DOCSLIB.ORG

Postoperative Sore Throat: More Answers Than Questions

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Postoperative Sore Throat: More Answers Than Questions EDITORIAL Postoperative Sore Throat: More Answers Than Questions Phillip E. Scuderi, MD ostoperative sore throat (POST) is a common adverse oral airway). The site or sites of mucosal injury would event after general anesthesia. Typically, the incidence obviously vary depending on the airway device. For in- Pof POST is highest in patients who are tracheally stance, endotracheal intubation can result in injury to any intubated; however, POST also occurs when a laryngeal mask portion of the pharynx as well as injury to the larynx and airway (LMA) is used.1 Even patients who are managed with trachea. Placement of an LMA can reasonably be expected a facemask are not immune.1 Most of the measures that have to cause injury to pharyngeal mucosa in the supraglottic been recommended for reducing this complication have been regions only, whereas the use of a facemask with an oral directed at limiting the physical trauma that might result from airway should result in injury to only the oropharynx, airway instrumentation and manipulation. Surprisingly few assuming that no other injuries occurred because of suc- investigations have evaluated pharmacologic interventions tioning or other airway maneuvers. It is therefore some- as a means of reducing POST. Furthermore, no single drug what surprising to note that the reported incidence of POST has achieved widespread acceptance in the clinical commu- after LMA insertion is, at least in some studies, remarkably nity. In this issue of Anesthesia & Analgesia, 4 articles similar to that seen with endotracheal intubation.6,7 Al- describe simple prophylactic measures that seem to signifi- though this might lead one to infer that the mechanism and 2–5 cantly reduce the incidence of POST. Two of these location of injury must also be similar, a number of facts articles evaluate the effectiveness of topical benzydamine seem to contradict this assumption. For instance, reducing hydrochloride applied to the cuff of the endotracheal tube, the size of endotracheal tubes results in a significant 2,3 directly to the pharyngeal mucosa, or both. A third article decrease in the incidence of POST.8 The design of tube cuffs 4 evaluates the efficacy of inhaled fluticasone propionate. has also been an area of intense research. The size, ௡ The fourth article evaluates Strepsils , a nonprescription pressure/volume characteristics, and shape of cuff have all lozenge that contains 2 active ingredients, amylmetacresol been implicated in tracheal mucosal injury and resultant 5 and 2,4-dichlorobenzyl alcohol. POST.9–12 Conversely, it has been suggested that cuff When considered in aggregate, these 4 articles raise a inflation pressure has less of a role in POST when an LMA number of interesting questions. The expression “sore is used.6 Both airway devices are clearly capable of induc- throat” is obviously common to the vernacular of many ing mucosal irritation and both can cause POST in patients different cultures, yet it provides at best a parsimonious at rates that are not strikingly different. Yet, anatomically, description of the actual phenomena. Consequently, the the site or sites of injury cannot be the same. expression “postoperative sore throat” likely represents a There are several interesting observations that arise broad constellation of signs and symptoms. For instance, in when one examines the data presented in the 4 articles its simplest form, sore throat is a lay description of phar- published in this issue of Anesthesia & Analgesia. The data yngitis, which in itself can have a variety of causes. 4 from Tazeh-kand et al. demonstrate that inhalation of However, sore throat may also include a variety of symp- fluticasone propionate before the induction of anesthesia toms including laryngitis, tracheitis, hoarseness, cough, or significantly reduces the incidence of POST at 1 hour and dysphagia. Postoperatively, it seems most plausible that the 24 hours after surgery compared with a placebo control. symptoms are the result of mucosal injury with resulting This is not necessarily an unexpected result. Topical13,14 inflammation caused by the process of airway instrumen- and systemic steroids15 have been demonstrated to reduce tation (i.e., laryngoscopy and suctioning) or the irritating the incidence of POST presumably because of their sys- effects of a foreign object (i.e., endotracheal tube, LMA, or temic antiinflammatory effects. More puzzling are the data presented by Ebneshahidi and Mohseni.5 Patients who From the Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. received a Strepsils lozenge before the induction of anes- Accepted for publication June 14, 2010. thesia had a significantly lower incidence of POST and Disclosure: The author reports no conflicts of interest. hoarseness both in the postanesthesia care unit and at 24 Address correspondence and reprint requests to Phillip E. Scuderi, MD, hours after surgery than did the placebo