Parotidectomy
Updated On: July 23, 2026
Anesthetic Approaches
Approach - GETT. Position ETT away from surgical side. Paralytics - Ask surgeon. If he/she is monitoring the facial nerve, you'll want to avoid paralysis. Deep Sedation - Keep patient deep to avoid coughing, bucking, or moving. You may consider a Remifentanil Drip (0.1-0.2 mcg/kg/min) with 1/2 MAC of gas to keep the patient still without paralytics. PONV prophylaxis - These patients are not particularly susceptible to PONV, but you'll still want to run full PONV prophylaxis given the location of the surgery. Emergence - Consider deep extubation and thoroughly suction the airway. It will be important at this interval to avoid coughing. Make sure airway is patent before moving to PACU as a bulky dressing may prevent a proper mask seal.
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.
Tourniquet (general considerations): Antibiotics should be administered prior to tourniquet inflation. Tourniquet pain usually begins 45-60 minutes after inflation and is unresponsive to regional anesthesia and analgesics. Upper extremity pressure should be set to approximately 70-90 mmHg above systolic blood pressure (SBP). Lower extremity tourniquet pressure should be set to approximately 2 times SBP. Upon tourniquet release, there will be increases in End-tidal CO2 and metabolic acidosis, while decreases will be seen in core body temperature, blood pressure, and mixed venous oxygen saturation (SvO2).
A parotidectomy is the removal of the parotid gland, usually due to a cancerous lesion. The parotid glands are the largest salivary glands located on each side of the face, just in front of the ears. There are typically 3 types of parotidectomy procedures: total, radical, and superficial. Total and radical parotidectomy involve the area around the facial nerve, while superficial usually does not. The goal of a total parotidectomy is to remove the parotid gland while preserving facial nerve function. During a radical procedure the facial nerve is intentionally removed along with the parotid gland.