1. ENT, OMFS, Optho Flashcards
1
Q
A
A
temporal bone
2
Q
B
A
external acoustic meatus (ear canal)
3
Q
C
A
maileus
4
Q
D
A
incus
5
Q
F
A
semicircular canals
6
Q
E
A
stapes
7
Q
G
A
cochlea
8
Q
J
A
eustachian tube
8
Q
H
A
vestibular nerve
9
Q
I
A
cochlear nerve
10
Q
L
A
tympanic membrane
11
Q
K
A
tympanic cavity
12
Q
external ear surgery
A
reconstuction of ear or auditory canal
13
Q
external ear surgery: anesthetic plan
A
GA w/LMA
or
local
14
Q
middle ear/mastoid surgeras
A
myringotomy/tube insertion
cholesteatoma
stapedectomy
15
Q
BMT
A
clears middle ear effusions due to dysfunctional eustachian tube
16
Q
cholesteatoma
A
erodes bone that can spread to mastoid and surrounding structures
17
Q
inner ear surgery
A
access to brain cavity for neoplasm
cochlear implant
18
Q
meneirs disease cause
A
labryrinth and/or semicircular canal issues
19
Q
meneirs disease symptoms
A
vertigo hearing loss
20
Q
BMT: anesthetic plan
A
fask mask sevo technique
21
Q
longer ear surgery: anesthetic plan
A
LMA
or
ETT
22
Q
is it better to mechanically ventilate or spontaneously ventilate a patient when surgeon is using surgical microscope?
A
mech ventilate
- SV causes movement of head/abdomen
23
Q
what 2 things should you avoid in ear surgery?
A
coughing
straining
24
what is CI in ear surgery?
nitrous
25
how to avoid coughing/straining?
give narcotics
lidocaine jelly on tube
deep extubation
26
can you paralyze in ear surgery
sometimes
27
which ear surgeries have incr PONV
middle
inner
28
superficial nasal surgery: anesthetic management
local
or
MAC
29
non-superficial nasal surgery: anesthetic management
GA
30
4 types or nasal surgeries
external
cavity
sinus
bony structure
31
what is nasal bony structure surgery used for?
access for craniotomies
airflow corrections
32
most common airway in nasal surgery
ETT taped to side/mandible
33
intraoral procedures
tonsillectomy
adenoidectomy
palatal surgery
34
laryngeal procedures
lesion removal
airway endoscopy
laser surgery
35
head and neck procedures
parotid
thyroid
nasopharyngeal tumor
neck dissection
laryngotomy
uvalopalatoplasty
36
tonsillectomy most common airway
ETT
(LMA possible, but rare)
37
do you need to paralyze for tonsillectomy?
no
38
can you give NSAIDs for tonsillectomy
yes - do not increase bleeding
39
decadron dosing for tonsillectomy
0.05-0.15 mg/kg
40
decadron effects during tonsillectomy
decr pain
decr PONV
incr food tolerance
41
3 major concerns for tonsillectomy
1. incr PONV risk
2. incr bleeding
3. airway fire risk
42
what FiO2 to decrease airway fire risk
FiO2 < 40%
43
is laryngospasm more liekly with ETT or LMA
ETT
44
techniques to mitigate extubation laryngospasm
topical lidocaine: 4mg/kg
IV lido: 1 mg/kg
IV mag
subhypnotic propofol: 30-50 mg
45
rescue position
lateral
46
what does the rescue position do?
promotes secretions out of mouth instead of down airway
47
bleeding tonsil management
reintubation (difficult) w/small ETT
trendelenburg
OG
48
bleeding tonsil: S+S
tachycardia
excessive swallowing
decreased cap refill
restlessness
49
bleeding tonsils are _______ in nature
venous
50
oral RAE
51
nasal RAE
52
micro laryngeal tube (MLT)
53
laser tube
54
why is the balloon yellow on the MLT
to highlight where the cuff/vocal cords are for the surgeon
55
what is different about the laser tube?
- 2 cuffs
- resists the effects of laser
56
yellow cuff on laser tube
air
57
clear cuff on laser tube
saline w/methylene blue
58
wire tube
59
what is unique about wire tubes?
resist kinking
can still be occluded
60
what central access should you avoid in head/neck surgery?
jugulars
61
montandon tube
62
what is a montandon tube used for
larynx removal
63
what is the impact of radiation therapy or lesions on airway?
increased scarring will decrease mobility
== more difficult airway
64
what happens if carotid sinus is manipulated?
vagal
65
what should you ensure you pt has in pre-op prior to head/neck surgery?
