Otolaryngologic clinics of North America
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Hemostasis is an important concept in pediatric otolaryngologic surgery. This article details the considerations the otolaryngologist should take when it comes to clinical evaluation and surgical technique. ⋯ We detail use of different hemostatic techniques in common pediatric procedures, and finally, we discuss indications for intraoperative and postoperative blood transfusion in pediatric patients if the surgeon encounters significant intraoperative hemorrhage. This paper gives a comprehensive look into the hemostatic considerations for the pediatric patient through the preoperative to postoperative period.
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Otolaryngol. Clin. North Am. · Jun 2016
ReviewAnesthetic Techniques in Endoscopic Sinus and Skull Base Surgery.
Endoscopic sinus approach has become one of the most common surgical techniques for endoscopic sinus and skull base surgery. Anesthetic management has an important impact on the overall patient management, from the preoperative assessment and management to the quality of the surgical field and the postoperative recovery. ⋯ Reduction of intraoperative bleeding should be considered during the treatment planning. Preoperative preparations include the optimization of comorbidities and cessation of drugs that may inhibit coagulation.
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Otolaryngol. Clin. North Am. · Jun 2016
ReviewManagement of Major Vascular Injury During Endoscopic Endonasal Skull Base Surgery.
A major vascular injury is the most feared complication of endoscopic sinus and skull base surgery. Risk factors for vascular injury are discussed, and an algorithm for management of a major vascular injury is presented. ⋯ A variety of techniques can be used to control a major injury, including coagulation, a muscle patch, sacrifice of the artery, and angiographic stenting. Immediate and close angiographic follow-up is critical to prevent and manage subsequent complications of vascular injury.
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Otolaryngol. Clin. North Am. · Jun 2016
ReviewSimulation Training for Vascular Emergencies in Endoscopic Sinus and Skull Base Surgery.
Carotid artery injury during endonasal surgery is a feared and potentially catastrophic complication. Simulation training provides the opportunity for a realistic experience with management of major vascular injuries. The sheep model of carotid artery injury reproduces the challenges of dealing with vascular emergencies during endoscopic sinus and skull base surgery, which include working in narrow nasal confines, high-flow/high-pressure vascular injury, and the immediately challenging surgical field. Simulated vascular emergencies allow for research and development; training using various surgical techniques to control the field, including hemostatic products or direct vascular closure techniques; and consequently improved patient care and outcomes.