Faculty of Medicine
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Item type:Publication, Does the Apolipoprotein E Genotype Increased the Risk of Postoperative Delirium in Adult Patients?(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023-12); ; ; ; Toleska, MarijaBackground: The relationship between genetic predisposition and the development of postoperative delirium has not yet been established. The e4 allele of the apolipoprotein E gene has been reported as a genetic risk factor for delirium. Objective: This paper analyzed the relationship between the frequency of genotypes of the APOE rs7412/rs429358 polymorphism, which contains the minor allele e4, and the occurrence of postoperative delirium. Material and Methods: The study included patients aged 65 years and older without pre-existing cognitive impairment admitted to the University Clinic for Traumatology and Orthopedics for operative treatment of a fracture of the upper end of the thighbone. The Confusion Assessment Method (CAM) confirmed the delirium diagnosis. APOE rs7412/rs429358 polymorphism genotypes were determined by molecular genetic analysis using the quantitative real-time amplification method (qRT-PCR) on DNA samples extracted from venous blood leukocytes. Results: The presented results are from analyzed samples and data from 51 patients. Out of these, postoperative delirium was diagnosed in 12 patients, while in 39 patients weren’t registered, and they are the control group in the trial. Conclusion: This study results indicate the association of the studied polymorphism in the apolipoprotein E gene, which contains the minor allele e4, with the occurrence of postoperative delirium in this group of adult patients. A larger group is necessary to reach more valid conclusions. - 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, LUNG ULTRASOUND DERIVED INSIGHTS IN VENTILATOR ASSOCIATED PNEUMONIA(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024); ; ; ; Toleska, MarijaLung Ultrasound (LUS) is widely used in diagnosis and monitoring of Ventilator Associated Pneumonia (VAP). The aim of our study is to evaluate and detect local lung events in mechanically ventilated patients, as well as to evaluate the usage of LUS in distinguishing VAP from Ventilator associated tracheobronchitis. We examined LUS finings in all patients who fulfilled the criteria for VAP, and stratified them according to the CLUE Protocol. We have examined the findings for VPLUS Score of each patient and tried to find a correlation between LUS Score and VPLUS Score. The average value of total LUSS of all patients examined was 11.05. LUS Score of the upper segments versus lower segments was 0.07 versus 2.1 respectively with 95% CI from 1.44 to 2.61, and significance level p<0.0001 suggesting the existence of statistically significant difference into distribution of pathological findings in between upper versus lower lung segments. Also, we found a LUS Scores difference of 3.46 with 95%CI of 0.95 to 5.96 and significance level of p=0.0099 which implies existence of statistically significant higher LUS Score values in patients with VPLUS >2 versus patients with VPLUS of 2. In conclusion, the pathological findings in patients with VAP were distributed in the dependent regions, while upper segments were spared. Also, only patients with VPLUS>2 instead of VPLUS≥2 should be considered as having VAP. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute hyponatriemia in a patient with schizophrenia: Case report water intoxication induced acute hyponatriemia(Udruženje anesteziologa i intenzivista Srbije, Beograd, 2019); ; ; - 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.