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Diseases of Nose and Septum

Question
17 out of 26
 

Which is not done in septoplasty: (LQ)



A Elective hypotension

B Throat pack

C Nasal preparation with 10% cocaine

D None

Ans. D None

Intranasal Operations

"Intranasal operations are polypectomy, septopiasty, rhinoplasty and functional endoscopic sinus surgery. Either a laryngeal mask or a cuffed endotracheal tube may be used with a throat pack, depending on the anesthetist's confidence, the surgeon, the amount of blood loss and the duration of surgery. A flexible laryngeal mask or south-facing preformed tube allows the airway to be secured away from the nose.

Topical nasal vasoconstriction is extremely useful and may be applied by the anesthetist or surgeon. Commonly used vasoconstrictors include 5-10% cocaine, cocaine paste, xylometazoline or ephedrine drops or spray, Moffett's solution, or dental cartridge injection of local anesthetic with epinephrine (adrenaline) 1:80,000. asocontstriction by block of the sphenopalatine ganglion, which carries the vasodilator fibers to the nasal blood vessels, has also been described.

Surgery is easier with controlled hypotension. Profuse bleeding may cause the operation to be abandoned."

Intraoperative and Postoperative Considerations

'The most important consideration of nasal surgery is achieving profound vasoconstriction in the nares to minimize and control bleeding. This vasoconstriction can be achieved with cocaine packs, local anesthetics, and epinephrine infiltration. Since these drugs have a profound effect on the cardiovascular system, a careful monitoring of the patients cardiovascular functioning is essential, especially for older patients or patients with known cardiac disease. A vasoconstrictor can also precipitate dysrhythmias.

A moderate degree of controlled hypotension combined with head elevation decreases bleeding in the surgical site. Blood may passively enter the stomach. Placing an oropharyngeal pack or suctioning the stomach at the conclusion of surgery may attenuate postoperative retching and vomiting." . Current Otolaryngology 2nd/ed p 175

Thus in any nasal surgery:

- Elective hypotension

- Throat pack all can be done

- Nasal preparation with 10% cociane

Diseases of Nose and Septum Flashcard List

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