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  1. Successful middle ear surgery depends on controlled hypotension to minimize blood loss and maintain a clear surgical field, use of short-acting muscle relaxants to promote facial nerve monitoring, avoidance of nitrous oxide to prevent graft disruption, and smooth extubations to prevent prosthesis displacement.

  2. Middle ear surgery can result in profound postoperative nausea and vomiting, requiring an aggressive, multimodal, pharmacologic approach for prevention and treatment.

  3. Complications of sinus surgery include hemorrhage, eye injury, vision loss, venous air embolism, cerebrospinal fluid leak, permanent neurologic injury, and death.

  4. Pediatric and adult patients with obstructive sleep apnea hypopnea syndrome may present with altered right ventricular diastolic function, pulmonary hypertension, arrhythmias, and silent carditis.

  5. Posttonsillectomy hemorrhage is a surgical emergency. Patients may be profoundly hypovolemic and tachycardic before the complication is recognized, and anesthetic care includes both fluid resuscitation and meticulous airway management.

  6. Careful preoperative planning will prevent the conversion of a partial airway obstruction into a complete airway obstruction when managing patients with foreign body aspiration.

  7. After radiation therapy to the head and neck, tissues become fixed, firm, and fibrotic. Despite a normal appearance, direct laryngoscopy may be extraordinarily difficult, if not impossible. Fiberoptic laryngoscopy is often the preferred approach for tracheal intubation.

  8. Lasers can produce thermal injury, induce photochemical reactions, exhibit mechanical effects, and release toxins, including viable microorganisms. Most laser injuries result from reflected beams, with the eye being the most vulnerable organ.

  9. No laser tube is perfect, and airway fires can occur under any condition. Precautions can reduce the risk of a surgical fire but cannot eliminate the risk.

  10. Use of a nerve integrity monitor (NIM) endotracheal tube can greatly reduce the risk of recurrent laryngeal nerve injury during thyroid and parathyroid surgery.


The origin of contemporary anesthesiology can be traced to patient James Venable, who presented with a neck mass to physician Crawford Long. Since that seminal moment, surgical procedures of otorhinolaryngology continue to promote research, creativity, and development of anesthesia practices. On a routine basis, anesthesiologists provide mask anesthetics, spontaneous or jet ventilation, controlled hypotension, and extubations during deep levels of anesthesia. Most of these cases are performed with little or no muscle relaxation. Moreover, in the contemporary surgical environment, the majority of these cases are performed in an outpatient setting. This presents its own challenges in the areas of analgesia and the prevention of postoperative nausea and vomiting (PONV). The patient population varies from neonates to elderly adults, with a significant number of pediatric cases.

As a unique feature of this subspecialty, anesthesiologists work with physician colleagues who have an understanding and appreciation of the airway. This is unlike most other surgical experience. The complicated nature of these procedures demands nothing less than complete cooperation between these two specialties. Frequently, the airway will be shared, and commonly, one practitioner will assist the other in times of difficulty. When a compromised airway is involved, any ...

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