Anesthesia For Ear,Nose and Throat Surgery

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Anesthesia For Ear,Nose and Throat Surgery

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by XuLi
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Profile and Demands
difficult airway
cardiac arrhythmiaapplicattion of Epinephrine,
reflex of carotid sinus, etc.
N2O and middle ear pressure
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Preoperative Evaluation and Preparation

• Interview(?????)
• Premedication(?????)
• ?sedatives(???)
• ?anticholinegics(????)

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Choice of anesthesia

• local anestehsiato those cooperative ones
  undergoing short-term and simple operations
• general anesthesiato those ones cant be
  undertaken operations under local anesthesia

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

• ???(urgent) ??(severe) ??(dangerous)
• ????,??????, ?????????????????????
• ??
• ?? ????????,????(dyspnea)?????
• ?? ????????????????????????????(split)???(pne
  umothorax) ?????(laryngeal edema)?
• ?? ????,????????????,???SPO2???????????

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Questions

• Try to describe the factors causing arrhythmia
  during ENT surgery.
• ??????,????????,????????????????????????
• ?????,?????????????

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THANK YOU!
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Difficult airway

• 1gtDifficult intubation

2gtcompromised airway
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N2O and middle ear pressure

• The 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.

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Difficult intubation

• ?anatomic abnormalities micrognathia(??),
  limited jaw motion, or congenital syndromes
  (craniofacial dysostoseslt???????gt) etc..
• ?Other causesobesity, acromegaly(?????),
  cervical spine problems, rheumatoid
  arthritis(??????), and even gastric reflux(??)

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Compromised airway

• Pathologic 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.

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Operations of ears

• operations of ear concha(??) and concha
  tract(???) local anesthesia(to cooperative
  patients)
• operations inside earsgeneral anesthesia
• Microsurgery(??????)controlled
  hypotension(??????) is sometimes needed
• N2O and middle ear pressure

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Operation of nasal cavity and nasal sinus

• local anesthesia
• general anesthesia

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Tonsillectomy

• attention
• topical anesthesia and cough reflex
• general anesthesia and the management of airway
• emergent surgery for bleeding after tonsillectomy
  and the anesthetic management

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bleeding after onsillectomy

• problems hypo-volemia, full stomach, and airway
  obstruction.
• induction of anesthesia good suctioning of
  blood?a 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.

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Total throat resection

• profile of the operationwide range,deep
  reach,airway obstruction of some extent
• anesthetic mangementgeneral anesthesia with
  endotracheal intubation through tracheotomy
• attention
• reflex of carotid sinus(??????)
• split(??) of main line(???)???(gas embolism)
• evaluation of respiration function and
  corresponding treatment

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Endoscopy and endoscopic surgery

• Profile
• interaction of anesthetic and surgical
  management with the compromised airway
• inconsistency(??) between the operation and
  anesthetic recovery

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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
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General anesthesia for endoscopy and endoscopic
surgery

• with endotracheal intubationthin tube
• without endotracheal intubation
• 1gtintensive inhalation anesthesia induction
  companied by topical anesthesia
• 2gt 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(????)
• 3gtsupply oxygen via the lateral tube of the
  bronchoscope(??????)