Nikola Brzanov

Preferred name

Nikola Brzanov

Translated Name

Никола, Брзанов

Alternative Name

Brzanov , N.

Brzanov N.

Brzanov,, Nikola

Brzanov, ,Nikola

Nikola, Brzanov

nikola.brzanov@medf.ukim.edu.mk

Now showing 1 - 10 of 26

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The Role of Erector Spinae Block in Urological Surgeries as a Promising Alternative to Conventional Analgesia: A Prospective Observational Study
(Walter de Gruyter GmbH, 2025-06-01)
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Trifunovski, Aleksandar
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Introduction: The erector spinae plane block (ESPB) is a regional anesthesia technique that provides somatic and visceral analgesia by targeting the dorsal and ventral rami of the spinal nerves. It is performed under ultrasound guidance. ESPB is particularly beneficial in urological surgeries, which often require multimodal analgesia due to complex pain management needs and patient comorbidities. However, its efficacy in urological procedures remains insufficiently studied. Therefore, our aim was to assess the effectiveness and advantages of ESPB in urological procedures. Material and Methods: This prospective observational study was conducted at a tertiary referral hospital. The study included all consecutive patients scheduled for urological surgery, classical approach, or laparoscopic surgery under general anesthesia. Patients were ASA I–III, aged ≥18 years. Exclusion criteria included coagulopathy, infection at the injection site, allergy to local anesthetics, and chronic opioid therapy. ESPB was performed under ultrasound guidance, and a 20G echogenic needle was used to administer 20–30 mL of 0.5% bupivacaine at the Th8–L2 vertebrae level, depending on surgical requirements. The primary outcome, postoperative pain, was measured using a visual analog scale at 2, 6, 12, and 24 hours. The incidence of postoperative nausea and vomiting (PONV), the total amount of opioids consumed in a 24-hour period, and intraoperative hemodynamic stability were the secondary outcomes. IV fentanyl and paracetamol were used for postoperative analgesia, and metoclopramide was used to control nausea. Results: Fifty patients (42 males, 8 females, mean age 66±9.8 years) were analyzed. The majority were ASA II (44%) and ASA III (50%). Open surgeries were performed on 21 patients, while 19 underwent laparoscopic procedures. Primary Outcome: Pain scores (VAS) at 6h, 12h, and 24h were significantly lower in laparoscopic groups compared to open surgeries (p<0.05). Secondary Outcomes: Only three patients (6%) from the open classical approach surgery required rescue opioids. PONV occurred in two patients (4%): one from the open and the other from the laparoscopic approach surgery. Intraoperative hemodynamics remained stable, with no significant fluctuations in MAP or HR. Conclusion: ESPB provided effective analgesia, reduced opioid consumption, and maintained hemodynamic stability in urological surgeries, supporting its role in multimodal pain management strategies.
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IMPLEMENTATION OF FOCUSED ASSESSMENT WITH ULTRASONOGRAPHY IN TRAUMA PATIENTS IN UNIVERSITY SURGICAL EMERGENCY DEPARTMENT
(University Ss. Cyril and Methodius in Skopje, 2023)
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Labacevski, Nikola
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Safe pediatric one-lung ventilation in a resource-limited setting: an age- and weight-guided approach
(Springer Science and Business Media LLC, 2025-12-10)
Sulejmani, Haris
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Golubic, Sanja
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Background One-lung ventilation (OLV) in children is technically demanding due to small airway calibers, variable bronchial anatomy, and limited pediatric-specific devices. Challenges are greater in resource-limited settings where double-lumen tubes (DLTs) and fiberoptic bronchoscopes are not consistently available. Methods We retrospectively reviewed five consecutive pediatric patients (ages 4–13 years) who underwent thoracic surgery with OLV between 2022 and 2024. Case summaries highlighted device choice, confirmation method, and perioperative challenges. Variables included demographics, diagnosis, surgical side, isolation technique, OLV duration, ventilatory parameters, arterial blood gases, and defined outcomes (desaturation, hypercarbia, hemodynamic instability, device dislodgement, and postoperative complications). Results Lung isolation was achieved with DLTs in two older patients and bronchial blockers in three younger ones, guided by age and weight. OLV lasted 105–150 min. Two children developed transient desaturation (nadir SpO₂ 75%), one experienced hypercarbia (PaCO₂ >50 mmHg), and two had hemodynamic instability. No tube dislodgement occurred. Median ICU stay was 17 h (IQR 8–19), and hospital stay 21 days (IQR 15–21). All patients were discharged in stable condition. Conclusion An age- and weight-based algorithm bronchial blockers for children < 8 years or < 30 kg, DLTs for older/heavier patients enabled safe OLV and preserved oxygenation, even without routine fiberoptic bronchoscopy. Vigilant ETCO₂ monitoring, careful device fixation, and close intraoperative assessment compensated for equipment limitations. This pragmatic workflow demonstrates feasibility in resource-constrained environments, provides practical guidance for clinicians, and is hypothesis-generating for future multicenter studies.
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Carboxyhemoglobin changes in relation to inspired oxygen fraction during general anesthesia
(Journal of Serbian Association of Anesthesiologists and Intensivists, 2017-04)
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Maja Slaninka Miceska
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Maja Mojsova-Mijovska
