ORL; journal for oto-rhino-laryngology and its related specialties
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2013
How to make tonsillectomy a safer procedure: the anaesthetist's view.
Anaesthetists use specific drugs peri-operatively to try to decrease the incidence and severity of postoperative pain and of postoperative nausea and vomiting. These drugs are usually administered pre-operatively with the premedication, or intra-operatively when the patient is still anaesthetised. The aim of this approach is to prevent the occurrence of intolerable pain or to avoid any nausea or vomiting symptoms which may be clearly unpleasant for the patient and which interfere with the patient's well-being, recovery and satisfaction. ⋯ Perhaps a 'wait-and-see' approach should be considered; especially non-steroidal anti-inflammatory drugs or dexamethasone should not be given pre-operatively to all patients but should be provided exclusively to those in whom alternative analgesics (for instance, paracetamol combined with a weak opioid) or alternative anti-emetics (for instance, a setron or droperidol) have failed or are associated with unacceptable adverse effects. There is no evidence that prophylactic administration of an analgesic or an anti-emetic is more efficacious than the therapeutic administration. An interesting alternative to achieve satisfactory posttonsillectomy analgesia may be with local anaesthesia swabs that are applied onto the wound.
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Dexamethasone is widely administered to children during elective tonsillectomy to reduce the rate of postoperative nausea and vomiting, as well as decrease postoperative use of pain medications. Over the past two decades, there has been a wealth of literature advocating the practice that has led to endorsement by a variety of anesthesia and otolaryngology professional associations. However, the publication of a trial that was halted due to a potential dose-dependent association between postoperative hemorrhage and dexamethasone raised significant scrutiny regarding the practice in 2008. ⋯ Ultimately, the body of evidence that currently exists appears to support the concept that a single dose of perioperative dexamethasone is not associated with undue risk. A decision to withdraw dexamethasone from use in pediatric tonsillectomy needs to be weighed against the potential of causing increased postoperative nausea, vomiting, pain, and resultant hospital readmission. At this point, surgeons and anesthesiologists should feel comfortable giving perioperative dexamethasone but must remain vigilant for bleeding complications.
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2012
Case ReportsEndoscopic microvascular decompression: a stepwise operative technique.
Microvascular decompression (MVD) of the trigeminal nerve is a widely accepted treatment for patients with trigeminal neuralgia caused by vascular compression. The neuroendoscope is rapidly becoming a complementary tool in minimally invasive neurosurgery of the ventral anterior skull base. Its adoption in the lateral approach to the posterior fossa has been slower and has been used primarily as an adjunct to conventional microscopic surgical techniques, e.g. endoscope-assisted microsurgery. ⋯ We believe endoscopic MVD is a safe and effective method of accessing the trigeminal nerve in the cerebellopontine angle and of performing MVD. This endoscopic technique can be implemented in other neurosurgical and neuro-otological procedures such as resection of cerebellopontine angle masses.
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2012
Resection of anterior cranial base meningiomas with intra- and extracranial involvement via a purely endoscopic endonasal approach.
The complete resection of anterior cranial base meningiomas with intra- and extracranial involvement is always challenging. We describe our experience of treating such meningiomas via a purely endoscopic endonasal approach (EEA). ⋯ Our limited experience indicates that EEA is feasible and safe for the complete resection of anterior cranial base meningiomas with intra- and extracranial involvement in one stage in selected cases.