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Principles 3 > ENT/FACE/Plastics > Flashcards

ENT/FACE/Plastics Flashcards

1
Q

RAE tube facing?

A

oral and nasal, oral down, nasal up towards head

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2
Q

Anode tube? armored, reinforced

A

Flexible, resists kinking, but
can be occluded with biting

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3
Q

Laser tubes

A

Metal
impregnated,
reduces risk of
fire

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4
Q

Anticholinergics used for

A

decrease secretions

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5
Q

Steroids used to

A

reduce edema, PONV &
prolong local anesthetic effects

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6
Q

ENT cases are high risk for what complication?

A

High risk for PONV, especially middle
ear procedures

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7
Q

Deliberate Hypotension goal

A

Decrease blood loss by reducing MAP
while maintaining cerebral and systemic
autoregulation

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8
Q

blood pressure for deliberate hypotension?

A

Maintain MAP ≥ 60 (pts with HTN may need
higher)

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9
Q

typical cases for deliberate hypotension?

A

extensive dissections and FESS*
cases

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10
Q

why are lazers popular?

A

Precise excision, minimal edema,
less blood loss

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11
Q

Most surgical fires during head/neck surgery are
r/t

A

lasers! big deal!

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12
Q

safety concerns for laser cases?

A

Eye protection (patient & staff), plume
dispersion and fires are biggest concerns

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13
Q

can you do deep extubation with ENT cases?

A

NO not if they are bleeding, need to protect airway

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14
Q

complications of endoscopy procedures?

A

Eye trauma,
epistaxis, laryngospasm,
bronchospasm, adverse effects to
locals and epinephrine

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15
Q

how can you relax vocal cord during bronchs?

A

can do it with volatiles and without paralytics! sometimes have to do this

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16
Q

HFJV complications

A

saO2 and CO2 levels
air trapping = subcu emphysema/pneumo

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17
Q

how does HFJV work?

A

pushing in lowest O2 possible without ETT at fast intermittent rates

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18
Q

HFJV contraindication?

A

full stomach (relatively)

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19
Q

how to anesthetize pt HFJV?

A

TIVA, dont want to blow volatiles in room

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20
Q

type of foreign body most problematic?

A

tracheal, can move to total obstruction

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21
Q

gold standard foreign body?

A

rigid bronch with GA

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22
Q

symptoms foreign body?

A

Wheezing, coughing, aphonia, cyanosis

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23
Q

complications rigid bronch?

A

Severe laryngeal edema, pneumothorax, pneumomediastinum, hypoxic brain injury

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24
Q

best way to deal with foreign body cases?

A

inhalation induction with spontaneous ventilation best

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25
Q

what to avoid with foreign body?

A

Positive pressure!

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26
Q

most common nerve problem

A

unilateral facial paresis

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27
Q

nerve preservation methods

A

avoid muscle relaxers or use short acting, avoid locals and N2O

28
Q

Nerve stimulators common in middle ear procedures meaning:

A

no muscle relaxers after intubation

29
Q

N2O implications with middle ear procedures?

A

Avoid N2O or turn off >15 min before closing
(moves into middle ear = displacement of graft)
-N2O also increases risk of PONV

30
Q

Myringotomy (tubes) implications

A

no IV
N2O ok
nasal fent and dext used

31
Q

Most common pediatric surgery

A

Tonsillectomy & Adenoidectomy

32
Q

implications of NSAIDS with T&A?

A

ENTs want to avoid
d/t increased risk of bleeding.
Studies show NSAIDs =
no difference in bleeding, less PONV

33
Q

anesthesia implications for T&A

A

Airway obstruction, shared airway, suspension,
rapid awakening, pain mgt, PONV

34
Q

Bleeding Tonsil can present

A

hypovolemic, tachycardic, hypotensive
give crystalloid bolus pre-op

35
Q

all bleeding tonsils are

A

full stomachs

36
Q

induction for bleeding tonsils?

A

rapid sequence induction

37
Q

anesthesia implications bleeding tonsils?

A

rapid sequence
Suction stomach before
emergence
Extubate FULLY awake!!

38
Q

thyroid procedure implications

A

myesthenia gravis
meds taken am
steroid stress dose

39
Q

Inadvertent resection symtpoms

A

unilateral or bilateral VC paralysis
= airway emergency after extubation

40
Q

motor innervation to vocal cords?

A

recurrent laryngeal and external branch of superior laryngeal

41
Q

type of MR used for thyroid procedures

A

sux or short acting

42
Q

gold standard for thyroid procedures?

A

Intra-op nerve monitoring
ETT with 4 embedded electrodes Red = R, Blue = L (“NIM” tube)

43
Q

thyroid storm signs?

A

Increasing core temp and/or hyperdynamics

44
Q

caution in thyroid procedure?

A

Hypocalcemia 24-96 hrs post-op d/t damaged parathyroid glands (Numb/tingling -laryngospasm- seizures-dysrhythmia-CV arrest

45
Q

huge anesthesia implication thyroid surgery?

A

post op hematoma!! ER a/w obstruction

46
Q

anesthesia implications cleft lip/palat

A

difficult mask/intubate
fluid moving around a/w and obstructing
elbow restraints

47
Q

damage to horizontal, nose/palate, septum, and posterior pterygoids

A

Le fort fracture I

48
Q

triangular nose, orbit, below zygoma, lateral maxilla and pterygois

A

le fort frature II

49
Q

complete separation of midface from the cranial base across nose, ethmoid, orbit, sphenopalantine fossa

A

le fort III

50
Q

When can you not use nasal ETT w/o fiberoptic guidance for le fort fracture

A

if basilar skull fracture suspected (csf/blood/raccoon)

51
Q

anesthesia implications facial fractures

A

full stomachs
nasal ETT
extubate awake
PONV

52
Q

important post op facial fractures?

A

wire cutters at bedside

53
Q

history of radiation leads to

A

difficult a/w related to tissue changes, TMJ, etc.

54
Q

head up position and open neck veins could result in

A

VAE

55
Q

Most common & effective for profound analgesia/akinesia of eye and lids

A

ocular LA (retrobulbar or peribulbar)

56
Q

what cranial nerves have to be blocked ophthalmic surgery?

A

III, IV, V, VI, VII

57
Q

For full stomach, open-eye pt, s this an easy airway and eye viable?

A

If yes, use rocuronium.

58
Q

For full stomach, open-eye pt, s the eye viable?

A

If yes, but airway could be difficult, use Sux because a/w trumps eyeball

59
Q

oculocardiac reflex afferent and efferent?

A

afferent trigeminal (V), efferent vagal (x)

60
Q

OCULOCARDIAC REFLEX

A

Sudden, profound bradycardia
(can cause other dysrhythmias)

61
Q

OCULOCARDIAC REFLEX txt

A

Stop the stimulus
-If unresolved, atropine or glycopyrrolate
- “Fatigues” with continued manipulation

62
Q

Max sub-cu lidocaine

A

35 mg/kg

63
Q

max sub cu epi

A

70 mcg/kg

64
Q

major cause of mortality in liposuction

A

VTE

65
Q

highest incidence of death from VTE?

A

abdominoplasty, especially combo lipo

66
Q

ways to decrease risk of fires?

A

Minimize FiO2, avoid flammable
preps, avoid O2 accumulation under drapes, communicate with surgeon (cautery)

Principles 3 (3 decks)

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