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Introduction: Measurement of carboxyhemoglobin could be a new method for evaluation of the severity of inflammatory airway disease, acute organ dysfunction,or stress by surgery and anesthesia. To use this measurement during mechanical ventilation, it is important to clarify the effects of factors that interfere with carboxyhemoglobin levels. The aim of our study was to investigate the perioperative changes of carboxyhemoglobin to inspired oxygen fraction during general anesthesia and mechanical ventilation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemoglobin. Methods: The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18–60 years, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin levels were determined preoperatively, after preoxygenation, and one hour after induction in anesthesia. Results: carboxyhemoglobin levels were decreased after preoxygenation in both groups. One hour after induction in anesthesia under mechanical ventilation with inhaled fraction of a mixture of O2 (50%) and air (50%) the average values of carboxyhemoglobin between the two groups were different. The average values of carboxyhemoglobin between the two groups in all three time points were statistically significantly different (p=0.00). Conclusion: Changes in carboxyhemoglobin concentrations in arterial blood occur during general anesthesia and mechanical ventilation, although these amplitudes are small when compared to carbon monoxide intoxication. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during surgery
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THORACIC POINT-OF-CARE ULTRASONOGRAPHY A RELIABLE DIAGNOSTIC TECHNIQUE FOR TRAUMATIC PNEUMOTHORAX
(MIT Univerzitet Skopje, 2024-02)
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Trpevski, Simon
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Introduction: Pneumothorax is a common and potentially life-threatening injury characterized by sudden chest discomfort and respiratory distress. Early diagnosis and management are crucial to prevent adverse outcomes. Thoracic point-of-care ultrasonography (POCUS) has emerged as a valuable tool for rapid and radiation-free diagnosis of pneumothorax, offering dynamic evaluation at the bedside. Aim: This study aimed to assess the accuracy of thoracic POCUS performed by physicians in detecting clinically significant traumatic pneumothorax. Material and Methods: A prospective clinical observation study was conducted in the Emergency Department of the University Clinic for Traumatology, with thoracic POCUS performed on trauma patients upon arrival. The procedure involved scanning for specific landmarks and assessing the pleural line for evidence of pneumothorax. Statistical analysis was conducted to evaluate the sensitivity, specificity, and predictive values of thoracic POCUS. Results: Forty trauma patients participated, predominantly males aged 35–50, with blunt trauma being the most common mechanism. Thoracic POCUS demonstrated a sensitivity of 89.4% , and a specificity of 95.8% in detecting P pneumothorax. The procedure had a high negative predictive value (92%) and positive predictive likelihood ratio (21.4), with no reported complications. Conclusion: Finally, our research validates that thoracic POCUS is a useful tool for identifying traumatic pneumothorax in trauma patients. Thoracic POCUS provides a quick and accurate way to diagnose, which helps with prompt intervention and potentially life-saving care.
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Is general anesthesia necessity for subdural hematoma drainage?
(2022-05)
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Gjoleva Trajkovska R
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Introduction. Neurosurgery and anesthesia have made amazing advancements in recent years. Despite this, in nations with limited resources, chronic subdural hema toma (CSDH) is usually treated surgically. Burr hole craniotomy under general anesthe sia is the most common procedure for its removal. However, because this group of pa tients is typically older and has several comorbidities, local anesthetic with sedation will improve recovery while reducing complications. The goal of this study is to assess the prognosis of using a local anesthetic potentiate with sedative for CSDH management. Material and methods. Five patients with CSDH were operated on under seda tion and local anesthetic from June to December 2020. Patients were enrolled in this study after receiving written consent from them. All patients under the age of 19, those with multilocular hematomas, and those who were unwilling to cooperate were elim inated from this study. The patient was given local anesthetic by injecting 10ml Lido caine 2% subperiosteally and subcutaneously. Sedation was provided by boluses of mid azolam and continuous propofol on an infusion pump. The CSDH was emptied after a burr hole craniotomy was done. All patients were evaluated for clinical appearance, he modynamic stability, complications, and satisfaction. The neurological state of patients was graded on admission and discharge using Markwalder's neurologic grading system. Results. Patients' demographic data ranged from 54 to 85 years old (mean 72). There were two females (40%) and three males (60 %). Trauma was the cause of all of the cases of CSDH. One patient had a disturbed state of consciousness, and all of the patients had a headache as a symptom. Markwalder's neurologic grading method iden tified grade 1 in four cases (80%) and grade 2 in one (20%). Markwalder's neurologic grading system improved after the evacuation. Grade 0 was classified in four patients (80%), and grade 1 was noticed in one patient (20%). During in the perioperative and postoperative periods, all patients were hemodynamically stable. In the two weeks fol lowing surgery, no bad outcomes or deaths had happened. There were no complaints from any of the patients. PROCEEDINGS 325 Discussion: It is vital to define the safest, simplest, and most successful surgical method, especially for developing nations. The gold standard for surgical therapy of persistent subdural hematoma is burr hole craniotomy. During CSDH surgery, a local anesthetic is usually chosen for patients with concomitant complicated systemic illness. Many studies have shown that both general and local anesthesia are safe in chronic subdural hematomas with a modest consequence. Furthermore, general anesthesia may affect the return to preoperative levels of awareness after such procedures, which must be evaluated early postoperatively to rule out the need for redoing due to early postop erative remembrance. Conclusion: Under local anesthetic with sedation, the treatment of CSDH is suc cessful, adequate, and safe. It will reduce the length of stay in the hospital, as well as the cost and complication rates
