Faculty of Medicine
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Item type:Publication, AIRWAY MANAGEMENT IN 7-WEEKS-OLD INFANT WITH PIERRE ROBIN SYNDROME AND CONGENITAL PYLORIC STENOSIS(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-05); ; Angjusev, DarkoPierre Robin Syndrome (PRS) is characterized by a sequence of events including mandibular hypotrophy (micrognathia), abnormal posterior placement of tongue (glossoptosis), and airway obstruction. Pyloric Stenosis on the other hand is the most common infant surgical condition which presents with episodes of projectile vomiting leading to dehydration and weight loss. Airway management in these patients is a true challenge for every anesthesiologist. The patient was 7 weeks old infant, weighted 3,1 kg, admitted in Intensive Care Department for surgical repair of pyloric stenosis, previously diagnosed with Pierre Robin Syndrome at birth. Preoperative preparation, intravenous rehydration and electrolyte substitution was obtained. Video laryngoscope was used for management of difficult airway. We had many attempts in visualization of the vocal cords, eventually we performed awake intubation with stylet uncuffed endotracheal tube size 3. Pyloromyotomy was performed. Maintenance of anesthesia was with Sevoflurane and bolus doses of Fentanyl as adjunct. Perioperative vital signs were within normal ranges. Awake extubation was performed. The facial malformation that appears in patients with Pierre Robin Syndrome makes visualization of the glottis extremely difficult to impossible. In cases where tracheal intubation is needed, awake fiberoptic intubation is recommended, but it can have many limitations. These two conjoined conditions present the quandary of safely managing an expected difficult airway in an uncooperative patient. With this case we can conclude that for children with Pierre Robin syndrome, video laryngoscopy should be considered as a first attempt intubation device both in the operating room and for emergent situations. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, DELAYED TREATMENT OF DECOMPRESSION SICKNESS TYPE II RESPONSIVE TO HYPERBARIC OXYGEN(Department of Anaesthesia and Reanimation Faculty of Medicine, “Ss. Cyril and Methodius” University, Skopje, R. N. Macedonia, 2023-10); ; Leshi, AlbertA 38-years-old recreational female diver presented at our hospital with fatigue, dizziness, cutis marmorata, swollen and painful ankles, back pain and pulmonary symptoms. The patient was diving in the Maldives, with series of daily dives mostly around 22m, each dive decompression made on 6m with duration of 3 minutes. After more than 30 hours from her last dive, she took an international flight Maldives – North Macedonia that lasted for about 12 hours. Her first checkup was more than 80 hours of the onset of symptoms. Neurological examination, electrocardiogram, chest X-ray and lung ultrasound were normal. Laboratory data only showed evidence of thrombocytopenia and elevated D-dimer. Decompression sickness type II was diagnosed according to history and physical examination. Recompression treatment with hyperbaric oxygen (HBO2) was immediately started (2.8 ATA on 100% oxygen over a period of 90 minutes) and additional session at the same day with a duration of 70 minutes to 2.4 ATA. Additional courses with HBO2 were required daily in the next 7 days to 2.4 ATA. The most of the patient’s symptoms were resolved after the third therapy with HBO2, and the cough after the 7th therapy. The patient was released from hospital after resolution of the symptoms. Conclusion: Cutis marmorata is often associated with more serious manifestations of decompression sickness. Treatment with HBO2 is the cornerstone therapy for DCS. Indeed, treatment with hyperbaric oxygen can be successful even in cases with delayed start. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration(ID Design 2012/DOOEL Skopje, 2016-03-15); ; ; Leshi, AlbertThe aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration.