Gordana Taleska - Independent Researcher (original) (raw)
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Papers by Gordana Taleska
Signa Vitae - A Journal In Intensive Care And Emergency Medicine
Background. The technique of one lung ventilation (OLV) is used with the purpose of achieving iso... more Background. The technique of one lung ventilation (OLV) is used with the purpose of achieving isolation of the diseased lung being operated upon, using a doublelumen endobronchial tube. Thoracic surgical procedures which are performed in the lateral decubitus position, nowadays could not be imagined without OLV. In spite of advantages regarding surgical exposure, OLV is associated with serious respiratory impairment. Hypoxemia is considered to be the most important challenge during OLV. The goal of this study was to establish the magnitude of intrapulmonary shunt, as well as the immensity of hypoxia during general anesthesia with OLV. Materials and Methods. In this prospective interventional clinical study thirty patients were enrolled who underwent elective thoracic surgery with a prolonged period of OLV. The patients received balanced general anesthesia with fentanyl/propofol/ rocuronium. A double-lumen endobronchial tube was inserted in all patients, and mechanical ventilation with 50% oxygen in air was used during the entire study. Arterial blood gases were recorded in a lateral decubitus position with two-lung ventilation, at the beginning of OLV (OLV 0) and at 10 and 30 min. (OLV 10, OLV 30, respectively) after initiating OLV in all patients. Standard monitoring procedures were used. Arterial oxygenation (PaO2), arterial oxygen saturation (SaO2) and venous admixture percentage-intrapulmonary shunt (Qs/Qt %) were measured, as well as mean arterial pressure and heart rate during the same time intervals. For the purpose of this study, the quantitative value of Qs/Qt% was mathematically calculated using the blood gas analyser AVL Compact 3. A p value <0.05 was taken to be statistically significant. Results. When OLV was instituted, arterial oxygenation decreased, whereas Qs/Qt% increased, about 10 min. after commencement, with improvement of oxygenation approximately half an hour afterwards. A statistically relevant difference (p<0.05) occurred in PaO2, SaO2 and Qs/Qt at the different time points. Conclusion. Hypoxia during OLV, with an increase in Qs/Qt, usually occurs after 10 min. of its initiation. After 30 min, the values of the Qs/Qt ratio regularly return to normal levels.
A rare complication after heart valve surgery
Initial leucocytosis and hyponatraemia occuring after aneurysmal subarachnoid haemorrhage - do they predict poor outcome?
European Journal of Anaesthesiology, 2008
Initial leucocytosis and hyponatraemia occuring after aneurysmal subarachnoid haemorrhage – do th... more Initial leucocytosis and hyponatraemia occuring after aneurysmal subarachnoid haemorrhage – do they predict poor outcome? G. T. Taleska, V. D. Durnev, V. M. Mircevski, M. S. Soljakova, Z. S. Suplinoski, T. T. Trajkovska, Lj. A. Agai, S. A. Ackovska, V. D. Davceva, Lj. M. Momirovska, M. N. Naumovska University Clinical Center, Clinic of Anaesthesiology Reanimation and Intensive Care, Skopje, Macedonia Background and objective: The blood clot size on admission remains the only factor that increases risk of cerebral vasospasm after SAH. Recently, it was reported that initial leucocytosis and hyponatraemia may be risk factors for development of cerebral vasospasm. Methods and materials: We reviewed data of 45 patients admitted for SAH in 2006–2007. There were 14 males and 31 females. The end-point of a poor outcome was overall mortality. Results: Overall mortality was 48.88%. Sex distribution of mortality rate was males/women 8.88%/40.0% (P , 0.05). Symptomatic vasospasm occurred in 51.1%. We found three predictors of vasospasm, namely Hunt and Hess grade 3, Fisher grade 3 and leucocytosis .15 3 109 per L up to the third day of admission. Initial leucocytosis was associated with greater mortality: discharged/deceased 18.2%/50% (P , 0.05). No correlation between admission leucocytosis and fever was observed nor between later leucocytosis (after day 5) and vasospasm. The examination of correlation of initial hyponatraemia (,135 mmol L) on third to fifth day of admission with mortality rate did not show statistical significance: discharged/deceased 20%/24.4%. Severe initial hyponatraemia (,125 mmol L) occurred less frequently: discharged/deceased 11.1%/17.8%. Conclusion: This study reveals that leucocytosis increases the risk of developing vasospasm but does not prove that initial hyponatraemia has a direct contribution to the pathogenesis of ischaemic complications following SAH.
Volume controlled versus pressure controlled ventilation during one-lung ventilation
European Journal of Anaesthesiology, 2006
Venous air embolism in patients undergoing posterior cranial fossa surgery in sitting position
European Journal of Anaesthesiology, 2006
Preemptive epidural analgesia with bupivacaine and the effects of epidurally added epinephrine for thoracic surgery
European Journal of Anaesthesiology, 2005
Hypoxia during one lung ventilation
Topics in Thoracic Surgery, 2012
Preemptive Epidural Analgesia with Bupivacaine and Sufentanyl and the Effects of Epiduraly Added Epinephrine for Thoracic Surgery
Macedonian Journal of Medical Sciences, 2010
Macedonian Journal of Medical Sciences, 2012
A surgery of ritual circumcision in healthy young boys is usually a safe procedure. However, an o... more 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.
