International anesthesiology clinics
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Int Anesthesiol Clin · Jan 1998
Anesthetic management of the patient undergoing head and neck cancer surgery.
The head and neck cancer patient should be in the best possible medical condition before facing surgery, bearing in mind the status of the tumor and the urgency of the procedure. Careful assessment of the patient's upper airway will enable the anesthesiologist to select an appropriate course of action to secure the airway before the operation begins. In many cases, the patient can be safely intubated after the induction of general anesthesia. ⋯ If the patient has evidence of a difficult airway, a flexible fiberoptic-guided intubation may be indicated to secure the airway in the awake patient patient before general anesthesia is induced. Some patients with severe airway obstruction or large, bulky supraglottic tumors usually undergo an initial tracheostomy with local anesthesia to secure the airway. Following surgery, extubation of the patient's trachea requires careful attention and may have to be performed over a jet-ventilating stylet.
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Int Anesthesiol Clin · Jan 1998
Biography Historical Article Classical ArticleSpinal anesthesia for cesarean section. 1963.
Safety in spinal anesthesia for cesarean section is achieved by strict adherence to the cardinal principles of proper evaluation and selection of patients, the use of prophylactic vasopressors, preanesthetic establishment of a reliable intravenous channel, small doses of the local anesthetic, close monitoring and maintenance of systolic blood pressure above 100 mm. Hg, and avoidance of ergot compounds in the presence of vasopressors.
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Int Anesthesiol Clin · Jan 1998
Biography Historical Article Classical ArticlePostoperative hepatic dysfunction in perspective. 1970.
Postoperative hepatic dysfunction will remain a difficult entity to place in perspective until increased data are obtained from prospective clinical trials. Ideally these data should compare hepatic dysfunction not only to other postoperative complications, both with regard to overall incidence and to mortality, but also to the overall risks of anesthesia and surgery. The contribution of drug-induced hepatic damage to postoperative hepatic dysfunction has remained unsettled since chloroform was first incriminated during the nineteenth century. ⋯ Just as we have conducted the definitive retrospective hypothesis-testing study--the National Halothane Study--demanded by the "halothane hepatitis" controversy, so must we now move to the final stage of epidemiological investigation (experimental epidemiology) by investigating the effects of multiple administrations of the drug. On this point the National Halothane Study acts more as a hypothesis-formulating study than as a hypothesis-testing study. Hill has noted that statistical problems must be dealt with by the statistical method. (ABSTRACT TRUNCATED)