Anaesthesia for ENT surgery

In recent years there has been a considerable tendency in the United Kingdom to draw together ENT services into custom-built units, instead of providing a few beds in separate wards with limited access to operating theatre facilities. While this is undoubtedly good for patients and for the streamlining of services, it can make it difficult to offer the trainee anaesthetist good exposure to the techniques required for these combined airway procedures. The drawing together of ENT services does have other benefits. It allows surgeons and anaesthetists to consider more carefully their work and the results which are obtained. Now that clinical audit has become essential, the ability of consultants and trainees to work in close approximation to each other in a single discipline allows much better comparison of outcome than was possible when services were widely spread and operating time frequently available only in a shared theatre. ENT procedures are common, and account for approximately 5% of the workload of an anaesthetic department. ENT operations are rarely life-saving and therefore safety is the prime consideration. Many patients who present for surgery are children or young adults who are otherwise fit; however, some patients, who may present for major procedures, are older and may have concomitant disease of the respiratory or cardiovascular systems. In all categories of patient, the potential risk of anaesthesia in the presence of a compromised airway either during or after the procedure must never be underestimated.