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931: Advanced Principles of Anesthesia I > Anesthesia for ENT surgeries part 2 > Flashcards

Anesthesia for ENT surgeries part 2 Flashcards

1
Q

Common ENT procedures include

A 
middle ear procedures
myringotomy
tonsillectomy & adenoidectomy
nasal procedures
thyroid surgery
cleft palate & lip
dental restoration
trauma
radical neck dissection
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2
Q

Describe nerve monitoring for ENT cases

A

meticulous identification and preservation of cranial nerves

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3
Q

Nerves most often monitored include

A

facial (VII)
recurrent & inferior laryngeal nerves (X)
vagus nerve (X)
spinal accessory nerve (IX)

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4
Q

When performing nerve monitoring, neuromuscular blocker can be used at

A

induction & intubation only

  • remifentanil 0.05-0.2 mcg/kg/min.
  • TIVA
  • nitrous oxide
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5
Q

Myringotomy is

A

tube placed in the tympanic membrane reducing middle ear pressure

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6
Q

The indication for myringotomy is

A

chronic otitis media- fluid in ear
recurrent otitis media- three or more acute infection in a six month period (four in a 1 year period)
accompanying URI are common

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7
Q

Do you cancel a myringotomy for rhinorrhea?

A

Typically sick kids so if they have some mild symptoms then it is okay to continue with surgery

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8
Q

Anesthetic considerations for myringotomy includes

A

short operations- sedatives may outlast procedure
mask induction- assisted ventilation throughout procedure
antibiotic and steroids placed in ear
-mild pain medications given orally or rectally

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9
Q

Indications for pediatric T&A include:

A

recurrent infections

airway obstruction

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10
Q

Indications for adult T&A include:

A

OSA
UPP (uvulopalatopharyngoplasty)
comorbidities- CHF

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11
Q

Induction for tonsillectomy & adenoidectomy include

A 
pediatric vs. adult- inhalation vs. intraveous
oral RAE tube- consider reinforced
Cuffed vs. un-cuffed
secure ETT midline
eye protection
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12
Q

Anesthetic considerations for T&A include

A 
mouth gag
HOB turned
medications
throat pack
orogastric suction
EBL- 4 mL/kg
IV fluids
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13
Q

Emergence considerations for T&A include:

A

protect airway reflexes
reduce risk of laryngospasm
minimize coughing- topical vs. intravenous lidocaine

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14
Q

Postoperative considerations for T&A include:

A

pediatric position- side lying with head slightly down

adult position- high sitting

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15
Q

Post-tonsillectomy can require surgery for

A

rebleeding (0.3-0.6% of cases)

75% occur within first 6 hours

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16
Q

Anesthetic considerations for return T&A bleed include:

A

hypovolemic- H&H, T&S, IV placement preop

Full stomach- RSI

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17
Q

Septoplasty can be performed to

A

correct deformities of nasal septum

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18
Q

Rhinoplasty can be performed to

A

repair or reshape the nose
cosmetic
airway restoration

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19
Q

Nasal fractures can be

A 
closed reduction (MAC)
open reduction (more invasive- ETT vs. LMA)
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20
Q

The “middle ear” refers to the

A

air-filled space between the tympanic membrane & oval window

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21
Q

Common surgeries of the middle ear in adults & children include:

A

tympanoplasty
staphedectomy or ossiculoplasty
mastoidectomy
cochlear implants

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22
Q

Surgical considerations for middle ear procedures include:

A

congenital defects, trauma, treatment of disease
-bloodless field
microsurgery

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23
Q

Anesthetic considerations for middle ear procedures include:

A

general anesthesia- avoid nitrous oxide, muscle relaxants are avoided
local anesthesia- ability to test hearing during surgery
PONV common
controlled hypotension
deep extubation

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24
Q

Tympanoplasty is performed for

A

a perforated eardrum

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25
Q

The approach for tympanoplasty can be

A

post auricular- posterior auditory canal
or
temporal fascial graft- ossicular chain abnormalities repaired with prosthesis

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26
Q

Mastoidectomy is performed for

A

mastoid cells are “open air”

-indications: cholesteatoma or mastoiditis

27
Q

The approach for mastoidectomy include

A

entry through post auricular region

28
Q

Anesthetic considerations for mastoidectomy include

A

avoid nitrous oxide & muscle relaxation

29
Q

The largest endocrine gland in the body is the

A

thyroid

-blood supply is via carotid arteries

30
Q

Indications for thyroid surgery include

A

thyrotoxicosis

malignancies

31
Q

RLN & external branch of SLN course along _____ of the thyroid

A

lateral lobes

-associated with movement of intrinsic muscles of the larynx

32
Q

Anesthetic considerations of thyroid surgery (preop) include

A

preop- euthyroid, airway assessments b/c goiters can compromise airway status, medications- thyroid & beta blockers

33
Q

Anesthetic considerations for thyroid surgery include:

A

regional anesthetic- combined deed & spinal cervical plexus block
direct acting vasopressor- phenylephrine
“Rose” position with arms tucked- second IV
eye protection- goggles

34
Q

Intraoperative anesthetic considerations for thyroid surgery include

A

general endotracheal anesthesia

  • nerve integrity monitor (NIM) EMG endotracheal tube
  • electrodes contact right & left vocal cords
35
Q

Postoperative anesthetic considerations for thyroid surgery involve

A

hypocalcemia- signs & symptoms develop within 24-96 hours

  • perioral numbness & tingling
  • abdominal pain
  • extremity paresthesia
  • tetany
  • laryngospasm
  • QT prolongations
  • mental status changes & seizures
  • Chvostek sign
36
Q

