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Advanced anesthesia 2 > Anesthesia for Otorhinolaryngologic Surgery > Flashcards

Anesthesia for Otorhinolaryngologic Surgery Flashcards

1
Q

cholesteatoma

A
  • abnormal collection of skin cells inside your ear
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2
Q

Local anesthesia for ear surgery

A
  • infiltration w/ lido and epi, topical lido on tympanic membrane, EMLA cream on TM
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3
Q

sensory nerves of the ear

A
  • auriculotemporal nerve
  • greater auricular nerve
  • auricular branch of vagus nerve
  • tympanic nerve
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4
Q

NO2 and ear surgery

A
  • 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
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5
Q

facial nerve monitoring uses during ear surgery

A
  • 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
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6
Q

PONV with ear surgery

A
  • vomiting increases ICP, venous pressure, causes bleeding
  • prophylaxis with serotonin antagonists
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7
Q

maxillary antrostomy

A
  • 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
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8
Q

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

A
  • consists of asthma, recurrent sinus disease, nasal polyps and a sensitivity to NSAIDs
  • can have severe bronchospasm
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9
Q

nasal vasoconstrictors

A
  • cocaine
  • epi
  • phenylephrine
  • lido w/ epi
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10
Q

cocaine

A
  • 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)
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11
Q

nasal surgery and ETT vs LMA

A
  • LMA may be better protection from lower airway blood
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12
Q

Coroner’s clot

A
  • 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
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13
Q

Waldeyer’s ring

A
  • consists of palatine tonsils, nasopharyngeal tonsils (adenoids), and lingual tonsils
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14
Q

tonsillectomy

A
  • removal of tonsils and adenoids
  • adenoids disappear with age d/t enlarged pharyngeal structures
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15
Q

signs of OSA in peds

A
  • 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
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16
Q

T&A meds and anesthesia

A
  • 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)
17
Q

dexamethasone dosing

A

0.15 mg/kg
max 20 mg

18
Q

Zofran dosing

A

0.1 mg/ kg

19
Q

Tylenol dosing

A

15 mg/kg

20
Q

incidence of laryngeal spasm

A

12-25 %
Larson’s maneuver

21
Q

reasons for post-op tonsil bleeding

A
  • males
  • qunisy (tonsillar abscess)
  • usually occurs within 6 hours and is venous or capillary
  • 7-8 days post-op scab falls off
22
Q

S&S of tonsil bleed

A
  • unexplained tachycardia
  • excessive swallowing
  • pallor
  • restlessness
  • sweating
  • increased cap time
  • hypotension is a late sign
23
Q

risks for bleeding

A
  • hypovolemia
  • aspiration risk
  • difficult laryngoscopy from clots, oozing, swelling, reduces venous and lymph drainage
24
Q

management of tonsillar bleed

A
  • o2, fluids, H&H, coags, T&C
  • blades
  • 2 suctions
  • RSI, head down
  • mask induction w/ pt lateral or head down
25
Q

Reinke’s space

A
  • the vocal fold (non-muscle part of the vocal cord)
  • lamina propria
26
Q

Reinke’s edema

A
  • sac-like appearance of the fluid filled vocal cords
  • swelling causes the voice to become hoarse
27
Q

laryngeal amyloidosis

A
  • abnormal proteins deposits
  • yellowish candle wax appearance
28
Q

Microlaryngoscopy tube (MLT)

A
  • laser tubes with metal except cuff
  • double cuffs (one filled with NSS and one filled with methylene blue)
29
Q

precautions with laser

A
  • avoid NO2
  • use fiO2 <30%
  • YAG laser use green lens
  • Argon laser use amber lens
  • CO2 use clear lens
30
Q

what to do with an airway fire

A
  • 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
31
Q

sanders type jet injector

A
  • 16 gauge jet on side arm of laryngoscope or bronch
  • pressurized O2 30-50 PSI
  • surgeon directs tip
  • IV agents for anesthesia
32
Q

supraglottic jet ventilation

A
  • placed above cords via laryngoscope
  • blood, smoke, and debris blown into trachea
  • cant monitor etCO2
  • risk of pneumomediastinum, pneumothorax, SQ emphysema
33
Q

subglottic jet ventilation

A
  • small catheter through glottis into trachea
  • reduced driving pressures
  • greater risk of barotrauma than supraglottic
34
Q

high frequency ventilation (HFV)

A
  • small tidal volumes with rapid rates via 3.5 - 4 mm catheter
35
Q

positive pressure ventilation (HFPPV)

A
  • respiratory rates 60-120
36
Q

jet ventilation (HFJV)

A
  • vT 100-400 less than dead space

Advanced anesthesia 2 (10 decks)

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