Anesthesia Applications – Anesthesiology

Anesthesia Application in Adult Era Nose Throat Surgeries

Anesthesia method implemented for adult patients for otorhinolaryngologic diseases that necessitate surgery changes according to the type of surgery.  Small operations shall require only local anesthesia.  If the operation shall be realized for nose, small cotton pieces that were impregnated with the local anesthetics shall be placed into the nose, thus numbing of the inside of the nose shall be provided.  If the operation shall be realized in the mouth, numbing shall be provided by local anesthetic sprays and by giving local anesthetics with very fine-needles.  Method of giving tranquilizer and analgesics to the vein by means of serum while applying local anesthetics to the operation region may be utilized for oen group of patients.  In this method patient is taken to the operation room.  His/her heart rate, oxygen saturation in the blood and blood pressure are measured by means of a device called monitor.  Serum is given from one arm of the patient.  Generally these operations are short-term.  Patient can talk despite the tranquilizers given and perform the things told.  Effect of the drugs given does not last long, and patient may leave our center within half an hour or one hour.

Operations of otorhinolaryngologic diseases are usually realized under general anesthesia.  Pain, memory and consciousness may temporarily disappear, however vital activities continue normally.  Patient is evaluated perfectly before the operation, thus anesthetist decides the drugs to be given to the patient in order for realization of the surgery and for the patient to wake up securely, easily and in the fastest way.

Interview to be realized with the patient, evaluation, examination and enlightenment of the patient are significant steps of the anesthesia application.  You will be acquainted with the anesthetist and receive detailed information form him/her in this interview.  Anesthetist shall ask you some questions and decide whether or not there is any inconvenience for your to receive anesthetics.  Anesthetist may request additional examinations and medical analyses in line with the information given by the patient (such as untreated or under-treatment of cardiac trouble, hypertension, diabetes or lung disease) or ask opinion of another specialist (such as internal disease, chest and heart disease specialist).  If anesthetist finds it necessary after all of these examinations, he/she may postpone the operation until the patient in an appropriate health condition or sometimes may suggest the surgery to be realized under local anesthesia.  Otherwise date of operation is determined. 

Patient, whose operation date is finalized, shall sign two forms.  One of them is informed surgery consent form.  Purpose of this form is to ascertain that you received information about the surgery, and you approve your physician to perform the surgery.  Other form is the informed consent form concerning anesthesia.  Purpose of this form is to ascertain that you received information about the method of anesthesia and you approve your anesthetist to apply anesthesia to you.

What Should You Pay Attention to Before the Operation in Terms of Anesthesia?

You should act according to the suggestions of the anesthetist before the operation.  Following are among these suggestions:

• Do not eat solid food for at least 6 hours before the operation.
• You can drink (water, fruit juice, sugar free tea, etc.) until 2 hours before the operation.
• Do not take alcohol the night before.
• Do not smoke cigarettes on the day of operation.
• Act according to the suggestions of the anesthetist on the subject of drugs you should constantly use.  It is recommended to take some of the drugs (for example drugs of hypertension) in the morning of the operation day, while some drugs (for example drugs for diabetes) are not recommended to be taken in the morning of the operation day.
• You should take off the jewelry you use before the operation.
• Women with polished nails should take of the polish on the index finger of the left hand.
• If you are using aspirin constantly or sometimes, you should not use it at least 5 days before the operation.

You should be in our center at least half an hour before the operation time informed to you.  You shall be asked to take off your daily clothes (only top clothing) and put on surgical gown before your are taken to the operation room (Picture 1).

After you are taken to the operation room, your heart rate and oxygen saturation in the blood shall be followed-up continuously and your blood pressure shall be measured once in every five minutes by means of a device called monitor (Figure-2).  Serum shall be given from one of your arms (mostly left arm).  Anesthetics shall be added to the serum and thus you shall be asleep. Your heart rate, oxygen saturation in blood and your blood pressure shall be followed up closely during the operation and they shall be maintained within normal limits.

