Sinus Surgery

airway management ent lma patient safety shared airway Jun 24, 2024

🌟 What and why? 🌟
Septoplasty, turbinoplasty, endoscopic sinus surgery, polypectomy. Sinus surgery is often performed to treat sinusitis, polyps, structural abnormalities (septal), infections, and tumours.

🔍 Intraoperative considerations: 🔍
📍 Position: Supine, head ring, head up tilt
⏱️ Duration: 30-120 mins
🌬️ Airway plan: LMA (usually reinforced) or south-facing RAE tube. Throat pack often used (see Concept Series article on throat packs!)

💡 Expert tips:
The surgeon will often inject lignocaine with adrenaline into the surgical site. This can cause profound hypertension and arrhythmias. These are usually short-lived. Prolonged hypertension should be treated to avoid surgical bleeding. Remifentanil and propofol TIVA provide ideal surgical conditions. Ensure closed-loop communication around throat pack handling. Suction under vision prior to extubation.

🌟 Postoperative considerations: 🌟
💥 Pain: Frontal headache is common in recovery. Overall, postoperative pain is usually mild-moderate.
❗ Airway risks: Bleeding in the recovery period is common and worsened by hypertension (pain/anxiety/adrenaline). Posture (sitting up) and good pain management is essential. Consider throat pack or bleeding if sudden loss of airway. Nasal packing mandates mouth breathing.

🔄 Other:
Be aware of patients who are usually dependent on CPAP machines in the postoperative period.

✅ Build knowledge
✅ Improve safety

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.

Stay connected with news and updates!

Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.

We hate SPAM. We will never sell your information, for any reason.

Want to keep learning?

Want more content like this? Check out our premium membership for exclusive content. 

Click Here for Access

 

 

Join our mailing list for free weekly educational content.

 

By entering your details you consent to receiving amazing educational materials and updates about our products and events.