Anesthesia for Otologic Surgery

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Anesthesia for Otologic Surgery

Otology/Audiology
Author Credentials 

Robert Rhodes, MD
Resident Physician
Department of Otolaryngology – Head & Neck Surgery
University of Oklahoma Health Sciences Center
Oklahoma City, OK

 

Alexander Bien, MD, FACS
Associate Professor
Department of Otolaryngology – Head & Neck Surgery
University of Oklahoma Health Sciences Center
Oklahoma City, OK

Module Summary

Otologic surgery is associated with many unique considerations, one of which is anesthesia principles and technique. Whether implementing general anesthesia, local anesthesia, or a combination of both, a knowledge of the fundamental principles as they relate to surgery of the ear is paramount. The application of these principles allows otologic surgery to be adapted to a variety of indications and surgical settings.

Module Learning Objectives 
  1. Describe the mechanism of action of local and general anesthetic agents.
  2. Summarize the advantages of local anesthesia for otologic surgery.
  3. Identify intraoperative anesthetic considerations.

 

Anatomy

Learning Objectives 
  1. Explain the sensory innervation to the ear as applicable to local anesthetic regional blocks
  2. Describe the vascular supply to the external ear

 

References 
  1. Bien AG, Wagner R, Wilkinson EP. (2018). Local and Regional Anaesthesia Techniques for Otologic (Ear) Surgery. Open Access Atlas of Otolaryngology, Head and Neck Operative Surgery. Available: https://vula.uct.ac.za/access/content/group/ba5fb1bd-be95-48e5-81be-586fbaeba29d/Local%20and%20regional%20anaesthesia%20techniques%20for%20otologic%20_ear_%20surgery.pdf
  2. Zide BM, Swift R. How to block and tackle the face. Plast Reconstr Surg. 1998 Mar;101(3):840-51.
  3. Liang S, Irwin MG. Review of anesthesia for middle ear surgery. Anesthesiol Clin. 2010 Sep;28(3):519-28.

 

Basic Science

Learning Objectives 
  1. Identify the mechanism of action for common general and local anesthetic agents
  2. Identify the maximum dose of local anesthetics to prevent toxicity
  3. Summarize the potential benefits and risks with epinephrine
  4. Described pharmacologic therapies for postoperative nausea and vertigo
  5. Recognize adverse effects of scopolamine

 

References 
  1. Pardo MC, Miller RD. Basics of Anesthesia. Seventh ed. Philadelphia: Elsevier; 2018.
  2. Liang S, Irwin MG. Review of anesthesia for middle ear surgery. Anesthesiol Clin. 2010 Sep;28(3):519-28.
  3. Kaur B, Clark MPA, Lea J. Anaesthesia for ear surgery in remote or resource-constrained environments. J Laryngol Otol. 2019 Jan;133(1):34-38.
  4. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018 Aug 8;11:35-44.

 

Genetics

Learning Objectives 
  1. Identify genetic predisposition to complications with local and general anesthetics
  2. Recognize signs and management of malignant hyperthermia

 

References 
  1. Saba R, Kaye AD, Urman RD. Pharmacogenomics in Anesthesia. Anesthesiol Clin. 2017 Jun;35(2):285-294.
  2. Pardo MC, Miller RD. Basics of Anesthesia. Seventh ed. Philadelphia: Elsevier; 2018.

 

Patient Evaluation

Learning Objectives 
  1. Recognize risks of general anesthesia in patients with medical comorbidities
  2. Identify important preoperative considerations

 

References 
  1. Svrakic M, Pollack A, Huncke TK, Roland JT, Jr. Conscious sedation and local anesthesia for patients undergoing neurotologic and complex otologic procedures. Otol Neurotol. 2014 Dec;35(10):e277-85.
  2. Pardo MC, Miller RD. Basics of Anesthesia. Seventh ed. Philadelphia: Elsevier; 2018.
  3. Kaur B, Clark MPA, Lea J. Anaesthesia for ear surgery in remote or resource-constrained environments. J Laryngol Otol. 2019 Jan;133(1):34-38.

 

Surgical Therapies

Learning Objectives 
  1. Identify applications for office-based otologic procedures
  2. Explain the effects of nitrous oxide during otologic procedures
  3. Describe intraoperative considerations such as nitrous oxide, emergence from anesthesia, hemostasis, facial nerve monitoring, etc.
  4. Summarize conservative measures to prevent postoperative nausea and vomiting

 

References 
  1. Pynnonen MA, Schmalbach CE. Office-based Procedures in Otolaryngology. Otolaryngol Clin North Am. 2019 Jun;52(3):xv-xvi.
  2. Kaur B, Clark MPA, Lea J. Anaesthesia for ear surgery in remote or resource-constrained environments. J Laryngol Otol. 2019 Jan;133(1):34-38.
  3. Pardo MC, Miller RD. Basics of Anesthesia. Seventh ed. Philadelphia: Elsevier; 2018.
  4. Liang S, Irwin MG. Review of anesthesia for middle ear surgery. Anesthesiol Clin. 2010 Sep;28(3):519-28.

 

Complications

Learning Objectives 
  1. Identify the side effects and potential complications of local and general anesthetics
  2. Be aware of intraoperative complications from lack of hemostasis

 

References 
  1. Sekimoto K, Tobe M, Saito S. Local anesthetic toxicity: acute and chronic management. Acute Med Surg. 2017 Apr; 4(2): 152–160.
  2. Pardo MC, Miller RD. Basics of Anesthesia. Seventh ed. Philadelphia: Elsevier; 2018.
  3. Kaur B, Clark MPA, Lea J. Anaesthesia for ear surgery in remote or resource-constrained environments. J Laryngol Otol. 2019 Jan;133(1):34-38.

 

Review

Review Questions 
  1. What is the recommended dose per kilogram of 1% lidocaine with and without epinephrine?
  2. What are the potential intraoperative advantages and disadvantages of nitrous oxide?
  3. What is the sensory innervation to the pinna?
  4. What cranial nerves innervated the external auditory canal?
  5. Describe the injection technique of local anesthetic for otologic surgery.