2 contralateral IVs
type and screen
66
what sedation drips are tracheostomy pts typically on?
precedex
propofol
fentanyl
67
A
outer cannula
68
C
inner cannula
68
B
cuff inflation line
69
D
obturator
70
F
cuff
70
E
pilot balloon
71
outer cannula
keeps stoma open
72
obturator
guides outer cannula into stoma during placement
73
inner cannula
fits inside outer cannula
74
what cannula can be removed for cleaning
inner cannular
75
what kind of trach tube do you ned for PPV
cuffed (pilot balloon)
76
when are cuffless trach tubes indicated?
1. pts with tracheal problems
2. pts ready for decannulation
77
fenestrated trach cuffed tube indication
pts on ventilator but unable to tolerate speaking valve
78
fenestreated trach cuffless tube
pts w/difficulty using speaking valve
79
most common trach tube type
cuffless
80
immature trach
<7 days old
81
mature trach
7+ days old
82
Proximal XLT trach
longer proximally to bypass thick neck tissue
83
Distal XLT trach
longer distally to bypass tracheal stenosis
or for longer tracheas (tall people)
84
what type of ventilation does ambu bag provide
PPV only
(cannot SV)
85
options to provide O2 to SV pt on trach
mapleson w/T piece
trach mask
simple face mask over trach
86
extreme risk factor in cleft palate repair
blood loss
87
how do you reduce blood loss in cleft palate?
permissive hypotension
surgeon uses local w/epi
88
what do you need if you are going to allow permissive hypotension?
art line
89
lefort 1
horizontal maxillary
90
lefort 2
pyramidal
91
lefort 3
???
92
lefort 1
93
lefort 2
94
lefort 3
95
lefort 2 and 3 are associated with
higher blood loss
CSF leak
96
which lefort has highest CSF leak potential
lefort 3 with cribiform disruption
97
what procedures are CI in lefort fractures
nasal intubation
NG insertion
PPV
98
airway for zygomatic arch or mandible fracture
nasal rae
99
CN 2
optic nerve
100
optic nerve function
neural signal from retina
101
CN 3
oculomotor
102
CN 4
trochlear
103
CN 6
abducens
104
which CN control extrinsic eye muscles
CN 3
CN4
CN 6
105
CN 5
trigeminal
106
what does CN 5 control
touch and pain
107
normal intraocular pressure
10-20 mmHg
108
what happens if you increase IOP
decrease blood flow
109
oculocardiac reflex
trigemiovagal response that can cause severe bradycardia/asystole
110
what causes oculocardiac reflex?
retraction on extraocular muscles
111
most potent muscle for oculocardiac reflex
medial rectus muscle
112
oculocardiac reflex is a ______ pathway
afferenbt
113
what exacerbates oculocardiac reflex?
hypercapnia
hypoxia
114
what can prevent oculocardiac severe bradycardia?
0.2mg glyco
115
acetazolamide class
carbonic anhydrase inhibitor
116
acetazolamide indication
treats glaucoma by decreasing IOP
117
acetazolamide SE
alkaline diuresis can cause hypokalemia
118
echothiphate class
topical anticholinesterase
119
echothiphate indication
glaucoma
120
echothiphate SE
inhibits plasma cholinesterase
-- prolongs sux
121
pilocarpine / acetylcholine class
cholinergics
122
pilocarpine/ acetylcholine SE
pupil constriction
bradycardia
acute bronchospasm
123
timolol class
beta blocker
124
timolol indication
glaucoma
125
timolol SE
bronchospasm
CHF exacerbation
caution w/COPD
126
common comorbidies in optho patients
HTN
DM2
OSA
127
sedations for optho blocks
small dose versed
PO alprazolam / diazepam
12.5-50 mcg fentanyl
50-100 mcg alfentanil
30-50 mg propofol
128
what do surgeons need to perform optho facial nerve block?
akinesia
129
which block provides eyelid akinesia
retrobulbar block
130
retrobulbar block SE
hemorrhege
incr IOP
intra-arterial injection induced seizures
131
posterior peribulbar block
lower hemorrhage
2 injections
longer onset
incomplete akinesia
132
sub-tenons block
longer onset
sedation required
133
optho topicals
tetracaine 0.5%
lidocaine 4%
134
optho long duration surgeries: managment
GA
LMA or ETT
135
which airway increases IOP
ETT
136
which airway can interfere with opthomalogist
LMA
137
what shoud you avoid in optho surgery
nitrous
138
what is in vitreous gas bubble
sulfur hexaflouride
perflouopropane
139
what is a major issue with optho
PONV
140
optho surgeries that require GA
enucleations
vitroretinal surgery
orbital surgery
141
most common peds eye case
strabismus correction
142
rate of PONV in ped strabismus cases
50--80%
143
common SE during peds strabisums case intraop?
bradycardia
144
urgent eye case
open globe
retinal detachment
corneal foreign body
145
semi-urgent eye case
orbital fx blow-out
tumor
chronic retinal detachment
146
emergent eye case
chemical burn to cornea
central retinal artery occlusion
