Providing Anesthesia in the Oral and Maxillofacial Surgery Office: A Look Back, Where We Are Now and a Look Ahead.

Throughout its development the practice of oral and maxillofacial surgery has been richly associated with the provision of anesthetic services. Dentists and particularly oral and maxillofacial surgeons have advanced the science associated with anesthesia especially in the outpatient setting. This article will look back on the development of anesthesia as it relates to oral and maxillofacial surgery, discuss the current mode of anesthesia in the oral surgeon's practice and look ahead to what innovations are advancing this field.

[The history of outpatients surgery in Transylvania]. / Az erdélyi magyar egynapos (járóbeteg-) sebészet története.

The authors reported 291 outpatient general surgical interventions performed during a 10-year period (1948-1957). All surgeries were scheduled and performed in local anaesthesia with bend of 0.5% novocain and 0.5‰ percain solutions. The type of surgery was abdominal wall surgery in 68 cases, intraabdominal (mainly appendectomy, gastric resection and cholecystectomy) in 144 cases, anorectal in 50 cases, urogenital in 10 cases, thyroid in 12 cases and other interventions in seven cases. There was neither surgical mortality nor complications which needed hospitalisation. Postoperatively the patients returned home or were placed at private accommodation nearly. In the early postoperative period the most important factor was the good analgesia, early movement, physiotherapy and early oral intake of adequate fluid and food.

Twenty-five years of ambulatory laparoscopic cholecystectomy. / Veinticinco años de colecistectomía laparoscópica en régimen ambulatorio.

It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

Nineteenth century mortality at the Royal Hospital for Sick Children, Glasgow.

BACKGROUND AND AIMS: Since Glasgow's Royal Hospital for Sick Children opened in 1882, significant advances have been made in child health. Our aim was to investigate the hospital mortality that occurred in the last decade of the 19th century at Royal Hospital for Sick Children. METHODS AND RESULTS: Hospital mortality records for the decades, 1890-1899, were collected from the Archives of the Royal Hospital for Sick Children. Data were extracted from the hospital inpatient records and the pathology records. In the decade 1890-1899, there were 731 hospital deaths. The main cause of death at that time in the 19th Century was infection, particularly of the respiratory tract. The age at which death occurred was analysed and the recorded cause were analysed as was the distance patients travelled to the hospital. The ratio of boys to girls and length of inpatient stay was similar to that seen in the hospital currently. CONCLUSION: This study records the mortality in a children's hospital in a large developing industrial city in the 19th century as experienced in a children's hospital.

History of anesthesia for ambulatory surgery.

PURPOSE OF REVIEW: Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. RECENT FINDINGS: The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. SUMMARY: Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.

Cirugía mayor ambulatoria: antecedentes, evolución y logros / Major ambulatory surgery: history, evolution and achievements

RESUMEN Fundamento: La cirugía mayor ambulatoria comprende los procedimientos o intervenciones mayores en los que, con anestesia general o regional y tras un tiempo variable de control y observación, el paciente regresa a su domicilio el mismo día de la intervención. Objetivo: Exponer los antecedentes históricos de la cirugía mayor ambulatoria a nivel internacional y en Cuba. Metodología: Se realizó una revisión sobre los antecedentes históricos de la cirugía mayor ambulatoria mediante la búsqueda bibliográfica en Infomed, en las bases de datos Pubmed y SciELO, así como en memorias de eventos científicos y tesis. Resultados: Aunque la cirugía ambulatoria es la forma más antigua de cirugía que se conoce, desde el pasado siglo se ha popularizado y difundido y actualmente representa hasta el 80 % de la cirugía mayor electiva. En Cuba los primeros acercamientos a esta modalidad se realizaron a finales de la década de los 70 del pasado siglo con un desarrollo ascendente. Tanto a nivel internacional como en Cuba una parte de los profesionales de la salud han comprendido la necesidad de la cooperación entre los niveles primario y secundario de atención para esta actividad. Conclusiones: La cirugía mayor ambulatoria se ha convertido en una modalidad quirúrgica imprescindible en la práctica asistencial cotidiana, que ha perdurado y se ha arraigado por las innegables ventajas que ofrece a todos los involucrados en el proceso de atención y que es perfectible sobre la base de postulados de colaboración entre los niveles de atención primario y secundario de salud.

ABSTRACT Background: Major ambulatory surgery includes procedures or major interventions in which, with general or regional anesthesia and after a variable time of monitoring and observation, the patient returns home the same day of the intervention. Objective: To expose the historical background of major ambulatory surgery internationally and in Cuba. Methodology: A review of the historical background of the major ambulatory surgery through the bibliographic searching in Infomed, Pubmed and SciELO databases, as well as in scientific event memories and theses was made. Results: Although mayor ambulatory surgery is the oldest form of surgery known, since the last century it has become popular and widespread and it currently represents up to 80 % of elective major surgery. In Cuba the first approaches to this modality were made at the end of the 70s of the last century having an upward development. Both, internationally and in Cuba, the need for cooperation between the primary and secondary health care levels for this activity has been understood by health professionals. Conclusions: Major ambulatory surgery has become an essential surgical modality in everyday health care practice, which has endured and grew up due to the undeniable advantages that it offers to all those involved in the care process and which is perfectible based on the collaborative postulates between primary and secondary health care levels.

Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia.

Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation. denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.

Development of procedures and techniques for the office.

This article presents the evolution of current office-based surgery of the larynx, focusing on the development of the tools and techniques for these ambulatory procedures, including laryngoscopy, bronchoscopy, esophagoscopy, and current office-based interventions. Additionally, a historical timeline is presented for the development of office-based laryngology within the context under which laryngology, as a subspecialty, has evolved over the past 200 years, with questions posed to the reader regarding what further developments may arise and how those will affect the practice.

Current US military operations and implications for military surgical training.

BACKGROUND: Since 2001, US military surgeons have deployed frequently, with many surgeons deploying within 1 year of graduating residency. The purpose of this study was to evaluate readiness of recent graduates to manage combat-related injuries and to make recommendations for improvements in training military surgeons. STUDY DESIGN: We reviewed casualties treated at the 31st Combat Support Hospital in Baghdad from December 2003 to November 2004. We identified 3,426 wounded patients; of these, 2,648 (77.3%) required an operative procedure. There were 2,788 patients (81.4%) who sustained penetrating injuries. The most common procedures performed were debridement of wounds (39%), skeletal fixation (14.7%), and exploratory laparotomy (11.4%). Common procedures were compared with 15 case logs from the ACGME database for our institution from 2005 to 2009. RESULTS: Graduating residents averaged 973 cases during residency (range 867 to 1,293, median 921). This included experience with most procedures encountered except nephrectomy (1.5 procedures per resident [PPR]), craniotomy (1.1 PPRs), inferior vena cava injury (1.1 PPRs), bladder repair (0.87 PPR), and duodenal injury (0.6 PPR). Residents had minimal experience with skeletal fixation and external genital trauma. CONCLUSIONS: Recent surgical residency graduates are prepared for deployment in support of US military operations for the majority of injuries encountered. However, familiarization with procedures that fall outside the traditional general surgical curriculum would improve their ability to treat these injuries. To enhance experience with rare injuries, cadaver studies and animal models may serve as training tools before deployment.