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Advanced Anesthesia > ENT > Flashcards

ENT Flashcards

1
Q

Waldeyer’s ring

A

soft palate
the base of the tongue
uvula
palatine tonsils
adenoid

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2
Q

What is the pharynx composed of?

A

Composed of the terminal end of the nasopharynx
Oropharynx
Laryngopharynx
Hypopharynx

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2
Q

Upper airway Sensory and Motor supply originates what nerves?

A

5, 7, 9, 10

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3
Q

med for nasal congestion

A

Afrin aka Oxymetazoline

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4
Q

the floor is composed of

A

1 palatine process of maxilla
2 horizontal plate of the palatine bone.

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5
Q

Extensive vascular supply leads to severe bleeding if an endotracheal tube is not inserted along the what?

A

The superior margin of the hard palate.

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6
Q

Tonsils and blood supply are the causes of concern for bleeding.

A

Branches from the
1 facial arteries
2 external and internal carotid
3 maxillary arteries

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7
Q

How does the epiglottis cover the larynx during swallowing?

A

The larynx is pulled cephalad, allowing the epiglottis to cover the trachea.

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8
Q

Swallowing

A

1 RLN (10)
2 SLN (10)
3 Glossopharyngeal (9)

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9
Q

3 unpaired cartilages

A

Thyroid
Cricoid
Epiglottis

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10
Q

3 paired cartilages

A

§ Arytenoid
§ Corniculate
§ Cuneiform

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11
Q

What connects the oropharynx to trachea

A

larynx

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12
Q

What is the narrowest portion of the larynx in the adult?

A

Rima Glottis (Glottidis) or the area of the vocal cords.

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13
Q

What is the narrowest portion of the larynx in the pediatric patient?

A

The narrowest portion of the Larynx is the CRICOID RING until 10 years of age

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14
Q

Cuffed tubes are generally recommended for those older than

A

8-10 years of age to allow for better airway seal, prevent subglottic edema, and reduce the incidence of postoperative airway compromise.

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15
Q

Which Law applies to non-ideal fluids to explain the change in ventilation?

A

Poiseuille

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16
Q

What cranial nerve is responsible for gag reflex

A

glossopharyngeal
vagal

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17
Q

what act as a significant dilating muscle of the nasopharynx?

A

The stylopharyngeus muscle

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18
Q

where does SLN end ?

A

above the vocal cord

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19
Q

where does RLN end ?

A

Subglottic area

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20
Q

Provides motor function to the cricothyroid muscle of the larynx

A

external SLN

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21
Q

branches from the vagus nerve and loops around the brachiocephalic artery

A

Right RLN at T1 - T2

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22
Q

branches from the vagus nerve and loops around the aorta

A

Left RLN at T2

The heart is on the left, and so is the aorta

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23
Q

Common Local anesthetic (amides) & max doses

A

Lido 5 mg/kg max 300
Lido w epi 7 mg/kg max 500
Bup 2.5 mg/kg max 175
Bup w epi 3 mg/kg max 225
Ropi 2 mg/kg max 200 mg

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24
Q

Why should you give decadron after the patient is asleep?

A

IV injection can cause Perineal Pain and Pruritus

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25
Q

What is avascular necorosis and what medication may cause it?

A

corticosteroids

A condition where bone tissue dies due to a lack of blood supply. This can lead to the collapse of the bone structure and subsequent joint dysfunction.

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26
Q

Why do ENT procedures have especially high-risk PONV?

A

swallowing blood

Drain the stomach at the end of a bloody procedure with OG tube carefully.

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27
Q

benefits of anticholinergics (glyco)

A

helps reduce or diminish vagal tone
reduces secretions
increases bronchodilator.

Can cause closed-angle glaucoma

28
Q

what color glasses for Nd: YAG?

A

Green

29
Q

What color glasses for the CO2 laser?

A

clear or plastic

30
Q

What color glasses for argon laser?

A

Orange-tinted glasses are required for the Argon Laser

31
Q

A pediatric sized standard ETT with an adult length OR an adult sized ETT with a pediatric sized diameter.

A

Microlaryngeal Endotracheal Tube or MLTs

32
Q

The surgeon will remove the ETT, operates for a brief period of apnea, and then allows the anesthesia provider to reintubate the patient.

A

Intermittent Apnea

33
Q

For when the trachea is not intubated, a metal needle is mounted in the operating laryngoscope or passed through the cords.

A

Jet Ventilation

34
Q

With the tip of the needle either above or below the glottis, the anesthetist directs a high velocity stream of O2 into the airway lumen, typically low tidal volumes with high respiratory rates.

A

High Frequency Jet Ventilation

35
Q

What kind of expiration happens with High Frequency Jet Ventilation?

A

passive expiration

36
Q

when is HFJV contraindicated?

A

Contraindicated in any situation in which an unprotected airway is a concern (full stomach, hiatal hernia or trauma)

37
Q

Most common site of Foreign Body Aspiration ?

A

right bronchus

Lying down? upper R lobe
Sitting? Lower R lobe

38
Q

How to treat Foreign Body Aspiration that is superior or level of the larynx?

A

simple laryngoscopy with Magill forceps

39
Q

How to treat Foreign Body Aspiration that is distal to larynx?

A

The patient should have an inhalational induction in the OR, maintaining spontaneous respiration without cricoid pressure or positive pressure ventilation.

+ Rigid Bronchoscope

40
Q

What cranial nerves are involved in ear and face surgery?

A

9 10 11 12

41
Q

Can you use paralysis for facial nerve monitoring?

A

Yes, may be performed despite significant neuromuscular blockade detected by conventional ulnar TOF.

However, profound skeletal muscle relaxation should be avoided, and volatile anesthetic drug should be used judiciously as a primary anesthetic.

Remifentanil and ½ MAC VA could be employed and adequate enough for the procedure.

42
Q

Nitrous oxide is how much more soluble than air?

A

NO diffuses into air-containing cavities in the body 34, which is more soluble than nitrogen.

“The blood: gas partition coefficient of nitrous oxide (0.46) is about 34 times greater than that of nitrogen (0.014)”

43
Q

may elicit a vagal response.

A

1Stimulation of the epiglottis with the tip of a straight laryngoscope
2 blades
3 suction catheters
4 placement of an endotracheal tube

44
Q

this allows the pressure to equalize between the middle ear and the atmosphere, reducing the pressure in the middle ear compartment.

A

Myringo Tube Placement

45
Q

anesthesia set up for tubes

A

-No need to intubate
-mask induction
-mask ventilation (CPAP for TV)
-tylenol suppository
-Keep patient deep, 3% Sevo, assist with breathing if you have to.

46
Q

what is the signal of procedure end for tube placement?

A

ear drops and cotton ball placed in ear.

47
Q

Uvulopalatopharyngoplasty (UPPP) may be apart of T&A for what?

A

Pickwickian syndrome or Obstructive Sleep Apnea.

48
Q

ICU / OR standard tubes

A

TUBES WE USE ARE LOW PRESSURE/HIGH VOLUME

49
Q

when not to use a nasal rae?

A

Facial trauma

Known facial trauma in the unconscious patient should be avoided to prevent possible penetration into the brain.

50
Q

Where should rae tubes face?

A

Oral RAE- South facing-towards feet

Nasal RAE- North facing-towards head

51
Q

USE BITE BLOCK WITH THIS TUBE

A

Wire Embedded ETTs

52
Q

Induction for T&A in peds

A
  1. Inhalation induction, 8% Sevoflurane
  2. Prop, opiod, decadron
  3. intubate gently
  4. A cuffed oral RAE ETT is recommended for children older than 8-10 years of age.
  5. Neck roll
  6. Mouth gag removal (may vagal)
  7. suction out stomach
  8. Move the bed back to the induction position, back from 90 degrees
53
Q

incidence of bleeding tonsils

A

Incidence of post tonsillectomy bleeding requiring surgery is 0.3%-0.6%.

75% of post op hemorrhages occur within 6 hours of surgery.

Remaining 25% of post op bleeds occur within 24 hours of surgery.

** Slow Ooze **

54
Q

the bones of the face develop between what weeks?

A

between 5th and 9th week

55
Q

growth of palatal bones develop what weeks?

A

between the 6th and 11th week.

56
Q

where does the cleft occur?

A

The cleft develops when the bones of the NASAL and MAXILLARY or the palatal bones fail to fuse.

57
Q

How do you prime your lines for cleft lip repair babies?

A

All air bubbles removed from IV lines to prevent air embolus due to increased incidence of cardiac anomalies (atrioventricular defect).

58
Q

extubation for cleft lip happens only after airway reflexes have _____ .

A

returned

59
Q

Symptoms seen in Downs SYndrome

A

Unstable atlantoaxial instability (C-spine cleared?)
Large tongue
Large occiput and fat pad
Congenital heart disease
Small oropharynx
Enlarged tonsils
Increased secretions
Patients on Phenytoin for seizures may present with gingival hyperplasia.

60
Q

Presents with nasal polyps, asthma, and aspirin allergy.

A

Samter Syndrome

61
Q

what med is used to vasoconstirct in sinus surgery?

A

cocaine max 300mg
epinephrine max 200mcg??

62
Q

How do you keep the neck neutral during intubation on a trauma patient?

A

1 manual in line axial stabilization
2 cervical collar

63
Q

when should trauma patients with smoke inhalation be intubated?

A

immediately

64
Q

Le Fort 1

A

horizontal fracture through hard palate, nasal septum, and pterygoid plates.

65
Q

Fe Fort 2

A

triangular fracture from nose, orbit, cheek, maxilla, and pterygoid plates.

65
Q

Le Fort 3

A

totally separates the midfacial skeleton from the cranial base.

(nose, the ethmoid bone, the eye orbits, and the sphenopalatine fossa)

66
Q

what La Fort Procedures are you strongly advised NOT to nasally intubate?

A

2 and 3 may place the tube into the cranial vault.

3 words: Basilar Skull Fracture.

67
Q

what do you need to always have on you incase of maxillofacial trauma

A

Make sure you have wire cutters available at all stages of stay in case of airway emergency at extubation to PACU to transport to ICU/floor.

Advanced Anesthesia (8 decks)

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