Nasal and Sinus Surgery

Polypectomy, endoscopic sinus surgery, maxillary sinusotomy (Caldwell-Luc procedure), rhinoplasty, and septoplasty.

The five major branches of the facial nerve (CN VII), which runs through the parotid gland, are from top to bottom: "To Zanzibar By Motor Car" (all also Mnemonics - Facial Nerve Branches and Cranial Nerves)

• Temporal (frontal) branch of the facial nerve
• Zygomatic branch of the facial nerve
• Buccal branch of the facial nerve
• Marginal mandibular branch of the facial nerve
• Cervical branch of the facial nerve

Sinuses

• Frontal Sinus
• Anterior ethmoidal sinuses
• Middle ethmoidal sinuses
• Posterior ethmoidal sinuses
• Sphenoid sinus
• Maxillary sinus

Anesthetic considerations

Nasal obstruction making FM ventilation difficult - use oral airway

Consider RAE tube

Secure airway

Rich vascular supply

• Check for a history of bleeding/aspirin use

Tape eyes to prevent corneal abrasion

Endoscopic Sinus Surgery

The surgeon may want to check eye movement with dissection due to proximity to orbit (facial nerves, spinal accessory CNXI (provides motor innervation from the central nervous system to two muscles of the neck: the sternocleidomastoid muscle and the trapezius muscle)

NMBD is recommended due to potential neurological or ophthalmic complications with patient movement

Local anesthetic with epinephrine to minimize bleeding and blood loss

• Epinephrine 5 mcg/kg with sevoflurane or isoflurane 1-1.5 MAC
• Epinephrine 7 mcg/kg with desflurane 1-1.5 MAC
• Sensitization (increases excitability of receptors to stimuli) of the heart to arrhythmogenic effects of epinephrine

Posterior pharyngeal pack

Minimize cough and straining on extubation while trying to prevent aspiration at the same time

Allergies (asthma/aspirin = no Non-steroidal anti-inflammatory drugs such as Toradol