Anesthesia for Otorhinolaryngologic Surgery

Question 1

cholesteatoma

Answer 1

• abnormal collection of skin cells inside your ear

Question 2

Local anesthesia for ear surgery

Answer 2

• infiltration w/ lido and epi, topical lido on tympanic membrane, EMLA cream on TM

Question 3

sensory nerves of the ear

Answer 3

• auriculotemporal nerve
• greater auricular nerve
• auricular branch of vagus nerve
• tympanic nerve

Question 4

NO2 and ear surgery

Answer 4

• diffuses into the middle ear and increases pressure, great for BMT
• pressure relieved by d/c or eustachian tube
• negative pressure produced by rapid reabsorption can displace graft

Question 5

facial nerve monitoring uses during ear surgery

Answer 5

• used during middle ear, mastoid, and inner ear procedures near facial nerve
• do not use NMB
• remifentanil is a good choice to maintain depth w/o NMB

Question 6

PONV with ear surgery

Answer 6

• vomiting increases ICP, venous pressure, causes bleeding
• prophylaxis with serotonin antagonists

Question 7

maxillary antrostomy

Answer 7

• procedure to clear the maxillary sinuses
• Caldwell-Luc is the fenestration of the anterior wall of the maxillary sinus and the surgical drainage of the sinus into the nose

Question 8

Samter’s Triad (aspirin exacerbated respiratory disease (AERD)

Answer 8

• consists of asthma, recurrent sinus disease, nasal polyps and a sensitivity to NSAIDs
• can have severe bronchospasm

Question 9

nasal vasoconstrictors

Answer 9

• cocaine
• epi
• phenylephrine
• lido w/ epi

Question 10

cocaine

Answer 10

• small doses are vagotonic and decrease HR
• CV effects are from a blockade of epi reuptake
• avoid w/ heart patients
• dose 1.5-3 mg/kg, max 200 mg (4% is common)

Question 11

nasal surgery and ETT vs LMA

Answer 11

• LMA may be better protection from lower airway blood

Question 12

Coroner’s clot

Answer 12

• ensure throat pack is out before extubation
• neck flexion encourages clot to fall past soft palate
• any clot can be inhaled and cause total airway obstruction

Question 13

Waldeyer’s ring

Answer 13

• consists of palatine tonsils, nasopharyngeal tonsils (adenoids), and lingual tonsils

Question 14

tonsillectomy

Answer 14

• removal of tonsils and adenoids
• adenoids disappear with age d/t enlarged pharyngeal structures

Question 15

signs of OSA in peds

Answer 15

• enlarged T&A obstruct pharynx
• present with loud persistent snoring w/ gasping nad choking and apneic periods
• hypoxemia, hypercarbia, pulm HTN, cor pulmonale
• pulm edema may develop minutes or hours after relief of airway obstruction

Question 16

T&A meds and anesthesia

Answer 16

• FiO2 < 30%
• NSAIDS routine but not at Hamot
• no antibiotics
• dexamethasone 0.15 mg/kg, max 20 mg
• Zofran (0.1 mg/kg)
• rectal Tylenol (15 mg/kg)

Question 17

dexamethasone dosing

Answer 17

0.15 mg/kg
max 20 mg

Question 18

Zofran dosing

Answer 18

0.1 mg/ kg

Question 19

Tylenol dosing

Answer 19

15 mg/kg

Question 20

incidence of laryngeal spasm

Answer 20

12-25 %
Larson’s maneuver

Question 21

reasons for post-op tonsil bleeding

Answer 21

• males
• qunisy (tonsillar abscess)
• usually occurs within 6 hours and is venous or capillary
• 7-8 days post-op scab falls off

Question 22

S&S of tonsil bleed

Answer 22

• unexplained tachycardia
• excessive swallowing
• pallor
• restlessness
• sweating
• increased cap time
• hypotension is a late sign

Question 23

risks for bleeding

Answer 23

• hypovolemia
• aspiration risk
• difficult laryngoscopy from clots, oozing, swelling, reduces venous and lymph drainage

Question 24

management of tonsillar bleed

Answer 24

• o2, fluids, H&H, coags, T&C
• blades
• 2 suctions
• RSI, head down
• mask induction w/ pt lateral or head down

Question 25

Reinke's space

Answer 25

- the vocal fold (non-muscle part of the vocal cord) - lamina propria

Question 26

Reinke's edema

Answer 26

- sac-like appearance of the fluid filled vocal cords - swelling causes the voice to become hoarse

Question 27

laryngeal amyloidosis

Answer 27

- abnormal proteins deposits - yellowish candle wax appearance

Question 28

Microlaryngoscopy tube (MLT)

Answer 28

- laser tubes with metal except cuff - double cuffs (one filled with NSS and one filled with methylene blue)

Question 29

precautions with laser

Answer 29

- avoid NO2 - use fiO2 <30% - YAG laser use green lens - Argon laser use amber lens - CO2 use clear lens

Question 30

what to do with an airway fire

Answer 30

- disconnect circuit - extubate (submerge tube in water) - mask ventilate - reintubate and bronch - maintain anesthesia with IV agents - extensive pulmonary care: high humidity, PEEP, steroids, antibiotics, racemic epi

Question 31

sanders type jet injector

Answer 31

- 16 gauge jet on side arm of laryngoscope or bronch - pressurized O2 30-50 PSI - surgeon directs tip - IV agents for anesthesia

Question 32

supraglottic jet ventilation

Answer 32

- placed above cords via laryngoscope - blood, smoke, and debris blown into trachea - cant monitor etCO2 - risk of pneumomediastinum, pneumothorax, SQ emphysema

Question 33

subglottic jet ventilation

Answer 33

- small catheter through glottis into trachea - reduced driving pressures - greater risk of barotrauma than supraglottic

Question 34

high frequency ventilation (HFV)

Answer 34

- small tidal volumes with rapid rates via 3.5 - 4 mm catheter

Question 35

positive pressure ventilation (HFPPV)

Answer 35

- respiratory rates 60-120

Question 36

jet ventilation (HFJV)

Answer 36

- vT 100-400 less than dead space