Airtraq® is the preferred device for difficultintubation by residents?

Background: The Airtraq® optical laryngoscope is an intubation device designed to provide a view of the glottis without alignment of the oro-pharyngeal and laryngeal axes. Recent literature shows that, given its two significant features: time effectiveness and short learning curve, Airtraq® is the most favorable option when it comes to difficult intubation. Objectives: The goal was to analyze Airtraq® effectiveness when used by inexperienced physicians in anticipated difficult intubation in adult patients. Materials and methods: We conducted a prospective evaluation in ten medical residents using the Airtraq® device for the first time. All of them were experienced in using Macintosh. Each resident conducted laryngoscopy and intubation with the Airtraq® device after short didactic guidance. Eighteen patients were included, over a period of seven months. The patients showed four difficult intubation predictors: history of difficult intubation, thyromental distance less than 60 mm, mouth opening less than 35 mm and Mallampati class 3 or 4. All of them were clinically examined for difficult airway by an ENT specialist. Results: Before induction of anaesthesia all residents received a short demonstration on the use of the Airtraq®. Every participant was supervised by an Airtraq® handling specialist for each intubation maneuver. In sixteen patients, Airtraq® insertion, glottis visualization and subsequent intubation were easy and rapid, without arterial oxygen desaturation. In two patients the trachea was intubated from the second and third attempt. There were two tracheal intubation failures, associated with extended tracheal intubation and an Airtraq® specialist had to continue with intubation. The Airtraq® reduced the duration of intubation attempts in all cases, reduced the number of optimization maneuvers required, and reduced the potential for dental trauma. However, the two intubation failures emphasize the fact that Airtraq® laryngoscopy requires a clinical training process, especially in the event of anticipated difficult airway management situations. Conclusion: The residents participating the study, found the Airtraq® easier to use in all scenarios compared to the Macintosh laryngoscope. The Airtraq® may be the preferred device, required by inexperienced physicians in cases of difficult airwa

Arterial blood gas alterations in retroperitoneal and transperitoneal laparoscopy

Background: Due to its numerous benefits laparoscopic surgery become very popular among physicians, hospitals and patients nowadays. In the urologic pathology laparoscopy can be performed with retroperitoneal or transperitoneal approach. Insufflation of CO2 for achieving visibility in both of the approaches can be absorbed in the vessels and can lead to alterations in arterial blood gasses. Material and Method: Study population was elective urologic patients scheduled for laparoscopic surgery. Investigated arterial blood gas variables were determined in three time points: T0 before induction – basal, T1 after one hour of CO2 insufflation, and T2 at the end of the surgery. Results: Alterations in arterial blood gasses were seen in T1 and T2 for PaO2 in retroperitoneal vs transperitoneal group 173.3 ± 19 vs 196.6 ± 29 (p < 0.003) and 95.5 ± 5.4 vs 101.1 ± 8.2 (p < 0.001). The PaCO2 was also statistically significant in second observed time point T1 in retroperitoneal vs transperitoneal group 45.9 ± 4.1 vs 38.2 ± 0.3 (p < 0.002). Conclusion: The findings that we have presented can suggest that both approaches are safe although hypercarbia is observed in retroperitoneal group. Key Words: arterial blood gasses, retroperitoneal laparoscopy, transperitoneal laparoscopy, urologic laparoscopy. Corresponding author: Aleksandra Gavrilovska-Brzanov, University Clinic for Anesthesia, Reanimation and Intensive Care, Skopje, Republic of North Macedoni

ANALYSIS OF THE FINANCIAL STATEMENTS WITH SPECIAL REFERECE TO THE APPLICATION AND IMPACT OF THE INTERNATIONAL FINANCIAL REPORTING STANDARD 16-LEASES

“Financial analysis is the evaluation of a business in order to determine its profitability, liabilities, strengths and future earnings potential. A wide variety of techniques may be utilized to assess an organization’s financial viability including the most common methodologies of horizontal analysis, vertical analysis and ratio analysis. Most analytical methods involve the company’s financial statements, internal or external audits, and investigations.Financial analysis is a critical aspect of all commercial activity as it provides actionable insights into the organization’s health and future potential. Not only does this information provide investors and lenders with critical data that may affect the price of stocks or interest rates, these reports also allow company managers to gauge their performance with regard to expectations or industry growth. From a managementpoint of view, financial analyses are critical to the success of the company because they highlight weaknesses and strengths that directly affect competitiveness.International Accounting Standards / International Financial Reporting Standards (IAS / IFRS) are used to standardize accounting data and financial statement data in order for stakeholders to obtain objective information about a company’s profitability and success”