20 minute day case ENT surgery. These patients often smoke. Shared airway. Discuss choice of airway device at the brief- options include: a subglottic jet ventilation catheter, microlaryngeal tube, injector needle on operator laryngoscope, or rarely a cricothyroidotomy needle.
Pre-op
- Medications: paracetamol, NSAID
- Careful airway assessment- beware stridor
Peri-op
- 20G cannula
- Propofol / remifentanil TCI
- Processed EEG
- Muscle relaxant – 20-30mg rocuronium
- Anti-emetics
- Ondansetron 4mg
- Dexamethasone 6.6mg
- Laryngoscopy
- Insert subglottic jet ventilation catheter – tip to cords, then insert further ~8cm
- At end of procedure, repeat laryngoscopy and suction
- Reversal – often sugammadex
- Either remove jet ventilation catheter and face mask ventilate, or continue jetting until breathing again.
Post-op
- Not particularly painful- may have a sore throat
- Fentanyl in recovery
- TTO paracetamol and NSAID
Alternatives
- Spraying cords with LA – more comfortable in recovery, but then unable to drink for one hour post-op. Patients seem to prefer being able to drink immediately post-op.
- MLT allows traditional ventilation, but cannot be used for laser cases. It protects the airway from blood and debris, but does impair the surgeon’s view.
Anaesthetic Recipes 