control group that Department of Anesthesiology, Wake Forest University School of Medicine, received a flavored lozenge without the active ingredient. Medical Center Blvd., Winston-Salem, NC 27157-1009. Address e-mail to [email protected]. Unless one postulates a systemic effect from the active Copyright © 2010 International Anesthesia Research Society ingredients in the Strepsils lozenge (i.e., amylmetacresol DOI: 10.1213/ANE.0b013e3181ee85c7 and 2,4-dichlorobenzyl alcohol), the effect site must be the October 2010 • Volume 111 • Number 4 www.anesthesia-analgesia.org 831 EDITORIAL pharyngeal mucosa. Whereas it is plausible to postulate a eliminated. The 4 studies presented here may provide the reduction on pharyngeal irritation due to the lozenge, it is impetus for a more careful evaluation of POST resulting in harder to postulate a mechanism for the reduction in more precisely targeted therapies. “hoarseness” that was reported in this study. It is also difficult to understand how a preoperative lozenge could AUTHOR CONTRIBUTIONS reduce a reaction to injury to the larynx and trachea and the PES designed and conducted the study, analyzed the data, and resultant laryngotracheitis that must have a role in POST wrote the manuscript. This author approved the final manuscript. that occurs after intubation. 2,3 Conversely, 2 of the articles describe a reduction in REFERENCES POST with the application of benzydamine hydrochloride 1. Higgins PP, Chung F, Mezei G. Postoperative sore throat after to the endotracheal tube cuff alone compared with a ambulatory surgery. Br J Anaesth 2002;88:582–4 placebo control (normal saline and distilled water, respec- 2. Hung NK, Wu CT, Chan SM, Lu CH, Hang YS, Yeh CC, Lee MS, tively). It seems unlikely that the small dose of benzydam- Cherng CH. The effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% ine hydrochloride (1.5 and 0.75 mg, respectively) used lidocaine, and 2% lidocaine. Anesth Analg 2010;111:882–6 would have resulted in a systemic effect. Therefore, the 3. Huang YS, Hung NK, Lee MS, Kuo CP, Yu JC, Huang GS, reduction in POST that was observed in both of these Cherng CH, Wong CS, Chu CH, Wu CT. The effectiveness of studies must be assumed to have resulted from a localized benzydamine hydrochloride spray on the endotracheal tube decrease in mucosal injury and/or inflammatory response. cuff or oral mucosa for postoperative sore throat. Anesthesia Analg 2010;111:887–91 The incidence of and reduction in POST is strikingly similar 4. Tazeh-kand NF, Eslami B, Mohammadian K. Inhaled flutica- when Strepsils lozenges were used when compared with the sone propionate reduces postoperative sore throat, cough and application of benzydamine hydrochloride to the endotra- hoarseness. Anesth Analg 2010;111:895–8 ௡ cheal tube cuff. There are unavoidable questions that must be 5. Ebneshahidi A, Mohseni M. Strepsils tablets reduce sore throat and hoarseness after tracheal intubation. Anesth Analg 2010;111:892–4 asked: How can a lozenge that is administered orally result in 6. Wakeling HG, Butler PJ, Baxter PJ. The laryngeal mask airway: a similar reduction in POST when compared with the topical a comparison between two insertion techniques. Anesth Analg application of benzydamine hydrochloride to the endotra- 1997;85:687–90 cheal tube cuff? In addition, How can either an oral lozenge or 7. Joshi GP, Inagaki Y, White PF, Taylor-Kennedy L, Wat LI, topical antiinflammatory agent applied to an endotracheal Gevirtz C, McCraney JM, McCulloch DA. Use of the laryngeal mask airway as an alternative to the tracheal tube during tube cuff yield reductions in POST that compare favorably ambulatory anesthesia. Anesth Analg 1997;85:573–7 with a more widespread application of topical steroids to both 8. Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of the pharyngeal and laryngotracheal mucosa? endotracheal tube size with sore throat and hoarseness follow- POST is unquestionably a common adverse event after ing general anesthesia. Anesthesiology 1987;67:419–21 9. Loeser EA, Kaminsky A, Diaz A, Stanley TH, Pace NL. The general anesthesia. A number of physical factors have been influence of endotracheal tube cuff design and cuff lubrication implicated as noted above. Most notable would seem to be on postoperative sore throat. Anesthesiology 1983;58:376–9 endotracheal tube and cuff design and the approach to airway 10. Loeser EA, Bennett GM, Orr DL, Stanley TH. Reduction of management (i.e., endotracheal tube, LMA, or mask anesthe- postoperative sore throat with new endotracheal tube cuffs. sia). In addition, female gender, younger patients, gynecologic Anesthesiology 1980;52:257–9 11. Loeser EA, Hodges M, Gliedman J, Stanley TH, Johansen RK, surgery, and the use of succinylcholine also seem to increase Yonetani D. Tracheal pathology following short-term intuba- 16 the incidence. Of particular note, the use of topical lidocaine tion with low- and high-pressure endotracheal tube cuffs. appears to confer no benefit and may in fact make POST Anesth Analg 1978;57:577–9 worse,17,18 a fact that seems to have been confirmed by Hung 12.
