Intubation is the process of inserting a tube, called an endotracheal tube, into the mouth and then into the airway. This is done so that a patient can be placed on a ventilator to assist with breathing. Intubation is required when general anesthesia is given.
Dr. Thomas, the Senior Anesthetist in Jubilee Hospital, Trivandrum, South India intubate a patient for ENT Surgery.Skilled anaesthesia is required in ENT surgery as both the surgeon and the anaesthetist often share the same field. Major ENT surgical procedures are done using general anaesthesia using a cuffed endotracheal tube with throat packing.
GA Considerations for Nasal Surgery:
Nasal and sinus surgery carries the risk of bleeding into the airway and aspiration of blood. It is usually performed under general anaesthesia with an endotracheal tube and a throat pack. When a throat pack is used the anaesthetist must be certain that it has been removed at the end of surgery. Local anaesthesia and vasoconstrictors are commonly used to reduce bleeding even with general anaesthetic techniques. Surgeons may infiltrate with adrenaline. This drugs will cause tachycardia, hypertension and dysrhythmias especially when used with halothane. Patients must be monitored with an ECG.
Swallowed blood after emergence will increase the risk of postoperative nausea and vomiting. Care should be taken to limit the dose of adrenaline in the presence of halothane anaesthesia, as arrhythmias will occur.
The nasal operations are not usually very painful. After the procedure, a direct laryngoscopy is performed and the pharynx is suctioned under vision. There may be some blood in the nasopharynx. Some surgeons will pack the nose after surgery, which can be distressing to the patient after emergence. An airway will encourage the patient to breathe through the mouth at this time. Mask ventilation may be difficult on emergence, as the surgeon will not want pressure on the nose, particularly after rhinoplasty.
