Anesthesiology clinics
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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.
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Anesthesiology clinics · Jun 2010
ReviewAmbulatory anesthesia and regional catheters: when and how.
Several clinical trials have demonstrated the superiority of continuous peripheral nerve block compared with traditional opioid-based analgesia. The ability to provide safe and effective continuous peripheral nerve block at home is an attractive alternative to opioid-based analgesia with its related side effects. ⋯ Techniques for catheter placement, infusion regimens, patient education, and complications are subject to many institutional preferences. In this review, special emphasis is placed on evidence-based techniques.
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Anesthesiology clinics · Jun 2010
ReviewOffice-based anesthesia: how to start an office-based practice.
Ambulatory, office-based anesthesia (OBA) has experienced an exponential growth in the last decade, and is popular among patients and health care providers alike. About 17% to 24% of all elective ambulatory procedures in the United States are currently being performed in an office-based setting. ⋯ Increasing regulation will ensure that patient safety remains the primary focus. In the meantime, the anesthesia provider must take adequate steps to ensure that the quality of care in OBA is comparable to that in a hospital.