Tympanoplasty and/or mastoidectomy

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
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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

Potential complications

PONV, facial nerve injury

Procedure variants

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