Journal of clinical anesthesia
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Review Case Reports
Frequency of anesthetic cardiac arrest and death in the operating room at a single general hospital over a 30-year period.
To determine the anesthetic cardiac arrest (CA) and death rates in the operating room (OR) and to determine whether anesthetic CA and death are preventable. ⋯ The results of 30 years' experience do not support the hypothesis that all anesthetic CAs and deaths are preventable. However, careful clinical management can reduce their frequency to a level lower than those reported in the referenced literature.
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For the patient scheduled for head and neck cancer surgery, careful assessment of the airway demonstrates the most appropriate course of action for securing the airway before surgery begins. Often the patient may be anesthetized safely before intubation of the trachea. The patient may require an awake examination of the airway under sedation and topical analgesia or an awake fiberoptic intubation before the induction of general anesthesia. ⋯ After the operation, extubation of the trachea requires careful attention and may be even more of a challenge than the original intubation. Current principles and techniques for the anesthetic management of the patient undergoing head and neck cancer surgery are reviewed. Emphasis is placed on avoiding the airway problems associated with this kind of surgery.
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The LMA has been commercially available since 1988, and in the United States since 1992. The device combines several advantages of endotracheal tubes and face masks and may be used in many situations where either device was previously used routinely. ⋯ Although not suitable for all patients and procedures, the LMA has become widely used in all other countries where it is available. Many of the surgical procedures for which the LMA is most suited are performed in outpatients, and we expect this device will soon become popular in carefully selected cases in this country.
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Recent pharmacologic and technologic advances in anesthesia and surgery allow outpatients with complex medical problems to undergo a wide variety of diagnostic and surgical procedures on an ambulatory basis. Increasingly, however, anesthesia practitioners, as well as pharmacy and therapeutic committees, are demanding proof that a new, more costly drug or medical device is superior to existing products in achieving its desired effect, is associated with fewer adverse effects, enhances efficiency, and reduces health care costs. The new field of pharmacoeconomics has emphasized the importance of cost-effectiveness analyses that consider both direct and indirect costs of newer drugs and therapeutic modalities. ⋯ Ambulatory anesthesia and surgery will continue to increase because of the potential cost savings for patients undergoing elective operations on an outpatient basis. However, the challenge we face will be to continue to provide high-quality anesthesia care at a reduced cost. A careful examination of commonly accepted (but unproven) clinical practice patterns will be necessary to meet this challenge.