Anesthesiology clinics
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The professional singer comes to the day of surgery with a measure of anxiety about the effects of anesthesia or surgery on his or her voice. A detailed informed consent should be obtained to discuss and document risks, as well as set realistic expectations for recovery. ⋯ Movement of the tube should be minimized, both during anesthesia, as well as in emergence. Postoperative care may be coordinated with an otolaryngologist and speech language pathologist as the singer plans a return to performance.
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Anesthesiology clinics · Jun 2015
ReviewPredictors of difficult intubation and the otolaryngology perioperative consult.
Airway management is one of the most important aspects of anesthesia care. Although the incidence of difficult intubation is low, predicting a potentially difficult airway can ensure that necessary staff and equipment are available. A preoperative airway evaluation should include a history and physical examination focusing on elements that can cause problems with intubation. ⋯ Specific patient and situational factors should be considered. Alternative plans should be defined before the initiation of anesthesia. Management of a complex airway should be a coordinated effort between anesthesiologists and otolaryngologists.
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A prepared airway practitioner performs safe airway management, displaying skill, knowledge, and a full awareness of human factors, within a culture of safety. The education of prepared practitioners should include deliberate practice and distributed learning and should aim for expertise rather than mere competence. Translational outcomes from improved education and training can significantly decrease patient morbidity and mortality.
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Anesthesiology clinics · Jun 2015
ReviewObstructive sleep apnea, sleep disorders, and perioperative considerations.
Data suggest that surgical patients with obstructive sleep apnea (OSA) may be difficult to ventilate and intubate, and may be prone to postoperative complications. This article addresses the identification of patients at risk for OSA, epidemiology of the disorder, and treatment options, as well as the perioperative management of this population.
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Anesthesiology clinics · Jun 2015
ReviewIntegration of a difficult airway response team into a hospital emergency response system.
Hospital-wide emergency response teams have been an area of development for several decades. Highly specialized to address emergent needs, they mimic the cardiac-pulmonary arrest teams established at hospitals nationwide, such as heart attack, brain attack, medical emergency, rapid response, and difficult airway response teams (DART). The DART at Johns Hopkins Hospital is a collaboration of the Anesthesiology and Critical Care Medicine, Otolaryngology-Head and Neck Surgery, General Surgery, and Emergency Medicine departments. This successful model may be used by other hospitals to establish improved and comprehensive care of the difficult airway patient.