Ear, audiovestibular, and temporal bone procedures

Ear, audiovestibular, and temporal bone procedures

Anesthesia type	General
Airway	ETT
Lines and access	1 PIV
Monitors	Standard ASA
Primary anesthetic considerations
Preoperative
Intraoperative	Nerve monitoring often used, avoid muscle relaxants and consider remifentanil
Postoperative
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Procedures include

• Tympanoplasty/mastoidectomy
• Myringoplasty
• Meatoplasty
• Stapedectomy

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

N/A

Operating room setup

Prepare for patient bed rotation

Patient preparation and premedication

N/A

Regional and neuraxial techniques

N/A

Intraoperative management

Monitoring and access

• Standard ASA monitors
• 5-lead EKG
• 1 PIV

Induction and airway management

Consider induction with succinylcholine instead of non-depolarizing muscle relaxant if nerve monitoring is needed

Positioning

Bed will generally be turned either 90 degrees or 180 degrees away for optimal surgical access.

Maintenance and surgical considerations

Many procedures involve nerve monitoring, which preclude the use of muscle relaxants. Consider remifentanil infusion.

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications