Anesthesia Topics for Plastic and Reconstructive Surgery最新文献

{"title":"Regional Anesthesia for Urgent Reconstructive Surgery","authors":"Shivakumar M. Channabasappa","doi":"10.5772/INTECHOPEN.80647","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80647","url":null,"abstract":"In polytrauma patients, the primary goal is to administer early resuscitation and effective analgesia with medications or techniques, which minimally affect the patient’s physiology. Adequate pain control will reduce posttraumatic stress disorder and facilitate in early functional recovery and better wound healing. Most of these polytrauma patients are hemodynamically unstable and require anesthesia and analgesia with techniques that produce minimum hemodynamic derangements; these techniques depend on the severity of trauma. The complexity of the surgery varies from primary closure to free flap reconstruction. More complicated injuries with larger tissue loss require free flap cover for better wound healing and optimal functional outcome. Optimum care of flap is an important part of perioperative management to prevent flap failure. Regional anesthesia has been proven to prevent flap failure by increasing perfusion to injured area by blocking local sympathetic system and minimizing pain-induced vasospasm. Postoperative prevention of hypothermia maintaining normocarbia plays a vital role in maintaining perfusion of free flap and prevention of flap failure. Regional anesthesia allows safe management of these patients.","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131500112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia Management for Large-Volume Liposuction","authors":"Sergio Granados-Tinajero, Carlos Buenrostro-Vásquez, CeciliaCárdenas-Maytorena, Marcela Contreras-López","doi":"10.5772/INTECHOPEN.83630","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.83630","url":null,"abstract":"The apparent easiness with which liposuction is performed favors that patients, young surgeons, and anesthesiologists without experience in this field ignore the many events that occur during this procedure. Liposuction is a procedure to improve the body contour and not a surgery to reduce weight, although recently people who have failed in their plans to lose weight look at liposuction as a means to contour their body figure. Tumescent liposuction of large volumes requires a meticulous selection of each patient; their preoperative evaluation and perioperative management are essential to obtain the expected results. The various techniques of general anesthesia are the most recommended and should be monitored in the usual way, as well as monitoring the total doses of infiltrated local anesthetics to avoid systemic toxicity. The management of intravenous fluids is controversial, but the current trend is the restricted use of hydrosaline solutions. The most feared complications are deep vein thrombosis, pulmonary thromboembolism, fat embolism, lung edema, hypothermia, infections and even death. The adherence to the management guidelines and prophylaxis of venous thrombosis/thromboembolism is mandatory.","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131903925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Complications in Plastic Surgery","authors":"Víctor M. Whizar-Lugo, Jaime Campos-León, Alejandro Moreno-Guillen","doi":"10.5772/INTECHOPEN.82269","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82269","url":null,"abstract":"Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. The proper selection and correct preoperative assessment of patients are the key to stay away from unwanted events. Preanesthesia evaluation is mandatory in each patient and must include clinical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, type of surgery, experience of the anesthesiologist, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of moving away from the guidelines already established for an excellent practice or the result of sentinel events rather than human errors. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most frequent complication in plastic surgery. Less common complications include arrhythmias, overhy- dration, allergies, bleeding, skin necrosis, dehiscence of wounds, brain damage, and dead. Anesthesiologists, surgeons, nurses, and all personnel involved in the care of these patients must work as a team of highly qualified and updated professionals.","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125637293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia for Plastic Surgery Procedures","authors":"V. Whizar-Lugo, Ana C. Cárdenas-Maytorena","doi":"10.5772/INTECHOPEN.81284","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81284","url":null,"abstract":"Plastic surgery is currently more popular and available with increasing frequency throughout the world. Its advances are related to progress in anesthesiology. Nowadays, it is possible to operate patients with pathologies that previously did not allow this type of surgery. The developments in perioperative monitoring, pharmacology, prevention of complications, and the wide communication between patients and physicians, as well as the development of surgical units that facilitate a prompt programming and reduce the total costs, have resulted in a logarithmic growth of plastic and reconstructive surgery procedures. Local, regional, or general anesthesia, anesthetic monitoring, or conscious sedation is used routinely, allowing to manage patients as ambulatory or short stay. Deep vein thrombosis and pulmonary embolism remain the most frequent