surgeon, it was decided to apply regional anesthesia. Ankle block was administered, with 25 ml 0.5% Bupivacaine. Good perioperative analgesia was provided. DISCUSSION AND CONCLUSION: The potential for respiratory compromise in patients with myasthenia gravis requires the anesthesiologist to be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs. When possible, regional anesthetic techniques are preferred by many anesthesiologists. Ester anesthetics, which are metabolized by cholinesterase, may present particular problems in patients taking anticholinesterases. That’s why regional and local anesthesia should be performed using reduced doses of amide (rather than ester)