09/02/2025

Post Anesthesia Care for ENT

Post-Operative Care for Ear Surgery

Monitoring for Complications:
Check for clear fluid in the ear or dressing, indicating potential cerebrospinal fluid leakage.
Infection Prevention:
Use aseptic techniques for dressings to protect against infections that can spread to the
meninges and brain.
Patient Positioning:
Follow the surgeon's instructions. If not specified, allow the patient to lie comfortably, typically
with the head elevated or on the un-operated side.
Managing Symptoms:
Patients may experience nausea, vertigo, and nystagmus. Advise slow movements and deep
breathing to alleviate nausea.
Medications:
Prescribe antiemetics and sedatives (e.g., dimenhydrinate, diazepam, Ondansetrone (Zufran)
to manage nausea and vertigo.
Safe Handling:
Avoid jarring the bed and use gentle approaches to prevent sudden movements that could
cause discomfort or complications

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Special Considerations for

Myringotomy
A myringotomy is a procedure to create a
hole in the eardrum, allowing trapped fluid
(blood, pus, or water) in the middle ear to
drain out. A small tube may be inserted to
help maintain drainage.
Post-Operative Care for Infants and
Small Children
1.Positioning:
•Position the patient to promote
effective drainage from the ear.
2.Drainage Management:
•Place a small piece of sterile cotton
loosely in the external ear to absorb
drainage.
•Change the cotton frequently to
prevent contamination.
3.Monitoring:
•Check the back of the patient’s throat
regularly for any blood.

Patient Instructions:
Advise the patient not to blow their nose.
Instruct them to avoid swallowing
secretions; instead, they should spit them
into a basin.
The patient placed in lateral position on the operated
ear side to facilitate drainage.

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Post-Operative Care for Nose Surgery

Special Considerations
1.Airway Management:
•Be aware of potential airway obstruction or laryngeal spasm if a post-nasal pack slips out of place.
•Keep a flashlight, scissors, hemostat, and emergency airway equipment readily available at the bedside for
quick access.
2.Fluid Management:
•Withhold fluids until:
•Bleeding is controlled.
•Nausea and vomiting have subsided.
•Independent airway management is established.
•An antiemetic may be prescribed to alleviate nausea and vomiting.
3.Oral Hygiene:
•Mouth breathing, bleeding, and postnasal drainage can lead to dryness and unpleasant tastes or odors.
•Once the gag reflex has returned, prioritize oral hygiene to maintain comfort.
4.Pain and Edema Management:
•Apply small, lightweight iced packs across the nose to minimize pain, edema, discoloration, and bleeding.
5.Oxygen Delivery:
•Deliver oxygen via a cool mist mask through a face tent to combat dry mucous membranes, which can lead
to coughing, dyspnea, and decreased respiratory exchange.

Post-Operative Care for Tonsillectomy and Adenoidectomy

Patient Positioning

1.Recovery Position:
• Place unconscious or semi-conscious
patients in the tonsillar position (lying on
their side with the face partially down).
• The Trendelenburg position may also be used to
facilitate drainage.
• Ensure the patient’s airway and chest expansion
are visible to maintain respiratory integrity.
2.Secretion Management:
The patient assumes a position between
• This position helps drain secretions from the
mouth effectively. lateral and prone position. The lower
• An oral airway should remain in place until the arm is positioned behind and the upper
swallowing reflex returns and the patient can
arm is flexed at the shoulder and the
manage secretions.
elbow. The upper leg is more acutely
flexed at both the hip and the knee.

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Patient Instructions (Tonsillectomy and Adenoidectomy)

•Advise the patient to spit out secretions and avoid coughing, clearing the
throat, blowing the nose, or excessive talking.
Pain and Swelling Management
•Apply an ice collar to minimize pain and postoperative bleeding.
•Administer cool, humidified air to provide comfort, reduce swelling, and
supply oxygen.
Monitoring for Complications
• Be vigilant for postoperative bleeding, the most common complication:
Signs include frequent swallowing, throat clearing, and vomiting of dark
blood.
Regularly check the back of the throat with a flashlight for any signs of
trickling blood.
• Notify the surgeon if cardiac symptoms of hemorrhage occur (e.g.,
decreased blood pressure, tachycardia, pallor, restlessness).

Preparedness for Emergencies

1. Keep a tonsil tray readily available in the PACU, including:
• Electro-cautery unit Adequate lighting (headlight) Suction equipment
2. Postoperative bleeding may be managed with vasoconstrictors via
nasal packing and pressure.
3. Significant bleeding may require return to the operating room for
suturing or cauterizing blood vessels.
Considerations for Laser Procedures
1. Laser dissection can increase swelling in the hypo-pharyngeal
area, necessitating close observation and measures to reduce
swelling.
2. Administer dexamethasone as needed.
3. The advantage of laser dissection is a significantly reduced risk of
bleeding.

