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Surgery on the head and neck requires excellent communication between surgeon and anaesthetist for a successful and safe outcome. The shared and often complex airway means that the anaesthetist and surgeon are integral in facilitating the work of each other and require a clear understanding of the needs of the other. Airway difficulties can mean that speed is of the essence and both parties need to work quickly together to obtain a safe airway.
The age range covered in routine otolaryngology and maxillofacial surgery spans from cradle to grave and covers a wide variety of pathology. Those patients who are generally fit and well with no significant cardiovascular or respiratory pathology require no more than standard pre-operative assessment appropriate for the age of the patient and nature of the surgery. Many cases are suitable for treatment as a day case. There are some notable exceptions where a more detailed pre-assessment is required.
Head and neck malignancy
A significant number of upper aerodigestive tract malignancies are associated with a prolonged history of smoking. The cardiovascular and pulmonary effects of this exposure need to be ascertained to establish any potential pre-operative optimisation or contraindications to surgery.
Do international standards regarding human rights require the existence of a liberal regime? This was the thrust of Rhoda Howard and Jack Donnelly's essay in the September 1986 issue of this Review. Neil Mitchell takes vigorous issue with this contention, arguing first and foremost that Howard and Donnelly have not defined liberalism satisfactorily. Howard and Donnelly present a spirited rejoinder.
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