Difference between revisions of "Tympanoplasty and/or mastoidectomy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = 1 PIV | ||
| monitors = | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Avoid long-acting paralysis for facial nerve monitoring. Succinylcholine induction | ||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
| Line 13: | Line 13: | ||
== Overview == | == Overview == | ||
=== Indications: Repair perforated or damaged eardrum, remove mastoid air cells damaged by infection or cholesteatoma | === Indications: === | ||
Repair perforated or damaged eardrum, remove mastoid air cells damaged by infection or cholesteatoma | |||
=== Surgical procedure: Incision can be postauricular, endaural or transcanal | === Surgical procedure: === | ||
Incision can be postauricular, endaural or transcanal | |||
== Preoperative management == | == Preoperative management == | ||
| Line 53: | Line 55: | ||
|} | |} | ||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->As indicated by H&P, consider WBC if associated with URI | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ||
As indicated by H&P, consider WBC if associated with URI | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->NIMS to monitor integrity of facial nerve | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ||
NIMS to monitor integrity of facial nerve | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> | ===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ||
Standard premedication | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->N/A | ===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->=== | ||
N/A | |||
== Intraoperative management == | ==Intraoperative management== | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->Standard monitors, 18g PIV x 1 | ===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
Standard monitors, 18g PIV x 1 | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->Standard induction, succinycholine for intubation (avoid long acting muscle relaxants), ETT | ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
Standard induction, succinycholine for intubation (avoid long acting muscle relaxants), ETT | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->Supine, HOB often turned 90 or 180 degrees | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
Supine, HOB often turned 90 or 180 degrees | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->Avoid long acting muscle relaxants, volatile anesthetic/TIVA, '''avoid''' N2O, remifentanil to maintain a still patient, dexamethasone and ondansetron as patients are prone to PONV | ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
Avoid long acting muscle relaxants, volatile anesthetic/TIVA, '''avoid''' N2O, remifentanil to maintain a still patient, dexamethasone and ondansetron as patients are prone to PONV | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->Avoid bucking and straining on ETT, consider deep extubation | ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
Avoid bucking and straining on ETT, consider deep extubation | |||
== Postoperative management == | ==Postoperative management== | ||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> | ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
Routine PACU | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->PONV, facial nerve injury | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
PONV, facial nerve injury | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->== | ||
{| class="wikitable wikitable-horizontal-scroll" | {| class="wikitable wikitable-horizontal-scroll" | ||
|+ | |+ | ||
! | ! | ||
!Variant 1 | !Variant 1 | ||
!Variant 2 | !Variant 2 | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
| Line 118: | Line 131: | ||
|} | |} | ||
== References == | ==References== | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
Latest revision as of 16:15, 9 September 2025
Tympanoplasty and/or mastoidectomy
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
1 PIV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Avoid long-acting paralysis for facial nerve monitoring. Succinylcholine induction |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary of this surgical procedure and its indications here.
Overview
Indications:
Repair perforated or damaged eardrum, remove mastoid air cells damaged by infection or cholesteatoma
Surgical procedure:
Incision can be postauricular, endaural or transcanal
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Possibly more prone to laryngospasm of associated with URI |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | Patients may have associated otitis or URI |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
As indicated by H&P, consider WBC if associated with URI
Operating room setup
NIMS to monitor integrity of facial nerve
Patient preparation and premedication
Standard premedication
Regional and neuraxial techniques
N/A
Intraoperative management
Monitoring and access
Standard monitors, 18g PIV x 1
Induction and airway management
Standard induction, succinycholine for intubation (avoid long acting muscle relaxants), ETT
Positioning
Supine, HOB often turned 90 or 180 degrees
Maintenance and surgical considerations
Avoid long acting muscle relaxants, volatile anesthetic/TIVA, avoid N2O, remifentanil to maintain a still patient, dexamethasone and ondansetron as patients are prone to PONV
Emergence
Avoid bucking and straining on ETT, consider deep extubation
Postoperative management
Disposition
Routine PACU
Pain management
Potential complications
PONV, facial nerve injury
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Ed Nguyen, Dominic Mangino and Tony Wang