Best practice & research. Clinical anaesthesiology
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The majority of upper extremity surgeries are performed on an ambulatory basis under intravenous regional anaesthesia or brachial plexus blockade. The former technique is easy to perform, has a rapid onset and a high success rate but provides limited post-operative analgesia. Brachial plexus blockade provides excellent intraoperative anaesthesia as well as post-operative analgesia, eliminates the need for post-operative opioids, resulting in a decrease in recovery time, shortened hospital stay, increased patient satisfaction and ultimately a decrease in perioperative costs when compared with general anaesthesia. This chapter reviews upper extremity surgical procedures performed below the shoulder, the anaesthetic options available, and techniques used to optimize post-operative pain control.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthesia for minimally invasive surgery in children.
There continues to be an increase in the applications of minimally invasive surgical techniques in infants and children. This increase includes their use for new surgical procedures as well as their application in younger patients including neonates. As with any new surgical procedure, specific modifications of the anaesthetic technique may be necessary. This chapter reviews (1) the pre-operative evaluation of infants and children scheduled for minimally invasive surgery; (2) techniques for pre-medication and anaesthetic induction; (3) intra-operative anaesthetic implications of laparoscopy, including the cardiorespiratory consequences of CO2 pneumoperitoneum; (4) intra-operative anaesthetic implications of thoracoscopy, including techniques for one-lung ventilation (OLV); and (5) post-operative issues, including pain management and monitoring of cardiorespiratory function as they apply to the patient of paediatric age.
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Anaesthetic requirements for endovascular surgery for aortic, carotid and peripheral vascular disease are reviewed. Peculiarities of the surgery which may impinge on anaesthetic management are discussed together with the pre-operative assessment issues of particular relevance to patients with generalized vascular disease. The detailed anaesthetic management for carotid and aortic endovascular repair is addressed. The lowered peri-operative stress and general morbidity levels which occur with endovascular surgery allow sicker patients with greater risk factors to present for this type of surgery, thus increasing the challenges facing anaesthetists.
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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.
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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.