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Language: search.filters.language.EnglishSubject: search.filters.subject.spinal anesthesia

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    ANESTHETIC MANAGEMENT FOR PATIENT WITH TRACHER COLLINS SYNDROME SCHEDULED FOR ELECTIVE CESAREAN DELIVERY
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2018-12)
    Zlatkova, Milica
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    Ivanov, Emilija
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    Popovska, Rusanka
    Tracher Collins Syndrome is an autosomal dominant genetic disorder, as a result from mutation in TCOF1 gene. Other names for Treacher Collins Syndrome include Franceschetti- Zwalen-Klein syndrome, mandibulofacial dysostosis (MFD), zygo-auro-mandibular dysplasia and Treacher Collins Franceschetti syndrome. These changes cause deformities of the facial bones and occurrence at antimongoloid slant of the eyes, micrognathia and deformity of the ears. Complications may include breathing problems, seeing problems, cleft palate and hearing lost. Diagnosis of TCS is made through clinical evaluation, radiographic examination and molecular genetic analysis. Treatment is tailored to the specific needs of each individual by a multidisci- plinary craniofacial management team. We report a case of TCS with second twin pregnancy achieved with IVF. The first pregnancy ended with c-section (and death of the newborn after 23 days of delivery due to dysmorphia – TCS on the fetus). The patient was hospitalized at our clinic for evaluation and ending of pregnancy with elective section cesarean. The patient was managed successfully under regional anesthesia which is generally preferred technique to general anesthesia, in order to avoid potential complications associated to difficult airway management. The patient was left home on the fifth postoperative day with her two healthy children.
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    Incarcerated Amyand’s hernia in a 6-week old infant repaired under spinal anesthesia
    (2022-12)
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    Aleksandar Stepanovski
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    Marjana Burmuzoska
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    Andrijana Andreevska Stepanovska
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    Amyand’s hernia is characterized by the presence of the vermiform appendix in an inguinal hernia sac. It occurs in less than 1% of all inguinal hernias in children’s age. As the usual pediatric inguinal hernia, it can present in multiple ways, from uncomplicated to incarcerated and/or strangulated hernia with normal, inflamed or even perforated vermiform appendix within the hernia sac. The repair of all the infant cases we came across in literature involved herniorrhaphy with or without appendectomy and general anesthesia. Herein, we present a case of Amyand’s hernia in an infant with concomitant patent ductus arteriosus (PDA), patent foramen ovale (PFO) and interventricular septum hypertrophy that presented with signs and symptoms suggestive of ordinary right-sided incarcerated inguinoscrotal hernia. Due to the cardiac anomaly the infant underwent spinal anesthesia for the hernia repair, thus contributing to the rarity of the case. By thorough literature review, we could not find any similar case of Amyand’s hernia incarceration in an infant operated on under spinal anesthesia. Furthermore, we discuss the surgical and anesthetic aspects of this condition in children.
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    Obturator Nerve Block for Transurethral Resection of Bladder Tumors
    (COPE, 2023-03)
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    Josif Janchulev
    Background: Bladder tumors are identified and treated using a surgical procedure called as transurethral resection of bladder tumors (TUR-BT). During TUR-BT resection, stimulation of the obturator nerve may cause violent adductor muscle spasms. The “obturator reflex,” as this disorder is known, generally causes the legs to move inadvertently (leg jerking). Since this condition can cause several complications, it is preferable to avoid it. Objective: In this study, we investigated the effectiveness of spinal anesthesia combined with obturator nerve block or general anesthetic without muscle relaxant in preventing adductor muscle spasm during TUR-BT procedures. Methods: Forty consecutive patients were enrolled in a prospective observational evaluation and divided into two groups. Patients in Group I underwent spinal anesthesia along with an obturator nerve block, while those in Group II underwent general anesthesia without a neuromuscular relaxant. The following details were recorded: time for obturator block performance, the severity of the motor blockade, the length of the procedure in both groups because a probable adductor spasm might make it more difficult. The level of the surgeon’s pleasure was noted throughout the surgery. Additionally, the patient’s satisfaction and any issues that may have arisen were documented (the incidence of vascular puncture, hematoma, nerve damage, and visceral injury was noted). Results: Block performance time in Group I was 4.8±0.5 minutes, whereas it was 5.0±0.3 minutes in Group II. The ease of access for the two groups was the same. Group I demonstrated increased patient and surgeon satisfaction with a general anesthesia without neuromuscular relaxants and an obturatorius nerve block. Mean surgical time did not differ between the groups.There were no complications in either group. Conclusion: During such operations, routine use of ONB in combination with spinal anaesthetic or general anesthetic without a neuromuscular blocker can enhance oncological outcomes for patients, reduce complication rates, and extend the period of time spent living without disease