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3766 results in Surgery

Page 94 of 189

  • Chapter 12 - Anesthesia for septoplasty and rhinoplasty

  • 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 113-120

  • 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 6 - Awake intubation

  • 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 58-82

  • 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.

  • 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 321-345

  • Summary

    Anesthesia for pediatric otorhinolaryngologic procedures represents the largest proportion of elective surgery for not only pediatric anesthesiologists but also general anesthesiologists taking care of children. Adenotonsillectomy (T&A) is one of the most commonly performed pediatric surgical procedures, with recurrent tonsillitis or pharyngitis and adenotonsillar hypertrophy as the major indications. Management and maintenance of anesthesia focuses on maintaining the patient's hemodynamic and volume status, guided by fluid therapy or blood transfusion. For urgent tracheotomies the anesthesiologist must determine whether the child can maintain an airway under general anesthesia and can be intubated by standard laryngoscopy or fiberoptic bronchoscopy. Otolaryngologic procedures require proper preoperative evaluation, intraoperative planning and anticipation of postoperative complications to ensure a favorable outcome. Laryngeal surgery can result in postoperative airway compromise, secondary to swelling or laryngo-tracheomalacia. A safe and smooth postoperative recovery can be achieved by anticipation of potential complications and careful planning for prophylaxis, and effective therapy.

  • Chapter 20 - Anesthesia for Zenker's diverticulectomy

  • 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 195-202

  • 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 2 - Otolaryngology instruments 101 for the anesthesiologist

  • 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 18-25

  • Summary

    This chapter introduces some of the more common otolaryngology instruments used during procedures involving the larynx, trachea, cervical esophagus, pharynx, and paranasal sinuses. Surgery of the larynx, pharynx, and trachea begins with securing the airway with an appropriate device that will allow for adequate ventilation. Many cases of septoplasty and rhinoplasty are performed under local anesthesia with varying degrees of sedation. Transoral robotic surgery is an emerging technology that is becoming more common at tertiary care centers. Surgery of the upper aerodigestive tract deals with diverse pathology that requires a variety of special surgical instrumentation. Given the demands of the surgeon and anesthesiologist, it is crucial for optimal patient care that open communication before, during, and after the procedure be the standard operating protocol. Basic understanding of otolaryngologic instrumentation as described in the chapter will hopefully allow for mutual understanding between the surgical and anesthesia teams.

  • Chapter 30 - Anesthesia for diagnostic 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 297-308

  • Summary

    The paired parotid glands are the largest among the three major salivary glands in the human body. The parotid gland is encapsulated between the superficial and deep layers of the parotid gland fascia (PGF). This chapter discusses the surgical treatment and anesthesia of sialolithiasis. Airway management after parotidectomy with radical neck dissection can be a challenging situation due to aggravating factors like previous neck interventions, radiation therapy, large fluid shift, intraoperative airway manipulation, swollen tissue and residual anesthetic effect. Ductal stone formation and ductal stenosis are common causes of obstructive salivary diseases of the parotid glands. Sufficient anesthetic depth and patient immobility are usually achieved by a balanced anesthetic technique employing relatively large doses of opioid and inhalational agents. Light anesthesia and patient movement lead to serious complications, especially in the absence of neuromuscular blockade.

  • Chapter 28 - Anesthesia for the management of subglottic stenosis and tracheal resection

  • 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 263-270

  • Summary

    The perioperative anesthetic management of carotid body tumor resection includes a comprehensive preoperative airway assessment, optimization of patient comorbidities, and identification of symptoms pointing to secreting tumors. The goals of intraoperative hemodynamic management are to maintain normal baseline hemodynamics, avoiding extreme swings in blood pressure and heart rate. Whether regional or general anesthesia is used, the goals of perioperative management are to preserve stable hemodynamics and maintain end-organ perfusion, to prepare for resuscitation of acute major blood loss, to utilize monitoring modalities to identify, avoid, and manage cerebral ischemia, and to provide a smooth controlled emergence. Internal carotid artery clamping, reconstruction or sacrifice may be required for large grade III tumors or when the internal carotid artery is inadvertently injured. In the postoperative period, complications should be anticipated, diagnosed, and promptly managed. Patients undergoing bilateral carotid tumor surgery should be continuously monitored in an intensive care environment postoperatively.

