Special Surgical Procedures II
LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery
Section IIi: nose SURGERY
1-29
1-29. PREP, POSITION, DRAPE, ANESTHESIA, AND LIGHTING
All procedures performed prior to the start of surgery must be explained to the patient to avoid fright and apprehension.
a. The male patient shaves his face prior to surgery. The immediate preoperative prep may include clipping the hairs within the nostrils using small tenotomy scissors. The specialist is to coat the blades of the scissors with a film of vaseline so that the patient will not aspirate the nasal hairs. The patient's face is then washed with antibacterial detergent and sponged dry. His eyes should be protected during this procedure with damp gauze compresses. No solution is applied inside the nose.
b. The patient is placed in either the supine position or the reclining position. For procedures done using local anesthesia, the reclining position enables the patient to expectorate any fluid collecting in his mouth and thus helps keep the operative area free from drainage.
c. A large drape sheet is placed lengthwise over the front of the patient and is secured bib-fashion. Suction tubing is pinned to the sheet. Sterile towels may be wrapped around the patient's head and secured with towel forceps, leaving his face exposed but his eyes covered. Another method of draping the head is to cover it with a small fenestrated sheet through which the nose and mouth are exposed.
d. Local anesthesia is usually employed for nasal surgical procedures on adults. The method of administration is a combination of topical (nasal packs) and infiltration anesthesia. The specialist assists the surgeon as necessary in packing the nose. Use of local anesthesia enables the patient to cooperate with the surgeon and avoids the complication of vomiting.
e. Illumination is provided by either of two methods: the electric head lamp or the overhead light. The two devices are sometimes used in conjunction.
