Trans-sphenoidal adenoidectomy
- Access
- PIV x2. +/- post-induction arterial line
- Airway
- Oral ETT (no tape on upper lip, tape off to left)
- Induction
- Standard
- Maintenance
- TIVA with paralytic. Or gas/paralytic.
- Emergence
- Awake
- Antibiotics
- Ceftriaxone
- Position
- 90 Right
- RASchlichter
- Prefers to use paralytic for akinesia. However, prefers TIVA over gas because positive pressure ventilation cannot be used and on emergence, gas can reaccumulate if patient stops breathing. Prefers TIVA with a smoother wakeup via propofol and remifentanil (which is used for smooth wakeup, not akinesia).
Notes
Ensure patient fully awake on emergence. Mask ventilation increases risk for pneumocephalus. Usually hydrocortisone 50 mg on induction and 50 mg post-op immediately.
If bigger case/hole, surgery may need to prep a leg for potential flap.
Pre-op aprepitant (PONV and minimize retching).