Anesthesiology clinics
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Anesthesiology clinics · Sep 2010
ReviewAnesthesia for functional endoscopic sinus surgery: a review.
Functional endoscopic sinus surgery has become one of the most common head and neck procedures performed. Proper anesthetic management is essential for a successful outcome. ⋯ The anesthetic plan should be tailored taking into consideration patient comorbidities, the surgeon and anesthesiologist experience, and individual preference. Specific anesthetic goals are to ensure the best possible surgical field and stable cardiovascular and respiratory status during the surgery, emergence of anesthesia, and upon recovery.
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Anesthesia and sleep both predispose to upper airway obstruction through state-induced reductions in pharyngeal dilator muscle activation and lung volume. The tendencies are related in patients with obstructive sleep apnea commonly presenting with difficulties in airway management in the perioperative period. This is a period of great potential vulnerability for such patients because of compromise of the arousal responses that protect against asphyxiation during natural sleep. ⋯ A significant proportion of patients will have previously undiagnosed obstructive sleep apnea and anesthesiologists are well placed to identify this potential. Patients with known or suspected obstructive sleep apnea need careful postoperative management, particularly while consciousness and arousal responses are impaired. Specific follow-up of suspected cases is needed to ensure that the sleep-related component of the problem receives appropriate care.
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Anesthesiology clinics · Sep 2010
ReviewLaryngeal mask airways in ear, nose, and throat procedures.
The use of laryngeal mask airway (LMA) and its variants in ear, nose, and throat procedures have been extensively described in case reports, retrospective reviews, and randomized clinical trials. The LMA has developed a considerable following because of its lack of tracheal stimulation, which can be a considerable advantage in ear, nose, and throat (ENT) procedures. ⋯ Although other approaches to smooth emergence have been described, few would argue that it is as easy to achieve a smooth emergence with an ETT as with an LMA. Although patients certainly exist for whom the LMA is contraindicated, many will experience better results with the LMA because of the features delineated in this article.
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Obstructive sleep apnea is the most prevalent breathing disturbance in sleep. It is linked to a host of preexisting medical conditions, and associated with poorer postoperative outcomes. Screening and vigilance during the preoperative assessment identifies patients at high risk of obstructive sleep apnea. ⋯ Patients with a known diagnosis of obstructive sleep apnea should be seen in the preoperative clinic, where risk stratification and optimization may be done before surgery. This review article presents functional algorithms for the perioperative management of obstructive sleep apnea based on limited clinical evidence, and a collation of expert knowledge and practices. These recommendations may be used to assist the anesthesiologist in decision-making when managing the patient with obstructive sleep apnea.
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Anesthesiology clinics · Jun 2010
ReviewPostoperative pain management after ambulatory surgery: role of multimodal analgesia.
Multimodal (or balanced) analgesia represents an increasingly popular approach to preventing postoperative pain. The approach involves administering a combination of opioid and nonopioid analgesics. ⋯ Early studies evaluating approaches to facilitating the recovery process have demonstrated that the use of multimodal analgesic techniques can improve early recovery as well as other clinically meaningful outcomes after ambulatory surgery. The potential beneficial effects of local anesthetics, NSAIDs, and gabapentanioids in improving perioperative outcomes continue to be investigated.