General considerations

General considerations

1. Airway. The airway during otorhinolaryngologic (ORL) procedures is often shared with the surgeon. Pathology, scarring from previous surgery or irradiation, congenital deformities, trauma, or manipulation can produce chronic or acute airway obstruction, bleeding, and a potentially difficult airway. Preoperative discussion with the surgeon and analysis of previous anesthetic records regarding perioperative airway management, endotracheal tube (ETT) size and position, patient positioning, and use of nitrous oxide and NMB are essential. The patient may require awake examination of the airway under sedation and topical anesthesia or an awake fiberoptic intubation (FOI) before induction of GA.
2. Patients presenting for ORL surgery may have a history of heavy smoking, alcohol abuse, obstructive sleep apnea (OSA), and chronic upper respiratory tract infections. Preoperative testing should be dictated by medical comorbidities.
3. In addition to standard monitors, intra-arterial blood pressure and urine output monitoring may be needed for major surgeries with significant anticipated blood loss.
4. Extubation after any upper airway surgery requires careful planning. Extubation is performed once the throat packs are removed, the pharynx is suctioned, and full protective laryngeal reflexes return. Excessive upper airway bleeding, edema, or pathology may preclude extubation in the operating room.