During microsurgery of the ear, the technique selected for anesthesia should help to provide good operative field for the surgeon. A 10- to 15-degree head-up tilt increases venous drainage, keeps venous pressure low, and decreases venous bleeding. The use of a volatile anesthetic agent helps to control arterial blood pressure. The patient\’s normal range of head movement should be assessed before surgery. Access to the airway may be limited during long procedures. The endotracheal must be carefully secured. In procedures such as stapedectomy and mastoidectomy, facial nerve monitoring may be performed, so it is important that neuromuscular paralysis has worn off. The need for the patient to be immobile in operations on the ossicles requires deep anaesthesia. Emergence from anaesthesia needs to be smooth so that there is no increase in venous pressure. After mastoidectomy, a head bandage will be applied and there can be much movement of the head resulting in coughing and bucking on the endotracheal tube. This is not desirable due to the risk of bleeding, so a deep plane of anaesthesia is maintained until the bandage has been applied. Postoperative nausea and vomiting can disrupt grafts and prostheses and needs to be controlled.
(Here a patient is put to sleep for ear surgery-General Anesthesia, in Jubilee Hospital, Trivandrum, South India. Dr.Thomas, the senior anesthetist, who is specialist in ENT anesthesia explains the techniques of hypotensive technique for ear surgery, Mastoidectomy and Tympanoplasty done by Dr.K.O.Paulose, FRCS, consultant ENT Surgeon of Jubilee Hospital, Trivandrum, South India).