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Post-Operative Care for Laryngoscopy

Patient Positioning

Laryngoscopy is a medical procedure used to visualize the

larynx and vocal cords. It can be performed for diagnostic
or therapeutic purposes, including biopsies, removal of
obstructions, or assessment of voice disorders
1. Conscious Patients:
1. Place in a semi-sitting position or lying on either side once gag
and cough reflexes have fully returned.
2. Unconscious Patients:
2.Position in a side-lying position to prevent aspiration.
Cough Relief Measures
Use cool mist, sips of water, and intravenous narcotics to
relieve coughing, which is common after the procedure

Airway Monitoring
•Monitor for signs of laryngospasm, as patients are susceptible to
respiratory complications.
•Important observations include:
•Laryngeal stridor
•Dyspnea
•Decreased oxygen saturation
•Shortness of breath
Emergency Preparedness
•Keep equipment for endotracheal intubation and emergency
tracheostomy readily available at the bedside in case of laryngeal
edema or laryngospasm.

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Throat Discomfort Management

•Apply an ice collar to alleviate throat discomfort.
•Administer high-humidity oxygen via face tent or mask to reduce irritation.
Dietary Considerations
•After the return of cough and gag reflexes, allow sips of warm normal saline to soothe irritated
tissues.
Hemorrhage Monitoring
•Watch for signs of hemorrhage, including:
•Coughing or regurgitation of blood
•Apprehension
•Tachycardia
•Lowered blood pressure
Vocal Rest
•For patients who underwent laryngoscopy with biopsy or polyp removal, emphasize vocal rest:
•Encourage avoidance of coughing.
•Provide means of communication, such as paper and pencil or a “Magic Slate.”
Cough Management
•If intractable coughing occurs, consider administering codeine and lidocaine to suppress the
cough reflex.

Suctioning and Tracheostomy Care Summary

1. Suctioning Protocol
1. Use sterile disposable catheters and gloves for each procedure.
2. Consider using a plastic sleeve catheter for convenience in the PACU.
3. Ensure catheters are smooth and appropriately sized.
2. Pre- and Post-Suctioning Care
1. Hyperventilate the patient with increased FIO2 before and after suctioning.
2. Do not apply suction during insertion; suction intermittently by occluding the air valve.
3. Be prepared for coughing, and wipe expelled secretions with plain gauze.
3. Assessing Effectiveness
Auscultate the chest after suctioning to evaluate effectiveness.
4. Managing Thick Secretions
1. Instill 3 to 5 ml of sterile normal saline if secretions are thick.
2. Ensure inspired air is humidified and the patient is hydrated.

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5. Tracheostomy Tube Care

Clean the tube as often as every hour using saline, hydrogen peroxide, or sodium
bicarbonate.
Change the dressing as needed to maintain cleanliness and prevent infection.
6. Skin Care
Clean the stoma area with hydrogen peroxide and saline, then apply an antibiotic
ointment.
7. Dressing Specifications
Use plain gauze with bound edges, avoiding cotton filling.
Cut sterile gauze to fit over the tube.
8. Securing the Tracheostomy Tube
Use fabric tapes or Velcro to secure the tube.
Check tension regularly; one finger should fit comfortably under the ties.

Tracheostomy Complications Summary

1. Respiratory Obstruction
Causes: External pressure, foreign bodies, tracheal edema, or excessive secretions.
•Management: If suctioning fails, remove the tracheostomy tube, hold the stoma open with a
dilator or forceps, and notify the surgeon or anesthesiologist.
2. Bleeding
•Expectations: Some bloody secretions may be normal postoperatively, but frank bleeding
is abnormal and requires notifying the surgeon.
•Serious Cases: Significant bleeding may necessitate returning to the operating room for
vessel ligation.
3. Subcutaneous Emphysema
•Causes: Can result from tight suturing around the tracheostomy tube or partial obstruction.
•Nature: Generally resolves within several days and is usually not serious.
4. Emotional Support
•Importance: Essential for patients regaining consciousness post-surgery.
•Communication: Provide a pad and pencil for patients to communicate due to temporary
loss of speech.

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Tracheostomy tube with

one-way valves, called
speaking valves, are
placed onto the
tracheostomy.
Speaking valves allow air
to enter through the tube
and exit through the
mouth and nose. This will
allow patient to make
noises and speak more
easily.