Faculty of Medicine
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Item type:Publication, BILATERAL TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK FOR TREATMENT OF CHRONIC ABDOMINAL WALL PAIN: A CASE REPORT(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022-11); ; Transversus abdominis plane (TAP) block is a regional anesthesia technique where the local anesthetic is injected into the interfascial plane between the internal oblique and transversus abdominis muscle. This block is mainly used for treatment of acute pain following abdominal surgery. Persistent postsurgical pain (PPSP) or chronic postsurgical pain (CPSP) is pain that persists at least three months after surgery, which was not present before surgery, or which had different characteristics or increased intensity from preoperative pain. It is localized near the surgical site or a referred area, and other possible causes for the pain had been excluded (cancer recurrence or infection). This pain can lead to functional limitation and psychological trauma in patients. By presenting our case report we would like to describe the effect of TAP block on CPSP in a female patient who had previously undergone many abdominal surgeries. - Some of the metrics are blocked by yourconsent settings
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, Practicing opioid-free anesthesia for laparoscopic cholecystectomy opioid-free anesthesia(Centre for Evaluation in Education and Science (CEON/CEES), 2019); ; ; Dimitrovski, AleksandarOpioid free anesthesia (OFA) is an anesthesiological technique, which uses non-opioid analgesics, such as paracetamol, dexamethasone, lidocaine, ketamine, and magnesium sulfate instead of opioids. In this case, the report about patient who after previous surgeries experienced opioid side effects is followed by a narrative review; we present the OFA method for laparoscopic cholecystectomy. Case report: We present a case of a 55-year-old woman with a history of controlled hypertension and asthma, planned for laparoscopic cholecystectomy. Previously she underwent two surgical interventions; bilateral radical mastectomy performed separately with a three year gap. Both anesthesias were complicated, postoperatively with nausea, vomiting, dizziness, and respiratory depression. Based on the previous postoperative complications, we hypothesized that nausea, vomiting, dizziness, and respiratory depression were caused by opioids, and we decided to perform OFA. Before the induction the patient received dexamethasone 8 mg and paracetamol 1 gr intravenously, followed by induction with midazolam 3 mg, lidocaine hydrochloride 78 mg, propofol 160 mg, ketamine hydrochloride 39 mg and rocuronium bromide 60 mg. After tracheal intubation, continuous intravenous infusion with lidocaine hydrochloride 2 mg/kg/hr and magnesium sulfate 1.5 gr/hr was started. Anesthesia was maintained by using sevoflurane MAC 0.7–1. At the end of the surgery, 2.5 gr of metamizole was given intravenously. Postoperative recovery was uneventful. Conclusion: In our patient, OFA eliminated opioid-related side effects (nausea, vomiting, dizziness, and shortness of breath), and provided satisfying postoperative analgesia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, EFFECT OF BILATERAL ERECTOR SPINAE PLANE (ESP) BLOCK ON PAIN AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR: A CASE SERIES(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023); - 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, Anesthetic Challenges for Major Hepatectomy(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2022-03); ; Rushiti, KjemalHepatic resection is the treatment of choice for many liver diseases. However, it is a large and complex operation with a high risk of side effects in the patients, and it is a challenge for both surgeons and anesthesiologists. This paper presents a case of successfully performed right hepatectomy in a 45-years-old woman with the finding of a giant liver hemangioma, larger than 10cm, placed near the inferior vena cava and the challenges faced by the anesthesiologists when guiding such a patient during the entire perioperative period. The main concern was the risk of massive blood loss, which might significantly increase the rate of morbidity and mortality. During liver resection, central venous pressure (CVP) was optimally maintained below 5cmH2O to reduce blood loss. The cell salvage technique was used to minimize heterologous blood transfusion. Epidural anesthesia can be safely applied in patients undergoing major hepatic resection, provided that they have corrected perioperative hemostasis. The surgical approach after Belghiti “liver hanging maneuver” performed by the surgeons in our case may involve transient compression of the inferior vena cava that cause profound hypotension. Therefore, a successful outcome requires close collaboration between the anesthesiology and surgical team by sharing decisions throughout the operation and following and implementing the latest evidence-based recommendations. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Anaesthesia for pilonidal sinus surgery in a patient with Dilated cardiomyopathy. A case report(Wolters Kluwer, 2020-06); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Opioid sparing effect of transversus abdominis plane (TAP) block in open ventral hernia repair: case series(Wolters Kluwer, 2022-06); Background: Open ventral hernia repair surgery is characterised with pain that arises from skin, muscles of the anterior abdominal wall and parietal peritoneum. Transversus abdominis plane (TAP) block can be suitable for these operations and can lower usage of opioids during surgery and in the postoperative period. Case report: We represent five patients, all ASA classification 2, scheduled for open ventral hernia repair surgery. After induction to standard general anesthesia with 2 mg midazolam, 100 µgr fentanyl, propofol 2 mg/kg, and rocuronium bromide 0.6 mg/kg, ultrasoundguided TAP block was performed with 20 ml 0.25% bupivacaine + 4 mg dexamethasone on both sides before surgical midline incision. Anesthesia was maintained with sevoflurane 0.7-1 MAC. Pain was measured first 48 hours after surgery with numeric rating score (NRS) from 1 to 10, where for NRS 4-6/10 1 gr metamizol was given, and for NRS 7-10/10 1 mg/kg tramadol was administered. Opioid consumption during surgery and in the postoperative period was measured too. The first three patients have pain 22 hours after surgery with NRS 4/10, other two patients have pain 25 hours after surgery with NRS 6/10 and all received 1 gr metamizol. Next complaint was 34 and 46 hours after surgery in all patients with NRS 4-5/10 and 1 gr metamizol was given. Total opioid consumption during surgery in all patients was 150 µgr fentanyl and none of the patients received opioids in the postoperative period. Discussion: Pain in open ventral hernia repair operations is from somatic origin and can lead to high pain scores in the postoperative period, bigger opioid consumption and prolonged stay in hospital.1 Bilateral TAP block is ideal for treatment of somatic pain and given together with dexamethasone can prolong analgesia in first 48 hours after surgery. References: 1. Zhang D, Zhou C, Wei D, Ge L, Li Q. Dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plain (TAP) block for analgesia after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE 14(1): e0209646. https://doi.org/10.1371/journal.pone.0209646 Learning points: TAP block given with steroids before surgical incision achieves prolonged analgesia during and after surgery, minimise opioid consumption and better pain control. - 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, Milky Lungs: Ultrasonographic Findings in Pediatric Acute Respiratory Distress Syndrome(2020); ; ; Trposka, AngelaDiagnosis and following up the dynamics of Pediatric Acute Respiratory Distress Syndrome demand a more feasible, non-invasive and bedside tool, such as lung ultrasound, for monitoring the damaged lungs. We report on a 6-month-old child admitted in our Pediatric Surgical Intensive Care Unit with a clinical presentation of ileus and concomitant community acquired pneumonia. Lung ultrasound (LUS) examinations according to the BLUE Protocol were done several times during the hospital stay. A-lines were seen at admission in the upper segments, but 2–3 B-lines were present in the posterolateral segments bilaterally. Later on, separated and coalescent B-lines were seen. White lung parenchyma or milky lungs with a thickened pleural line were seen, while the worst gas exchange according to the results of Arterial Blood Gases (ABGs) has been detected. According to the findings, as many B-lines will be detected, as the severeness of lung damage and gas exchange impairement. The improvement of the gas exchange with the disappearance of the coalescent B-lines was seen later on, after ventilating the child in a prone position. Bedsides, LUS is a feasible and non-invasive point of care method that could be used for diagnosing Pediatric Acute Respiratory Distress Syndrome (PARDS) but in guiding therapy of the damaged lungs, also. The finding of diffuse, coalescent and homogenous B-lines interpreted as “Milky lungs” is consistent with the diagnosis of PARDS.