Radical neck dissection. Endoscopies: Bronchoscopy. Direct laryngoscopy. Procedure: Prior pre anesthetic checkup done and consent taken. Inj Midazolam 0. Inj Atropine 0. Reversal of patient from anesthesia is done by injection Myopyrolate Neostigmine 0. Extubation done only after complete recovery of all oropharyngeal, laryngeal reflexes and patient is responding to verbal commands.
To reduce bleeding and provide a clear operating field as in ear surgeries under microscope , Septorhinoplasty and FESS; hypotensive anesthesia with a controlled pulse rate is required. Drugs used are a Antihypertensive drugs like Nitroglycerine, Beta blockers like Metoprolol, Labetalol, Esmolol and alpha agonist like Clonidine. Anesthesia in specific cases: Ear surgery: Since ear surgeries are under microscopic vision, minimal bleeding may hamper the operative field. Hypotensive anesthesia with controlled pulse rate and blood pressure is done as mentioned above.
Endoscopic nasal surgery: The majority of bleeding encountered during endoscopic sinus surgery is from the well vascularized capillary beds of the sinonasal mucosa.
Bleeding from nasal mucosa is due to the mean arterial pressure MAP and central venous pressure. Deliberate hypotension can therefore be achieved either via decreasing the systemic vascular resistance using vasodilatory agents sodium nitroprusside, calcium channel blockers, sevoflurane, isoflurane or by decreasing the cardiac output by choosing anesthetic agents that decrease preload and contractility b-blockers, remifentanil.
Vasodilatation results in a compensatory reflex tachycardia to maintain cardiac output. Mean arterial pressures between 50 and 70mm Hg are generally considered the goal for deliberate hypotension. Deliberate hypotension achieved through decreasing cardiac output is believed to be superior to decreasing systemic vascular resistance with respect to the surgical field quality.
CO is decreased with use of alpha-2 adrenergic agonists such as clonidine or dexmedetomidine or via beta-blockade that decrease heart rate and contractility. Total intravenous anesthesia TIVA - It is achieved with a continuous infusion of propofol and opiods to improve surgical fields. Propofol infusion causes a decrease in cerebral perfusion thereby decreasing perfusion pressure to the nasal cavity via the anterior and posterior ethmoid arteries.
This is in contrast to inhalational anesthetics that cause vasodilatation and increased blood flow to the ethmoid arteries. Regional anesthesia technique- Infraorbital nerve blocks and pterygopalatine fossa injections with lidocaine and epinephrine are two methods used to assist with analgesia and improve surgical field conditions.
One potential issue with this block is distortion of the skin contour that may interfere with intraoperative image guidance registration. Patient positioning- The reverse Trendelenburg position RTP reduces Cardiac output by causing a pooling of blood in the lower extremities that decreases cardiac preload. Both degree and degree RTP improves the surgical field of view and total blood loss during the procedure. This means much more than adjustable telescopic columns or an extremely smooth-running chassis even under high loads.
Because different fields and special challenges require flexible solutions. Our references show how the flexibility of BRUMABA operating tables effectively reduces costs and increases performance in stationary use. Find out more. November um - Bozner Symposium of Plastic Surgery January - As a medium-sized family business in its second generation, we are proud to actively carry on the idea of our founder and to successfully place the name BRUMABA together with our dedicated employees and partners in more than 80 countries by now.
Surgical procedures do not tolerate mistakes. That is why we are certified as a supplier of medical products according to strict quality criteria. In addition to regular maintenance and inspections, this naturally includes reliable complaints management. Our products offer an edge in ergonomics, design, function, comfort, accessories, service and value that is valued in medical practice. They offer such incredible comfort for my patients.
The ability to customize and adjust the chair to each individual patient and procedure is unparalleled. I can manipulate the chair with its many fine adjustments, including the tilt that help me keep the patient in the sweet spot for stereotactic tracking. The Brumaba table allows you the ability to position the patient in degrees of space. My patients love the comfort and I love the stability and adjustability of the chairs.
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