Superficial Parotidectomy

Anesthesia Implications

Position: Supine, head turned away from field, Bed turned 90 degrees, Bed turned 180 degrees
Time: 2-4 hours (long)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: No

Approach – GETT is typically employed. Opioid based techniques for induction are beneficial.  Inhalational agents are acceptable for anesthesia maintenance. For antibiotic prophylaxis, IV Ancef is the typical choice.

Positioning – The patient is placed in a supine position with the head slightly turned to the opposite side. Secure the oral endotracheal tube (ETT) to the mandible on the opposite side using tape.   Table usually is rotated 90-180 degree away from anesthesiologist. 

Paralytic – During the procedure, facial nerve stimulator and monitor are utilized. Therefore, a short-acting paralytic like succinylcholine is preferred solely for intubation.

180 degree turns (general considerations): Arrange lines and monitor cords in anticipation to turn. If turning right, keep cords and lines draped to the left. If turning left, keep cords and lines draped to the right. Have a circuit extension connected. Disconnect the circuit when turning and immediately reconnect.

Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.

The parotid gland is comprised of two lobes: the superficial lobe and the deep lobe. If a tumor needs to be removed from the superficial lobe, the procedure is referred to as a superficial parotidectomy. On the other hand, when a tumor in the deep lobe, or in both lobes, needs to be removed, the surgical procedure is known as a total parotidectomy. The facial nerve acts as the boundary separating the two lobes.