Load more

Recommended publications
  • Hemodynamically Unstable/ Shocked Patient in OR. Challenge For
    Journal of Anesthesia & Critical Care: Open Access Opinion Open Access Hemodynamically unstable/ shocked patient in OR challenge for teamwork efficacy when time is critical Volume 7 Issue 4 - 2017 Dimosthenis Petsas,1 Yasir Othman AT,1 Marton Hannus,1 Eljona Cumashi2 Opinion 1Anaesthetics Department, HMG Hospital, UAE 2OB/GYNAE Department, HMG Hospital, UAE In the present article we present a case report with comments/ suggestions about team dynamics. The emergency case report is only Correspondence: Dimosthenis Petsas, Anaesthetics used to highlight the importance of teamwork dynamics and many Department, HMG Hospital Dubai, Dubai Healthcare City, Building 57, UAE, PO BOX 505005, Tel 00306972008383, clinical details are not mentioned. Treating a hemodynamically Email unstable/shocked patient can be a challenging procedure and requires perfect teamwork to have the best possible outcome. Reviewing Received: March 10, 2017 | Published: March 15, 2017 the present case report we should always keep in mind that the organization is a private hospital with all the differences in resources compared to a large public hospital. A 33-year old female patient presented to ER department with signs of circulatory shock (low blood pressure, tachycardia, drowsiness and clumsy sweaty skin). Her vital signs were BP=75/35 mmHg, HR ranging from 120-135 bpm, temperature was 35.9 Celsius, pale skin and drowsiness. Initial resuscitation in ER included administration of Table 2 Intraoperative hemoglobin and coagulation 2 liters IV ringers lactate and oxygen through face mask at 5-6 lt/ min. There was temporary improvement of vital signs. Bloods were sent Investigation Value for complete blood count, coagulation, biochemistry.
    [Show full text]
  • Annual Medical Student Abstract Journal
    Medicine of the Highest Order 2015 Annual Medical Student Abstract Journal Sponsored by: Center for Advocacy, Community Health, Education and Diversity Offices for Medical Education Medical Student Research Faculty Advisory Committee Community Outreach Faculty Advisory Committee International Medicine Faculty Advisory Committee Medical Humanities Faculty Advisory Committee Basic Science, Clinical & Translational Research Aaserude, Eric & Hong, Steven Preceptor: Beau Abar, Ph.D. University of Rochester School of Medicine and Dentistry Department of Emergency Medicine Access to care and depression among emergency department patients Introduction: Major depressive disorder is a serious, common public health concern that is characterized by a series of symptoms including depressed mood and diminished interest or pleasure in most activities of the day (DSM-V). The prevalence of depression during a lifetime is 16.2% and the 12-month prevalence is 6.6%. 1 In particular, several studies have shown that among patients in the Emergency Department (ED), the prevalence of depression is even higher than in the general population.2-3 One study showed that the prevalence of a positive depression screen is approximately 33%, and using a 33% positive predictive value, an estimated 10.5% would met the diagnostic criteria for major depressive disorder.2 Because of the high concentration of patients with depression, the ED may serve as an important forum for the identification of depression and the intervention in the disease process.4 Concomitant to identification of potential concerns regarding depression is the issue of patient access to appropriate care. Many patients lack the ability to affordably receive efficacious treatment due to insurance-related barriers.5 Furthermore, other individuals may be unaware of their level of access for primary and behavioral health services, and this lack of awareness will lead to patients in need not receiving the care appropriate to their concerns.
