Neck Surgery

ett neck surgery nerve monitoring shared airway Jun 20, 2024

🌟 What and why? 🌟
Neck dissection, thyroidectomy, parotidectomy, anterior cervical spine surgery, and other procedures in the neck.

🔍 Intraoperative considerations: 🔍
📍 Position: Supine +/- pad under the shoulders or head ring. Head up tilt.
⏱️ Duration: 1.5-4 hours
🌬️ Airway plan: Reinforced oral ETT or south-facing RAE tube directed away from the surgical area.

💡 Expert tips:
Some neck procedures require nerve monitoring. Remifentanil is commonly used for these procedures. Arms may be wrapped, so ensure all lines and monitoring are safe and secure before the start of surgery.

🌟 Postoperative considerations: 🌟
💥 Pain: Neck dissection/thyroid surgery: mild-moderate. Cervical spine surgery: moderate.
❗ Airway risks: Postoperative swelling or bleeding can require urgent return to theatre. Reintubation with acute neck swelling can be difficult: have a low threshold for videolaryngoscope +/- awake intubation.

🔄 Other:
May be performed with another procedure (e.g., laryngectomy).

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Ref: Turner, Grant, 'Ear, nose and throat surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021), accessed 13 June 2024.

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