Faculty of Medicine
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Item type:Publication, ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERY IN CARDIOVASCULAR COMPROMISED PATIENT(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025); ; Introduction: We can use the supraclavicular block as a postoperative pain management approach, as an addition to general anesthesia, or as the sole form of anesthesia for upper limb surgery. For upper limb surgery, this block is a fantastic substitute for general anesthesia in patients with pulmonary and cardiac comorbidities. Case Presentation: In order to undergo surgery for a fracture of the proximal portion of his upper arm, a 66-years-old male AA was brought to the Clinic for Orthopedic Diseases in Skopje. The anesthesiologic examination revealed that the patient had diabetes mellitus type II, cardiomyopathy, untreated ischemic heart disease and wheezing and crepitations in the distal portions of his lungs. We planned the open fixation of the fracture for the patient. A supraclavicular brachial plexus block was performed as the most non-invasive procedure for perioperative treatment, taking into consideration the patient’s health. The patient’s vital indicators were normal and stable during the procedure. After receiving therapy for two days, the postoperative course was uneventful, leading to the patient’s discharge. Conclusion: If not addressed earlier, preoperative pulmonary and cardiac comorbidity increases the risk of perioperative and postoperative problems. With no postoperative problems, peripheral nerve block – in our case, supraclavicular brachial plexus block – proved to be a safe option for anesthesia management used for upper limb surgery. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, REGIONAL ANESTHETIC MANAGEMENT OF A PATIENT WITH CHARCOT MARIE TOOTH DISEASE WITH HIP FRACTURE(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024); ; Todorova, TeodoraIntroduction: Charcot-Marie-Tooth disease (CMT) is a hereditary peripheral neuropathy characterized by progressive peripheral muscular atrophy and muscle-sensitive disorders, especially in extremities. The choice of anesthesia in these patients is a great challenge, as the neurological symptoms may worsen. Case presentation: Female S.G., 53 years old, with a previously diagnosed Charcot Marie Tooth disease, was admitted to the Clinic for Orthopedic Diseases in Skopje for the treatment of a basicervical fracture of the femur. Apart from the existing neurological disease, the patient had no other comorbidities. An indication for surgery was set, and regional, i.e. spinal anesthesia was the choice for the surgical management of the patient. In the postoperative period, the patient was treated with analgesic therapy. After 9 days of treatment at the Clinic for Orthopedic Diseases, the patient was discharged in good general condition, without worsening of the neurological symptoms. Conclusion: Regional anesthesia has been shown to be a safe type of anesthesia in surgical treatment of the lower limb. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Accidental injection of succinylcholine into epidural space as a test dose(Wolters Kluwer – Medknow, 2020); Dimitrovski, AleksandarInadvertent injection of nonepidural drugs into the epidural space is a rare situation, which is under-reported, and can lead to serious complications, such as cardiovascular and respiratory complications, paraplegia, or quadriplegia, and can worsen the patients' outcome from surgery. Succinylcholine administered epidurally leads to the appearance of fasciculation and shortness of breath and can prolong neuromuscular blockade. We report a case of accidental administration of 100 mg of succinylcholine via an epidural catheter as a test dose instead of 2 ml 0.5% bupivacaine in a patient planned for major abdominal surgery. After 2 min, the patient complained of shortness of breath; dysarthria; and fasciculation in the trunk, upper limbs, and face. This was managed with induction to general anesthesia (GA). In the postoperative period, no neurological or cardiovascular complications were observed. There is no adequate drug as an antidote of accidentally given nonepidural drugs via an epidural catheter. Succinylcholine given via epidural catheter has been shown to prolong neuromuscular blockade. Proper labeling and storage of syringes are of utmost importance for avoiding these unpleasant situations. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Aerosol box for peripheral nerve blocks(Aga Khan University Hospital, 2020-08-16); The COVID-19 pandemic has posed new challenges to the anesthesiologists the world over. Keeping in mind the way the virus was known to be spreading through aerosols and the global deficiency of personal protective equipment, medical workers embarked upon to create and develop devices and equipment to protect themselves from the virus during this pandemic period.</jats:p> - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Efficacy of Intraperitoneal Bupivacaine on Pain Relief After Laparoscopic Cholecystectomy(Macedonian Academy of Sciences and Arts /Walter de Gruyter GmbH, 2018-07-01); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Opioid Free Anesthesia for Laparotomic Hemicolectomy: A Case Report(Macedonian Academy of Sciences and Arts /Walter de Gruyter GmbH, 2018-12-01); ; ; Opioid free anesthesia (OFA) is deffined as anaesthesiological technique where opioids are not used in the intraoperative period (systemic, neuroaxial or intracavitary). Anaphylaxis caused by opioids (fentanyl) is very rare, and the reaction is presented with hypotension and urticaria. When we have proven allergy to fentanyl, patients' refusal of placing epidural catheter and refusal of receiving bilateral ultrasound guided transversus abdominis plane block (USG TAPB), we must think of using multimodal nonopioide analgesia. The concept of multimodal balanced analgesia is consisted of giving different analgesic drugs in purpose to change the pathophysiological process which is included in nociception, in way to receive more effective intraoperative analgesia with less adverse effects. This is a case report of a 60-year-old male patient scheduled for laparotomic hemicolectomy, who previously had proven allergy to fentanyl. We have decided to give him an opioid free anaesthesia. Before the induction to anaesthesia, the patient would receive dexamethasone (dexasone) 0.1 mg/kg and paracetamol 1 gr intravenously. The patient was induced into general endotracheal anesthesia according to a standardized protocol, with midazolam 0.04 mg/kg, lidocaine hydrochloride 1 mg/kg, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg. Anaesthesia was maintained by using sevoflurane MAC 1 in order to maintain mean arterial pressure (MAP) with a value of +/- 20% of the original value. After tracheal intubation, the patient had received ketamine hydrochloride 0.5 mg/kg (or 50 mg ketamine) in bolus intravenously and a continuous intravenous infusion with lidocaine hydrochloride (lidocaine) 2 mg/kg/hr and magnesium sulfate (MgSO4) 1,5 gr/hr. At the end of surgery the continuous intravenous infusion with lidocaine and magnesium sulfate was stopped while the abdominal wall was closed and 2.5 g of metamizole (novalgetol) was given intravenously. VAS score 2 hours after surgery was 6/10 and 1 gr of paracetamol was given and the patient was transferred to the Department. Over the next 3 days, the patient had a VAS score of 4-6/10 and only received paracetamol 3x1g and novalgetol 3x1 gr daily, every four hours. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study(Elsevier BV, 2019-02) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Hypernatremia-induced Neurologic Complications After Hepatic Hydatid Cyst Surgery: Pretreat to Prevent(Academy of Medical Sciences of Bosnia and Herzegovina, 2019-10); ; ; ; Surgery is effective treatment for echinococcosis; however, there is a risk of hypertonic saline resorption and acute hypernatremia.