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The problems in the pregnant woman are universal: physiological changes during pregnancy lead to a reduction in time from onset of apnea to oxygen desaturation and to an increased likelihood of regurgitation from a full stomach. An antenatal visit allows the airway to be evaluated and discussion to be held with the parturient about the use of invasive monitors, such as invasive arterial blood pressure monitoring and the use of continuous positive airway pressure devices during and after labor and delivery. A recent development in the management of the airway in the obese patient is the use of the so-called ramped position. Perhaps the main factor responsible for a higher incidence of difficulties in airway management is that general anesthesia is generally reserved for extreme obstetric emergencies. The use of supraglottic airways in the management of the obstetric airway is undergoing evaluation.
Functional endoscopic sinus surgery is among the most challenging of ENT procedures for a variety of reasons including the need for immobility, hemostasis, and, especially, gentle emergence from anesthesia. Anesthesiologists have contributed significantly, using anesthetic techniques to mitigate intraoperative hemorrhage into the surgical field, thus significantly improving visualization of the surgical field. Functional endoscopic sinus surgery (FESS) strives to enable direct examination in situ with subsequent correction of encountered chronic changes and barriers which limit sinus drainage and aeration. The use of supraglottic airway (SGA) over endotracheal tubes (ETT) appears additionally advantageous, providing reduced incidence and severity of coughing intraoperatively and during emergence. Propofol/remifentanil total intravenous anesthesia (TIVA) with spontaneous respiration (PRTSR) is considered by some an optimal strategy to avoid emergence problems and provide flexibility, and minimize nausea, vomiting, and estimated blood loss (EBL), while ensuring rapid induction and emergence.
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