Current opinion in otolaryngology & head and neck surgery
-
Curr Opin Otolaryngol Head Neck Surg · Oct 2017
ReviewPerioperative care of head and neck free flap patients.
This article reviews the recent literature on the perioperative care of head and neck surgical patients undergoing free tissue transfer. ⋯ Rates of complications for head and neck free flap surgery remain stubbornly high. Optimization of perioperative nutrition, antibiotics, fluid management, and the establishment of structured pathways has the potential to decrease these complication rates. However, more research is needed into defining and implementing optimal comprehensive care regimens for this complex patient population.
-
Curr Opin Otolaryngol Head Neck Surg · Feb 2017
ReviewAnesthesia for functional endoscopic sinus surgery.
The present article summarizes anesthetic techniques used during functional endoscopic sinus surgery to decrease bleeding and aid in creating a clear surgical field. The applicable physiology behind these anesthetic techniques is reviewed with emphasis on the effect on bleeding and the surgical field. Deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring are discussed. ⋯ Total intravenous anesthesia using propofol and remifentanil is the current favored technique for producing deliberate hypotension during endoscopic sinus surgery due to its hemodynamic stability and smooth rapid emergence.
-
Management of headache disorders is not part of most craniomaxillofacial surgery practices; however there are certain indications for surgical management of headaches by the craniomaxillofacial surgeon. ⋯ Trigger site decompression is an effective treatment for chronic migraine, as are botulinum neurotoxin injections in reducing attacks in cluster headaches. The craniomaxillofacial surgeon is uniquely qualified to treat these primary headache disorders.
-
Curr Opin Otolaryngol Head Neck Surg · Feb 2016
ReviewUpdates in anterior skull base reconstruction.
This article summarizes the indications and surgical techniques for the reconstructions of anterior skull base defects. ⋯ Vascularized pedicled flaps, and especially the NSF, have greatly reduced complications associated with endoscopic skull base surgery. Multiple considerations should be taken into account during closure of skull base defects, and several options are available to accommodate different needs.
-
Curr Opin Otolaryngol Head Neck Surg · Aug 2015
ReviewNear-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.
Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. ⋯ Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.