Parotidectomy
Anesthesia type

General

Airway

ETT

Lines and access

PIV

Monitors

Standard 5-lead ECG Facial nerve monitoring

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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A parotidectomy is a surgical procedure to remove some or all of the parotid gland.

Overview

Indications

  • Tumor of parotid gland

Surgical procedure

  • Superficial: removal of parotid gland lateral to facial nerve.
  • Total: removal of parotid gland lateral and medial to facial nerve, often combined with neck dissection.
  • Radical: removal of parotid gland with facial nerve

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

  • As indicated by H&P

Operating room setup

  • Facial nerve stimulator

Patient preparation and premedication

  • Routine

Regional and neuraxial techniques

  • N/A

Intraoperative management

Monitoring and access

  • Standard monitoring
  • 18G PIV x 1

Induction and airway management

  • Standard induction avoiding long acting paralytic (succinylcholine or remifentanil)
  • ETT taped to opposite side.

Positioning

  • Supine
  • Head turned to opposite side
  • Bed may be turned 90 or 180 degrees

Maintenance and surgical considerations

  • Volatile anesthetic or TIVA
  • Avoid long acting paralytic to allow for facial nerve, monitoring, consider remifentanil to maintain a still patient, facial nerve monitoring by surgeon

Emergence

Postoperative management

Disposition

PACU

Pain management

Potential complications

  • Bleeding
  • Infection
  • Dysesthesia of greater auricular nerve
  • Facial nerve weakness
  • Frey's syndrome

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time 1.5-2
EBL 25-200
Postoperative disposition
Pain management
Potential complications

References: