Chapter 25 - ENT surgery

Summary

Ear, nose and throat (ENT) patients probably present more airway management problems than any other branch of surgery. This chapter discusses the factors affecting airway safety and maintenance during ENT surgery. Surgical conditions are superior for ear surgery in children with a laryngeal mask airway because there is less movement of the surgical field. The flexible laryngeal mask airway (FLMA) is used in ear, nose and throat procedures including tonsillectomy. Operations on the airway are unique in that both anaesthetist and surgeon are working in the same anatomical field. Anaesthesia for ENT surgery requires specialised equipment and techniques. Anaesthetic techniques can be broadly classified into two groups. Closed systems in which a cuffed tracheal tube is employed with protection of the lower airway and Open systems in which no tube is used leaving the airway open. Other anaesthetic techniques include awake transtracheal catheter placement with jet ventilation, and awake tracheostomy.