Preparation of a patient for rhinoplasty

Preparation of a patient for Rhinoplasty

Dr. Ajay Jain, MS, DNB

PREPARTION IN CLINIC

Preparation of a patient for Rhinoplasty starts the day he first visits you. This preparation involves studying the overall appearance, thought process, financial aspects, surgical techniques and your own limitations vs patient’s expectation. First convince yourself that you can really make a change in his life with your rhinoplastic skills. There is no point spoiling your name with unsatisfied patient despite your best efforts. Once you are convinced, note down silent points on a piece of paper and take patient’s signatures as well. Explain what is achievable and what is not. Explain the need of graft from other boy parts as well if needed. Computer graphics may work in your favor initially but may prove disaster later on. So stay away, if you are not sure. Keep good quality large size prints out as well.

Then do the investigations in form of routine tests for general/ local anesthesia. Being an ENT Surgeon, do Nasal endoscopy and get a CT scan of sinuses if you feel necessary. Stop medicines like Aspirin and take care of his pulse and blood pressure. Have physician consultation to keep these under control.

Arrange a second visit after few days to review what was discussed at first visit and review the investigations. Ask his or her spouse or a family member to participate in his thought process. Give ample time for consultation- 30 minutes for cosmetic part. Once this meeting takes a right note, finalize a date for surgery and proceed for pre anesthesia checkup and financial approval part.

PREPARATION IN OPERATING ROOM.

Discuss your case with your anesthesia colleague- very important.

Discuss Local Vs General Anesthesia.

In General Anesthesia, Discuss position of the tube- Flexo metallic fixed in center to lower lip.

Warn patient about mouth breathing when he will come out of anesthesia.

Position of patient: Reverse Trendelenberg position.  Do it yourself before scrubbing.

Drape patient yourself.

At Induction: Steroids, Ethamsylate, Antibiotics, Ice packs.

Keep Systolic Blood pressure around 100-110 and Pulse 50-70

TIVA with Propofol allows rapid onset anaesthetic, excellent operating conditions with minimal adverse side effects (nausea) and rapid elimination of anaesthetic drugs,

Use two sets of spot lights. One focused directly above the patient’s head and other from the leg side to focus on vestibule of nose so that no shadow is formed.

Display large size printed photographs or use iPad or Laptop during all time. Keeps your regular nursing assistant for an honest opinion regarding progress of surgery. Be open for suggestions (She may have different valuable opinion!)

Pre recovery room decongestant nasal drops coupled with adrenaline soaked pack and intravenous lignocaine-adrenaline infiltration will keep field blood free.

Personally, I like to sit while operating as this also makes me relaxed but it is a personal choice.

All main instruments should be placed on a Mayo stand positioned directly above patient’s abdomen.

ONE IMPORTANT KEY TO SUCCESS IS SELF CONFIDENCE.

ONE IMPORTANT KEY TO SELF CONFIDENCE IS PREPARTION.