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
ReviewThe laryngeal mask airway in emergency medicine, neonatal resuscitation, and intensive care medicine.
In assessing the potential role of the LMA outside the operating room, the risks of a less secure airway must be balanced against the benefits of ease of training, success and speed of insertion, no need for direct visualization of laryngeal structures, and lesser need for ancillary equipment. The LMA has a role as an alternative to FMV in CPR when personnel skilled in tracheal intubation are not available. ⋯ The LMA is incorporated into advanced life support training and as such should be regarded as a device providing temporary airway support, rather than a replacement for a tracheal tube. The LMA, and possibly also the ILM, should be standard equipment carried by prehospital trauma teams and by all those attending victims in the field.
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Postoperative pain can be effectively managed, even in the most complex oncologic procedures. Although the primary agents for treatment of severe pain continue to be opioids, routes of administration and dosing regimen have undergone a dramatic metamorphosis in the past 10 years. The intramuscular injection given every 4 hours has been replaced by patient-controlled analgesia and epidural techniques. ⋯ Early outcome studies are beginning to confirm the belief that improved pain management translates into between outcomes and earlier dismissals. In the first century BC, Publilius Syrus, a Latin mime, wrote, "There are some remedies worse than the disease." For centuries, pain was inextricably linked to treatment. We may now be approaching a time in the development of medical care when this is no longer true.
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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.