Anesthesia for Airway Endoscopy and Micro-Laryngeal Surgery

2021 ◽  
Author(s):  
Vicki E. Modest ◽  
Paul H. Alfille
Keyword(s):  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Jet Ventilation ◽  
Control Plan ◽  
Airway Control ◽  
Laryngeal Surgery ◽  
Anesthetic Considerations ◽  
Surgical Field ◽  
Suspension Laryngoscopy ◽  
Type Of Surgery

Pre- and intra-operative anesthetic management considerations for airway endoscopy and micro-laryngeal surgery are covered in this chapter. Often presenting with critically obstructed or otherwise compromised airways, a carefully devised induction and airway control plan is essential. Unique to this type of surgery is the shared surgical field, requiring the utmost level of communication and cooperation between the surgical and anesthesia teams. Included is a discussion of ventilation options, routine and otherwise, and associated airway instrumentation such as jet ventilation catheters. Challenges of patient management during suspension laryngoscopy, are presented. Also addressed are laser basics, specific anesthetic considerations including risks and potential harms in the setting of these high-risk for fire procedures. This review contains 5 figures, 2 tables, and 40 references. Keywords: airway endoscopy, micro-laryngeal surgery, anesthetic considerations, obstructed airway, preoperative evaluation, airway intubation, laryngeal microsurgery, fire, OR

scholarly journals Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

2014 ◽  
Vol 61 (3) ◽  
pp. 103-106 ◽  
Author(s):  
Yuri Hase ◽  
Nobuhito Kamekura ◽  
Toshiaki Fujisawa ◽  
Kazuaki Fukushima
Keyword(s):  
Airway Management ◽  
Cervical Vertebrae ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Fatal Outcome ◽  
Laryngeal Edema ◽  
Airway Control ◽  
First Choice ◽  
Surgical Airway ◽  
Preoperative Examination

Abstract Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

scholarly journals Anesthesia and Analgesia in the Patient with an Unstable Shoulder

2017 ◽  
Vol 11 (1) ◽  
pp. 848-860 ◽  
Author(s):  
Ismael Acevedo Bambaren ◽  
Fernando Dominguez ◽  
Maria Elena Elias Martin ◽  
Silvia Domínguez
Keyword(s):  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Postoperative Pain Management ◽  
Good Health ◽  
Cerebral Hypoperfusion ◽  
Nerve Blocks ◽  
Airway Control ◽  
Intraoperative Management

Introduction:The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities.Material and Methods:For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed.Conclusion:The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.

scholarly journals Facilitating Airway Surgery in a Morbidly Obese Patient Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Si-Jia Lee ◽  
Kelvin Howyow Quek
Keyword(s):  
Obese Patient ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Airway Surgery ◽  
Laryngeal Surgery ◽  
Morbidly Obese Patient ◽  
Obese Population ◽  
Obese Subjects ◽  
Difficult Airways ◽  
Surgical Field

Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a relatively new noninvasive oxygenation technique with a broad range of applications. It is used in the treatment of type one respiratory failure, as a preoxygenation tool, as a rescue and temporising measure in difficult airways, and as step-down oxygen therapy in patients after extubation. Its use has also been described in laryngeal surgeries, but they mainly involved normal-weight subjects or were used as a bridging oxygenation therapy before definitive airway is secured. The major benefits of using THRIVE in obese subjects undergoing laryngeal surgery include a tubeless and uninterrupted surgical field. This advantage is especially crucial in obese patients as they tend to have limited oropharyngeal space, rendering a shared airway technically challenging for surgeons. However, concerns of potential difficult airway and shorter safe apnoeic time in the obese population limit its use. In this case, we report its use as the sole oxygenation strategy in a morbidly obese patient undergoing airway surgery. Our experience suggests that THRIVE can provide a conducive operating field and adequate oxygenation in short apnoeic laryngeal procedures in the obese population, without causing excessive hypercarbia.

scholarly journals Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Aliki Tympa ◽  
Kassiani Theodoraki ◽  
Athanassia Tsaroucha ◽  
Nikolaos Arkadopoulos ◽  
Ioannis Vassiliou ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Ischemia Reperfusion ◽  
Anesthetic Management ◽  
Vascular Occlusion ◽  
Air Embolism ◽  
Preoperative Assessment ◽  
Mortality Rates ◽  
Vascular Control ◽  
Hemodynamic Management ◽  
Anesthetic Considerations

Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms “anesthetic,” “anesthesia,” “liver,” “hepatectomy,” “inflow,” “outflow occlusion,” “Pringle,” “hemodynamic,” “air embolism,” “blood loss,” “transfusion,” “ischemia-reperfusion,” “preconditioning,” was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed.

scholarly journals Anaesthesia management of a case of huge neck mass due to cervical spine chondrosarcoma with distorted anatomy

2021 ◽  
Vol 8 (4) ◽  
pp. 600-603
Author(s):  
Utkarsha P Bhojane ◽  
Jyoti P Deshpande ◽  
Akshay M Salunke ◽  
Noopur D Singh
Keyword(s):  
Cervical Spine ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Neck Mass ◽  
Fiberoptic Intubation ◽  
Surgical Intensive Care Unit ◽  
Blood Products ◽  
Surgical Intensive Care ◽  
Cervical Spine Surgery ◽  
Mucosal Edema

