In-office Endonasal Minor Revision Rhinoplasty

2021 ◽  
Author(s):  
Samuel R. Auger ◽  
Anil R. Shah
Keyword(s):  
General Anesthesia ◽  
Operating Room ◽  
Recovery Time ◽  
Plastic Surgeon ◽  
Endonasal Approach ◽  
Revision Rhinoplasty ◽  
Minor Revision ◽  
Facial Plastic ◽  
Level Of Experience ◽  
Technical Considerations

AbstractThe revision rhinoplasty presents many unique challenges to the facial plastic surgeon. While many cases will require a full revision in the operating room, there are several isolated deformities which may be repaired in the office via an endonasal approach. This provides many benefits to the patient and surgeon including decreased cost, shorter recovery time, avoidance of general anesthesia, and less discomfort. It is critical to identify defects appropriate for endonasal repair, establish clear expectations with the patient, and work within one's skill set and level of experience. The surgeon who can comfortably navigate both open and endonasal techniques can offer their patients a comprehensive set of solutions for revision rhinoplasty. In this article we outline the defects amenable to this type of repair as well as technical considerations for each defect addressed. We hope it serves as a useful framework for the range of deformities the rhinoplasty surgeon may take on for in-office repair.

Grafts in Endonasal Rhinoplasty

2021 ◽  
Author(s):  
Daniel D. Lee ◽  
Ziad Katrib ◽  
Edwin F. Williams
Keyword(s):  
Plastic Surgeon ◽  
Endonasal Approach ◽  
Facial Plastic ◽  
Nasal Function

AbstractRhinoplasty is arguably one of the most challenging but rewarding procedures for the facial plastic surgeon. To adequately improve facial aesthetic parameters and preserve nasal function, the appropriate utilization of grafts is of utmost importance. While there is no best method, I found that in my hands, the endonasal approach allowed me to achieve greater control over my results by limiting dissection, utilizing less cartilage, and minimizing variables. In this manuscript, I outline the surgical pearls I have developed throughout my career that have helped me execute these grafts efficiently and effectively.

scholarly journals Emergency Drug Kits: Pharmacological and Technical Considerations

2014 ◽  
Vol 61 (4) ◽  
pp. 171-179 ◽  
Author(s):  
Daniel E. Becker
Keyword(s):  
Adverse Events ◽  
Continuing Education ◽  
General Anesthesia ◽  
Intraoperative Monitoring ◽  
Preoperative Assessment ◽  
Procedural Sedation ◽  
Dental Procedures ◽  
Dental Practices ◽  
Emergency Drugs ◽  
Technical Considerations

Abstract The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.

scholarly journals Endoscopic Endonasal Approach of Congenital Meningoencephalocele Surgery: First Reported Case in Lithuania

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Svajūnas Balseris ◽  
Giedrius Strazdas ◽  
Saulius Ročka ◽  
Tomas Jakštas
Keyword(s):  
Recovery Time ◽  
Rare Condition ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Runny Nose ◽  
Short Recovery Time ◽  
Operative Outcome ◽  
Surgery First ◽  
Skull Base Defect

Meningoencephalocele is a rare condition that usually occurs in children and is treated by neurosurgeons with occasional help from ENT doctors. The symptoms of meningoencephalocele might not develop until adulthood, but usually they are apparent immediately after birth. The case of small anterior basal transethmoidal meningoencephalocele in a 24-year-old patient who had headaches and runny nose since childhood is presented. Endonasal endoscopic approach for meningoencephalocele removal and skull base defect reconstruction was used. It was concluded that endoscopic endonasal approach is less invasive and provides an acceptable operative outcome with short recovery time and less postoperative complications in comparison with other external microsurgical approaches.

scholarly journals Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room

2017 ◽  
Vol 127 (3) ◽  
pp. 466-474 ◽  
Author(s):  
Brad S. Karon ◽  
Leslie J. Donato ◽  
Chelsie M. Larsen ◽  
Lindsay K. Siebenaler ◽  
Amy E. Wells ◽  
...  
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Operating Room ◽  
Whole Blood ◽  
Insulin Infusion ◽  
Subcutaneous Insulin ◽  
Intravenous Insulin ◽  
Diabetes Status ◽  
Glucose Meter ◽  
Arterial Glucose

