Anesthesia For EarNose and Throat Surgery

Profile and Demands difficult airway cardiac arrhythmiaapplicattion of Epinephrine, reflex of carotid sinus, etc. N2O and middle ear pressure

Preoperative Evaluation and PreparationInterview() Premedication() sedatives() anticholinegics()

Choice of anesthesialocal anestehsiato those cooperative ones undergoing short-term and simple operationsgeneral anesthesiato those ones cant be undertaken operations under local anesthesia

Several common ENT operations*operation of ear*operation of nasal cavity() and nasal sinus()*tonsillectomy()*total throat resection()*Endoscopy()and endoscopic surgery()

PS(urgent) (severe) (dangerous) , *: (dyspnea) *: (split)(pneumothorax) (laryngeal edema) *: SPO2

QuestionsTry to describe the factors causing arrhythmia during ENT surgery.

THANK YOU

Difficult airway *1>Difficult intubation*2>compromised airway

N2O and middle ear pressureThe middle ear and paranasal sinus() are normal body air cavities that consist of open, nonventilated spaces. The blood/gas coefficient() is 0.013 for nitrogen versus 0.46 for N2O. When inhaled in high concentrations, N2O enters the air cavities faster than nitrogen can leave. In a fixed cavity such as the middle ear, the result is an increase in pressure. After discontinuation of N2O, the gas is rapidly reabsorbed, marked, negative middle ear pressure may develop.

Difficult intubationanatomic abnormalities micrognathia(), limited jaw motion, or congenital syndromes (craniofacial dysostoses) etc.. Other causesobesity, acromegaly(), cervical spine problems, rheumatoid arthritis(), and even gastric reflux()

Compromised airwayPathologic conditions above the glottis may prevent a clear view of the glottic opening, whereas subglottic lesions permit a good view of the vocal cords, but they require careful placement of a small endotracheal tube or bronchoscope.

Operations of earsoperations of ear concha() and concha tract() local anesthesia(to cooperative patients)operations inside earsgeneral anesthesiaMicrosurgery()controlled hypotension() is sometimes neededN2O and middle ear pressure

Operation of nasal cavity and nasal sinuslocal anesthesia

general anesthesia

Tonsillectomyattentiontopical anesthesia and cough reflexgeneral anesthesia and the management of airwayemergent surgery for bleeding after tonsillectomy and the anesthetic management

bleeding after onsillectomy problems: hypo-volemia, full stomach, and airway obstruction. induction of anesthesia: good suctioning of blooda rapid-sequence induction of anesthesia with application of cricoid pressure and slight head-down positioning of the patient will protect the trachea and glottis from aspiration of blood. after induction, a nasogastric() tube may be placed and removed. extubation: as with elective tonsillectomy, extubation is safest with the patient awake.

Total throat resectionprofile of the operationwide rangedeep reachairway obstruction of some extentanesthetic mangementgeneral anesthesia with endotracheal intubation through tracheotomyattention * reflex of carotid sinus() *split() of main line()(gas embolism) *evaluation of respiration function and corresponding treatment

Endoscopy and endoscopic surgeryProfile interaction of anesthetic and surgical management with the compromised airway inconsistency() between the operation and anesthetic recovery

Anesthesia selection for endoscopy and endoscopic surgery*local anesthesiatry to perform local anesthesia to the cooperative adult patients especially to those with some extent of airway obstruction during short-term operations*general anesthesiamainly fits children patients

General anesthesia for endoscopy and endoscopic surgerywith endotracheal intubationthin tubewithout endotracheal intubation 1>intensive inhalation anesthesia induction companied by topical anesthesia 2> with a thin plastic tube above the carina() to supply oxygen or to ventilate by connecting a high frequency jet ventilator() perform a short-term operation under the usage of scoline() 3>supply oxygen via the lateral tube of the bronchoscope()