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3766 results in Surgery

Page 93 of 189

  • Chapter 23 - Anesthesia for face transplantation

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 220-227

  • Summary

    The terms neck dissection and laryngectomy describe a wide variety of surgical procedures that attempt to remove a cancer and its main route of spread. Neck dissection is commonly performed during laryngectomy for cancer to prevent and treat any local spread of the primary disease. A careful airway evaluation is an essential part of preparation for a patient undergoing laryngectomy with neck dissection. The treatment of laryngeal cancer has three primary goals: tumor removal, prevention of spread and recurrence, and preservation of organ function (phonation and swallowing) where possible. Neck radiation changes can make airway management difficult as its presence is an independent predictor of failure for both bag-mask ventilation and GlideScope intubation. Systolic blood pressure variation of the arterial line tracing can help guide fluid replacement. Alternatively a central line, at a different location from the neck dissection, can be used.

  • Chapter 21 - Anesthesia for parotid surgery

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 203-209

  • Summary

    Functional endoscopic sinus surgery is among the most challenging of ENT procedures for a variety of reasons including the need for immobility, hemostasis, and, especially, gentle emergence from anesthesia. Anesthesiologists have contributed significantly, using anesthetic techniques to mitigate intraoperative hemorrhage into the surgical field, thus significantly improving visualization of the surgical field. Functional endoscopic sinus surgery (FESS) strives to enable direct examination in situ with subsequent correction of encountered chronic changes and barriers which limit sinus drainage and aeration. The use of supraglottic airway (SGA) over endotracheal tubes (ETT) appears additionally advantageous, providing reduced incidence and severity of coughing intraoperatively and during emergence. Propofol/remifentanil total intravenous anesthesia (TIVA) with spontaneous respiration (PRTSR) is considered by some an optimal strategy to avoid emergence problems and provide flexibility, and minimize nausea, vomiting, and estimated blood loss (EBL), while ensuring rapid induction and emergence.

  • Section 1 - Introduction

  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 1-112

  • Summary

    An understanding of anatomy is paramount to the ability to safely anesthetize the head and neck surgery patient. The basic underlying structure of the face is formed by the skull, facial bones and mandible. The cochlear hair cells activate the cochlear nerve, resulting in hearing transmission. The labyrinthine and tympanic portions of the facial nerve lie in close proximity to these structures and may be dehiscent, necessitating lack of neuromuscular blockade and close monitoring of facial movements during certain otologic procedures. The nose projects from the face largely based on the amount of cartilage. The oral cavity therefore includes the lips, buccal mucosa, maxillary and mandibular alveolar ridges/teeth/gingiva, floor of the mouth, hard palate, the retromolar trigone and the anterior oral tongue. Neck anatomy can be significantly altered by cancer or cancer treatments including surgery and radiation or chemoradiation therapy.

  • Chapter 31 - Anesthesia for therapeutic bronchoscopic procedures

  • from Section 5 - Anesthesia for bronchoscopic surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 309-320

  • Summary

    This chapter focuses on non-traumatic maxillary procedures and endoscopic maxillary sinus surgery. Successful surgery involves open dialog between the anesthesiologist, ENT surgeon, and at times the plastic surgeon. Salivary gland resection poses technical challenges to both the surgeon and the anesthesiologist. The anesthetic management of these procedures mainly involves preservation of motor function of the face. Salivary gland resection is an example of the integrated efforts of both surgeon and anesthesiologist. The chapter focuses on the surgery of the mandible and temporomandibular joint (TMJ). Surgery for the mandible can range from biopsy to radical mandibular resection. An example of an anesthetic management for reconstructive mandibular cancer surgery is discussed in the chapter. TMJ arthroscopy is an effective minimally invasive technique to reduce pain and improve the mandibular range of motion that can be done safely on an outpatient basis.

  • Chapter 5 - Preoperative endoscopic airway examination

  • from Section 1 - Introduction
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 50-57

  • Summary

    This chapter highlights a technique of airway evaluation which is readily available to the anesthesiologist, is minimally invasive, and may provide enough information to reduce the use of awake intubation by providing improved clinical information. Preoperative endoscopic airway examination (PEAE), uses the commonly available flexible intubation scope, and unlike use of the same instrument for awake intubation, requires minimal time and patient preparation because it is well tolerated by patients, mimicking an ordinary office ENT laryngoscopic examination. Patients presenting to the operating room under the care of an otolaryngologist for management (diagnostic or therapeutic) of an airway lesions have, in most cases, undergone a flexible endoscopy in the surgeon's office. PEAE may be performed in the preoperative clinic setting, holding area or operating room. Patients who present with invisible airway pathology (e.g. papillomas, supraglottic masses), which may compromise the clinician's ability to control the airway, can be more thoroughly assessed.

