The Laryngoscope
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Randomized Controlled Trial Clinical Trial
Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery.
Controlled hypotension is used to improve surgical conditions during microscopic and endoscopic sinus surgery. New short-acting anesthetics such as propofol and remifentanil allow exact control of intraoperative blood pressure and thus might be valuable tools to improve intraoperative conditions for the otorhinolaryngological surgeon. Intravenous anesthesia was compared with traditional balanced anesthesia by subjective assessment of surgical conditions made by two experienced otorhinolaryngological surgeons. ⋯ Intravenous anesthesia using propofol-remifentanil provides better surgical conditions compared with a traditional balanced anesthesia technique using isoflurane-alfentanil. It is hypothesized that lower cardiac output caused by decreased heart rate during deep general anesthesia is responsible for this result.
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To determine the predictors and incidence of hypothermia in patients undergoing head and neck surgery. ⋯ Patients undergoing head and neck surgery are at risk for the development of intraoperative hypothermia and require careful temperature monitoring. Elderly patients and patients with low body mass are more prone to develop low intraoperative core body temperatures. Active warming with forced-air warmers should be considered for patients at risk for intraoperative hypothermia and for patients who develop hypothermia intraoperatively, to avoid hypothermia-related complications.
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Approximately 8 million people in the United States report some degree of dysphagia annually; as the population continues to age, this will become a greater problem. A comprehensibly performed and interpreted fiberoptic endoscopic evaluation of swallowing provides invaluable information for the evaluation and management of individuals with dysphagia or aspiration, or both. ⋯ The state-of-the-art technique, interpretation, predictive value, and safety of fiberoptic endoscopic evaluation of swallowing was reviewed.
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For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume-outcome relationship for surgical excision of acoustic neuromas. ⋯ For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges.