scholarly journals Before and after major neck surgery

2018 ◽  
Vol 53 (24) ◽  
pp. 1565-1566
Author(s):  
Stefano Della Villa
Keyword(s):  
Neck Surgery ◽  
Before And After

Multimodal Analgesia Protocol after Head and Neck Surgery: Effect on Opioid Use and Pain Control

2019 ◽  
Vol 161 (3) ◽  
pp. 424-430 ◽  
Author(s):  
Eugenie Du ◽  
Zainab Farzal ◽  
Elizabeth Stephenson ◽  
April Tanner ◽  
Katherine Adams ◽  
...  
Keyword(s):  
Head And Neck ◽  
Pain Control ◽  
Neck Surgery ◽  
Multimodal Analgesia ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Protocol Implementation ◽  
Pain Scores ◽  
Before And After ◽  
Average Pain

Objective To assess the effect that implementation of a multimodal analgesic plan has on opioid requirements and pain control in head and neck (H&N) surgery patients. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods An institutional review board (IRB)–approved quality improvement initiative was undertaken to implement a multimodal analgesic protocol for all admitted H&N surgery patients starting November 2017. Postprotocol data from January to May 2018 were compared to preprotocol data from May to October 2017. Data were obtained from the electronic health records as well as through preoperative and postoperative surveys. Average pain scores and opioid use in morphine milligram equivalents (MMEs) before and after protocol implementation were compared. Results In total, 139 postprotocol patients were compared to 89 preprotocol patients. The adjusted MMEs in the first 24 hours after surgery decreased significantly from 93.7 mg to 58.6 mg ( P = .026) with protocol implementation. When averaged over the length of stay (MME/hospital day), the change was no longer statistically significant (57.9 vs 46.8 mg, P = .211). The average pain score immediately after surgery and on day of discharge did not change with protocol implementation. Conclusion Implementation of a multimodal analgesia plan reduced opioid use immediately after surgery but not over the course of hospitalization without any change in reported pain scores. This study shows that multimodal opioid-sparing analgesia after H&N surgery is feasible. Future studies are needed further refine the optimal analgesic strategy for H&N patients and assess the long-term efficacy, safety, and cost of such regimens.

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

scholarly journals Ketamine Infusion in Post-Surgical Pain Management after Head and Neck Surgery: A Retrospective Observational Study

2019 ◽  
Vol 13 (1) ◽  
pp. 132-138
Author(s):  
Vincenzo Pota ◽  
Maria B. Passavanti ◽  
Caterina Aurilio ◽  
Manlio Barbarisi ◽  
Luca G. Giaccari ◽  
...  
Keyword(s):  
Observational Study ◽  
Head And Neck ◽  
Pain Control ◽  
Neck Surgery ◽  
Retrospective Observational Study ◽  
Ketamine Infusion ◽  
Surgical Pain ◽  
Significant Difference ◽  
Before And After ◽  
Remifentanil Group

Background: Head and neck cancer affects approximately 382,000 new patients per year worldwide with a significant portion undergoing surgical treatment. During postoperative period key elements in the Intensive Care Unit (ICU) are airway management and pain control. Objective: We evaluated the average change of inpatient pain control using a Numerical Rating Score (NRS). We also evaluated the time of extubation after ICU admission recording the incidence of desaturation and the necessity of re-intubation. Secondary outcomes were the incidence of postoperative complications, included those narcotics-related, and the use of rescue analgesics. Methods: In this retrospective observational study, we analyzed data of registry before and after we have changed our postoperative analgesic protocol from remifentanil infusion to ketamine infusion. Results: Medical records of 20 patients were examined. 10 patients received 0.5 mg/kg ketamine bolus at the end of surgery, followed by a continuous infusion of 0.25 mg/kg/h. All patients presented a significant decrease in pain intensity from the 4th to 48th postoperative hour (p < 0.05), but statically not a significant difference in NRS score was recorded between the two groups. Time to extubation was shorter in ketamine group compared to the remifentanil group (112.30 min ± 16.78 vs. 78 min ± 14.17; p < 0.05). Desaturation rate was 10% in the remifentanil group, while no case was recorded in the ketamine group. Conclusion: The level of analgesia provided by ketamine and remifentanil was comparable. Ketamine was superior in ventilatory management of the patient with more rapid extubation and with no case of desaturation.

scholarly journals Treatment of Head and Neck Venous Malformations with Sodium Tetradecyl Sulfate

OTO Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 2473974X1879706 ◽  
Author(s):  
Ebrahim Karimi ◽  
Mehrdad Jafari ◽  
Keyvan Aghazadeh ◽  
Saeed Sohrabpour ◽  
Fatemeh Tavakolnejad
Keyword(s):  
Head And Neck ◽  
Venous Malformation ◽  
Case Series ◽  
Neck Surgery ◽  
Lesion Size ◽  
Sodium Tetradecyl Sulfate ◽  
Venous Malformations ◽  
Medical Sciences ◽  
Before And After

Objective The purpose of this study was to discuss the clinical outcomes and complications of treating venous malformations with sclerotherapy, with sodium tetradecyl sulfate as the sclerosing agent. Study Design Case series with planned data collection. Setting Amiralam Hospital—a referral otolaryngology–head and neck surgery hospital affiliated with Tehran University of Medical Sciences. Subjects and Methods A total of 345 patients with venous malformations were treated with sclerotherapy with sodium tetradecyl sulfate 3% (1 mL for every 1 cm3 of the lesion). The venous malformation location, treatments before the current sclerotherapy with sodium tetradecyl sulfate, the number of sclerotherapy sessions, and complications resulting from sclerotherapy were recorded. Follow-up assessments were done for a minimum of 1 year following the procedure. A favorable outcome was defined as a 50% decrease in the lesion size based on clinical and radiologic assessments. Results A total of 759 injection sessions were documented, ranging from 1 to 6 injections per patient (mean = 3.1). The follow-up duration ranged from 12 to 84 months (mean = 55 months). Based on clinical assessment, a 50% reduction of size was reported for 95.6% of the patients. According to the imaging before and after the procedures, a 50% reduction of size was seen among 67.3% of the patients. Conclusion The results of the study showed that the use of sodium tetradecyl sulfate as a sclerosing substance can effectively reduce the size of venous malformation lesions.

scholarly journals Simulation-based otolaryngology – head and neck surgery boot camp: ‘how I do it’

2016 ◽  
Vol 130 (3) ◽  
pp. 284-290 ◽  
Author(s):  
C J Chin ◽  
C A Chin ◽  
K Roth ◽  
B W Rotenberg ◽  
K Fung
Keyword(s):  
Medical Training ◽  
Panel Discussion ◽  
Opportunity To Learn ◽  
Neck Surgery ◽  
Boot Camp ◽  
Simulation Based ◽  
Before And After ◽  
Competency Based ◽  
Set Up ◽  
Main Components

AbstractBackground:In otolaryngology, surgical emergencies can occur at any time. An annual surgical training camp (or ‘boot camp’) offers junior residents from across North America the opportunity to learn and practice these skills in a safe environment. The goals of this study were to describe the set-up and execution of a simulation-based otolaryngology boot camp and to determine participants' confidence in performing routine and emergency on-call procedures in stressful situations before and after the boot camp.Methods:There were three main components of the boot camp: task trainers, simulations and an interactive panel discussion. Surveys were given to participants before and after the boot camp, and their confidence in performing the different tasks was assessed via multiple t-tests.Results:Participants comprised 22 residents from 12 different universities; 10 of these completed both boot camp surveys. Of the nine tasks, the residents reported a significant improvement in confidence levels for six, including surgical airway and orbital haematoma management.Conclusion:An otolaryngology boot camp gives residents the chance to learn and practice emergency skills before encountering the emergencies in everyday practice. Their confidence in multiple skillsets was significantly improved after the boot camp. Given the shift towards competency-based learning in medical training, this study has implications for all surgical and procedural specialties.

scholarly journals Analysis of Taste Disturbances in Patients Before and After Mastoid Surgery

2012 ◽  
Vol 2 (1) ◽  
pp. 14-16
Author(s):  
R Maharjan ◽  
RP Shrivastav ◽  
H Bhattarai
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Before And After ◽  
Mastoid Surgery

Nepalese Journal of ENT Head and Neck Surgery Vol.2 No.1 Issue 1 (Jan-Jun 2011) 14-16 DOI: http://dx.doi.org/10.3126/njenthns.v2i1.6778

scholarly journals Hearing status before and after Stapes surgery in otosclerotic patients

2019 ◽  
Vol 24 (2) ◽  
pp. 137-142
Author(s):  
Md Nazmul Haque ◽  
Md Abul Hossain ◽  
KM Nurul Alam ◽  
Muhammad Rafiqul Islam ◽  
Mohammad Abdullah
Keyword(s):  
Hearing Loss ◽  
Bone Conduction ◽  
Neck Surgery ◽  
Stapes Surgery ◽  
Common Symptom ◽  
Hearing Level ◽  
Age Group ◽  
Bony Tissue ◽  
Hearing Status ◽  
Before And After

Background: Otosclerosis is a disease of the otic capsule that is characterized by resorption and redeposition of bony tissue. Stapes surgery has established its position as the primary treament of conductive hearing loss in otosclerosis. It is anticipated that the hearing level of approximately 90% of patients should improve after surgery. Objective: To evaluate the hearing status of an otosclerotic patient and compare their preoperative and postoperative hearing status. Methods: In this prospective study, 34 patients with otosclerosis from head-Neck Surgery department of Sir Salimullah Medical College & Mitford Hospital, Bangladesh ENT Hospital, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Period from January 2008 to December 2008. The patients were examined and hearing assessment after admission into the hospital pre-operatively and in the post-operative period. Results: In this study most of the cases were age group 21-30 years (50%), male (64-71%), middle socio economic condition (67-71%), rural (58-82%), primary educated (35-29%). It was observed that most common symptom was progressive deafness; duration of hearing loss was 2-5 years, pre-operative conductive type of hearing loss (50-55 dB). It was also observed that after surgery, hearing status were improved in 82.35% cases, the most of the patients were within 21-30 years age group. Conclusion: Stapedotomy obtaining closure of the air-bone gap to within 10dB of the preoperative bone conduction level in 90% of their patients. So, it is supperior to other procedures  Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 137-142

scholarly journals Prognostic factors influencing anatomical and functional outcome of Myringoplasty

2013 ◽  
Vol 19 (1) ◽  
pp. 18-23
Author(s):  
KM Nurul Alam ◽  
Mohammad Idrish Ali ◽  
Md Mahmudul Huq ◽  
Md Abu Hanif
Keyword(s):  
Neck Surgery ◽  
Cross Sectional Study ◽  
Clinical Findings ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Number Of Patients ◽  
Before And After ◽  
Operative Assessment ◽  
Head Neck Surgery

Objective: To assess the rate of healing of tympanic membrane, hearing status before and after operation and determine the factors influencing surgical outcome. Methods: This cross-sectional study was done in the department of Otolaryngology & Head- Neck Surgery of SSMC & Mitford Hospital, Dhaka, during the period of January, 2008 to December, 2009. A total of 60 patients was underwent myringoplasty operation and taken detailed history, clinical findings and post operative assessment. Analyzed data presented by various tables, graphs and figures. Results: The study included 60 patients of myringoplasty operation. Age of the patient was between 15-45 years. Out of 60 patients male was 60% and female was 40%. Highest number of patients was in the age group of 15-25 years. Conclusion: Hearing improvement after myringoplasty in anatomically successful cases improve quality of life of the patient. DOI: http://dx.doi.org/10.3329/bjo.v19i1.14858 Bangladesh J Otorhinolaryngol 2013; 19(1): 18-23

scholarly journals Multidisciplinary Tracheotomy Teams: An Analysis of Patient Outcomes and Resource Allocation

2019 ◽  
Vol 98 (4) ◽  
pp. 232-237 ◽  
Author(s):  
Timothy R. Holmes ◽  
Benjamin D. Cumming ◽  
Anders W. Sideris ◽  
Jennifer W. Lee ◽  
Nancy E. Briggs ◽  
...  
Keyword(s):  
Chart Review ◽  
Neck Surgery ◽  
Multidisciplinary Teams ◽  
Complication Rates ◽  
Insufficient Evidence ◽  
Icu Stay ◽  
System A ◽  
Medicine Service ◽  
Before And After ◽  
Potential Benefits

We sought to establish the effect of introducing a multidisciplinary tracheotomy management team (MDT). Tracheotomies are high-cost interventions with potentially devastating complications. Multidisciplinary teams have been introduced in many hospitals with the aim of reducing complications, however, data supporting them are lacking. There is currently insufficient evidence to conclude MDTs reduce length of hospital or intensive care unit (ICU) stay, and there is little information on cost analysis. A chart review identified patients who had a tracheotomy inserted at a major metropolitan teaching hospital with an acute spinal medicine service 2 years before and after the MDT was implemented. The primary outcome was time to decannulation. Other outcomes included tracheotomy complications, the proportion of patients decannulated, length of ICU and hospital stay, and admission cost. Our search identified 174 (78 prior and 96 post-MDT) patients. Baseline demographics were similar between groups. There was no difference in time to decannulation, the decannulation rate, or the length of hospital or ICU stay. Complication rates were low in both groups. There was an increase in the proportion of patients who received speaking valves and a reduction in cost of admission in a subgroup of patients who did not undergo head and neck surgery. There is insufficient evidence to support the widespread introduction of tracheotomy MDTs. Institutions considering introducing a tracheotomy team should carefully consider their case-mix, volume, and available resources as well as the structure and responsibilities of the team, and the timing of its activities within the working week. The potential benefits of MDTs including teaching of staff, and collaboration of teams should be acknowledged. Given the potentially significant implications for cost to the health system, a randomized trial is needed to guide policy in this area.

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