21 - Anaesthesia for eye, ENT and dental surgery

Summary

We endeavoured to look at the best available evidence to support some of our current practices in areas of ENT (ear, nose and throat), eye and dental anaesthesia.

• Endotracheal anaesthesia has been the standard for anaesthesia for tonsillectomy. Laryngeal mask airway (LMA) is used more often for the procedure than in the past. We look at the safety of this transition.

• Many surgeons use local anaesthesia for better postoperative analgesia after tonsillectomy. In spite of lack of supportive evidence this practice is still common.

• There is a belief that non-steroidal anti-inflammatory drugs (NSAIDs) might increase posttonsillectomy bleeding and newer COX2 inhibitors are devoid of this problem. We look at the evidence for such contention.

• We explore for any generally accepted way of providing safe anaesthesia for surgery for the human papilloma virus (HPV) of the larynx.

• There is considerable difference of opinion on fasting before cataract surgery under local anaesthetic blocks and on the indications for sedation during eye blocks.

• Opinion varies on the use of LMA for outpatient dental surgery. Evidence is sought for all the above from available literature.

Anaesthesia for ENT surgery

Anaesthesia for ENT surgery has to specifically address the problems of a shared airway, perioperative bleeding and postoperative pain and discomfort.