    [Show full text]
  • A Comparison Between the I-Gel® and Air-Q® Supraglottic Airway Devices
    Hindawi BioMed Research International Volume 2018, Article ID 5202957, 7 pages https://doi.org/10.1155/2018/5202957 Research Article A Comparison between the i-gelD and air-QD Supraglottic Airway Devices Used for the Patients Undergoing General Anesthesia with Muscle Relaxation Nilofar Massoudi ,1 Mohammad Fathi,1 Navid Nooraei ,2 and Alireza Salehi1 Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Anesthesiology Research Center, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence should be addressed to Navid Nooraei; [email protected] Received 14 February 2018; Revised 30 April 2018; Accepted 17 May 2018; Published 18 November 2018 Academic Editor: Yukio Hayashi Copyright © 2018 Nilofar Massoudi et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Te aim of the present study was to compare two supraglottic airway (SGA) devices (i.e., the i-gel5 ©IntersurgicalLtd and air-Q5 (Reusable) Cookgas company) in terms of the insertion time, amount of leak during ventilation with maximum positive pressure, and postoperative complications in patients referring to Modarres Hospital in Tehran. Method. Te present double-blind clinical trial was performed on 60 patients undergoing elective surgeries that required general anesthesia with muscle relaxation. Patients were randomly assigned to either i-gel5 (n =30)orAir-Q5 (n =30)groups.Results. Te mean age, body mass index, duration of surgery, duration of anesthesia, and gender ratio were not signifcantly diferent between the two groups.
    [Show full text]
  • Health Hazard Evaluation Report 77-85-445
    U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE CENTER FOR DISEASE CONTROL NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH CINCINNATI, OHIO 45226 HEALTH HAZARD EVALUATION DETERMINATION REPORT NO. 77-85-445 MESA VETERINARY HOSPITAL GOLDEN, COLORADO NOVEMBER 1977 I. TOXICITY DETERMINATI ON A Health Hazard Evaluation was conducted by the National Institute for Occupational Safety and Health (NIOSH) in the Mesa Veterinary Hospital, Golden, Colorado. On August 22 &24, 1977, environmental samples were col lected to determine concentrations of waste anesthetic gases. Findings on the days of this evaluation indicate that the mean 8-hou r time weighted average exposure to nitrous oxide was 34 ppm for the veterinarian and 45 ppm for the anesthesia technicians. Average exposure to halogenated anesthetic was 0.8 and 2.2 ppm for the same two groups. These concentrations were slightly above the NIOSH Recommended Limit of 25 ppm nitrous oxide and 0.5 ppm ha logenated anesthetic. Since information on adverse health effects due to exposure to waste anesthetic gases is not completely definitive and many unknown factors still exist, recommended permissible levels of exposure are not defined as safe levels but rather as levels which are attainable with current technology. These levels should prevent the effects caused by acute exposure and significantly reduce the risk associated with long term, low level exposure . Recommendations to further reduce concentrations are included in this report. II. DISTRIBUTION AND AVAILABILI TY OF DETERMINATION REPORT Copies of this Determination Report are currently available upon request from NIOSH, Division of Technical Services, Information and Dissemination Section, 4676 Columbia Parkway, Cincinnati, Ohio 45226.
