Faculty of Medicine

Permanent URI for this communityhttps://repository.ukim.mk/handle/20.500.12188/14

Browse

Settings

Language: search.filters.language.EnglishSubject: search.filters.subject.pediatric patients

Search Results

Now showing 1 - 3 of 3
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    BLOOD LOSS AND FLUID REPLACEMENT IN PEDIATRIC PATIENTS
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
    While strategies for the management of hemorrhage, transfusion and blood loss replacement in adults are well established, there aren’t any concrete, evidence-based recommendations for pediatrics. Promoting hemodynamic stability, preserving organ perfusion, minimizing transfusion-related injury, avoiding over-transfusion, and avoiding the deadly triad of coagulopathy, acidosis, and hypothermia are among the objectives of bleeding therapy in pediatric patients. At the beginning of treatment, crystalloid or colloid solutions may be used until blood products are available. Preventing dilutional coagulopathy requires caution. Monitoring end-organ perfusion and maintaining a healthy blood pressure are essential. Red blood cell transfusion should be matched with “yellow” blood product transfusion in the form of a 1:1:1:1 volume ratio of PBRC: fresh frozen plasma (FFP): cryoprecipitate: platelets form, in order to prevent coagulopathy and preserve sufficient oxygen supply to tissues. Hemolytic transfusion reactions, transfusion-related acute lung injury (TRALI), transfusionassociated circulatory overload (TACO) and transfusion-related immunomodulation (TRIM) are only few of the hazards connected with blood transfusion. Rapid and appropriate access for blood product transfusions is essential. To calculate the maximum permitted blood loss, a weight-based estimated blood volume (EBV) is used. A tried-and-true strategy for managing intraoperative hemorrhage should be used, including blood preservation techniques, balanced transfusion ratios and adjunct medicines. Transfusion decisions may be influenced by point-of-care and laboratory tests, such as thromboelastography. Transfusion-related laboratory abnormalities should be watched for and treated as appropriate. Children’s platelet transfusion thresholds are unclear; however, maintaining a platelet count of 50,000/L while bleeding continues is seen as sufficient in adults. When EBV loss surpasses 50%, fresh frozen plasma (FFP) and platelet transfusions should be taken into consideration. Electrolyte levels, particularly those of calcium, magnesium and potassium, need to be monitored. As a result, controlling severe bleeding and transfusion in pediatric patients necessitates specialized approaches, such as meticulous preoperative planning, goal-directed therapy and monitoring of laboratory derangements. PBM program implementation can improve patients’ outcomes and lower transfusion-related hazards.
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    IS REGIONAL POPLITEAL SCIATIC NERVE BLOCK A BETTER OPTION FOR TREATING PEDIATRIC SPORTS INJURIES THAN GENERAL ENDOTRACHEAL ANESTHESIA?
    (Faculty of Physical Education, Sport and Health in Skopje, Republic of Macedonia, 2023)
    ;
    ;
    Ristevski, Toni
    ;
    Trifunovski, Aleksandar
    ;
    In pediatric anesthesia, the use of ultrasound-guided peripheral nerve blocks has grown in favor. In order to determine the most effective anesthetic technique for pediatric ankle and foot sport procedures, this study evaluated the effectiveness of popliteal sciatic nerve blocks. ASA I or II pediatric patients between the ages of 1 and 14 who had either a localized popliteal sciatic block or general endotracheal anesthesia for surgery due to a sport injury were included in the retrospective analysis. The length of analgesia, the length of recovery, the time until hospital discharge, and any problems that were reported were evaluated. In comparison to general endotracheal anesthesia, popliteal plexus regional anesthesia showed quicker operation times, shorter recovery times, and longer analgesia durations. Additionally, the popliteal plexus anesthetic group's average hospital stay was shorter and there were no problems. Despite several cases of unsuccessful blocks and minor problems in the general anesthetic group, it was clear that popliteal nerve blocks often reduced pain, reduced the need for opioids, increased patient comfort, and sped up recovery. In conclusion, popliteal nerve blocks are a safe, dependable, and effective alternative to conventional anesthetic methods for treating postoperative pain in pediatric ankle and foot procedures.
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    Dexamethasone As Adjuvant in Supraclavicular Brachial Plexus Regional Anesthesia in Pediatric Patients
    (2023-03)
    ;
    ;
    ;
    Tijana Nastasovic
    ;
    Abstract: Introduction: Despite being one of the most efficient anesthetic techniques for upper extremity surgery, supraclavicular brachial plexus blocks are uncommon in pediatric patients due to the risk of possible complications like pneumothorax and local anesthetic toxicity. Blocks are more effective when administered using ultrasound-guided techniques, which may also lower the risk of problems. Adjuvants are frequently used in conjunction with local anesthetics to prolong the duration of the sensory-motor block and reduce the total amount of local anesthetic required. Aim: The purpose of this study is to compare the efficacy of supraclavicular brachial plexus blocks with bupivacaine 0.25% and | 229 bupivacaine o.25% with dexamethasone. Methods: Twenty consecutive patients admitted to our clinic were randomly assigned to receive supraclavicular brachial plexus block with Bupivacaine 0.25%, o.3 ml/kg, or Bupivacaine 0.25%, 0.3 ml/kg, with 2 mg dexamethasone. Included were all patients with an upper extremity fracture, aged 3 to 14 years, ASA II (American Society of Anesthesia Physical Status)- eligible for supraclavicular brachial plexus, and I block regional anesthesia. Excluded were all patients who refused regional anesthesia or had contraindications to receiving one, patients who received general endotracheal anesthesia, patients with ASA III and IV, and patients scheduled for multiple surgeries. Every five minutes, the sensory and motor blocks were evaluated to determine whether the entire arm had reached an appropriate level of blockage. We evaluated the time for block performance, the duration of analgesia, any complications, and the hospital stay. Results: Twenty patients, ranging in age from three to fourteen years (mean 65 SD), were given supraclavicular brachial plexus block regional anesthesia. Ten of them received only Bupivacaine 0.25% 0.3ml/kg, and 10 of them received Bupivacaine 0.25% 0.3ml/kg with Dexamethasone 2mg. The mean onset of sensory block was faster in the dexamethasone group (245 seconds), along with motor block (495 seconds). Block lasted longer in the dexamethasone group. The mean analgesia time was longer in the dexamethasone group (14 hours). There were no complications observed during this evaluation. The average hospital stay was one day. Conclusion: In comparison to using bupivacaine alone, adding dexamethasone to the supraclavicular brachial plexus block speeds up the start of the sensory and motor block and lengthens the duration of analgesia.