Faculty of Medicine

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    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)
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    Dimitrovski, Aleksandar
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    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.
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    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)
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    Dimitrovski, Aleksandar
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    Todorova, Teodora
    Introduction: 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.
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    HYDROCEPHALUS WITH VENTRICULOPERITONEAL SHUNT IN INFANTS: OUR EXPERIENCES AND CLINICAL OUTCOMES
    (Macedonian Association of Anatomists, 2022-12)
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    Tamara Voinovska
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    Mica Kimovska-Hristov
    AbstractHydrocephalus is a condition resulting from disorder in absorption and circulation of the cerebrospinal fluid (CSF). It leads toaprogressive ventricular dilatation and need of ventriculoperitoneal shunt (VP)placement. The aim of our study wasto present our experience withinfantswith hydrocephalus,ventriculoperitoneal shunt placement, and earlypostoperative follow-up.A retrospective study was conducted comprising infantswith hydrocephalus born between January 2019-January 2022with ventriculoperitoneal shunt placement performedatthe University Clinic for Neurosurgery in Skopje,Macedonia. Demographic and clinical characteristics, complications and the need for ventriculoperitoneal shunt were documented.Of twenty-three infantswith hydrocephalus,14 (60.8%) were preterm infants (median birth weight 2120g; mean gestational age 33.1weeks), 9(39.1%) were term infants(mean birth weight 3600g; mean gestational age 38.4 weeks). The etiology of hydrocephalus was:congenital hydrocephalusin 5infants(21.7%),prematurityin 6 infants(26.08%), spina bifida in 2 infants(8.7%),systemic infection in 4 infants(17.3%), and intraventricular hemorrhage in 6 infants(26.08%).Ventriculoperitoneal shunt was placed inall 23infants, at the mean age of 33.5(30-43) days.Postoperative complicationsas a result of ventriculoperitoneal shuntplacement were:ventriculitismanifested in3 preterm (13%) infants,of which 2(8.6%) died;fiveterm infants(21.7%) had postoperativeseizures, of which2 infants(8.6%) died. Nineteeninfants(82.6%) were discharged and transferredto the neonatology department. Ventriculoperitoneal shunt placementis atreatment of choice for infantswith hydrocephalus, although postoperative complications in preterm infantsincrease the percentageof morbidity and mortality.