Chondrosarcoma is the tumor which affects bone and soft tissue with only 2% spinal involvement. Anesthetic management becomes challenging in patients with cervical chondrosarcoma. Here, we are presenting a case of huge neck mass due to cervical spine chondrosarcoma in 70 year old male hypertensive patient. The patient has distorted anatomy with mucosal edema with left tracheal deviation and compression from right side. Awake Nasal Fiberoptic intubation was done with cuffed ETT no 8. The neck mass was removed and Anterior Cervical Discectomy and Fusion (ACDF) with bone grafting. The case was managed with adequate analgesia, replacement of fluids and Blood and Blood products. Considering complex cervical spine surgery and airway edema the patient was shifted to Surgical Intensive Care Unit (ICU) for elective ventilation and advanced monitoring. After serial ABG and proper weaning the patient was extubated next morning smoothly. Extensive preoperative evaluation, planning, clinical judgement and skilled experienced personale are essential for proper execution of difficult airway cases.

scholarly journals Anaesthesia for Tracheobronchial Stent Insertion Using an Laryngeal Mask Airway and High-Frequency Jet Ventilation

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Anne M. Dolan ◽  
Michael F. Moore
Keyword(s):  
Laryngeal Mask Airway ◽  
High Frequency ◽  
Malignant Tumour ◽  
Laryngeal Mask ◽  
Spontaneous Respiration ◽  
Stent Insertion ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation ◽  
Tracheobronchial Stent ◽  
Surgical Field

An approach which promotes a rapid return to spontaneous respiration after tracheobronchial stent (TBS) insertion is considered the optimal one and is a belief shared by anaesthetists, respiratory physicians, and surgeons alike (Calvey and William (2008)). The value of the laryngeal mask airway (LMA), followed by use of the Monsoon 111 Acutronic jet ventilator pressure limiting system of ventilation, for the deployment of stents in the three individual cases that of tracheoesophageal fistula, a bronchoesophageal fistula, and tracheal compression from an invading oesophageal malignant tumour are reported. The roles of target controlled anaesthesia, high-frequency jet ventilation (HFJV), and the laryngeal mask airway in optimising the surgical field and reducing the risk of bronchospasm at emergence are advantages of this technique.

Open Rhinoplasty

2020 ◽  
Author(s):  
Ginger Xu ◽  
Paul Hwang ◽  
Nargiz Seyidova ◽  
Samuel J. Lin
Keyword(s):  
Key Words ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
Black Box ◽  
Open Rhinoplasty ◽  
Nasal Tip ◽  
Nasal Anatomy ◽  
Nasal Function ◽  
Type Of Surgery

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.   Key words: open rhinoplasty, nasal anatomy, nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques This review contains 23 figures, 2 tables, and 43 references.

Anesthesia

2019 ◽  
pp. 175-187
Author(s):  
Christopher J. Plambeck ◽  
Michael K. Loushin ◽  
Michael F. Sweeney
Keyword(s):  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Management Plan ◽  
Left Ventricular ◽  
Care Providers ◽  
Anesthetic Care ◽  
Ventricular Assist ◽  
Hemodynamic Deterioration ◽  
Left Ventricular Assist ◽  
Post Cardiopulmonary Bypass

The anesthetic care of the left ventricular assist device (LVAD) recipient presents to the anesthesiologist a unique set of challenges which must be skillfully managed for the successful completion of this complex surgical procedure. The anesthesiologist must perform a thorough preoperative evaluation and carefully assess the patient’s cardiovascular, pulmonary, renal, and hepatic systems. Special consideration to the risk of post-implantation right ventricular (RV) dysfunction is critical. In patients with advanced heart failure, a well-formulated anesthetic management plan must be developed to provide adequate anesthesia while at the same time preventing hemodynamic deterioration. The performance of a comprehensive transesophageal echocardiogram study is essential for identifying potential issues that may need to be addressed during the surgery. The post-cardiopulmonary bypass period is fraught with several challenges which the anesthesiologist must address, such as RV dysfunction or failure, vasoplegia, and coagulopathy. The transition of care to the ICU is facilitated by the application of a standardized checklist to ensure that all critical information is conveyed to the critical care providers. The anesthesiologist also frequently provides care for the LVAD patient undergoing a non-cardiac surgery or procedure. A careful preoperative evaluation and a thorough understanding of the technology and physiology of the LVAD patient is essential to the development of a safe and sensible anesthetic management plan.

Trauma: The Burn Patient

2018 ◽  
pp. 81-86
Author(s):  
Ethan Kim ◽  
Ruchir Gupta
Keyword(s):  
Carbon Monoxide ◽  
Fluid Therapy ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Initial Assessment ◽  
Area Burned ◽  
Intraoperative Management ◽  
Parkland Formula ◽  
Burn Patient

In this chapter the essential aspects of anesthetic management of the burn patient are discussed. Subtopics include use of the Parkland formula for calculating fluid requirements, airway considerations, and carbon monoxide toxicity. The differences between first-, second-, and third-degree burns are also discussed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues discussed that are related to preoperative evaluation include initial assessment, calculating percentage of body area burned, and airway evaluation. Topics related to intraoperative management include muscle relaxation, monitoring, and fluid therapy. Postoperative issues involve extubation criteria and treatment to induce muscle relaxation.

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