ENT Anesthesia Flashcards

Question

anesthesia considerations for head and neck surgery

Answer 1

Vagal response from carotid artery manipulation Open neck veins may create air emboli May require tracheostomy as a part of the procedure or to avoid airway edema from extensive surgical manipulation

Answer 2

an airway that is inserted subglottically through neck tissues directly into the trachea.

Answer 3

dissection and incision of trachea under direct vision.

Answer 4

Seldinger technique and dilatation of trachea.

Answer 5

in OR with anesthesia provider present

Answer 6

To remove cancer that has spread to lymph nodes in the neck Radical vs. Modified Radical Neck Dissection Radical: lymph nodes of the neck, sternocleidomastoid muscle, internal jugular vein, and spinal accessary nerve are removed.

Answer 7

Where is the donor site? Common pedicle flaps include; cervicothoracic, pectoralis major, sternocleidomastoid, and temporoparietal A free flap is removed from a distant site Microsurgery is required to reconstruct vascular supply

Answer 8

Long procedures Fluid and temperature management Arterial line and two large IV’s Tracheostomy is usually performed Muscle relaxants are avoided Vasoconstrictors are avoided (? dobutamine) Transfusions are avoided to minimize micro thrombosis

Answer 9

Anticipate difficult intubation Communicate with surgeon Techniques: Mask with volatile agent when deep surgeon preforms endoscopies Conventional GETA Remifentanil a short acting mu-opioid analgesic

Answer 10

Goal to provide the surgeon with a clear view an immobile field and room to work The anesthetist must protect the trachea, ensure good ventilation and oxygenation minimize secretions and reflexes and promote rapid awaking and return of protective airway reflexes

Answer 11

Use < 30% FIO2 Air/Oxygen. NOT N2O H2O or saline available Most ETT are flammable Laser resistant ETT are not laser proof The cuff is most vulnerable to damage Laser ETT cuff filled with water +/- dye Laser ETT do not protect against electrocautry Eye care: taped close no petroleum lube, covering with saline soaked gauze, and protective glasses

Answer 12

wavelength: 10,600 um type of surgery: Oropharyngeal, Vocal Cord structure damaged: Cornea eye protection: clear lenses

Answer 13

wavelength: 1064 um type of surgery: Tumor Debulking, Tracheal structure damaged: retina eye protection: green goggles

Answer 14

wavelength: 694 um type of surgery: retinal structure damaged: retina eye protection: red goggles

Answer 15

wavelength: 515 um type of surgery: vascular lesions structure damaged: retina eye protection: amber goggles

Answer 16

GETA is usually preferred for procedures such as endoscopic sinus surgery Considerations Blood in the oropharynx at the time of extubation may lead to coughing or laryngospasm Throat pack can reduce the amount of blood entering the glottis Blood collections can occlude the glottis after extubation and result in airway obstruction

Answer 17

Preoperative evaluation: loose teeth and checking coagulation variables Standard technique: Deep GA that prevents reflex induced hypertension tachycardia and arrhythmias. Muscle relaxation??. Rapid recovery and return of protective airway reflexes. LMA (reinforced flexible) Pediatric “tonsil position”

Answer 18

BLEEDING Incidence requiring surgery 0.3-0.6% Usually occur within 6 hours of surgery Blood loss is underestimated Anesthesia Check coagulation, type and cross, good IV access, adequate hydration before induction, RSI with cricoid pressure, slight head down, and extubate when patient is awake

Answer 19

Incidence as high as 70% during the first 24 hours after tonsillectomy Dexamethasone Metoclopramide Ondansetron N2O Decompress the stomach

Answer 20

More than 289000 preformed on children younger than 15 Recommendations important to anesthesia IV Dexamethasone Against perioperative antibiotics Importance of pain management after tonsillectomy

Answer 21

A common craniofacial abnormality occurring in 1:700 births, bones of the face develop in the fifth and ninth weeks, and the palatal development in the sixth to eleventh weeks Up to 30% of these newborns have other congenital anomalies such as Downs syndrome, Pierre Robin and Treacher Collins syndrome

Answer 22

Small mandible = micrognathia or mandibular hypoplasia Glossoptosis: A tongue that falls back and downward Cleft Palate Neonate often requires intubation

Answer 23

A genetic condition caused by changes in gene on chromosome 5 which affects facial development Downward slanted eyes small jaw and chin unusually formed or absent ears hearing loss and cleft palate May present for plastic surgery Small mouth, small underdeveloped mandible Nasal airway is blocked by tissue (choanal atresia) Ocular and auricular anomalies

Answer 24

John Langdon Down published in 1866 the first accurate description of a person afflicted with the syndrome In Down’s syndrome the cell contains 47 chromosomes with an extra chromosome linked to chromosome 21, resulting in trisomy 21 Small mouth Large tongue Atlantoaxial instability Small subglottic diameter (subglottic stenosis)

Answer 25

Cleft lip usually at 3 mm of age to allow to feed and demonstrate facial expressions Closure of the hard and soft palate 5-8mm age for speech development

Answer 26

PREOP Guidelines: Rule of 10’s Weight 10 lbs, hemoglobin10 mg/dl, white cell count < 10,000/mm3, and more than 10 weeks Laryngoscope may slip into cleft Oral RAE ETT taped to lower lip Eye care Tongue suture to avoid oral airway Cleft lip may have a Logan Bow placed at the end of procedure, this makes mask ventilation difficult to impossible

Answer 27

Can reduce venous drainage and cause tongue swelling Post op airway obstruction

Answer 28

Anesthesia can be by infiltration of local anesthetic or by general anesthesia Premeatal operations, stapedectomy, and uncomplicated middle ear surgery can be preformed with local anesthesia

Answer 29

Positioning of the the patient Preservation of the facial nerve N2O and middle ear pressure Nausea and vomiting

Answer 30

Commonly preformed pediatric surgical procedure Short surgical procedure under GA by face mask Treat postoperative discomfort by: acetaminophen 40/kg PR, intranasal fentanyl 2mcg/kg