After operation is completed anesthetics shall be discontinued, thus you shall awaken from sleep slowly and calmly.  Analgesics shall be added to the serum and given to you during the operation in order to avoid pain in the post operation period.  If you have pain despite this precaution, analgesics shall be given again with a serum or intramuscularly (from hip).  You shall be kept in the observation room for several hours after the operation (Picture-3).   At the end of this period, most of the patients are ready for discharge from hospital.  Patients who are coming from outside of the city or those who should be kept under observation medically may stay one night in our center.

Anesthesia Application in Ear-Nose-Throat Surgeries of Children

Following surgeries of children are most frequently made in the EFES Ear-Nose-Throat Center:

• Putting ear tube (ventilation tube)
• Removing adenoid (adenoidectomy)
• Removing tonsils (tonsillectomy)
• Removing both adenoid and tonsils (adenotonsiliectomy)

Application of general anesthesia that enables the child to awake rapidly and has the least side effects is preferred for these operations.

Preparation Before the Operation

Child shall be examined and prepared before the operation.  Various questions shall be asked about the previous diseases of the child, his/her allergies, drugs currently used, whether or not he/she has received anesthesia previously, and his/her current medical condition.  Airway (mouth, teeth and throat structure), heart and lungs of the child shall be examined.  Anesthetist may postpone the operation if the child has fever, wheezing, sputum together with coughing or influenza, or diarrhea or if he/she is vomiting.

Mother and Father of the child whose operation decision is finalized shall sign two forms.  One of them is informed surgery consent form.  Purpose of this form is to ascertain that you received information about the surgery, and you approve your physician to perform the surgery.  Other form is the informed consent form concerning anesthesia.  Purpose of this form is to ascertain that you received information about the method of anesthesia to be applied t o your child and you approve the anesthetist to apply anesthesia.

Our aim is to provide a happy and secure environment for the child.  If the child is excessively excited, tranquilizer syrup may be given 20-30 minutes before the operation.  This syrup generally enables the child to relax, to leave his/her family easily and  not to recall the events (amnesia).  There is also analgesic in this syrup that prevents post-operation pain (Picture 4).  However, this application is not required for some children (especially for older children).  Analgesic added to the serum is given to the children who did not take syrup containing analgesic during or after the operation.

Analgesic Syrup and Tranquilizer

Anesthesia During Operation

1- Putting ear tube (ventilation tube)
For the placement of ear tubes, short general anesthesia is given and anesthesia continues by providing the child to breath anesthetic gas by means of a mask (a soft device in size suitable to the face of the child).  Generally there is no need to establish vascular access.

Anesthetist shall follow the child closely during the operation.  Heart rate, blood pressure and oxygen saturation in the blood are controlled routinely.  Children usually awake within 15-20 minutes.  Side effects of anesthesia are fairly low.  Whole procedure lasts approximately within 1 hour (from start of the operation till discharge from hospital).

2- Tonsil and Adenoid Operations (Tonsillectomy and Adenoidectomy)
Anesthesia application for tonsillectomy and adenoidectomy usually starts with the respiration of the child the anesthetic gas by means of the mask.  Narcotizing by establishing vascular access (by inoculating serum) and thus giving drugs may be realized for older children.  Vascular access is established after the child is asleep by means of the mask.  After other anesthetics added to the serum are given, a tube shall be placed to the respiratory tract and anesthetic gases shall be given from here.  Anesthetist shall follow the child closely during the operation.  Heart rate, blood pressure, oxygen saturation in blood and respiration is controlled routinely.

Drugs required to prevent pain, nausea, vomiting and edema in the airway of the child are given during the operation.

After the Operation
Dizziness, throat ache, nausea, vomiting and wheezing may be observed in the child after the operation as side effects.  Vascular access is generally used until the child is ready to go home.  Child can be discharged from the hospital after he/she is kept in the observation room for three-four hours.

Observation Room After the Operation

Some patients may stay in our center for one night. These patients are those who:

• have other serious medical problems,
• came from outside of the Izmir province,
• are under age 3,
• have sleep apnea (respiration stops for 10 seconds or more during sleeping)
• have respiration problems, nausea and vomiting after the operation