complications, followed by postoperative pain, nausea, and vomiting.","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114872524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Anesthesia for Patients with Cleft Lip and Palate","authors":"A. Brzenski, Ofelia Ham-Mancilla, Silvia Peña-Olvera, A. Gosman, A. Sigler","doi":"10.5772/INTECHOPEN.74926","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.74926","url":null,"abstract":"Cleft lip and palate are the most common craniofacial deformities in the United States of America and México. Their aesthetic and functional implications influence the life style of the patient: social relationships, school and working performances, self-esteem and health. Surgical repair of the cleft lip is around the third to sixth month of age and the palate repair is when the patient is between six and eighteen months old. There are other surgical repairs during childhood and ideally all of them should be performed by an experienced surgeon teaming up with a pediatric anesthesiologist following the gold standards in cleft care, in a setting where the safety of the patient is paramount.","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126888372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Management in Plastic Surgery","authors":"I. M. Aribawa, M. Wiryana, T. Senapathi, Pontisomaya Parami","doi":"10.5772/INTECHOPEN.79302","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79302","url":null,"abstract":"Most patients who undergo cosmetic surgery do not report pain during the immediate postoperative period. However, most patients who underwent liposuction combined with or without other plastic surgical procedure suffer pain after surgery. There are three main techniques in acute pain management postoperatively which are systemic analgesia, regional analgesia , and local/topical analgesia, and these are the extent of trauma during the procedure, surgeon’s skill, prior disease, location and type of incision, and psychological and cultural factors. Treatment for each type of plastic surgery and the resulting pain require techniques that can be used as single method or combined with each other to relieve postoperative pain after plastic surgery. Nausea, vomiting, constipa - tion, somnolence, etc., are well-known adverse effects of opioids. Although these effects may seem minor, they can lead to significant complications following some type of plastic surgeries, for example, face-lift hematoma following nausea and vomiting, pulmonary complications from respiratory depression, and even thromboembolic phenomena from bed rest following prolonged opioid use. Multimodal pain management has been docu mented to increase patient satisfaction and reduce both opioid use and the incidence of PONV. Combination of pain management in plastic surgery included patient-controlled analgesia intravenous (PCA-IV), patient-controlled epidural analgesia (PCEA), patient- controlled regional analgesia (PCRA), field block), continuous wound infusion system using pain pump and tumescent analgesia with local anesthetics. of peripheral nerve catheters, the protection of limbs, and plans for catheter release. In addition, it is necessary to inform the onset of pain in the operative limb after the loss of peripheral nerve block effects, the possibility of fluid leakage at the site of the catheter and its treatment, and possible complications such as nerve injury, local infection, toxicity of local anesthetics, and pulmonary disorders. One variation of the technique that recently attracted attention was the use of mandated/programmed intermit tent bolus (PIB) doses, using the theoretical basis that increased local anesthetic volumes administered at one time that could increase perineural spread compared to volume/dose equivalent given as a basal infusion. Continuous adductor channel block requires a higher local basal anesthetic rate than the femoral nerve block. One study showed that although local anesthetic agents were given at relatively high rates (8 ml/h), the spread of local anesthetics remained limited. Subsequent studies involving healthy volunteers showed 0.2% ropivacaine at 8 ml/h as basal dose or intermittent bolus doses hourly gave the same sensory percep tions and quadriceps strength. Similar results are also reported for interscalene, femoral, and popliteal/sciatic catheters. For these reasons, the use of recurrent bolus doses can be reduced, unless recent RCTs may d","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"334 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133711622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain Monitored Propofol Ketamine for Elective Cosmetic Surgery","authors":"B. Friedberg","doi":"10.5772/INTECHOPEN.71442","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.71442","url":null,"abstract":"Brain monitored level of propofol hypnosis provides a numerically reproducible paradigm to block negative ketamine side effects. 50 mg IV ketamine 3 minutes prior to local anesthetic injection blocks virtually all midbrain NMDA receptors and is the basis for nonopioid preemptive analgesia. Opioid avoidance essentially eliminates postoperative nausea and vomiting (PONV) as well as the need for antiemetic agents. Over the past 20 years, no elective cosmetic surgical cases required hospital admission for either postoperative pain control or PONV.","PeriodicalId":338997,"journal":{"name":"Anesthesia Topics for Plastic and Reconstructive Surgery","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121450255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}