A Very Important Warning for Septoplasty under Local and Local Anesthesia with Sedation
Fatih Arslan1* and Tuğba Kokulu Arslan2
1Department of Otolaryngology, Head and Neck Surgery, Beytepe Murat Erdi Eker State Hospital, Turkey
2 Ministry of Health Diskapi Research and Training Hospital Anesthesiology and Reanimation Clinic, Turkey
Submission: August 16, 2018; Published: August 20, 2018
*Corresponding author: Fatih Arslan, Department of Otolaryngology, Beytepe Murat Erdi Eker State Hospital, Beytepe 06500, Ankara, Turkey.
How to cite this article: Fatih Arslan, Tuğba K A. A Very Important Warning for Septoplasty under Local and Local Anesthesia with Sedation. J Anest &
Inten Care Med. 2018; 7(3): 555713. DOI: 10.19080/JAICM.2018.07.555713
Nasal septum deviation is one of the most important reasons of nasal obstruction. This common medical problem exists in approximately one third of world population, and it is treated surgically for a long time. Septoplasty, which is one of the most common surgical procedures in ENT practice, is applied under local anesthesia, local anesthesia with sedation or general anesthesia . Extreme pain can cause decrease in heart rate by overexciting the parasympathetic nervous system. This results in a significant decrease in heart rate, which in turn decreases the pulse and leads to a dangerous drop in blood pressure .
In septoplasty operation under local or local anesthesia with sedation, while the maxillary crest is being excised by cheesel or gouge, bleeding of greater palatine artery occasionally occurs. Most commonly used methods to stop the bleeding include; drilling the bleeding point, using bone wax, aspirating and applying monopolar cauterization. Monopolar cauterization has a very important point that should be noted, when the patient is operated under local or local anesthesia with sedation. If the used analgesic does not provide deep analgesia like fentanil (the most common analgesic used in this surgery), appliance of monopolar cauterization in order to control bleeding may result in severe bradicardia or even cardiac arrest, probably via pain related neurologic shock. In that case surgeon must be alert and
act quickly. Either general anesthesia should be enhanced or a
deep analgesic like ketamine should be applied to patient before trying to control the bleeding.
This material has never been published and is not currently under evaluation in any other peer-reviewed publication. This material has never been presented in any scientific meeting. The study began after the approval of the local ethics committee was obtained. There is no funding received for this work from any
organizations or commercial associations. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. All authors declare that they have no conflict of interest.