What are the postoperative concerns for this patient?
Surgical considerations include cerebrospinal fluid (CSF) rhinorrhea and bleeding. Intraoperatively, after tumor resection, the sinus is occasionally packed with autologous fat. If a CSF leak occurs intraoperatively, a lum-bar drain can be placed postoperatively to potentially divert the leak until the diaphragma sella has healed. A rare complication is excessive bleeding from the carotid artery or cavernous sinus requiring excessive pressure and packing for control. Such pressure may result in partial or complete occlusion of the intracavernous portion of the internal carotid artery and pressure on cranial nerves III, IV, V, and VI. Postoperative ophthalmoplegia, facial anesthesia, and contralateral hemiparesis or hemiplegia may result from direct pressure or vasospasm.
While intact airway reflexes are essential before extuba-tion, emergence from anesthesia should proceed smoothly to avoid excessive coughing, bucking, and hypertension. Suctioning of the oropharynx commonly reveals blood as the throat pack is removed. Adequate tidal volume is con-firmed and the head should be elevated to facilitate venti-lation. Facemask application must be gently performed as one or both of the nares will be packed. The patient is asked to breathe via the mouth and is evaluated for return of consciousness and assessment of vision. Prolonged mouth-breathing requires airway humidification, which improves oxygenation. Postoperative pain is generally mild and limited to headache or mild discomfort. Small doses of opioids may help, as well as oral analgesics with a sip of water as soon as tolerated.