Parotidectomy

Anesthesia Implications

Position: Supine, arms tucked
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Ask surgeon

Approach – GETT. Position ETT away from surgical side.

Paralytics – Ask surgeon. If he/she is monitoring the facial nerve, you’ll want to avoid paralysis.

Deep Sedation – Keep patient deep to avoid coughing, bucking, or moving. You may consider a Remifentanil Drip (0.1-0.2 mcg/kg/min) with 1/2 MAC of gas to keep the patient still without paralytics.

PONV prophylaxis – These patients are not particularly susceptible to PONV, but you’ll still want to run full PONV prophylaxis given the location of the surgery.

Emergence – Consider deep extubation and thoroughly suction the airway. It will be important at this interval to avoid coughing. Make sure airway is patent before moving to PACU as a bulky dressing may prevent a proper mask seal.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

A parotidectomy is the removal of the parotid gland, usually due to a cancerous lesion. The parotid glands are the largest salivary glands located on each side of the face, just in front of the ears.

There are typically 3 types of parotidectomy procedures: total, radical, and superficial. Total and radical parotidectomy involve the area around the facial nerve, while superficial usually does not. The goal of a total parotidectomy is to remove the parotid gland while preserving facial nerve function. During a radical procedure the facial nerve is intentionally removed along with the parotid gland.