General Medical Information

Anesthesiology

Dirk Youngker
Shawn D. Newlands

Anesthetizing a patient for surgical procedures involving the head and neck is one of the most challenging aspects of modern anesthesia practice. These patients frequently have partial upper airway obstruction or impending decompensation. The urgency of the operation and the stability of the airway direct selection of anesthetic technique, particularly the maneuvers needed to secure the airway before induction of anesthesia. Paramount is continuous, thoughtful communication between surgeon and anesthesiologist. Amnesia, anesthesia, muscle relaxation, airway management, fluid management, and cardiac and respiratory monitoring all are components of anesthetic care. Successful surgical and anesthetic care are intertwined. Understanding the basic principles, physiology, and pharmacology of anesthetic care is crucial to the success of the otolaryngologist.

Anesthesia can be administered in a number of ways. The major division is general anesthesia, in which the patient is rendered unconscious, and other techniques, in which pain is prevented by means of central blocking of conduction of painful stimuli. The latter techniques involve use of local anesthetic administered by means of infiltration around the surgical site, peripheral nerves, major nerves, such as the brachial plexus, or spinal cord (spinal, epidural, or caudal block). Infiltration of major nerves or the spinal cord rarely is used in head and neck surgery.