Anesthesiology clinics
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Anesthesiology clinics · Sep 2010
ReviewApplications of ultrasonography in ENT: airway assessment and nerve blockade.
This article presents a comprehensive narrative review of the published literature relating to ultrasound imaging relevant to anesthesia for ear, nose, and throat (ENT) surgery. The review comprises 2 main subject areas: the use of ultrasonography related to assessment and management of the airway, and the use of ultrasonography related to nerve blockade for ENT surgery. The relevant sonoanatomy and suitable probe placement are illustrated in relation to applicable regional anatomy (they are not discussed). The possible value of the use of ultrasonography to improve existing clinical practice in these areas is explored.
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Anesthesiology clinics · Sep 2010
ReviewLaser surgery and fire hazards in ear, nose, and throat surgeries.
Operating room fires are rare but can be devastating. These fires can occur during almost any surgical procedure but are more likely during airway surgery, during head and neck surgery, and if volatile flammable liquids are used. Each team in the operating room (ie, anesthesia, surgery, and nursing) has special expertise and responsibility in preventing and responding to a fire. Fires can be prevented by ongoing education and an interdisciplinary discussion of risks and responsibilities prior to each high-risk case.
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Anesthesiology clinics · Sep 2010
ReviewAnesthesia for functional endoscopic sinus surgery: a review.
Functional endoscopic sinus surgery has become one of the most common head and neck procedures performed. Proper anesthetic management is essential for a successful outcome. ⋯ The anesthetic plan should be tailored taking into consideration patient comorbidities, the surgeon and anesthesiologist experience, and individual preference. Specific anesthetic goals are to ensure the best possible surgical field and stable cardiovascular and respiratory status during the surgery, emergence of anesthesia, and upon recovery.
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Anesthesia and sleep both predispose to upper airway obstruction through state-induced reductions in pharyngeal dilator muscle activation and lung volume. The tendencies are related in patients with obstructive sleep apnea commonly presenting with difficulties in airway management in the perioperative period. This is a period of great potential vulnerability for such patients because of compromise of the arousal responses that protect against asphyxiation during natural sleep. ⋯ A significant proportion of patients will have previously undiagnosed obstructive sleep apnea and anesthesiologists are well placed to identify this potential. Patients with known or suspected obstructive sleep apnea need careful postoperative management, particularly while consciousness and arousal responses are impaired. Specific follow-up of suspected cases is needed to ensure that the sleep-related component of the problem receives appropriate care.
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Anesthesiology clinics · Sep 2010
ReviewLaryngeal mask airways in ear, nose, and throat procedures.
The use of laryngeal mask airway (LMA) and its variants in ear, nose, and throat procedures have been extensively described in case reports, retrospective reviews, and randomized clinical trials. The LMA has developed a considerable following because of its lack of tracheal stimulation, which can be a considerable advantage in ear, nose, and throat (ENT) procedures. ⋯ Although other approaches to smooth emergence have been described, few would argue that it is as easy to achieve a smooth emergence with an ETT as with an LMA. Although patients certainly exist for whom the LMA is contraindicated, many will experience better results with the LMA because of the features delineated in this article.