Best practice & research. Clinical anaesthesiology
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Technological advances in imaging, computing and surgical instrumentation have encouraged the application of minimally invasive surgical techniques to various neurosurgical disorders. This chapter discusses the wide application of neurosurgery and the implications for anaesthesia, focusing on the specific anaesthetic considerations for neuroendoscopy, stereotactic procedures and radiosurgery.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthesia for minimally invasive cardiac surgery.
Minimally invasive cardiac surgery is used for both extracardiac and intracardiac procedures. Extracardiac procedures, such as coronary artery bypass grafting, are often performed on a beating heart. Intracardiac procedures are done with the aid of cardiopulmonary bypass. ⋯ Patient selection is important to avoid intra-operative and post-operative complications. Prolonged single-lung ventilation, incomplete revascularization in hybrid procedures, and limited access for rapid intervention pose challenges with patient management. Conversion to sternotomy that may be required occasionally and extension of portals over several dermatomal segments mandate a versatile analgesic technique.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthetic considerations for laparoscopic cholecystectomy.
Minimally invasive surgical procedures aim to minimize the trauma of the interventional process but still achieve a satisfactory therapeutic result. Tissue trauma is significantly less than that with conventional open procedures, offering the advantages of reduced post-operative pain, shorter hospital stay, more rapid return to normal activities and significant cost savings. Laparoscopic cholecystectomy is now a routinely performed procedure and has replaced conventional open cholecystectomy as the procedure of choice for symptomatic cholelithiasis. ⋯ Intra-operative complications may include traumatic injuries associated with blind trocar insertion, gas embolism, pneumothorax and surgical emphysema associated with extraperitoneal insufflation. Appropriate monitoring and a high index of suspicion can result in early diagnosis of, and treatment of, complications. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.
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The surgical requirement for thoracoscopy is a good view of the contents of the thorax. This is achieved by capitalizing on natural consequences and the skills of anaesthesiologists to produce a pneumothorax and collapse the ipsilateral lung--a process that is commonly enhanced by insufflating carbon dioxide. Insufflating CO2 to actively promote lung collapse creates the dynamics of a tension pneumothorax. ⋯ The mechanism is not defined but it differs from that associated with thoracotomy. Epidural analgesia and opioids may be required. Chronic pain syndromes have been described as complications.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthetic considerations for hysteroscopic surgery.
Use of the hysteroscope in modern gynaecological practice continues to develop as a diagnostic and management tool for intrauterine disease. Operative hysteroscopy (OH) is now an accepted alternative to hysterectomy for women with menorrhagia. The advantages of OH are associated with its short operating time, rapid post-operative recovery and low morbidity. ⋯ There are no controlled studies comparing different anaesthetic techniques for OH. Regional anaesthesia may offer an advantage over general anaesthesia because it enables early detection of fluid overload. Great care should be taken when positioning the patient to prevent peripheral neuropathy.