Medical Sciences

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The Medical Sciences community showcases scholarly publications and research outputs authored by faculty and researchers in the Faculty of Medical Sciences. This collection includes journal articles, working papers, conference proceedings, and other academic works that contribute to the understanding of theory, policy, and practice. It aims to promote open access to high-quality economic research conducted within the institution.

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Intrathecal clonidine added to small-dose bupivacaine prolongs postoperative analgesia in patients undergoing transurethral surgery
(AAB College, 2025-07-16) Gecaj Gashi, Agreta
Introduction: The aim of this prospective, double-blinded study was to investigate the effects of clonidine in co-administration with bupivacaine during spinal anesthesia, regarding the onset and regression of motor and sensory block, postoperative analgesia and possible side effects. Methods: We randomly selected 66 male patients (age 35 to 70), from the American Society of Anesthesiologists (ASA) class I-II; these patients were scheduled for transurethral surgical procedures. These patients were randomly allocated into two groups of 33 patients each: group B (bupivacaine) only received 0.5% isobaric bupivacaine 7.5 mg intrathecally and group BC (bupivacaine + clonidine) received bupivacaine 7.5 mg and clonidine 25 μg intrathecally. We performed the spinal anesthesia at a level of L3-L4 with a 25-gauge needle. We assessed the sensory block with a pinprick, the motor block using the Bromage scale, analgesia with the visual analog scale and sedation with the modified Wilson scale. We also recorded the hemodynamic and respiratory parameters. Results: The groups were demographically similar. The mean time of achievement of motor block (Bromage 3) and sensory block at level T9 was significantly shorter in the BC group compared with B group (p = 0.002, p = 0.000, respeectively). The motor block regression time was not significantly different between the two groups (p = 0.237). The postoperative analgesia requirement was significantly longer in group BC compared with group B (p = 0.000). No neurological deficit, sedation or other significant adverse effects were recorded. Conclusion: The intrathecal application of clonidine in combination with bupivacaine improves the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without significant side effects.
Intravenous lidocaine suppresses fentanyl-induced cough in Children
(AAB College, 2025-07-16) Gecaj Gashi, Agreta
Objective: Fentanyl-induced cough is usually mild and transitory, but it can be undesirable in patients with increased intracranial pressure, open wounds of the eye, dissecting aortic aneurism, pneumothorax, and reactive airway disease. The aim of this study is to evaluate the efficacy of lidocaine in suppressing fentanyl-induced cough in children during induction in general anesthesia. Methods: One hundred and eighty-six children of both sexes, aged between 4–10 years, ASA physical status I and II, and scheduled for elective surgery, were recruited for the study. Patients with a history of bronchial asthma, obstructive pulmonary disease, or infections of the respiratory tract were excluded. Patients were randomly allocated to three equal groups (n = 62) to receive 1.0 mg/kg lidocaine (Group I), 0.5 mg/kg lidocaine (Group II), or placebo (equal volume of 0.9% saline; Group III). Each was administered over 5 s one minute before intravenous (IV) administration of fentanyl 2−3 μg/kg during induction in general anesthesia. The severity of coughing was graded by counting the number of episodes of cough: mild (1−2), moderate (3−4) or severe (5 or more). Results: Demographic information was comparable between groups. The most frequent coughing was observed in the placebo group (Group III; 43.5%), of whom 4.8% (three patients) were graded with severe cough. In Group II, 22.6% patients had cough, of which 1.6% (one patient) was graded as severe. In Group I, 16.1% patients had cough, none of whom were graded as severe. Conclusion: Our results demonstrate that IV lidocaine can markedly suppress fentanyl-induced cough in children, even in doses as low as 0.5 mg/kg.
Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report
(AAB College, 2025-07-17) Jaha, Luan; Gecaj Gashi, Agreta
Introduction: Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter. Case presentation: We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up. Conclusion: The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery
Safety of Low Flow Sevoflurane Anesthesia for Patient with Dextrocardia and Situs Inversus Totalis: A Case Report
(AAB College, 2025-07-16) Gecaj Gashi, Agreta
Situs inversus totalis with dextrocardia also named situs inversus totalis is a rare congenital condition in which the anatomy of the abdominal and thoracic organs are arranged in a mirror image reversal of the normal positioning. Case Report: A 42-year-old Albanian female was scheduled for elective maxillofacial surgery, cyst in the left side of the neck, and previously undiagnosed dextrocardia with situs inversus was picked up in preanesthetic evaluation by an anesthesiologist, during auscultation of the heart revealed a grade 2/6 holosystolic murmur at the left parasternal border. General anesthesia was induced with propofol 3mg/kg, fentanyl 3mcg kg, rocuronium 1mg/kg to facilitate endotracheal intubation and maintained with sevoflurane 1.0- 1, 5 MAC, in O2 /N2O 50:50%. After tracheal intubation, the fresh gas flow was set to 4 L.min -1 (O2 2 L.min, N2O 2 L.min). When the target gas concentrations have been achieved, FGF was reduced in 1 l/min, with the relative proportion of O2 /N2O titrated to maintain the inspired oxygen fraction (FiO2) between 0.30 and 0.35. Inhaled and exhaled gas concentrations were continuously monitored. The patient was calm after extubation (score 1-of agitation), awareness according to Awareness Categorization was pointed with score 1- no awareness. In the PACU she was hemodynamically stable and after full recovery returned to the ward. Results of arterial blood gas analyzes BUN, AST, ALT, LDH, glycemia, total bilirubin, proteinogram, haemogram and electrolytes were within normal reference range. Her postoperative course was uneventful and she was discharged on the third postoperative day. Conclusion: With particular attention in preanesthetic visit we managed to find out dextrocardia with situs inversus totalis. We realized low flow sevoflurane anesthesia, which showed to be safe.