  • Chapter 24 - Anesthesia for airway panendoscopy

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 228-236

  • Summary

    During panendoscopy, the anesthesiologist and surgeon must share the airway, with different objectives. The anesthesiologist must deliver oxygen, remove carbon dioxide, provide anesthesia and protect the airway from soiling or aspiration. The surgeon requires an immobile, unobstructed surgical field and adequate time for diagnostic evaluation and intervention. Some patients requiring panendoscopy will present with critical airway obstruction and in these circumstances the safest approach is to proceed to elective tracheostomy under local anesthesia prior to any further endoscopic evaluation. Ventilation techniques can be considered in terms of open and closed systems. A closed system implies ventilation via a cuffed endotracheal tube (ETT). An open system without an ETT is more commonly used for panendoscopy. Panendoscopy is a brief yet highly stimulating procedure that requires deep anesthesia, obtunded hemodynamic reflexes, an immobile surgical field and rapid emergence with early return of protective airway reflexes.

  • Chapter 29 - Anesthesia for otologic and neurotologic surgery

  • from Section 4 - Anesthesia for laryngotracheal surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 271-296

  • Summary

    The location of Zenker's diverticulum along with the inherent risks of aspiration at any given stage of surgery (pre-, intra- or postoperative periods) adds an element of unique difficulty in the anesthetic approach to these patients. This chapter explores the anesthetic considerations for this unique procedure. The surgical procedure is generally curative and a majority of the patients live symptom-free for the rest of their lifetime. A main concern during the induction period is to safely secure the airway without increasing the risk of aspiration. While regurgitation and aspiration may occur during induction of anesthesia and during intubation, they might still happen even after successful uneventful intubation. Pertinent perioperative evaluation should include detailed cardiovascular and nutritional status evaluation and optimization. Perforation of Zenker's diverticulum may occur during a difficult intubation, or during blind placement of a nasogastric tube.

  • Chapter 11 - Prevention and management of airway fires

  • from Section 1 - Introduction
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 105-112

  • Summary

    This chapter deals with difficult airway management in the context of otolaryngologic surgery. To a large extent, the airway management technique for otolaryngologic surgery will depend on clinical circumstances as well as the airway management skills of the anesthesiologist and the available equipment. Should intubation be difficult, clinicians can still provide ventilation and oxygenation via face-mask ventilation. Most patients undergoing otolaryngologic surgery have their airway managed via tracheal intubation. Difficult airway management for otolaryngologic surgery relies heavily on the American Society of Anesthesiologists difficult airway algorithm and, particularly, on the use of awake intubation in the spontaneously breathing patient. The use of fiberoptic intubation for the airway management of patients undergoing otolaryngologic surgery is popular because this technique works well in the presence of many kinds of airway pathology. Many clinicians opt to perform this technique under topical anesthesia with the patient only lightly sedated.

  • Chapter 13 - Anesthesia for endoscopic sinus surgery

  • from Section 2 - Anesthesia for nasal, sinus and pituitary surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 121-132

  • Summary

    The incidence of difficult airway is higher in patients undergoing ENT surgery and, specifically, in patients undergoing ENT cancer surgery. Even the process of topicalization with local anesthetic can precipitate loss of the airway, as can some of the complications associated with awake intubation (e.g. airway bleeding and laryngospasm). The preoperative interview should also address the possibility of events having occurred since the last anesthetic such as weight gain, laryngeal stenosis from previous airway intervention, airway radiation, facial cosmetic surgery, and worsening temporomandibular joint disorder or rheumatoid arthritis. Prior to awake intubation, premedication is commonly used to reduce secretions, enable adequate topicalization of the airway, reduce the risk of epistaxis, and protect against the risk of aspiration. Depending on the clinical circumstance, intravenous sedation may be useful in allowing the patient to tolerate awake intubation by providing anxiolysis, amnesia, and analgesia.

  • Chapter 4 - The difficult airway in otolaryngology

  • from Section 1 - Introduction
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 36-49

  • Summary

    This chapter deals with difficult airway management in the context of otolaryngologic surgery. To a large extent, the airway management technique for otolaryngologic surgery will depend on clinical circumstances as well as the airway management skills of the anesthesiologist and the available equipment. Should intubation be difficult, clinicians can still provide ventilation and oxygenation via face-mask ventilation. Most patients undergoing otolaryngologic surgery have their airway managed via tracheal intubation. Difficult airway management for otolaryngologic surgery relies heavily on the American Society of Anesthesiologists difficult airway algorithm and, particularly, on the use of awake intubation in the spontaneously breathing patient. The use of fiberoptic intubation for the airway management of patients undergoing otolaryngologic surgery is popular because this technique works well in the presence of many kinds of airway pathology. Many clinicians opt to perform this technique under topical anesthesia with the patient only lightly sedated.