    [Show full text]
  • Susan Burns, BS, RVT, VTS (Anesthesia)
    Susan Burns, BS, RVT, VTS (Anesthesia) Graduated from University of California at Davis in 1984 with a Bachelor of Science in Wildlife Biology. Received Registered Veterinary Technician License in 1991. Consultant for Pfizer Animal Health (Zoetis) November 2005 to present. Applied for AVTA acceptance in 2009 and passed examination in October 2009. Currently she is chairman of the AVTA exam committee. Susan has spoken locally, statewide and nationally in the US on various anesthetic topics. She has her own anesthetic consulting business and has been employed at East Bay Veterinary Specialist in Walnut Creek, California for the last 25 years. Susan L. Burns BS, RVT, VTS (Anesthesia) 9925 San Luis Ave. San Ramon, CA. 94583 (925)413-6289 [email protected] EDUCATION Veterinary Technician Specialty – Anesthesia 2009 California Registered Veterinary Technician 1991 BS in Wildlife Biology, University of California Davis 1984 Professional Experience Speaking Engagements 2007-present VCA-San Francisco Veterinary Specialists San Francisco, California, “Patient Monitoring with Multi Parameter Monitors Oct/Nov. 2013 San Francisco SPCA San Francisco, California, “Ventilation & ETCO2” March 2013 Central Veterinary Conference Kansas City, Kansas, “Geriatric Anesthesia: Welcome to Senior Living”, “Pediatric Anesthesia: What You Didn’t Learn in Kindergarten” & “Ventilation vs. ETCO2” August 2011 San Francisco SPCA San Francisco, California, “Anesthetic SOS” July 2011 San Francisco SPCA San Francisco, California, “Successful Everyday Anesthesia”
    [Show full text]
  • Oral Magnesium Lozenge Reduces Postoperative Sore Throat a Randomized, Prospective, Placebo-Controlled Study
    Oral Magnesium Lozenge Reduces Postoperative Sore Throat A Randomized, Prospective, Placebo-controlled Study Hale Borazan, M.D.,* Ahmet Kececioglu, M.D.,† Selmin Okesli, M.D.,‡ Seref Otelcioglu, M.D.‡ ABSTRACT Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/117/3/512/257313/0000542-201209000-00019.pdf by guest on 30 September 2021 What We Already Know about This Topic • Sore throat is a prevalent adverse outcome from endotracheal Background: Postoperative sore throat (POST) is an unde- intubation sirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The pres- What This Article Tells Us That Is New ent study aimed to investigate the effect of preoperative ad- ministration of oral magnesium lozenge on POST. • Compared with placebo, the administration of magnesium lozenge 30 min preoperatively is effective to reduce both inci- Methods: Seventy patients undergoing orthopedic surgery dence and severity of postoperative sore throat were randomly allocated into two groups, to either receive placebo (control) or magnesium lozenges (magnesium) to be dissolved by sucking 30 min preoperatively. Patients were OSTOPERATIVE sore throat (POST) is a common assessed for incidence and severity (four-point scale, 0–3) of P complaint in patients receiving general anesthesia fol- POST at 0, 2, 4, and 24 h postoperatively. The primary lowing orotracheal intubation, with reported incidences of 21–65%.1,2 Irritation and inflammation of the airway were outcome was sore throat at 4 h after surgery. The secondary 3 outcome was the severity of POST at four evaluation time- considered the causes of POST.
    [Show full text]
  • Anaesthesiology, Reanimatology and Intensive Care Medicine Course Name of the Assoc
    COURSES OFFERED IN A FOREIGN LANGUAGE IN THE ACADEMIC YEAR 2020/2021 Department Department of Health Studies Description of the courses offered in a foreign language in the academic year 2020/2021 Name of the Anaesthesiology, Reanimatology and Intensive Care Medicine course Name of the Assoc. prof. Tatjana Šimurina MD, PhD teacher Number of ECTS 3 credits Semester X □ autumn/winter spring/summer Teaching will be Lectures Consultations organized as □ yes X no X yes □ no The courses will Lectures Seminars Exercises be organized as X yes □ no □ yes X no X yes □ no Description of the The aim of the course: course Acquire basic knowledge and skills in anaesthesiology, resustitation and intensive care treatment that are necessary for understanding the work of an anesthesiologist and anesthetic technician, and for understanding the needs of patients in perioperative period, particularly in operating room OR, and in the intensive care unit, ICU. Acquire basic skills necessary for reanimating the life-threatening patient. Topics: General and regional anesthesia – basic considerations; Acute and chronic pain - medications and procedures in pain management; Keeping the airways open, difficult intubation, anesthesia instruments and systems; Anesthetics and medications in anesthesiology; Anesthesia machine; Anesthesia maintenance and monitoring of vital functions during anesthesia; Postoperative supervision of the patient and postoperative pain treatment; Critically ill patients in ICU - monitoring of vital signs; Medications, intravenous therapy for intensive care treatment, enteral/parenteral nutrition; Devices for mechanical ventilation and procedures related to the patients who need mechanical ventilation; Medical documentation during preparing for anesthesia, administering anesthesia and recovery from anesthesia and medical documentation in ICU; Basic life support BLS Learning outcomes 1.
