Anesthetic Considerations for Septoplasty

2. ANAESTHESIA FOR
SEPTOPLASTY
Dr. Muhammad Iqbal
PGT Anaesthesia BBH

3. NASAL SEPTUM
• It is cartilaginous & Bony partition between 2 nasal
cavities.
• Arterial Supply:
• Sphenopalatine artery
• Anterior & Posterior ethmoidal arteries
• Superior Labile Artery
• Greater palatine

4. DIAGRAM

5. NERVE SUPPLY
• Nasopalatine
• Nasocilliary

6. SEPTOPLASTY (SUBMUCOUS SEPTAL
RESECTION)
• It is corrective surgical procedure done to straighten a DNS.
• Types:

7. INDICATIONS:
1. Cosmetics
2. Post trauma
3. Reconstruction after tumour resection.
4. To improve nasal breathing

8. PREOPERATIVE CONSIDERATIONS:
Mostly healthy & young, may have OSA.
Old patients after basal cell carcinoma resection, comorbidities severe OSA.
Difficult Ventilation
Stop aspirin & NSAID 2 weeks before surgery.

9. CHOICE OF
ANAESTHESIA
Depends on:
Length of Surgery
Number of Procedures
Degree of expected bleeding
Invasiveness of procedure
Patient’s Willingness to tolerate
Patient’s preference.

10. SURGICAL REQUIREMENTS
Patient’s Immobility
Clear Surgical Field
Smooth emergence

11. TYPES OF ANAESTHESIA
• Local Anaesthesia:
• Twilight Anaesthesia (Deep Sedation Anaesthesia)
• General Anaesthesia.

12. LOCAL ANAESTHESIA WITH
SEDATION
Advantages:
1. Avoidance of airway instrumentation & PPV.
2. Less IV sedation
3. Avoidance of inhaled anesthetics.
Disadvantages:
1. Patients Awareness
2. Patients Movement
3. Pain if inadequate block
4. Over sedation Hypoventilation
5. Aspiration.
6. Risk of surgical fire.

13. • Topical decongestants e.g Cocaine,Phenyephrine Or Oxymetazoline applied for
vasoconstriction.
• Submucosal Injection of local aesthetic e.g 1% lidocaine(10mg/ml)with 1:100000 Or
1:200000 epinephrine is used.

14. TWILIGHT ANAESTHESIA
• It is an anaesthetic technique where a mild dose of sedation is applied to induce
anxiety reliefe,hypnosis & anterograde amnesia.
• The patient is not unconscious but sedated.
• This technique may also be used in Septoplasty.

15. GENERAL ANAESTHESIA
Advantages:
1. Total patient’s analgesia
2. Immobility
3. Controle of airway
4. Dec.Aspiration risk.
Disadvantages:
1. Coughing at emergence
2. PONV
3. Inc.IV medication
4. Longer recovery time
5. Post Op disorientation.

16. INDUCTION
• Oral Airway may be needed
• IV Dexa & Propofol may help in dec. PONV
• Suxamethonium is preferable agent for induction.

17. MAINTENANCE
• Volatile inhaled anaesthetics
• TIVA
• Balanced anaesthesia technique
• IV alfentanil or Remifentanil.
• Both these drugs blunt tracheal response leading to rapid & smooth
emergence.
• Propofol leads to dec. BP & bleeding.
• Inhalational agents also dec. BP & bleeding.

18. GENERAL ANAESTHESIA
SAD:
Advantages:
• Patent airway
• Spontaneous breathing
• Less chances of sore throat(6-34%)
• Less CVS response
• Smooth emergence
Disadvantages:
• Risk of Aspiration
• Sealing difficulty
• Dislodgement
• Laryngospasm

19. INTRA OPERATIVE CONSIDERATIONS:
Bleeding:
Epinephrine containing local aesthetic
Controlled Hypotension
Vasoconstriction:
Phenylephrine initial dose < 0.5 mg(500mcg)
Mucosal absorption may lead to hypertension & cardiac decompensation.
Use short acting vasodilators or alpha antagonists
avoid Beta Blockers,specially long acting(labetalol,metoprolol)
Eye Protection:
Apply ointment Or minimum taping to recognise orbital injury.

20. EMERGENCE
Smooth extubation
Laryngospasm(due to trickling of blood from surgical side)
Mask Ventilation difficult & undesirable
Give Antiemetic prior to emergence
Head side elevation

21. POST OP CONSIDERATIONS:
Head elevation at 30 degree in PACU
Pain control using narcotics or Paracetamol
Avoid NSAID because of potential for platelet inhibition & Inc. Bleeding.
Overnight Observation:
Uncontrolled pain
Severe OSA
Severe underlying medical condition