Management of outpatient ear, nose and throat surgery

In the year under review there have been steady advances in anaesthesia. Premedication in children is best achieved with oral midazolam formulated in flavoured syrups, and the inhalational induction of anaesthesia may be accomplished using sevoflurane. Pain management of the most common surgical procedure performed in children, tonsillectomy/adenoidectomy, is still sub-optimal, but combinations of opioids and non-steroidal anti-inflammatory drugs are helpful. There are, however, some concerns regarding the possible increases in postoperative blood loss after tonsillectomy when non-steroidal anti-inflammatory drugs are used. Middle ear surgery leads to a high incidence of postoperative nausea and vomiting, and these are best managed by utilizing a total intravenous anaesthetic technique with propofol, the avoidance of nitrous oxide, and administration of dexamethasone and a 5-hydroxytryptamine receptor antagonist such as ondansetron.     

Anaesthesia for elective ear,nose and throat surgery in children

This review outlines anaesthetic considerations for commonly performed elective ear, nose and throat procedures, which constitute a major portion of the paediatric anaesthesia workload. Most routine surgery can be performed on a daycare basis, but careful preoperative assessment is vital to identify those patients who are unsuitable for daycare surgery owing to complications of their presenting illness (e.g. obstructive sleep apnoea; OSA) or other co-morbidities. Children undergoing middle ear surgery need special attention to prevent bleeding, hypothermia and postoperative nausea and vomiting (PONV). Adenotonsillectomy is most commonly performed to relieve the symptoms of OSA. The main anaesthetic concerns are analgesia, PONV, risk of postoperative haemorrhage and postoperative disposition. Daycare tonsillectomy involves careful patient selection and good communication with families regarding the postoperative phase and potential complications. Use of lasers is common in airway surgery; associated risks include airway fire and injury to the eyes of the patient and theatre staff.     

Anaesthesia for elective ear,nose and throat surgery in children

This review is an update of anaesthesia for elective ear, nose and throat procedures commonly performed in the paediatric population. Increasingly these often-complex procedures are being undertaken as day cases and so preoperative assessment needs to be tailored accordingly to identify those children requiring closer postoperative monitoring. Assessment of co-morbidities, consequences of the child’s presenting pathology (e.g. obstructive sleep apnoea (OSA)), bleeding risk and the presence of any concurrent upper respiratory tract infections needs to be the focus of the preoperative visit. Day case procedures involve careful patient selection and good communication with families regarding the post-operative phase and potential complications. Adenotonsillectomy is most commonly performed to relieve the symptoms of OSA. The main anaesthetic concerns include co-morbidities (e.g. obesity), analgesia including the potential use of non-opioids like dexmedetomidine, post-operative nausea and vomiting (PONV), risk of postoperative haemorrhage, postoperative respiratory complications and postoperative disposition. Children undergoing middle ear surgery need careful consideration to prevent problems associated with bleeding, hypothermia and PONV, and staff need to be aware of any hearing deficit that the child may have. Use of lasers is common in airway surgery with children often having repeated laser procedures; associated risks include airway fire and injury to the eyes of the patient and theatre staff.     

Indoramin-induced hypotension. An evaluation during ear, nose and throat surgery

Indoramin, a competitive alpha 1-adrenoceptor antagonist, was administered intravenously to 12 fit patients aged 20-49 years during general anaesthesia with either halothane or enflurane for ear, nose and throat surgery. A mean decrease of systolic blood pressure of 6 mmHg followed the initial dose of 0.1 mg/kg. Systolic blood pressures of 70-80 mmHg were achieved in nine patients using 0.29-4 mg/kg. The maximum effect of every dose was achieved within 3 minutes, with a probable duration of action of at least 30 minutes. Large changes of heart rate did not occur, though there was gradual slowing of the heart during each series of incremental administrations. Junctional rhythm, sometimes with bradycardia and hypotension, occurred in five patients (four in halothane group; one in enflurane group). Because of this, and the greater than ten-fold variation in decrease of blood pressure for a single weight-related dose, indoramin is not recommended for the reduction of blood pressure during halothane anaesthesia.     

眼耳鼻喉科专科护理技术管理多终端信息系统的开发与应用

目的开发眼耳鼻喉科专科护理技术管理多终端信息系统,探讨其应用效果,提升眼耳鼻喉科专科护理技术管理水平.方法整合眼耳鼻喉科专科护理技术操作标准及流程等资源,基于现有护理信息系统平台进行功能升级,构建多终端(PC端、PAD端、手机App端)信息管理系统,形成"护理部一护理技术管理小组一护士长"三级专科护理技术管理模式.于2...     

Metal tube anaesthesia for ear, nose and throat carbon dioxide laser surgery

Tracheal tube anaesthesia in ear, nose and throat surgery using the carbon dioxide laser is reviewed. The development of metal tubes and techniques is described.     

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

INTRODUCTION

The objective of this study was to evaluate the current involvement of ear, nose and throat (ENT) surgeons in lacrimal surgery.

SUBJECTS AND METHODS

A postal survey was distributed to 796 practicing UK consultant otorhinolaryngologists listed at the drfoster website.

RESULTS

Overall, 531 questionnaires were returned, giving a response rate of 66.7%. Of these, 108 (20.6%) respondents indicated they were involved in lacrimal surgery. The majority of otolaryngologists seem to work in collaboration with ophthalmologists. In our survey, 98% (106) perform endoscopic dacryocystorhinostomy (DCR). Most respondents believed lacrimal intubation and dilation to have limited success, endoscopic DCR to have moderate success and external DCR to have high success.

CONCLUSIONS

Lacrimal surgery is carried out in a spirit of collaboration with ophthalmologists rather than competition. Endoscopic DCR is the favoured surgical procedure of otolaryngologists. The perceived success rate for endoscopic DCR reported in this survey coincides with that reported in the literature.     

Low-dose ketamine failed to spare morphine after a remifentanil-based anaesthesia for ear, nose and throat surgery

BACKGROUND: Ketamine has been claimed to prevent acute opioid tolerance and hyperalgesia following acute exposure to opioids and its use has been proposed to decrease postoperative morphine consumption. METHODS: We conducted a randomized, double-blind, controlled study to evaluate the effect of intravenous (i.v.) ketamine on postoperative pain for 48 h after major ear, nose and throat (ENT) surgery. Thirty-one patients received i.v. ketamine 0.15 mg kg(-1) before induction and 2 microg kg(-1) min(-1) during anaesthesia, and 31 patients were administered placebo in a similar manner. Anaesthesia was standardized with remifentanil and propofol, but without nitrous oxide. Standardized postoperative analgesia included paracetamol, methylprednisolone and morphine administered via a patient controlled analgesia (PCA) device. RESULTS: Intra-operative remifentanil consumption was not different between the ketamine group (0.25 +/- 0.07 microg kg(-1) min(-1)) and the control group (0.22 +/- 0.07 microg kg(-1) min(-1)). In the postoperative period, both groups experienced an identical pain course evolution. Cumulative morphine consumption was not significantly different between groups: at 24 h it was 33.3 +/- 14.9 with ketamine and 31.9 +/- 15.3 mg in controls, at 48h it was 40.4 +/- 20.6 mg with ketamine and 42.5 +/- 25.9 mg in controls. CONCLUSION: Low-dose ketamine added to a remifentanil-based propofol anaesthesia did not reduce morphine consumption after major ENT surgery.     

Vomiting, retching, headache and restlessness after halothane-, isoflurane- and enflurane-based anaesthesia: An analysis of pooled data following ear, nose, throat and eye surgery

Background: Isoflurane has exceeded halothane and enflurane in usage. A literature search, however, revealed no data comparing the effects on emesis, headache and restlessness of these three agents.
Methods: With hospital ethics committee approval and patient consent, a prospective, randomised, double-blind study of 556 patients undergoing ENT and eye surgery was undertaken to evaluate the effects of halothane, isoflurane and enflurane on vomiting, retching, headache and restlessness until 24 h after anaesthesia. Balanced general anaesthesia was administered comprising benzodiazepine premedication, induction with thiopentone-atracurium-morphine (ENT patients) or fentanyl (eye patients), controlled ventilation and maintenance with either halothane 0.4–0.6 vol% (n = 186), isoflurane 0.6–0.8 vol% (n = 184) or enflurane 0.8–1 vol% (n=186) in nitrous oxide 67% and oxygen.
Results: The three study groups were comparable, and comprised comparable subgroups having ear, nose, throat, intraocular and non-intraocular surgery. During early recovery from anaesthesia, the respective requirements for halothane, isoflurane and enflurane for analgesia (7%, 9% and 10%), frequency of emesis (6%, 8% and 8%), antiemetic requirements (1%, 1% and 2%), restlessness-pain scores and time spent in the recovery ward (27 SD 10, 31 SD 12 and 26 SD 9 min) were similar. During the ensuing 24-h postoperative period, patients who had isoflurane experienced emesis less often than those who had halothane (36% vs 46%, P <0.025) but did so with similar frequency to those who had enflurane (46% vs 41%). Antiemetic requirements were least in those given isoflurane (isoflurane 12%, halothane and enflurane 23% each, P <0.005), but headache and analgesic requirements were similar.
Conclusion: Isoflurane induces less postoperative emesis than halothane, but headache is similarly frequent after anaesthesia with any of these agents.