ENT

Question 1

What is the nerve supply to the nose?

Answer 1

Sensation to nose, septum, nasal cavity and sinuses is V1 (opthalmic) and V2 (maxillary) branches of trigeminal nerve

Question 2

What are important pre op considerations for patients prior to Nasal/sinus surgery?

Answer 2

• airway assessment - may be difficult BVM due to nasal obstruction, need for ETT
• comorbidities - resp diseases, CVS (ability to tolerate hypotensive anaesthesia)

Question 3

What are key intra operative aims in sinus surgery

Answer 3

Minimising bleeding - worsens surgical field and increases post op bleeding

Can be non pharmacological (head up 30 degrees, limiting PEEP) or pharmacological (nerve blockade, vasoconstrictors eg Adrenaline, cocaine, corticosteroids, TXA, hypotensive anaesthesia)

Question 4

What is Moffetts solution?

Answer 4

Cocaine 5%
Adrenaline 1:1000
Sodium bicarb 8.4%
Made up to 10ml with normal saline

Question 5

What is hypotensive anaesthesia for sinus surgery?

Answer 5

Induced hypotension to MAP between 50 and 65. However currently aim for systolic 90 and MAP >65, HR 60 in all patients to reduce side effects of hypotension