    [Show full text]
  • Anesthesia 1 Anesthesia
    Anesthesia 1 Anesthesia Anesthesia, or anaesthesia (see spelling differences; from Greek αν-, an-, "without"; and αἲσθησις, aisthēsis, "sensation"), has traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846.[1] Another definition is a "reversible lack of awareness," whether this is a total lack of awareness (e.g. a general anesthetic) or a lack of awareness of a part of the body such as a spinal anesthetic or another nerve block would cause. Anesthesia is a pharmacologically induced reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes and decreased stress response. Terms Today, the term general anaesthesia in its most general form can include:[2] • Analgesia: blocking the conscious sensation of pain; • Hypnosis produces unconsciousness but not necessarily freedom from pain registration; • Amnesia: preventing memory formation; if you are unconscious, by definition you will be unable to recall events. • Paralysis: preventing unwanted movement or muscle tone; • Obtundation of reflexes, preventing exaggerated autonomic reflexes. Patients undergoing anaesthesia usually undergo preoperative evaluation. It includes gathering history of previous anesthetics, and any other medical problems, physical examination, ordering required blood work and consultations prior to surgery. There are several forms of anaesthesia. The following forms refer to states achieved by anesthetics working on the brain: • General anaesthesia: "Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation." Patients undergoing general anesthesia can often neither maintain their own airway nor breathe on their own.
    [Show full text]
  • Routine Dental Package ROUTINE PREVENTIVE DENTAL CARE for DOGS
    Routine Dental Package ROUTINE PREVENTIVE DENTAL CARE FOR DOGS 344 W. State Street Package Type: Canine Routine Dental Eagle, ID 83616 208-938-3383 Total Package Price: $519.00 eagleanimalclinic.com [email protected] Package Value: $611.00 Total Savings: $92.00 (15% Discount) SERVICES INCLUDED IN THE DENTAL PACKAGE Office Visits/Exams Anesthetic & Safety Procedures Dental Procedures Comprehensive Pre-Surgical Blood Work Full Mouth Dental X-Rays Pre-Surgical Exam Chem 14 and CBC Ultrasonic Scaling of All Teeth performed the morning of the I.V. Catheter and I.V. Fluids removal of plaque and tartar dental procedure Pre-Anesthetic Medication Polishing of All Teeth Comprehensive Oral Exam with Full General Anesthesia removal of micro abrasions on the teeth Mouth Charting (help prevent future tartar build up) performed while pet is under Dedicated Anesthetic Technician Fluoride Treatment general anesthesia Dedicated Anesthetic Nursing and Recovery Care Dental Home Care Kit PURCHASE OPTIONS Payment in Full of $519.00 Payment in full is accepted in the form of cash, check, debit card, or credit card (Visa, MasterCard, Discover or American Express). Payment via Care Credit is also accepted for the Routine Dental Packages, however a service fee of $45 will be assessed. Three Monthly Installments of $173.00 The purchase may be divided into three (3) separate consecutive monthly installments; however, a onetime $25 service fee will be assessed and is due with the first monthly payment. Remaining payments must be scheduled and billed directly to a credit or debit card (Visa, MasterCard, Discover or American Express) via a stored card number.
