Multiple comorbidities, sinus surgery

Gabrielle Morris

57-year-old lady for septal reconstruction, bilateral inferior turbinectomy, FESS, radical middle meatal antrostomy

Background:

  • Chronic sinusitis, pain, and sinus infections
  • Asthma/COPD – no admissions, regular respiratory review
  • Pulmonary nodules – under surveillance
  • Ex-smoker
  • Sjogrens syndrome – no DMARDs/steroids
  • Renal cell carcinoma – nephrectomy 2006
  • Thyroid nodule/MNG
  • Fibromyalgia and chronic back/neck pain

Issues:

  • BMI 48.
  • Severe mixed obstructive and central sleep apnoea:
    • Compliant with CPAP
    • Recent re-titration of therapy due to 20kg weight-gain
    • Nasal mask, will not be able to use post-operatively
  • IDDM:
    • Longstanding suboptimal glycaemic control
    • HbA1c >11% at clinic, Postponed for optimization
    • Endocrinologist review – commenced SGLT2 inhibitor and new insulin regime
  • Recent cervical fusion:
    • Reports uneventful perioperative course
    • 4-day ICU stay for monitoring and CPAP
    • Good range of neck movement

Discussion:

  • Perioperative use of CPAP with nasal/sinus surgery
    • Will have nasal packs in-situ
    • Unlikely that ENT team will allow CPAP use in the immediate postoperative period
    • Tolerates full face mask – will bring to hospital
  • HbA1c now 8.7%, unlikely to improve further – not a barrier to this procedure
  • Disposition – will require ICU post-op

Plan:

  • Discuss with surgical team – long delay between booking and ready for care due to optimisation and Covid delays
  • ICU 2 post-operatively