ENT And Ophthalmology Flashcards
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South facing preformed et tube
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North facing preformed et tube
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North facing preformed et tube
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South facing preformed et tube or right angled ETT
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Endotracheal tube for laser surgery: 2 bulbs ( 1 with water to prevent burn injury and reduce risk explosion)
What type of airway is seldom used in ENT surgery?
Jet insufflators for ventilation
What 3 type of airway is commonly used in ENT surgery?
• Preformed south facing ETT = tonsillectomy
• preformed north facing ETT
• laser compatible ETT
Which anaesthetic agent should be avoided in ear surgery and why?
Nitrous oxide
Expand gas filled spaces so will disrupt suture lines
How can an airway fire be prevented in ENT surgery when lasers are used? ( 5)
• low fio2
• saline soaked plegets
• intensity and duration of laser
. ETT bulb saline filled
• airway device resistance to laser
What type of airway should be used for tonsillectomies and adenoidectomies?
Oral RAE tube ( south facing) and throat pack to catch soiling at back of throat
Name 3 relatively common complications or occurrences during eye surgery under anaesthesia
• Extubation of patient
• bradycardia
• overheating
Name 4 cardiac and respiratory variables that increase intraocular pressure
• Increased CvP increase severely!
• increase arterial blood pressure
• increased paco2 (hypoventilation)
• decrease pa02
What is the oculo-cardiac reflex? Name 4 causes and presentation
Cardiac arrhythmia (usually Brady) due to:
• traction on ocular muscles
• pressure on eyeball
• admin retrobulbar block
• trauma to eye
Presentation ranges: bradycardia, ventricular ectopy, sinus arrest, v fib.
Pathophysiology of oculo-cardiac reflex?
• trigeminal V1 afferent
• vagal efferent
Risk group for oculocardiac reflex?
Most commonly Paeds strabismus surgery
Management oculocardiac reflex? (4)
• Notify surgeon so they can cease surgical stimulation until heart rate increase
• confirm adequate ventilation, oxygenation, depth of anaesthesia
• administer atropine! 10 micrograms/kg
• infiltrate rectus muscle with local anaesthesia if persist
Name 4 ophthalmic drugs with systemic side effects
• Topical phenylephrine: hypertension, bradycardia
• echothiopate: prolong succinylcholine duration (irreversible cholinesterase inhibitor)
• epinephrine adrenaline eye drops: sympathomimetic side effects and arrhthmogenic
• timolol: atropine resistant bradycardia, hypotension, bronchospasm (beta blocker)
How perform retrobulbar blockade? (4)
• Inject 2,5 ml ligno/bupiva/ropiva (add hyaluronidase to encourage spread) into cone formed by extra-ocular muscles
• patient look supranasally
• needle advanced 1,5 cm along inferotemporal wall
• needle directed upward and nasally toward apex orbit
Name 5 complications retrobulbar blockade?
• Haemorrhage especially retrobulbar (affect optic nerve and intraocular pressure)
. Perforation globe
• intravascular injection
• potent inducer oculocardiac reflex
• respiratory arrest
• acute neurogenic pulmonary oedema
How perform peribulbar blockade? (6)
• Patient look straight ahead
• 2 trans conjunctival injections given
• inferotemporal-halfway between lateral canthus and lateral limbus
• needle advance under globe parallel to orbital floor
• directed medial and cephalad
• 5 ml injection of ligno and bupivacaine
Less risk damage to globe and surrounding structures compared to retrobulbar but not as good of a block
Best method of induction and airway establishment in patient with large neck mass for exploration?
Mask inhalation induction
Which agent must be avoided in ear surgery
Nitrous oxide
Name 2 agents that increase intraocular pressure so should be avoided in eye surgery
• Ketamine
• succinylcholine
