Clinics in plastic surgery
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Review
Management of postoperative nausea and vomiting in ambulatory surgery: the big little problem.
Identifying those patients with the highest risk leads to the greatest success in reducing postoperative nausea and vomiting by modifying the anesthetic plan to decrease baseline risk, and implementing the appropriate use of prophylaxis. The strategies that will be effective in the reduction of postdischarge nausea and vomiting are currently being studied.
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Most outpatient cosmetic procedures are now performed in surgeons' offices, with patients under local anesthesia and minimal intravenous sedation. Sedation at any level beyond minimal creates the risk of airway obstruction and ventilatory depression, which can result in irreversible brain injury or death within minutes. This article discusses appropriate patient and procedure selection, and outlines the personnel, equipment, and techniques necessary to avoid such outcomes.
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Ambulatory surgery centers (ASCs) are being asked to use a safe surgical checklist in 2012 and to report that it has been used in 2013. Checklists should focus on communication and safe surgery practices in each of 3 perioperative periods: (1) before administration of anesthesia, (2) before skin incision, and (3) the period of incision closure and before the patient leaves the operating room. This article reviews the origin of surgical checklists. It examines evidence that indicates that checklists decrease the incidence of human errors, mortality, and morbidity.
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The safety, efficacy, and rapid recovery of conscious sedation/local anesthesia make this anesthetic technique useful in the ambulatory setting. The care of the sedated patient requires a team effort. ⋯ The current technique, using low-dose propofol, is described in detail. Using conscious sedation, the patient's level of consciousness is depressed, but respiratory drive and airway reflexes are maintained and anesthesia is provided by infiltration of local anesthetic.
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The main goal of reconstructive microsurgery must be an optimal functional and esthetic reconstruction meeting the individual trauma site requirements with minimal donor site morbidity. The authors discuss new microsurgical options for extremity salvage: indications for reconstruction versus amputation, timing of free tissue transfer, reconstruction of soft tissue and bone, and functional muscle transfer. They discuss indications and contraindications for these procedures, along with emphasizing the important points of each.