Vesna Durnev, Marija Soljakova, Venko Filipce, Maja Mojsova Mijovska and Marina Temelkovska Stevanovska
Introduction Cranial pins insertion is a method for head stabilization and together with the scalp incision is one of the biggest noxious stimulus associated with arousal and rapid increase of the blood pressure leading to pathological increase of the intracranial pressure. The aim of this investigation is to study the superiority of the locally infiltrated anesthetic bupivacaine just before the skull pin insertion and the scalp incision in craniotomy under general anesthesia.
Methods In the study thirty patients of both genders aged 24-72 years were included. They were categorized as ASA 1 and 2 and divided into two group of 15 patients each, group B (bupivacaine) and group S (saline). We recorded the bispectral (BIS) index, the mean arterial pressure (MAP) and the pulse rate (PR) in five time intervals: t 0-2 min before pin insertion; t 1-2 min after pin insertion; t 2-5 min after; t 3-10 min after and t 4-15 min after.
Results Significant difference p<0.05 was achieved in group S for all three followed parameters: blood pressure, heart rate and bispectral index. The difference is present in all four time intervals compared to the initial one before the pin insertion. With further analysis it was demonstrated that the investigated BIS index participates the most in the overall significance in group F.
Conclusion The scalp infiltration with local anesthetic bupivacaine results with stable hemodynamic parameters and stable intracranial pressure during the painful procedures as craniotomy.
Marina Temelkovska-Stevanovska, Vesna Durnev, Marija Jovanovski-Srceva, Maja Mojsova-Mijovska and Sime Trpeski
Introduction: Systemic postoperative analgesia is inefficient in most patients with hip fracture, which is the reason for pain, especially during leg movement. Peripheral and plexus nerve blocks are an efficient option for postoperative pain relief.
The aim of this study was to compare the effect and duration of continuous FNB versus a single FIC block as a postoperative analgesia in patients with hip fracture.
Methods: Sixty patients with hip fracture were included and were randomly assigned to two groups of 30 patients: FNB group – patients with continuous femoral nerve block; and FIC group –patients with a single fascia iliaca compartment block. In all patients, pain intensity was measured at rest and in passive leg movement by using VDS (0–4) at several intervals: 1, 2, 12, 24, 36 and 48 hours after intervention. The amount of supplemental analgesia was measured, together with the time when the patient needed it for the first time, as well as the side effects.
Results: The values of VDS were significantly lower in patients with FNB block versus patients with FIC block in rest and movement at the 24-hour intervals (46.67% vs 0% felt moderate pain), after 36 hours (43.33% vs 0% felt moderate pain) and 48 hours after intervention (46.67% vs 3.33% felt moderate to severe pain) for p < 0.05. Patients with FNB block received a significantly lower amount of supplemental analgesia, 23.3% of the FNB group vs 50% of the FIC group (p < 0.05). Registered side effects were were nausea, dizziness and sedation, and they were statistically significantly more frequent in the FIC group (p < 0.05).
Conclusion: Pain relief in the postoperative period was superior in the FNB group versus the FIC group at rest and in movement in patients with hip fracture.
Aleksandra Gavrilovska-Brzanov, Zorka Nikolova, Nikola Jankulovski, Mirjana Sosolceva, Gordana Taleska, Maja Mojsova-Mijovska, Marija Jovanovski-Srceva, Darko Angusev, Darko Sazdov and Nikola Brzanov
Aim: The aim of the study was to evaluate the effect of different grades of increased intraabdominal hypertension (IAH) on the respiratory mechanics.
Material and Methods: In this prospective observational clinical study, the influence of intaabdominal pressure (IAP) on respiratory parameters was assessed in 20 patients requiring mechanical ventilation with IAH grade I, 20 patients with IAH grade II, and 20 patients with grade III IAH. Respiratory parameters were measured and recorded by a computerized system incorporated into the mechanical ventilator.
Results: A statistical difference was noticed between IAP and the dynamic respiratory parameters among the groups. Regarding the respiratory parameters positive correlation between the IAP on one hand, and peak airway pressure and resistance on the other hand was notable: IAP increased and so did pressures and the resistance in the respiratory pathways. Also the correlation between IAP, on one hand and the compliance and peripheral saturation with oxygen on the other hand, was negative. Referring the mean pulmonary pressure there wasn’t correlation among IAP and mean pulmonary pressure in the groups.
