A CRNA provided the anesthesia care with an anesthesiologist medically directing 3 concurrent cases. The patient’s physical status was -P1.
OPERATIVE REPORT, SEPTOPLASTY
LOCATION: Inpatient, Hospital
PATIENT: Katie Leigh
PHYSICIAN: Jeff King, M.D. ANESTHESIOLOGIST: Janice E. Larson, M.D.
PREOPERATIVE DIAGNOSES: 1. Nasal septal deformity with nasal obstruction. 2. Hypertrophic inferior turbinates.
POSTOPERATIVE DIAGNOSES: Same. PROCEDURE PERFORMED: Septoplasty and inferior turbinoplasties.
INDICATIONS: Patient presented with history of chronic sinus pain and infections. Discussed risks and benefits of surgical intervention. All questions answered and patient wishes to proceed.
FINDINGS: The patient had a severe nasal septal deformity into the left nasal passage with essentially complete occlusion of this side. The right inferior turbinate had become very hypertrophic, filling up the disparity.
PROCEDURE: After patient was placed under general anesthetic, the nose was cocainized and the septum was injected with 1% Xylocaine with epinephrine. The face was prepped and draped in a sterile fashion. A left hemitransfixional incision was made and the mucoperichondrium and periosteum were elevated off on the left-hand side. The incision was then made through the cartilage approximately 2 cm cephalad to the distal end, and then the mucoperichondrium and periosteum were elevated off on the right-hand side. The bent cartilage and perpendicular plate of the septum were removed. In the floor of the nose on the left-hand side, the patient had a very extensive bony spur and had displaced the cartilage entirely off into the left-hand side. This bony spur was removed with a 4 mm chisel. Once removed the septum floated freely and was able to be moved back into the midline. This still left a small amount of curvature now into the right nasal passage, but I feel at this point should not cause significant obstruction. The right nasal passage was suctioned and cleaned well. The left nasal passage was then open and straight. The septum was reattached anteriorly with a 4-0 nylon suture to hold it into position until it can glue down in the normal septal groove. The hemitransfixional incision was closed with interrupted 4- 0 chromic suture. Whip stitch was placed in the septum to bring the mucous membranes back together with 5-0 fast-absorbing suture. The inferior turbinates were then both injected full of 1% Xylocaine with epinephrine and following this, the Somnos machine was used and 500 joules of Copyright © 2014, 2013, 2012, 2011 Elsevier Inc. All rights reserved. energy were delivered to the superior part of both inferior turbinates and to the inferior part of both inferior turbinates to damage them and cause permanent retraction of the inferior turbinates. The nasopharynx was then suctioned and cleaned. Neo-Synephrine was placed in both sides of the nose. Telfa packing was placed; one pack in each side that was covered by bacitracin. The oral cavity was suctioned and cleaned well. The patient was awakened from the anesthetic and returned to the recovery room in stable condition. Prognosis immediate and remote is good. Estimated blood loss 20 cc.
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