Otolaryngologic clinics of North America
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Otolaryngol. Clin. North Am. · Dec 2002
A methodology for objective assessment of errors: an example using an endoscopic sinus surgery simulator.
A well-proven methodology (the modified Delphi method) was used to generate a first-order approximation of errors that should be measured in a virtual reality surgical simulator (the ES3). The methodology and the errors derived were crafted in such a way as to be generalizable. ⋯ The value of this process is that it can provide a uniform framework for investigators in surgical education and training to establish error measurements in their particular procedures or disciplines and to generate data and outcomes that are comparable, interoperable, and sharable with other investigators. Admittedly, the process is time consuming and rigorous, but it does provide a solid scientific basis to generate evidence-based data for the validation of training methods and for outcomes analysis.
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This article focuses on petroclival tumors, which are rare lesions of the posterior fossa-an area that is difficult to access. Because of their location, rarity, insidious growth, and relentless natural progression toward a fatal outcome, petroclival tumors pose major management problems. With improved microsurgical techniques, however, these tumors can be approached and removed with preservation of vital neural and vascular structures.
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Anesthesia for endoscopic assessment and treatment of airway problems in infants and children requires a systematic and thoughtful approach. The anesthesiologist and otolaryngologist should have a sound knowledge of the causes of airway obstruction. The anesthesiologist must be aware of the instrumentation likely to be used and the endoscopist must be well informed about the principles of anesthesia. The choice of technique depends upon the needs for each patient, but in most cases, the safest and most controlled method is a gaseous induction with assisted spontaneous respiration and continued maintenance by the inhalational method, supplemented by topically applied local anesthesia.
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Pediatric obstructive sleep apnea occurs in about 2% of children, and manifests as snoring, difficulty breathing, and witnessed apneic spells. Daytime symptoms include excessive sleepiness with poor performance and behavior problems. Severe forms may be associated with failure-to-thrive or death. ⋯ While most pediatric patients with obstructive sleep apnea can be treated with tonsillectomy and adenoidectomy; uvulopalatopharyngoplasty, tracheotomy, or other procedures are sometimes indicated. Nonsurgical treatment with continuous positive airway pressure is used in some children. Postoperative management in high-risk children includes careful perioperative monitoring and postoperative polysomnography.
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Otolaryngol. Clin. North Am. · Dec 1998
ReviewUpper airway bypass surgery for obstructive sleep apnea syndrome.
This article reviews the history of tracheostomy for sleep apnea syndrome along with current indications for temporary and permanent tracheostomy in these patients. Because most patients requiring tracheostomy for obstructive sleep apnea syndrome are morbidly obese and have a short thick neck, a skin-lined technique has been developed. This technique is described along with preoperative and postoperative care necessary to allow uneventful healing and prevent complications. Surgical techniques available for tracheostomy closure are also described.