Position: Supine, arms tucked
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Preference

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

Bleeding – For these surgeries, bleeding can be augmented by the vasodilation that’s common after the administration of anesthetic gases. Studies show that there is significantly less bleeding if the provider uses a TIVA approach. In addition, 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.

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