Abstract Background The aim of this study was to evaluate the use of a glucose meter with surgical patients under general anesthesia in the operating room. Methods Glucose measurements were performed intraoperatively on 368 paired capillary and arterial whole blood samples using a Nova StatStrip (Nova Biomedical, USA) glucose meter and compared with 368 reference arterial whole blood glucose measurements by blood gas analyzer in 196 patients. Primary outcomes were median bias (meter minus reference), percentage of glucose meter samples meeting accuracy criteria for subcutaneous insulin dosing as defined by Parkes error grid analysis for type 1 diabetes mellitus, and accuracy criteria for intravenous insulin infusion as defined by Clinical and Laboratory Standards Institute guidelines. Time under anesthesia, patient position, diabetes status, and other variables were studied to determine whether any affected glucose meter bias. Results Median bias (interquartile range) was −4 mg/dl (−9 to 0 mg/dl), which did not differ from median arterial meter bias of −5 mg/dl (−9 to −1 mg/dl; P = 0.32). All of the capillary and arterial glucose meter values met acceptability criteria for subcutaneous insulin dosing, whereas only 89% (327 of 368) of capillary and 93% (344 of 368) arterial glucose meter values met accuracy criteria for intravenous insulin infusion. Time, patient position, and diabetes status were not associated with meter bias. Conclusions Capillary and arterial blood glucose measured using the glucose meter are acceptable for intraoperative subcutaneous insulin dosing. Whole blood glucose on the meter did not meet accuracy guidelines established specifically for more intensive (e.g., intravenous insulin) glycemic control in the acute care environment.

Solid Organ Biopsies

2018 ◽  
pp. 246-249
Author(s):  
Jennifer Biber ◽  
Jenna Wheeler
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Operating Room ◽  
Local Anesthesia ◽  
Deep Sedation ◽  
Recovery Period ◽  
Contingency Planning ◽  
Solid Organ ◽  
Sedation And Analgesia ◽  
Pediatric Sedation

While solid organ biopsies are routinely done on adults with only local anesthesia or minimal sedation, children frequently require deep sedation or general anesthesia to achieve acceptable conditions (stillness, anxiolysis, analgesia) to facilitate these procedures. This is more frequently being done with pediatric sedation/anesthesia outside the operating room. Issues unique to sedation for these procedures are pain, the need for relative patient immobility (both during the procedure and following it), and the nonstandard positioning required during the procedure. Regardless of the medications chosen, adequate monitoring should occur during the procedure as well as during the recovery period. With a good sedation plan for both sedation and analgesia, adequate monitoring, and contingency planning for adverse events, this can safely be performed in institutions with highly motivated and organized sedation services.

scholarly journals Impact of Instituting General Anesthesia on Oral Sedation Care in a Tertiary Care Pediatric Dental Clinic

2019 ◽  
Vol 66 (4) ◽  
pp. 183-191 ◽  
Author(s):  
David L Moore ◽  
Lili Ding ◽  
Gang Yang ◽  
Stephen Wilson
Keyword(s):  
General Anesthesia ◽  
Operating Room ◽  
Low Income ◽  
Tertiary Care ◽  
Adverse Event Rate ◽  
Dental Clinic ◽  
Dental Services ◽  
Serious Adverse Events ◽  
Before And After ◽  
Oral Sedation