  • Chapter 26 - Anesthesia for laryngoplasty

  • from Section 4 - Anesthesia for laryngotracheal surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 245-254

  • Summary

    There are several specific issues that significantly affect the anesthetic management for patients undergoing thyroid surgery. In addition to the general considerations pertaining to anesthesia, specific attention should be directed to the assessment of thyroid function, the size and location of the thyroid gland, its relationship to the trachea and adjacent vascular structures, and the co-existence of a multiple endocrine neoplasia. Hyperparathyroidism due to an adenoma or hyperplasia is the most common presenting symptom of multiple endocrine neoplasia 1 syndrome. Patients at risk of iatrogenic hypoparathyroidism should have ionized calcium levels monitored postoperatively until calcium levels demonstrate that parathyroid function is intact. Primary hyperparathyroidism may result from benign parathyroid adenoma, multiple gland hyperplasia and carcinoma of the parathyroid glands. Clinical signs include carpopedal spasm during cuff inflation, facial twitching by tapping over the facial nerve at the parotid gland, and a prolonged QT interval on the ECG.

  • Chapter 32 - Anesthesia for pediatric otolaryngologic surgery

  • from Section 6 - Anesthesia for Pediatric ENT Surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 321-336

  • Summary

    This chapter outlines anesthetic considerations for face transplantation procedure based on the experience of two hospitals where the first face transplants in the United States took place as well as preliminary data from three international centers (personal communication). Careful examination of a patient's airway is critical since it dictates intraoperative airway management plan. The goals and principles of intraoperative fluid management in face transplantation are similar to any other long surgical procedure involving micro-vascular free flaps. Airway management in cases where the composite graft involves maxillary or mandibular structures may present a significant challenge: the forces associated with direct laryngoscopy for intubation could conceivably cause damage to incompletely healed bony structures. The duration and complexity of the face transplant operation requires participation of multiple teams, including more than one anesthesia team.

  • Chapter 17 - Anesthesia for thyroid and parathyroid surgery

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 163-174

  • Summary

    Stridor is noisy inspiration from turbulent gas flow in the upper airway. This chapter discusses the use of Heliox for temporarily treating stridor in the setting of ENT pathology. Stridor has many potential causes. It may occur as a result of foreign bodies, tumor formation, infections, subglottic stenosis, and airway edema, as well as a result of laryngomalacia, subglottic hemangioma, and vascular rings compressing the trachea. Stridor is usually diagnosed on the basis of symptoms and physical examination, with a view to revealing the underlying problem or condition. Chest and neck X-rays, CT scans, and/or MRIs may reveal structural pathology. Flexible fiberoptic bronchoscopy can also be very helpful, especially in assessing vocal cord function or in looking for signs of compression or infection. Heliox administered with a nonrebreathing face mask should be readily available in every operating room suite to assist in the treatment of stridor.

  • Chapter 16 - Anesthesia for head and neck flap reconstructive surgery

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 151-162

  • Summary

    This chapter discusses the minimal synopsis of selected airway pathology in terms of associated anesthetic and airway implications. The case types covered are those where awake intubation by some means is often the method of choice. Epiglottitis can occur in adults too but the situation is less dreadful because the adult airway is larger. Retropharyngeal abscess formation may occur from bacterial infection of the retropharyngeal space secondary to tonsillar or dental infections. Airway tumors can be benign or malignant, but regardless of type, suffocation from airway obstruction is always a potential concern. Nasal polyps and polyps elsewhere in the airway can lead to partial or complete airway obstruction. Patients with laryngeal papillomatosis caused by a HPV infection may require frequent application of laser treatment for attempted eradication of the papillomas. Since Ludwig's angina is often associated with trismus, nasal fiberoptic intubation is frequently needed.

  • Chapter 8 - Anesthesia for ENT emergencies

  • from Section 1 - Introduction
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 90-93

  • Summary

    This chapter provides a brief overview of otolaryngologic emergencies. Complete or partial airway obstruction is common in ENT practice and anesthesiologists are familiar with a variety of measures, such as tracheal intubation, to deal with this event. Intubation is often needed in cases of angioedema; this will usually be performed under topical anesthesia with the patient awake or lightly sedated. Airway-related bleeding may occur spontaneously, as with a bleeding tumor, as a consequence of anticoagulation (e.g. for atrial fibrillation), or following surgery (e.g. after UVPP surgery). Posterior epistaxis may be particularly severe, may be accompanied by hematemesis or melena, and may require general anesthesia and intubation as part of the treatment. Airway-related infections such as epiglottitis, retropharyngeal abscess and Ludwig's angina constitute an emergency airway. One approach commonly taken in such cases is awake intubation, especially in conjunction with a fiberscope.

  • Section 3 - Anesthesia for head and neck surgery

  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 143-244

  • Summary

    The terms neck dissection and laryngectomy describe a wide variety of surgical procedures that attempt to remove a cancer and its main route of spread. Neck dissection is commonly performed during laryngectomy for cancer to prevent and treat any local spread of the primary disease. A careful airway evaluation is an essential part of preparation for a patient undergoing laryngectomy with neck dissection. The treatment of laryngeal cancer has three primary goals: tumor removal, prevention of spread and recurrence, and preservation of organ function (phonation and swallowing) where possible. Neck radiation changes can make airway management difficult as its presence is an independent predictor of failure for both bag-mask ventilation and GlideScope intubation. Systolic blood pressure variation of the arterial line tracing can help guide fluid replacement. Alternatively a central line, at a different location from the neck dissection, can be used.

Page 93 of 189