Postoperative anesthetic considerations for thyroid surgery include:

A

RLN damage- unilateral more common
-hoarseness
bilateral more serious- biphasic stridor, dyspnea, respiratory distress, aphonia
hematoma- airway obstruction & asphyxiation

37
Q

One of the most common craniofacial abnormalities is

A

cleft palate & lip

1:7000

38
Q

The facial bones fuse by

A

9th week of development

39
Q

Up to 30% of those with cleft palate & lip have other congenital anomalies such as

A

Down syndrome
Pierre Robin
Treacher Collins
These present airway issues d/t small mouth opening, large tongue, micrognathia

40
Q

Cleft palate & lip involve a

A

two-stage repair
three months- cleft lip repair with primary tip rhinoplasty
eight months- closure of the hard palate

41
Q

Preoperative anesthetic considerations for cleft palate & lip include

A 
Rules of ten:
>10 weeks of age
weight- 10 pounds
hemoglobin 10 g
WBCs <10,000
42
Q

Intraoperative anesthetic considerations for cleft palate & lip include

A

standard induction
oral RAE tube (laryngoscopy can be tricky)
remove air from all lines
eye protection

43
Q

Postoperative anesthetic considerations for cleft palate & lip include

A

suture placed through tip of the tongue
-acts as an oral airway
-prevents damage to palatal repair
suction prior to extubation- reduce oral secretions & potential for laryngospasm
consider mittens or arm boards so they don’t disruption suture lines or surgery

44
Q

Dental restoration can be performed under

A 
general anesthesia for multiple reasons:
not appropriate for office visit
rampant cavities
history of cerebral palsy or Down syndrome
uncooperative
45
Q

Anesthetic considerations for dental restoration include preoperative

A 
oral midazolam (0.5 mg/kg)
intramuscular ketamine (3-4 mg/kg)
46
Q

Intraoperative anesthetic considerations for dental restoration include

A 
standard induction
nasal intubation-oxymetazoline spray, warmed RAE tube, nasal trumpet dilation
throat pack
orogastric suction
deep extubation
47
Q

The goal of trauma is to

A

secure the airway without causing additional damage or compromising ventilation

48
Q

Airway obstruction in trauma can be related to:

A

edema, bleeding, intraoral fractures, nasal passage injury, foreign bodies

49
Q

Airway management for trauma depends on

A

the situation

50
Q

In cases of severe face or neck trauma, consider

A

retrograde intubation
jet ventilation via cricothyrotomy
emergent tracheostomy

51
Q

Injuries to the head & neck may include

A

cervical or cranial injury as well so consider in-line stabilization

52
Q

LeFort determined common fracture lines along the

A

maxilla & face

53
Q

A LeFort 1 fracture is a

A

horizontal fracture extending from the floor of the nose and hard palate through the nasal septum

54
Q

A LeFort II fracture is a

A

triangular fracture running from the bridge of the nose, through the medial and inferior wall of the orbit, beneath the zygoma & through the lateral wall of the maxillar

55
Q

A LeFort III fracture

A

separates the midfacial skeleton from the cranial base, traversing the root of the nose, ethmoid bone, eye orbits & sphenopalatine fossa

56
Q

Anesthetic considerations for trauma include

A

avoid nasotracheal intubation
consider other trauma (cervical, thoracic, & abdominal)
correct ABCs before addressing facial trauma
consider remaining intubated
awake intubation- maintain airway reflexes
cutting tools attached to the patient or available at the bedside
anticipate extensive blood loss- T&C patient, deliberate hypotension if tolerated

57
Q

Radical neck dissection is the

A

resection of cancerous tumors from head & neck

58
Q

Frequent comorbidities of radical neck dissection include

A

elderly, smoking, ETOH abuse, cardiovascular disease, history of radiation therapy

59
Q

Anesthetic considerations for radical neck dissection include

A

airway management- CT results, consul surgeon, preoperative exam
preoperative labs- including type & cross
two large bore IVs (consider central venous access)
arterial line- tight blood pressure control, lab analysis

60
Q

Additional anesthetic considerations for radical neck dissection includes

A 
muscle paralysis
controlled hypotension
minimize vasoconstrictors- flap perfusion
intake & output- colloid vs. crystalloid
vagal response- anticholinergic
61
Q

Radical neck dissection may require an

A

intraoperative tracheostomy or laryngectomy

hyper-oxygenate patient

62
Q

When performing a radical neck dissection it is important to move

A

ETT to level above transection

  • once tracheostomy is in place verify ventilation & remove ETT
  • connect tracheostomy to ventilator
  • surgeon will suture in place
63
Q

Postoperative considerations for a radical neck dissection include

A 
tracheostomy care
controlled ventilation
chest radiography- rule out pneumothorax
monitor for laryngeal edema
ICU- potential edema, fluid shifts, altered ventilation, & extensive anesthesia time
64
Q

The essential goals of ENT surgery include:

A
  1. thorough knowledge of airway anatomy
  2. selecting & preparing for the appropriate airway technique
  3. preventing & managing airway complications
  4. producing brief & selective relaxation with potential for rapid recovery
  5. omitting neuromuscular relaxation for select cases
  6. maintaining cardiovascular stability
  7. preventing and/or containing airway fires
  8. minimizing intraoperative blood loss
  9. minimizing adverse responses from carotid sinus manipulation
  10. prevent & treat postsurgical airway obstruction
  11. avoid and/or limit use of nitrous oxide

931: Advanced Principles of Anesthesia I (22 decks)

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