  • Chapter 19 - Anesthesia for carotid body tumor resction

  • 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 186-194

  • Summary

    The majority of septoplasties and rhinoplasties are performed on healthy patients in the outpatient setting; however, occasionally patients present with medical comorbidities or obstructive sleep apnea (OSA). These surgeries can be performed with local anesthesia and sedation or general anesthesia with an LMA or endotracheal tube. The indication for surgery may be purely cosmetic, post trauma, reconstructive after tumor resection or to improve nasal breathing. Many nasal procedures can successfully be performed under local anesthesia with sedation. Operative and recovery times have been shown to be shorter for patients undergoing surgery with local anesthesia with sedation compared with general anesthesia. Bleeding is one of the biggest complications of nasal surgery. Minimization of intraoperative blood loss allows the surgeon to have an operative field which he can visualize well. The main intraoperative concern includes the minimization of bleeding with use of vasoconstrictors and submucosal epinephrine, controlled hypotension and a smooth emergence.

  • Chapter 33 - Anesthesia for reconstructive airway surgery in pediatrics

  • 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 337-345

  • 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 10 - Use of Heliox in managing stridor: an ENT perspective

  • 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 101-104

  • Summary

    A thorough preoperative evaluation will provide both anesthesiologist and surgeon valuable information which may alter the course of patient care. Anesthetic preoperative evaluation is composed of four components: patient history, physical examination, laboratory studies, and anesthetic plan. A review of systems examination is usually a useful approach; this includes assessment of cardiac, pulmonary, renal, hepatic, neurological, gastrointestinal, endocrinological/metabolic, musculoskeletal, psychiatric, gynecological and obstetric organ systems. For ENT surgery, most of the time, anesthetic-related reasons for cancellation are due to recent upper respiratory infection or non-compliance with preoperative fasting guidelines. Evaluation of patient capacity sometimes enters into the process of informed consent or refusal in the elderly. Traditionally, anesthesiologists often consider perioperative cardiac and pulmonary events relatively controlled and easily reversible. While most of the ENT procedures are in the low surgical risk category, some of the large elective ENT operations are considered intermediate-risk surgery.

  • 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 297-320

  • Summary

    Diagnostic bronchoscopic procedures are performed every day by both pulmonologists and thoracic surgeons. Diagnostic bronchoscopy is indicated for airway exam, bronchioalveolar lavage, biopsy of airway lesions, autofluorescence bronchoscopy, and narrow band imaging. Endobronchial ultrasound (EBUS) is a minimally invasive procedure that was designed to evaluate mediastinal and hilar lymphadenopathy using a linear array ultrasound probe modified flexible bronchoscope. Electromagnetic navigational bronchoscopy (ENB) is a bronchoscopic procedure that utilizes the principle of GPS to allow the bronchoscopist to reach peripheral lung lesions adjacent to very small distal bronchi. Diagnostic bronchoscopy can be considered an urgent procedure where a definitive diagnosis and/or staging of a known cancer is needed to plan treatment. Advanced diagnostic bronchoscopy can be performed under moderate sedation, monitored anesthesia care or general anesthesia. EBUS and EMN are considered relatively safe procedures. Rare complications and morbidities which can occur are described in this chapter.

  • Chapter 3 - Preoperative evaluation for ENT surgery

  • 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 26-35

  • Summary

    A thorough preoperative evaluation will provide both anesthesiologist and surgeon valuable information which may alter the course of patient care. Anesthetic preoperative evaluation is composed of four components: patient history, physical examination, laboratory studies, and anesthetic plan. A review of systems examination is usually a useful approach; this includes assessment of cardiac, pulmonary, renal, hepatic, neurological, gastrointestinal, endocrinological/metabolic, musculoskeletal, psychiatric, gynecological and obstetric organ systems. For ENT surgery, most of the time, anesthetic-related reasons for cancellation are due to recent upper respiratory infection or non-compliance with preoperative fasting guidelines. Evaluation of patient capacity sometimes enters into the process of informed consent or refusal in the elderly. Traditionally, anesthesiologists often consider perioperative cardiac and pulmonary events relatively controlled and easily reversible. While most of the ENT procedures are in the low surgical risk category, some of the large elective ENT operations are considered intermediate-risk surgery.