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Anesthesıa Management in Kidney Transplant Recipients
(Ankara Bilim Universitesi, 2022-09)
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IS THERE BENEFIT FROM BRACHIAL PLEXUS REGIONAL ANESTHESIA OVER GENERAL ENDOTRACHEAL ANESTHESIA FOR PEDIATRIC PATIENTS?
(MIT University Skopje, 2023-10)
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Nastasovich, Tijana
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Background: Improvements in ultrasonography technology have had an impact on how regional anesthesia is used in pediatric practice. Ultrasound-guided approaches increase the efficacy of blocks, and they may lower the risk of complications associated with needle insertion or the amount of local anesthetic. Aim: In this evaluation, we wanted to compare the advantages, risks, benefits, and complications of brachial plexus blockade over general endotracheal anesthesia in the pediatric population. Methods: All pediatric patients who underwent upper limb surgery between July and December 2022 were included in the analysis. The demographics of the patients were compiled. The type of anesthesia technique utilized, the procedural anesthesia time chosen by the attending anesthesiologist, the recovery period, the duration of analgesia, the time until hospital discharge, and reported complications, if any, were evaluated as well. Results: Sixty-seven pediatric patients underwent regional anesthesia with brachial plexus ultrasound guidance. A supraclavicular brachial plexus block required 45 minutes. A regional anesthetic for the brachial plexus reduced the amount of time needed for recovery. The brachial plexus regional anesthesia provided analgesia for 14±8 hours. The plexus block failure rate was 6.3%, and no complications were observed. Two patients were released from hospital the same day. Conclusion: The development of ultrasound-guided regional anesthesia increased safety, shortened the duration of the procedure, and enhanced the upper limb block strategy. The use of brachial plexus regional anesthesia reduces the complication rate compared to general anesthesia and improves the recovery time for patients undergoing surgery on the upper limb. Those children can have one-day surgery.
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Laparoscopic Donor Nephrectomy in the Republic of North Macedonia
(Macedonian Academy of Sciences and Arts, 2023-07)
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Dohchev, Sasho
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Mijovska Mojsova, Maja
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Trifunovski, Aleksandar
Introduction: Hand-assisted laparoscopic living donor nephrectomy has become the technique of choice for living donor kidney donations. Since 2018, 30 procedures have been performed at our clinic using this technique. The goal of this comparative analysis was to determine how surgical technique, specifically, hand-assisted laparoscopic living donor nephrectomy with hand assistance may affect early graft function when compared to open classical nephrectomy. Material and methods: Retrospective analyses were performed, comparing the two techniques of kidney donation. Kidney transplantation was performed with the open standard technique in both groups. The primary outcome was early graft function, and levels of urine output, and plasma creatinine were analyzed at three time points. A secondary outcome was the quality of the operative technique, which was determined by the time of warm ischemia, blood loss, and duration of surgery. Additionally, we noted all complications, length of hospital stay, and patient satisfaction. Results: In terms of warm ischemia time, there was no statistically significant difference between donors in both groups. It is important to note that in 2 recipients from Group II we did not observe diuresis at the conclusion of the operation. The recipients' diuresis was 515 ml ± 321SD in group I and 444 ml ± 271SD in group II. At 3, 12, and 36 hours postoperatively, there were statistically significant differences in the average serum creatinine values (p 0.05) in favor of group I. Similar results were observed in the second time measurement at 12 h and the third time measurement at 36 h for serum urea levels in recipients. The difference in serum urea values between the recipients in the groups at the first measurement (3h) following surgery was not statistically significant. Conclusion: Hand-assisted laparoscopic donor nephrectomy is recognized as a safe and effective treatment. Donors in this situation have a different profile from other surgical patients; hence, they do not undergo surgery due to their own medical condition but for an altruistic reason, and with hand-assisted living donor nephrectomy. Such patients receive all the advantages of minimally invasive surgery. The two main objectives of a donor nephrectomy are to give the recipient the best possible kidney and to ensure the donor's complete safety.
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The Influence of Smoking on the Variations in Carboxyhemoglobin and Methemoglobin During Urologic Surgery
(Academy of Medical Sciences of Bosnia and Herzegovina, 2017-06)
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Mojsova-Mijovska, Maja
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Taleska, Gordana
Surgery is supposed to modulate the production of carbon monoxide by the reduction of heme oxygenase activity or transcriptional regulation of inducible heme oxygenase. On the other hand, the inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Furthermore, methemoglobin is maintained at a constant level. However, excessive production of methemoglobin relative to total methemoglobin reductase activity results in methemoglobin increase.

Nikola Brzanov

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