Open access Macedonian journal of medical sciences, Jan 15, 2016
The postoperative low cardiac output is one of the most important complications following cardiac... more The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand. Furthermore, the drug opens potassium ATP (KATP) channels in cardiac mitochondria and in the vascular muscle cells, showing cardioprotective and vasodilator properties, respectively. In the past decade, levosimendan demonstrated promising results in treating patients with reduced left ventricular function when administered in peri- or post- operative settings. In addition, pre-operative use of levosimendan in patients with severely reduce...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine
Background. The technique of one lung ventilation (OLV) is used with the purpose of achieving iso... more Background. The technique of one lung ventilation (OLV) is used with the purpose of achieving isolation of the diseased lung being operated upon, using a doublelumen endobronchial tube. Thoracic surgical procedures which are performed in the lateral decubitus position, nowadays could not be imagined without OLV. In spite of advantages regarding surgical exposure, OLV is associated with serious respiratory impairment. Hypoxemia is considered to be the most important challenge during OLV. The goal of this study was to establish the magnitude of intrapulmonary shunt, as well as the immensity of hypoxia during general anesthesia with OLV. Materials and Methods. In this prospective interventional clinical study thirty patients were enrolled who underwent elective thoracic surgery with a prolonged period of OLV. The patients received balanced general anesthesia with fentanyl/propofol/ rocuronium. A double-lumen endobronchial tube was inserted in all patients, and mechanical ventilation with 50% oxygen in air was used during the entire study. Arterial blood gases were recorded in a lateral decubitus position with two-lung ventilation, at the beginning of OLV (OLV 0) and at 10 and 30 min. (OLV 10, OLV 30, respectively) after initiating OLV in all patients. Standard monitoring procedures were used. Arterial oxygenation (PaO2), arterial oxygen saturation (SaO2) and venous admixture percentage-intrapulmonary shunt (Qs/Qt %) were measured, as well as mean arterial pressure and heart rate during the same time intervals. For the purpose of this study, the quantitative value of Qs/Qt% was mathematically calculated using the blood gas analyser AVL Compact 3. A p value <0.05 was taken to be statistically significant. Results. When OLV was instituted, arterial oxygenation decreased, whereas Qs/Qt% increased, about 10 min. after commencement, with improvement of oxygenation approximately half an hour afterwards. A statistically relevant difference (p<0.05) occurred in PaO2, SaO2 and Qs/Qt at the different time points. Conclusion. Hypoxia during OLV, with an increase in Qs/Qt, usually occurs after 10 min. of its initiation. After 30 min, the values of the Qs/Qt ratio regularly return to normal levels.
A rare complication after heart valve surgery
Initial leucocytosis and hyponatraemia occuring after aneurysmal subarachnoid haemorrhage - do they predict poor outcome?
European Journal of Anaesthesiology, 2008
Initial leucocytosis and hyponatraemia occuring after aneurysmal subarachnoid haemorrhage – do th... more Initial leucocytosis and hyponatraemia occuring after aneurysmal subarachnoid haemorrhage – do they predict poor outcome? G. T. Taleska, V. D. Durnev, V. M. Mircevski, M. S. Soljakova, Z. S. Suplinoski, T. T. Trajkovska, Lj. A. Agai, S. A. Ackovska, V. D. Davceva, Lj. M. Momirovska, M. N. Naumovska University Clinical Center, Clinic of Anaesthesiology Reanimation and Intensive Care, Skopje, Macedonia Background and objective: The blood clot size on admission remains the only factor that increases risk of cerebral vasospasm after SAH. Recently, it was reported that initial leucocytosis and hyponatraemia may be risk factors for development of cerebral vasospasm. Methods and materials: We reviewed data of 45 patients admitted for SAH in 2006–2007. There were 14 males and 31 females. The end-point of a poor outcome was overall mortality. Results: Overall mortality was 48.88%. Sex distribution of mortality rate was males/women 8.88%/40.0% (P , 0.05). Symptomatic vasospasm occurred in 51.1%. We found three predictors of vasospasm, namely Hunt and Hess grade 3, Fisher grade 3 and leucocytosis .15 3 109 per L up to the third day of admission. Initial leucocytosis was associated with greater mortality: discharged/deceased 18.2%/50% (P , 0.05). No correlation between admission leucocytosis and fever was observed nor between later leucocytosis (after day 5) and vasospasm. The examination of correlation of initial hyponatraemia (,135 mmol L) on third to fifth day of admission with mortality rate did not show statistical significance: discharged/deceased 20%/24.4%. Severe initial hyponatraemia (,125 mmol L) occurred less frequently: discharged/deceased 11.1%/17.8%. Conclusion: This study reveals that leucocytosis increases the risk of developing vasospasm but does not prove that initial hyponatraemia has a direct contribution to the pathogenesis of ischaemic complications following SAH.
Volume controlled versus pressure controlled ventilation during one-lung ventilation
European Journal of Anaesthesiology, 2006
Venous air embolism in patients undergoing posterior cranial fossa surgery in sitting position
European Journal of Anaesthesiology, 2006
Preemptive epidural analgesia with bupivacaine and the effects of epidurally added epinephrine for thoracic surgery
European Journal of Anaesthesiology, 2005
Hypoxia during one lung ventilation
Topics in Thoracic Surgery, 2012
Preemptive Epidural Analgesia with Bupivacaine and Sufentanyl and the Effects of Epiduraly Added Epinephrine for Thoracic Surgery
Macedonian Journal of Medical Sciences, 2010
Macedonian Journal of Medical Sciences, 2012
A surgery of ritual circumcision in healthy young boys is usually a safe procedure. However, an o... more 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.
Open access Macedonian journal of medical sciences, Jan 15, 2016
The postoperative low cardiac output is one of the most important complications following cardiac... more The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand. Furthermore, the drug opens potassium ATP (KATP) channels in cardiac mitochondria and in the vascular muscle cells, showing cardioprotective and vasodilator properties, respectively. In the past decade, levosimendan demonstrated promising results in treating patients with reduced left ventricular function when administered in peri- or post- operative settings. In addition, pre-operative use of levosimendan in patients with severely reduce...