Septoplasty

Anesthesia Implications

Position: Supine, arms tucked
Time: 30-60 min (short)
Blood Loss: Low (10-50 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Preference

Preparation – Consider administering Afrin spray preoperatively to prevent bleeding.

Approach – GETT. Utilize a RAE or reinforced tube with extender to open up the surgical field.

O2 – Keep oxygen levels < 30% to prevent fire from cautery.

Paralytic – This is the provider preference. The Septum is very sensitive, so keeping the patient still can be challenging. For this reason, some providers prefer paralytics.

Pain – pain after the procedure is usually minimal. It is very common for the surgeon to inject local with epinephrine at the beginning of the case, which is usually effective for pain relief postoperatively.

Bleeding – The surgeon will inject local with epinephrine into the nasal passages. This practice is very effective at reducing blood loss. There's always the possibility of blood still pooling in the pharynx and/or nasopharynx. Make sure that the cuff is adequately inflated at the beginning of the case and the airway is thoroughly suctioned at the end.

Deep Extubation – Consider deep extubation as patient will likely be on sinus precautions.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

This surgery is the only surgery to correct a deviated septum. A deviated septum interferes with normal airflow in the nose. Occasionally, this surgery is paired with other surgeries (eg. removal of nasal tumors or sinus surgeries). The doctor will cut the mucosa inside the nose. This mucosa protects the septum, and when cut, will allow the doctor to reshape the septum’s bone and cartilage. Bone and/or cartilage may be removed in the process of reshaping the septum. Once reshaping is done, the mucosa is replaced. The nose will not be broken during surgery. The entire process lasts 30 to 90 minutes.