Common ENT Procedures and Anesthesia Choice

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Common ENT Procedures and Anesthesia Choice

• Franklin L. Scamman, MD
• September 30, 2002

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Most Common ENT Proceduresat UIHC for 2000-2001

• Panendoscopy 1109
• Mx and Tubes 420
• T and/or T and A 203
• Tracheostomy 132
• STSG 103
• Assorted flaps 97
• Mastoidectomy 94

• Radical Neck 84
• Nasal sinus surgery 75
• Tympanoplasty 54
• UP3 51
• Nose fracture 40
• Cochlear implant 37
• Nasal septoplasty 36

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References

• Miller Edition 5. See the scanned document server
  under faculty lectures
• Boezaart AP, van der Merwe J, Coetzee AR.
  Moderate controlled hypotension with sodium
  nitroprusside does not improve surgical
  conditions or decrease blood loss in endoscopic
  sinus surgery. J Clin Anesth. 2001
  Jun13(4)319-20.

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References

• Degoute CS, Ray MJ, Manchon M, Dubreuil C,
  BanssillonV. Remifentanil and controlled
  hypotension comparison with nitroprusside or
  esmolol during tympanoplasty. Can J Anaesth. 2001
  Jan48(1)20-7.

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Panendoscopy (1)

• Amnesia
• Potent agent or propofol
• Analgesia
• Narcotic
• Meet Surgeon Requirements
• Often intense relaxation, sometimes not
• Quick emergence

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Panendoscopy (2)

• Meet patient requirements
• BP control during light anesthesia
• Heart rate control
• Quick resumption of airway protection
• No laryngospasm on extubation

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Mx and Tubes

• If you cant make it quiet, make it quick
• IV?
• Quiet field for surgeon
• N2O?
• Quick emergence
• N and V?
• Pain Control?

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T and A

• Mask induction and IV
• Straight vs. RAE OET
• Fluid replacement
• Postop pain control
• N and V control
• Bring-back bleeder

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Tracheostomy

• Currently intubated
• Impending airway obstruction
• Heliox?
• Impossible intubation because of tumor
• Trach with mask anesthesia?

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Mastoidectomy and other Base of Skull Surgery

• Turn table 180 degrees
• OET out opposite operative side
• Pressure points
• Control BP on the low side
• No paralysis for facial nerve preservation
• Smooth emergence
• Postop N and V control

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Radical Cancer Surgery

• Probably turn 180
• Long case
• For free flaps, keep patient warm
• Art line
• Consider 2nd IV
• Rarely transfuse

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Tympanoplasty

• Turn 180
• N2O off as tympanic graft is placed
• Non-cough emergence

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Uvulo Palato Pharyngo PlastyUP3

• Most present with obstructive sleep apnea
• May be difficult mask airway
• Consider alternative airway such as fiberoptic
  intubation
• All sleep apnea has central component leading to
  apnea evening of POD 0

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Nose Fracture and Nasal Septoplasty

• Use oral RAE (in midline if surgeon requests)
• Bleeding into pharynx--use throat pack to prevent
  blood in stomach

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Controlled Hypotension

• There is only faint evidence that controlled
  hypotension for ENT surgery reliably decreases
  blood loss or improves the surgical field.