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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.

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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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