Vivian Wu, MD

ENT Surgeon

General overview of cases:

Mucosal diseases

Direct laryngoscopy with biopsy: recommend glide scope, paralysis ok. Usually short 5-10 minutes manipulation with wait for frozen section. 30-45 min total
Oral cavity oropharynx resection with neck dissection, no free flap – nasal intubation, nerve monitoring
oral cavity oral pharynx cases requiring advanced recon (with Kochhar) may need a trach. If possible trach listed, nasal intubation. If definite trach, ok for oral intubation and will trach first (need armored tube for rest of case, change to trach tube at the end of case)
glottic cases – same as above but securing airway may require fiberoptic awake nasal intubation.

Skin cancers

Wide local excision with sentinel node biopsy – nerve monitoring.
Advanced cases may require neck diseection, free flap, no trach. Nerve monitoring

Endocrine

Salivary

Cases involving Dr Kochar

With Kochhar when advanced recon is needed – large mucosal or skin cancer resections

When we need additional lines for sake of aniricipated lood loss

Meds you don't want used

Do you use multimodality analgesia?

PACU preferences if any?

endocrine cases - may ask for intraop PTH in pacu
nurses need to be aware of concerning symptoms related to hematoma: patient complaints of dysphagia, contour of neck