    [Show full text]
  • Robert Reynolds Macintosh, MD
    Thomas Jefferson University Jefferson Digital Commons Department of Surgery Gibbon Society Historical Profiles Department of Surgery 4-2017 Robert Reynolds Macintosh, M.D. (1897-1989): Forefather of Anesthesiology, Advocate for Patient Safety. Haig Minassian Thomas Jefferson University Scott W. Cowan Thomas Jefferson University Charles J. Yeo Thomas Jefferson University Follow this and additional works at: https://jdc.jefferson.edu/gibbonsocietyprofiles Part of the Anesthesiology Commons, and the History of Science, Technology, and Medicine Commons Let us know how access to this document benefits ouy Recommended Citation Minassian, Haig; Cowan, Scott W.; and Yeo, Charles J., "Robert Reynolds Macintosh, M.D. (1897-1989): Forefather of Anesthesiology, Advocate for Patient Safety." (2017). Department of Surgery Gibbon Society Historical Profiles. Paper 49. https://jdc.jefferson.edu/gibbonsocietyprofiles/49 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Surgery Gibbon Society Historical Profiles yb an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Brief Reports Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ‘‘Instructions for Authors’’.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references.
    [Show full text]
  • Anesthesia Technician
    Anesthesia Technician The Veterinary Hospital (VH) at the College of Veterinary Medicine at North Carolina State University invites applications for the position of Anesthesia Technician. The College of Veterinary Medicine was established in 1983 and is one of the highest rated veterinary academic medical centers in the country, serving communities throughout North Carolina as well as many other states. The hospital staffs over twenty clinical services with board certified specialists that are nationally and even internationally renowned, ensuring the VH is on the cutting edge of veterinary medicine. Patients benefit from the combined expertise of multiple specialists utilizing a team approach to patient health care. Each year, nearly 25,000 patients are treated in the VH. The VH provides compassionate care, state of the art specialty health care, and expert clinical instruction for 4th year veterinary students from College of Veterinary Medicine, and ongoing investigation of innovative techniques and procedures to further advance the field of veterinary medicine. North Carolina State University and the surrounding area have many enriching opportunities. Research Triangle Park, containing numerous pharmaceutical and biotechnology companies, is located within the Research Triangle formed by Raleigh, Durham and Chapel Hill, which are home to NC State University, Duke University, and UNC-Chapel Hill, respectively. Raleigh is located in central North Carolina, and both coastal and mountain communities are within a few hours’ drive. The Triangle community is active and culturally diverse and is often cited as one of the most desirable places to live in the United States. The quality of life in Central North Carolina is excellent, with many stimulating cultural, sporting, and outdoor activities.
    [Show full text]
  • Anesthesia for Interventional Cardiology Procedures
    Extended Abstract STRUCTURAL HEART DISEASE INTERVENTIONS Anesthesia for interventional cardiology procedures Rajka Gabelica, KEYWORDS: cardiac anesthesia, interventional cardiology procedure. Mario Pavlek, CITATION: Cardiol Croat. 2016;11(3-4):132. | DOI: http://dx.doi.org/10.15836/ccar2016.132 Željko Čolak*, *ADDRESS FOR CORRESPONDENCE: Željko Čolak, Klinički bolnički centar Zagreb, Kišpatićeva 12, Mirabel Mažar, HR-10000 Zagreb, Croatia / Phone: +385-91-562-4189 / E-mail: [email protected] Gordana Rajsman, ORCID: Rajka Gabelica, http://orcid.org/0000-0003-2170-419X • Mario Pavlek, http://orcid.org/0000-0002-1848-247X Sandra Uzun, Željko Čolak, http://orcid.org/0000-0003-0507-4714 • Mirabel Mažar, http://orcid.org/0000-0002-4589-2490 Gordana Rajsman, http://orcid.org/0000-0002-6496-7507 • Sandra Uzun, http://orcid.org/0000-0002-2346-3740 Sanja Konosić, Sanja Konosić, http://orcid.org/0000-0002-7420-7472 • Davor Strapajević, http://orcid.org/0000-0001-9378-3611 Davor Strapajević, Višnja Ivančan, http://orcid.org/0000-0002-7282-9753 Višnja Ivančan University of Zagreb School Anesthesia management for interventional procedures in cardiology becomes increasingly demand- of Medicine, University ing due to growing number and complexity of these procedures. Anesthesiologists are assuming an Hospital Centre Zagreb, important role in the multidisciplinary planning of management. A comprehensive understanding of Zagreb, Croatia each procedure is essential to ensure a reasonable plan for the anesthesia, monitoring, venous access and additional
    [Show full text]