Articles: surgery.
-
Ambulatory surgery is now one of the major areas of surgical and anesthetic practice, with up to 70% of procedures performed in the ambulatory setting. This review focuses on some of the recent studies performed in day case anesthesia. ⋯ Careful patient selection can minimize perioperative events. The concept of multimodal analgesic and antiemetic therapy, in combination with newer anesthetic drugs, help expand the field of ambulatory surgery.
-
In a companion article, we synthesized current clinical and preclinical data to formulate hypotheses about the etiology of drug administration catheter-tip inflammatory masses. In this article, we communicate our recommendations for the detection, treatment, mitigation, and prevention of such masses. ⋯ Attentive follow-up and maintenance of an index of suspicion should permit timely diagnosis, minimally invasive treatment, and avoidance of neurological injury from catheter-tip inflammatory masses. Whenever it is feasible, positioning the catheter in the lumbar thecal sac and/or keeping the daily intrathecal opioid dose as low as possible for as long possible may mitigate the seriousness, and perhaps, reduce the incidence of such inflammatory masses.
-
This review will bring to the reader's attention recent developments in the literature regarding regional anesthesia in the outpatient setting, and allow the reader to evaluate whether these developments are appropriate for inclusion in clinical practice. ⋯ Recent publications suggest additional ways to add regional anesthesia techniques to outpatient surgical practice, particularly with the promise of extensive postoperative pain relief for the ambulatory surgery patient.
-
Ieee T Inf Technol B · Dec 2002
ReviewTechnology improvements for image-guided and minimally invasive spine procedures.
This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. ⋯ The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient.
-
IEEE Trans Med Imaging · Dec 2002
Comparative StudyImplementation, calibration and accuracy testing of an image-enhanced endoscopy system.
This paper presents a new method for image-guided surgery called image-enhanced endoscopy. Registered real and virtual endoscopic images (perspective volume renderings generated from the same view as the endoscope camera using a preoperative image) are displayed simultaneously; when combined with the ability to vary tissue transparency in the virtual images, this provides surgeons with the ability to see beyond visible surfaces and, thus, provides additional exposure during surgery. A mount with four photoreflective spheres is rigidly attached to the endoscope and its position and orientation is tracked using an optical position sensor. ⋯ It is probable that much of the projection error is due to endoscope tracking error rather than calibration error. Two examples of clinical applications are presented to illustrate the usefulness of image-enhanced endoscopy. This method is a useful addition to conventional image-guidance systems, which generally show only the position of the tip (and sometimes the orientation) of a surgical instrument or probe on reformatted image slices.