Conclusion: IAP leads to impairment of the respiratory mechanics. An increase of the level of IAP is followed by an increase in the altering effects upon the respiratory system.
Aleksandra Panovska Petrusheva, Biljana Kuzmanovska, Maja Mojsova, Andrijan Kartalov, Tatjana Spirovska, Mirjana Shosholcheva, Marina Temelkovska Stevanoska, Milka Zdravkovska, Sasho Dohchev and Oliver Stankov
Introduction and objectives: The purpose of this study was to evaluate changes in serum electrolytes during Transurethral resection of the prostate (TURP) and to evaluate the degree of correlation of hyponatremia and the factors that affect the incidence of TURP syndrome and to show the impact of the duration of the procedure on the severity of hyponatremia due to absorption of irrigation fluid in the systemic circulation.
Materials and Methods: This study examined 60 male patients planned for elective TURP. The level of serum electrolytes are determined by taking venous blood samples preoperatively and Postoperatively and when the duration of the operation was longer than 60 minutes, the level of serum electrolytes was determined intraoperative. The amount of used irrigation fluid, the weight of resection prostate, and duration of surgery, were also followed. Patients were divided in two groups according to the length of the surgical procedure: Group 1 (30- 60 min) and Group 2 (> 60 min).
Results: Statistically significant reduction of serum sodium and the elevation of the potassium level in serum observed postoperatively and was directly proportional to the volume of of the used irrigation fluid, the duration of the procedure and volume of the resected prostate.
Conclusions: To evaluate changes in serum electrolyte during TURP is simple and economical method for the indirect estimation of irrigation fluid absorption into the systemic circulation during TURP and opportunity for early identification of TURP syndrome
Gordana Taleska, Zorka Nikolova, Vesna Durnev, Maja Mojsova-Mijovska, Elvis Aleksovski, Ljupco Donev, Trajanka Trajkovska, Marija Soljakova, Gordana Petrushevska, Aleksandra Gavrilovska, Vanja Dgambazovska-Trajkovska, Aleksandar Dimov, Vesna Cvetanovska, Vladimir Cadikovski and Risto Simeonov
A surgery of ritual circumcision in healthy young boys is usually a safe procedure. However, an outbreak of severe sepsis a few hours after surgery in patients who underwent this minor procedure is described and analyzed in this report. We describe the clinical course and discuss the causes of the sepsis and septic shock. Contamination of propofol, the intravenous anesthetic agent, was suspected as a probable cause. However, the most important question that had appeared from this case is the prognostic outcome regarding the delayed treatment of severe sepsis
Marija Jovanovski-Srceva, Biljana Kuzmanovska, Maja Mojsova, Andrijan Kartalov, Mirjana Shosholcheva, Marina Temelkovska-Stevanoska, Aleksandra Gavrilovska, Sotir Stavridis, Zoran Spirovski, Borislav Kondov, Anita Kokareva, Risto Todorov and Tatjana Spirovska
Introduction: Surgical stress response, results in elevated levels of anti-insulin hormones and reduced insulin secretion. This hormonal state may be detrimental for surgical patients due to the presence of insulin resistance and hyperglycemia. Additionally, pre-operative fasting favors this conditions. The aim of this study is to analyze the impact of pre-operative caloric load, with 440kJ from amino acid infusions on the levels of glucose, cortisol and insulin resistance in surgical patients.
Material and Methods: The study included 20 female patients scheduled for mastectomy, aged 30-60 years without diabetes and BMI < 30 m2, divided into two groups. The study group A, the evening before the surgery, received 1000 ml amino acid infusions, while the control group B didn′t receive any infusion. In both groups glucose, C-peptide and cortisol levels were determinate preoperatively and postoperatively. From the obtained C-peptide and glucose values, with the help of computer model (HOMA2*), the insulin resistance (IR), functionality of beta cells (BETA) and insulin sensitivity (IS) were calculated.
Results: Postoperative values of insulin resistance (0.94 ± 0.12 vs 1.13 ± 0.2; p = 0.02) and glucose (4.79 ± 0.5 vs 5.77 ± 0.6; p = 0.002) were lower in the study group compared to control group. Postoperative cortisol levels in both groups were higher than the preoperative, but no significant difference was found. The study group showed higher values for BETA and IS. Percentage changes between the groups were significant for all parameters.
Conclusion: Pre-operative caloric load (amino acids) reduces the level of insulin resistance and glucose in the presence of elevated cortisol levels.