  • Chapter 22 - Anesthesia for maxillary, salivary gland, mandibular and temporomandibular joint 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 210-219

  • Summary

    Transsphenoidal pituitary resection is a common surgical procedure that offers unique challenges to the anesthesiologist. Generally, the transsphenoidal approach to the sella region can be divided into two techniques: (1) the sublabial approach which involves an incision made beneath the upper lip into the gum and subsequently through the septum and (2) the transnasal approach which involves dissection through the nasal cavity wall using microsurgical or endoscopic instruments inserted through the nostrils. The heterogeneity of the patient population and their medical condition requires a fundamental knowledge of the nature of pituitary disease and management. Understanding the specific demands of the surgical technique allows the anesthesia provider to facilitate the procedure and increase the efficacy of the intervention. Additionally, predicting and managing the peri- and postoperative complications allows the anesthesiologist to maximize the safety of the patient.

  • Chapter 9 - Airway pathology in otolaryngology: anesthetic implications

  • 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 94-100

  • Summary

    This chapter introduces some of the more common otolaryngology instruments used during procedures involving the larynx, trachea, cervical esophagus, pharynx, and paranasal sinuses. Surgery of the larynx, pharynx, and trachea begins with securing the airway with an appropriate device that will allow for adequate ventilation. Many cases of septoplasty and rhinoplasty are performed under local anesthesia with varying degrees of sedation. Transoral robotic surgery is an emerging technology that is becoming more common at tertiary care centers. Surgery of the upper aerodigestive tract deals with diverse pathology that requires a variety of special surgical instrumentation. Given the demands of the surgeon and anesthesiologist, it is crucial for optimal patient care that open communication before, during, and after the procedure be the standard operating protocol. Basic understanding of otolaryngologic instrumentation as described in the chapter will hopefully allow for mutual understanding between the surgical and anesthesia teams.

  • Chapter 27 - Anesthesia for tracheotomy

  • 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 255-262

  • Summary

    The obstructive sleep apnea (OSA) patient presenting for OSA surgery presents a number of challenges to the anesthesiologist. OSA is diagnosed by clinical history and an overnight sleep study or polysomnography (PSG). PAP treatment attempts to maintain a competent airway through the application of continuous positive airway pressure (CPAP), bi-level positive pressure (BiPAP) or auto-titrating positive pressure (APAP). The three anatomic areas that can contribute to OSA as a result of increased nasal resistance include the alar cartilage/nasal valve area, the septum and the turbinates. These patients may have a number of cardiac and respiratory comorbidities as well as very challenging airways. Consideration should be given to optimization of medical comorbidities preoperatively, careful airway management, and minimization of sedating pain medications intraoperatively. Postoperatively airway edema, hemorrhage, and respiratory complications are a concern and the patient should be recovered in a monitored setting until they return to their baseline.

  • Chapter 25 - Anesthesia for ENT laser 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 237-244

  • Summary

    Otolaryngologic flap reconstructive surgery, while lengthy, risky and complex, can be performed with a high degree of safety. Flaps can be categorized based on their blood supply. For head and neck surgery patients, a group of patients have been well characterized as gaining the most benefit from free flap reconstructions. The anesthetic management includes careful planning of difficult airway issues such as tracheostomy if the airway is compromised, considerations to positioning, understanding of surgical sites, choice of intraoperative monitoring, considerations related to the length of surgery and thermoregulation, flap perfusion considerations, planning postoperative care and level of care. This is in addition to considerations related to coexisting morbidities in this elderly population, who commonly present with tobacco and alcohol abuse. Clear communication with otolaryngology colleagues will help greatly for proper planning and execution of these considerations, helping to ensure a favorable outcome.

Page 94 of 189