1
|
Spinos D, Doshi J, Garas G. Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand? J Laryngol Otol 2024; 138:373-380. [PMID: 37795753 DOI: 10.1017/s0022215123001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. METHOD Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. RESULTS The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. CONCLUSION Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.
Collapse
Affiliation(s)
- Dimitrios Spinos
- Department of Otorhinolaryngology - Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Department of Otolaryngology, Gloucester, UK
| | - Jayesh Doshi
- Department of Otorhinolaryngology - Head and Neck Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - George Garas
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Surgical Innovation Centre, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| |
Collapse
|
2
|
Rahman R, Patel C, Hathaway C, Patel E, Bouldin E, Tey CS, Raol N, Alfonso K. Opioid stewardship and perioperative management of pediatric tympanoplasty. Int J Pediatr Otorhinolaryngol 2023; 173:111713. [PMID: 37696228 DOI: 10.1016/j.ijporl.2023.111713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To provide insight into the intraoperative management, admission course, pain management, and graft success of microscope- and endoscope-assisted tympanoplasty. STUDY DESIGN Retrospective Chart Review. METHODS This study included children 18 years and younger who underwent ambulatory tympanoplasty at a tertiary pediatric hospital between January 2018 and December 2020. Medical records were reviewed and information about intraoperative factors, surgical approach, laterality, complications, and post-operative perforation closure success rates was collected. Multivariate analysis was performed to compare and contrast the two surgical approaches. RESULTS The review included 321 pediatric patients who underwent a tympanoplasty. Endoscopic tympanoplasty accounted for 17.4%, while microscopic tympanoplasty accounted for 82.6%. In both approaches, the rate of intraoperative complications, postoperative complications, audiological improvements, and perforation closure success rates were statistically similar. However, patients who underwent endoscopic tympanoplasty were 3.96 times less likely to require opioids in the post-anesthesia care unit (PACU) and had a shorter post-operative admission length. This pattern emerged regardless of the type of graft used. Obtaining an autograft was not associated with a higher opioid requirement in the PACU. CONCLUSION While both approaches are viable, our findings demonstrate the reduced need for opioids with similar success rates following an endoscopic tympanoplasty. Ultimately, the trade-off for the minimally invasive endoscopic approach appears to be a less painful experience for the child while promoting clinically appropriate opioid stewardship in the perioperative setting.
Collapse
Affiliation(s)
- Rahiq Rahman
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chhaya Patel
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Campbell Hathaway
- University of South Carolina School of Medicine, Greenville, SC, USA
| | - Eshan Patel
- Emory University School of Medicine, Atlanta, GA, USA
| | - Emerson Bouldin
- Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ching Siong Tey
- Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristan Alfonso
- Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
3
|
Comparative Analysis of the Anesthesia Effect of Cisatracurium Besylate and Mivacurium Chloride Otolaryngology Surgery. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6192409. [PMID: 35899229 PMCID: PMC9313922 DOI: 10.1155/2022/6192409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 12/17/2022]
Abstract
Objective The aim is to investigate and compare the anesthesia effect of cisatracurium besylate and mivacurium chloride otolaryngology surgery. Materials and Methods 108 patients who underwent ENT surgery under general anesthesia in our hospital from November 2021 to March 2022 were recruited for retrospective analysis, in which patients in the experimental group A were anesthetized with cisatracurium besylate and patients in the experimental group B were anesthetized with mivacurium, and the anesthetic effects and recovery of the two groups were compared and analyzed. Results There was no significant difference in mean arterial pressure, heart rate, and pulse oximetry levels between the two groups at the six time points of admission, anesthesia induction, intubation, end of operation, recovery of consciousness, and extubation (all P > 0.05). The train of four stimulation values at end of operation, recovery of consciousness, and extubation were significantly higher than those of the experimental group A (all P > 0.05). The recovery time of self-consciousness, extubation time, and eye-opening time of the experimental group B were significantly shorter than those of the experimental group A, and the occurrence of agitation was significantly less than that of the experimental group A (all P > 0.05). The total incidence of adverse conditions in the experimental group B was significantly lower than that in the experimental group A (P > 0.05). Conclusion Compared with cisatracurium besylate in otolaryngology surgery, mivacurium chloride anesthesia offers a promising route with respect to less impact on hemodynamics, faster postoperative recovery, absence of the accumulation of neuromuscular blockade, less adverse reactions, and higher safety.
Collapse
|
4
|
Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report. Healthcare (Basel) 2022; 10:healthcare10040741. [PMID: 35455918 PMCID: PMC9027904 DOI: 10.3390/healthcare10040741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult airways because of an improved laryngeal view, higher frequency of successful intubations, higher frequency of first-attempt intubation, and fewer intubation attempts. In this case series report, we describe the video-assisted intubating stylet technique in five patients with difficult airways. We believe that the intubating stylet is a feasible and safe airway technique for anesthetized tracheal intubation in patients with an anticipated difficult airway.
Collapse
|
5
|
Li S, Dan W, Chen L, Wu B, Ren L, Wei Y, Chen Q, Min S. The Investigation of Behavior Change in EEG Signals During Induction of Anesthesia. INT J PATTERN RECOGN 2021. [DOI: 10.1142/s0218001421580106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Anesthesiology aims to make anesthesia safer and increase the precision of prognoses. Correct assessment of the anesthesia depth is crucial to its safety. At present, intraoperative electroencephalogram (EEG) monitoring is the primary mode of anesthesia depth monitoring and judgment. However, most clinical anesthesiologists rely on commercial anesthesia depth monitors to judge anesthesia depth, such as bispectral index (BIS) and patient state index (PSI). This may lack an understanding of associated changes in brain wave quantization. Therefore, this study conducts quantitative analyses of EEG signals during anesthesia induction. EEG signals are processed within specific time windows and extracted brainpower density spectrum arrays with different frequency bands, brain electrical signal spectra, source frequencies and other key indicators. Analysis and comparison of these indicators clarifies patterns of variation in EEG signals during early anesthesia induction. The spectral edge frequencies (SEFs) of EEG signals within different time windows can be modeled accurately, from which the specific time points of EEG signal changes are derived. Furthermore, the relationship between patient age and the effect of anesthetic drugs is preliminarily investigated by analyzing the SEF variations of different age groups. This study quantifies changes in the EEG signals of patients at the initial stage of anesthesia induction and drug-related effects are observed, which opens a way for further exploration of EEG changes in patients under general anesthesia.
Collapse
Affiliation(s)
- Shangkun Li
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Wei Dan
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Lihao Chen
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Bin Wu
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Li Ren
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Yu Wei
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Qibin Chen
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| | - Su Min
- Department of Anesthesiology, First Affiliated Hospital of Chongqing, Medical University, Chongqing, P. R. China
| |
Collapse
|
6
|
McGuire SR, Doyle NM. Update on the safety of anesthesia in young children presenting for adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2021; 7:179-185. [PMID: 34430825 PMCID: PMC8356117 DOI: 10.1016/j.wjorl.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Tonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients' families.
Collapse
Affiliation(s)
- Stephanie R. McGuire
- Corresponding author. Department of Anesthesiology, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
| | | |
Collapse
|
7
|
Managing and securing the bleeding upper airway: a narrative review. Can J Anaesth 2019; 67:128-140. [DOI: 10.1007/s12630-019-01479-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
|