TY  - CHAP
M1  - Book, Section
TI  - Chapter 67. Anesthesia for Otorhinolaryngologic (Ear, Nose, and Throat) Surgery
A1  - Ragan, Bil
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - 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.Middle  ear  surgery  can  result  in  profound  postoperative  nausea  and  vomiting,  requiring  an  aggressive,  multimodal,  pharmacologic  approach  for  prevention  and  treatment.Complications  of  sinus  surgery  include  hemorrhage,  eye  injury,  vision  loss,  venous  air  embolism,  cerebrospinal  fluid  leak,  permanent  neurologic  injury,  and  death.Pediatric  patients  with  obstructive  sleep  apnea  syndrome  may  present  with  altered  right  ventricular  diastolic  function,  pulmonary  hypertension,  arrhythmias,  and  silent  carditis.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.Careful  preoperative  planning  will  prevent  the  conversion  of  a  partial  airway  obstruction  into  a  complete  airway  obstruction  when  managing  patients  with  foreign  body  aspiration.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.Lasers  can  produce  thermal  injury,  cause  photochemical  reactions,  have  mechanical  effects,  and  release  toxins,  including  viable  microorganisms.  Most  laser  injuries  result  from  reflected  beams,  with  the  eye  being  the  most  vulnerable  organ.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.Use  of  a  Nerve  Integrity  Monitor  (NIM)  endotracheal  tube  can  greatly  reduce  the  risk  of  recurrent  laryngeal  nerve  injury  during  thyroid  and  parathyroid  surgery.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/16
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56649512
ER  -