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Health and Healing
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
Having relatively little in the way of medications, physicians relied primarily on herbals in the hope of rejuvenating or restoring health before moving along to their next destination. Apollon the father, Asklepios the son and Hygeia the daughter are often portrayed with a single serpent next to them. The significance of the snake and staff, known as the asklepian, has been subject to various interpretations. The staff was thought to reflect the physician’s itineracy. The shedding of the snakeskin and its renewal is emphasized as symbolizing rejuvenation and regeneration. Although there is some controversy about the use of the term,13 one view of anesthesiology practice is as an ongoing resuscitation. In several countries, anesthesiology departments incorporate “reanimation” into their title.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Reanimation options: If the palsy duration is <12 months (with EMG evidence of depressor activity), then directly neurotise depressors using CFNG.If the palsy has lasted 12–24 months (EMG still shows some depressor activity) or failure of the above, then a mini XII-to-VII crossover or direct neurotisation (incorporates 20%–30% of the nerve trunk).With long-standing palsy: transfer of platysma (if functional) or anterior belly of digastric (ABD), which is supplied by the trigeminal nerve. The tendon is divided and mobilised to the corner of the mouth whilst the insertion on the mandible is then divided and inset to reproduce the smile vector. There is a scar in the submandibular fossa.In young patients, re-education is usually successful in reproducing a physiological smile, but older patients require coaptation to a CFNG.
Facial Paralysis in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Nerve exploration is unrewarding in this situation.22 Reanimation may be considered. There is a wide range of procedures for reanimation; the most desired neural tissue source for rejuvenation of the paralysed face is direct reanastomosis or interpositional grafting. Carr et al. 23 reviewed 186 children with congenital facial paralysis (60% male and 85% with bilateral paralysis) and found 29 in whom reanimation was performed (24 females and 5 males). All 5 males and 9 females had unilateral isolated facial nerve paralysis. Fourteen females had bilateral paralysis; only half of these were isolated. Other involved cranial nerves included abducens, hypoglossal, oculomotor and trochlear. The cranial nerve least likely to be involved was the accessory nerve, suggesting that this may be a reliable donor for reanimation procedures. As previously stated, early reanimation is advised by Glassock and Shambaugh19 if muscle is found on biopsy in neonates with facial paralysis when electromyography is silent.
Cerebral Circulatory Arrest and the Dead Donor Rule
Published in The American Journal of Bioethics, 2023
NRP follows standard DCD protocol where there is a hands-off period of 5 min before the declaration of death (for the possibility of autoresuscitation to elapse). Subsequently, measures are taken to maintain CCA before systemic circulation resumes. However, resumption of systemic circulation even when unaccompanied by brain perfusion may be considered an integrated function and under some views count as the reanimation of the patient. Although in biologic terms this may be a coherent position, I believe we ought to reject it; accepting it would amount to rejecting death by neurologic criteria. When CBF ceases permanently, the continuation of systemic circulation may only serve the purpose of thoracoabdominal organs perfusion. These individual organs serve no further purpose to the continuing existence of the donor. What DCD and NRP share pathophysiologically is permanent CCA. We should accept permanent cerebral circulatory arrest as the unifying criterion of death, the physiologic landmark at which death behaviors are appropriate.2
Twelve tips to teach culturally sensitive palliative care
Published in Medical Teacher, 2021
Jeanine Suurmond, Katja Lanting, Xanthe de Voogd, Roukayya Oueslati, Gudule Boland, Maria van den Muijsenbergh
Nowadays medical schools offer students classes about how to deal with language barriers and how to involve an interpreter. In palliative care it is even more essential that students learn how to deal with language barriers. Many older migrants have a low proficiency in the language of the host country (Esser 2006). A review study found that in case of language barriers, relatives were frequently asked to interpret information about prognosis, diagnosis, and assess symptom management for patients at the end of life (Silva et al. 2016). As a result, patients may have inadequate understanding about their diagnosis and prognosis, have worse pain management and anxiety management at the end of life (Silva et al. 2016). Words that may be lost in translation are for example ‘palliative care’, ‘sedation’, ‘reanimation’ or ‘hospice’. Teachers therefore need to make students aware of how a language barrier influences the quality of palliative care. In addition, teachers need to teach to students how to use a professional interpreter. In case of breaking bad news across language barriers (See Tip 5), a professional interpreter should always be used. Specific materials that teachers can use are e-learnings (see for example Ikram et al. 2015) and role play.
Petrous bone cholesteatoma: our experience of 51 patients with emphasis on cochlea preservation and use of endoscope
Published in Acta Oto-Laryngologica, 2019
Zhen Gao, Gang Gao, Wei-Dong Zhao, Xian-Hao Jia, Jing Yu, Chun-Fu Dai, Bing Chen, Fang-Lu Chi, Jing Wang, Ya-Sheng Yuan
The outcome of facial nerve function and surgical method used for facial reanimation are summarized in Table 4. There were 30 patients had a history of preoperative facial paralysis. The mean duration of facial paralysis was 40.35 months (ranged from 1 to 600 months). In 16 patients, the preoperative duration of facial paralysis was more than one year, and three of these patients underwent surgery for facial reanimation. In 14 patients, the preoperative duration of facial paralysis did not exceed one year and seven of these patients were operated for facial reanimation. Neurorrhaphy was also performed in one patient without preoperative facial paralysis due to the intraoperative facial nerve injury. Surgical treatment of facial paralysis was performed concurrently with the removal of PBCs in 10 patients. In one patient, the hypoglossal-facial end-to-end neurorrhaphy was performed 2 months later after the excision of PBC. In a total of 11 patients underwent facial reanimation or facial nerve repair, six patients had a facial function outcome of HB > 3; five patients had a facial function outcome of HB ≤ 3 and the onsets of facial paralysis of these patients were all within 1 year before the surgery.