Tertiary pediatric medical centers disproportionately care for low-income, underserved children with significant dental needs. Long wait times for hospital operating room treatment increase tooth loss rather than restoration. Oral sedation has commonly been provided to avoid the long waits for operating room treatment. However, this can be challenging with young, anxious patients. High failure rates and repeat visits for oral sedation have resulted in continued waiting for definitive dental services in the operating room. The Division of Dentistry requested the Department of Anesthesiology to create a general anesthesia program in the dental clinic to increase the use of anesthesia services but align the cost of the anesthetic with the revenue stream. Our aim was to objectively measure the performance of a dental clinic anesthesia service by comparing the percentage of case completions, percentage of complete radiographs, and number of serious adverse events to clinic-based oral sedations. We were also interested in total number of cases completed. We retrospectively studied data regarding an in-office general anesthesia (IOGA) program for dentistry and compared it to oral sedations before and after instituting the IOGA program. Patients received either a general endotracheal anesthetic or nonintubated total intravenous general anesthesia. Successful case completion increased from 88.6% (oral sedation) to 99.5% (IOGA). One hundred percent of IOGA cases had complete radiographs, as opposed to 63.4% for oral sedation. This was an increase from 53.5% from the previous 2 years with oral sedation. Serious adverse event rate was 0% (0/508) for oral sedation and 0.2% (1/418) for IOGA. Comparing 2 years before and after IOGA revealed a decrease in oral sedations from 930 to 508, whereas IOGA increased from 0 to 418 cases. Anesthesia services in dental clinic increased complete dental care and complete radiographs, reduced failed sedations, and were performed safely.

scholarly journals Observation of the clinical efficacy of dexmedetomidine in flexible bronchoscopy under general anesthesia: clinical case experience exchange

2019 ◽  
Vol 47 (12) ◽  
pp. 6215-6222 ◽  
Author(s):  
Hongtu Li ◽  
Na Zhang ◽  
Ke Zhang ◽  
Yanhua Wei
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Adverse Events ◽  
Arterial Pressure ◽  
General Anesthesia ◽  
Recovery Time ◽  
Flexible Bronchoscopy ◽  
Stress Indices ◽  
Group A ◽  
Group B

Object To investigate the clinical efficacy and safety of dexmedetomidine in flexible bronchoscopy under general anesthesia. Methods A total of 114 patients were randomly divided into intervention group A and control group B. Group A received dexmedetomidine, fentanyl, and propofol as anesthesia, while Group B received fentanyl and propofol only. Changes in heart rate, mean arterial pressure, pulse oxygen saturation, stress indices (blood cortisol, adrenaline, and norepinephrine levels), incidence of adverse events, anesthesia dose, duration of procedure, and recovery time were compared between the groups at specific time points T0, T1, and T2 during bronchoscopy. Results There was no statistical difference between the groups at T0. At T1 and T2, pulse oxygen saturation, mean arterial pressure, heart rate, and stress indices in group A were significantly more favorable than those in group B. The incidence of adverse events (5.26%) in group A was significantly lower than that in group B (17.54%), and patients in group A required less propofol and had a faster recovery time than patients in group B. Conclusion Dexmedetomidine use in flexible bronchoscopy under general anesthesia is safe and effective and decreases the stress response in synergy with propofol to provide hemodynamic stability.

scholarly journals The Potential for Telemedicine to Reduce Bias in Patients Seeking Facial Plastic Surgery

2020 ◽  
pp. 019459982096473
Author(s):  
Parsa P. Salehi ◽  
Brian J. F. Wong ◽  
Babak Azizzadeh
Keyword(s):  
Head And Neck ◽  
Plastic Surgery ◽  
Plastic Surgeon ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Facial Plastic Surgery ◽  
Facial Plastic

Telemedicine use among otolaryngologists–head and neck surgeons and facial plastic and reconstructive surgeons has accelerated as a result of the COVID-19 pandemic. Yet, it is unclear what impact the increased adoption of telehealth will have on the doctor-patient relationship, patients’ perceptions of individual practices, and the likelihood of patients proceeding with the next steps toward surgery. While an understanding of these complex questions is imperative for all otolaryngologists, it is extremely important for facial plastic surgeons who focus on elective procedures, particularly cosmetic/aesthetic operations. The use of telemedicine has the potential to reduce bias among patients seeking facial plastic surgery, especially cosmetic procedures. As reports of this phenomenon are anecdotal thus far, we recommend further study into the specific criteria that patients consider when selecting a facial plastic surgeon.

Ethics and the facial plastic surgeon

2015 ◽  
Vol 273 (9) ◽  
pp. 2323-2327 ◽  
Author(s):  
Neeraj Sethi ◽  
Keyword(s):  
Plastic Surgeon ◽  
Facial Plastic
Sign in / Sign up

Export Citation Format

Share Document