Now showing 1 - 10 of 35
  • Some of the metrics are blocked by your 
    Item type:Publication,
    The Effect of Rectus Sheath Block as a Supplement of General Anesthesia on Postoperative Analgesia in Adult Patient Undergoing Umbilical Hernia Repair
    (Walter de Gruyter GmbH, 2017-12-01)
    ;
    ;
    ;
    Zdravkovska, Milka
    ;
    Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair.
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia
    (Македонско лекарско друштво / Walter de Gruyter GmbH, 2017-06-01)
    ;
    ;
    ;
    Ivanov, Emilija
    ;
    Introduction.Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO<jats:sub>2</jats:sub>), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO<jats:sub>2</jats:sub> was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO<jats:sub>2</jats:sub> and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Side Effects of Intravenous Patient-Controlled Analgesia with Remifentanil Compared with Intermittent Epidural Bolus for Labour Analgesia - A Randomized Controlled Trial
    (Walter de Gruyter GmbH, 2019-12-01)
    ;
    ;
    Ivanov, Еmilija
    ;
    ;
    Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery.
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Effect of Adding Dexamethasone as a Ropivacaine Adjuvant in Ultrasound-Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair
    (Macedonian Academy of Sciences and Arts / Walter de Gruyter GmbH, 2015)
    ;
    ;
    ;
    Zdravkovska, Milka
    ;
    Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone. Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours. Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2(hr), 4(hr), 6(hr), 12(hr) and 24(hr). (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001). Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Influence of Spinal and General Anesthesia on Newborn’s Status
    (Македонско лекарско друштво / Walter de Gruyter GmbH, 2015-06-01)
    Ivanov, Emilija
    ;
    ;
    Nikolovski, Sotir
    ;
    ;
    Curlinov, Kiro
    The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied . Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.</jats:p><jats:p>Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.</jats:p><jats:p>Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO<jats:sub>2</jats:sub>and BE) did not affect the newborns’ Apgar score in the first and fifth minute.</jats:p>
  • Some of the metrics are blocked by your 
    Item type:Publication,
    COMBINED SPINAL-EPIDURAL ANESTHESIA FOR ABDOMINAL HYSTERECTOMY IN PATIENTS WITH COPD
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, 2017-04)
    ;
    ;
    ;
    Ivanov E
    ;
    Introduction: All patients with chronic obstructive pulmonary disease (COPD) are with increased risk for intra and postoperative complications during abdominal surgery. In our study we present another approach in anesthetic management in these highly risk patients. Methods: We analyzed 20 patients, ASA III, scheduled for elective abdominal hysterectomy. After appropriate preoperative preparation in every patient epidural catheter was placed on Th12 - L1 or L1-L2 level, while spinal punction with standard spinal anesthesia was performed on lower levels. We evaluate basic hemodynamic parameters, patients’ satisfaction and postoperative pulmonary complications.Results: All hemodynamic parameters showed decrease in the first 30 minutes and then constant flow until the end of surgery. 4 patients developed postoperative pulmonary infection, and ended well. All patients were very satisfied with anesthesia procedure.Conclusion: Combined spinal-epidural anesthesia provides good hemodynamic stability, large patients’ satisfaction with fewer postoperative pulmonary complications in patients with COPD. Encouraging this anesthesia technique might increase the safety margin of surgery in patients with severe pulmonary diseases.
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Clinical outcome of patients with neuromuscular disease and acute respiratory failure treated with mechanical ventilation - four years experience
    (League Against Epilepsy of the Republic of Macedonia/Лига против епилепсија на Република Македонија, 2013)
    ;
    Kuzmanovski Igor
    ;
    ;
    Spirovska Tatjana
    ;
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Point mutation C18R in pre-pro-PTH gene in brother and sister with hypoparathyroidism, Fahr’s syndrome and epilepsy
    (MIT Univerzitet Skopje, 2021)
    ;
    Lejla Shabani-Misini
    ;
    ;
    ;
    Biljana Todorova
    Idiopathic hypoparathyreoidism may be sporadic or familial, and may occur as an isolated defect or as a component of a more widespread disorder, such as autoimmune polyglandular failure type 1 or various developmental abnormalities. Familial isolated hypoparathyreoidism (FIH) can result from several types of genetic alterations, including, mutations in the calcium-sensing receptor (CASR) gene, glial cells missing-2 (GCM-2), G protein a11 (GNA11), or in the PTH gene itself. X-linked recessive hypoparathyroidism, a rare congenital form of hypoparathyroidism has also been described. Here, we report a family, brother and sister, with hypoparathyroidism, Fahr’s syndrome and epilepsy diagnosed in early childhood. The genetic testing proved a rare, point mutation in the PTH gene (C18R) with autosomal dominant inheritance. This is the first reported family from North Macedonia with FIH due to mutation in the PTH gene.
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Epidural Anesthesia for Caesarean Section and Occurrence of Horner’s Syndrome
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2017-06-01)
    Spasovski, Sasho
    ;
    ;
    ;
    Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.
  • Some of the metrics are blocked by your 
    Item type:Publication,
    Neuraxial Anesthesia in the Geriatric Patient
    (Frontiers Media SA, 2018)
    ;
    ;
    Ivanov, Emilija
    ;
    Neuraxial anesthesia is recommended as a well-accepted option to minimize the perioperative side effects in the geriatric patients. The available data from the current researches have shifted the focus from the conventional approach to spinal anesthesia to the concept of low dose local anesthetic combined with opioids. What remains clear from all these studies is that hemodynamic stability is much better in patients who received low-doses of intrathecal bupivacaine in combination with opioids, which is possibly result of a potent synergistic nociceptive analgesic effect and their minimal potential effects on sympathetic pathways thus minimizing spinal hypotension. Spinal anesthesia with 5-10 mg of 0.5% heavy bupivacaine, fentanyl 20 mcg and 100 mcg of long-acting morphine added to the perioperative plan decreased the incidence of spinal hypotension and improved perioperative outcomes in the geriatric patients undergoing (low segment) surgical procedures. These findings may be of interest in the gynecologic geriatric surgery also in which area there are very few studies concerning the use of low-dose concept.