Articles: surgery.
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Curr Opin Anaesthesiol · Jun 2002
Upper airway infection and pediatric anesthesia: how is the evidence based?
Anesthesia for the child with an upper respiratory infection remains one of the most common, yet contentious, issues facing the pediatric anesthesiologist. A general lack of evidence-based research has led to disparities in the manner in which children with upper respiratory infections have been traditionally managed. More recent research, however, suggests that children with uncomplicated infections can be managed safely, given that most complications can be anticipated, recognized, and treated. This review summarizes the evolving literature regarding cancellation of surgery for the child with an upper respiratory infection, perioperative outcomes, and anesthetic management.
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Endoscopes have been commonly used in transsphenoidal surgery to treat pituitary tumors, to compensate for the narrow surgical field. Although many navigation systems have been introduced for neurosurgical procedures, there have been few reports of navigation systems for endoscopic operations. This report presents our recently developed, endoscopic, augmented reality (AR) navigation system. ⋯ The endoscopic AR navigation system allows surgeons to perform accurate, safe, endoscope-assisted operations to treat pituitary tumors; it is particularly useful for reoperations, in which midline landmarks may be absent. We consider the AR navigation system to be a promising tool for safe, minimally invasive, endonasal, transsphenoidal surgery to treat pituitary tumors.
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Diabetes mellitus has diverse effects on all organ systems of the body. Insulin physiology and metabolic control are far more complex than previously thought. Research continues to reveal more information about the central role of insulin in metabolism. The treatment of hypertension and nephropathy as well as hyperglycemia in patients with diabetes has emerged as being critical for prevention of long-term diabetic complications. The issue of primary importance to the anesthesiologist is whether strict glycemic and hemodynamic control during the perioperative period affect outcome. ⋯ Tight long-term control of glucose and blood pressure improve outcome in patients with diabetes. The same philosophy of management is being applied to the perioperative period. Routine measurement of intraoperative blood glucose levels and appropriate insulin administration are now standard practice, but the ideal regimen for insulin administration remains to be determined.
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Plast. Reconstr. Surg. · Jun 2002
Randomized Controlled Trial Clinical TrialThe prevention of emesis in plastic surgery: a randomized, prospective study.
Perhaps the most unpleasant experience following outpatient plastic surgery procedures is postoperative nausea and vomiting. Postoperative nausea and vomiting often results in delayed recovery time and unintended admission, and it can be a contributing factor to the formation of hematoma following rhytidectomy. Ondansetron (Zofran) has proven benefit in preventing postoperative nausea and vomiting if given before general anesthesia in a variety of surgical procedures. ⋯ The zero incidence of emesis in cases less than 90 minutes does not support the routine use of prophylaxis in such cases. Patient satisfaction in plastic surgery is derived from the overall subjective experience of the event as much as by the final result. By remaining attentive to patient concerns and optimizing perioperative care, we can improve the subjective experience for our patients.