ENT/FACE/Plastics

Question 1

RAE tube facing?

Answer 1

oral and nasal, oral down, nasal up towards head

Question 2

Anode tube? armored, reinforced

Answer 2

Flexible, resists kinking, but
can be occluded with biting

Question 3

Laser tubes

Answer 3

Metal
impregnated,
reduces risk of
fire

Question 4

Anticholinergics used for

Answer 4

decrease secretions

Question 5

Steroids used to

Answer 5

reduce edema, PONV &
prolong local anesthetic effects

Question 6

ENT cases are high risk for what complication?

Answer 6

High risk for PONV, especially middle
ear procedures

Question 7

Deliberate Hypotension goal

Answer 7

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

Question 8

blood pressure for deliberate hypotension?

Answer 8

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

Question 9

typical cases for deliberate hypotension?

Answer 9

extensive dissections and FESS*
cases

Question 10

why are lazers popular?

Answer 10

Precise excision, minimal edema,
less blood loss

Question 11

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

Answer 11

lasers! big deal!

Question 12

safety concerns for laser cases?

Answer 12

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

Question 13

can you do deep extubation with ENT cases?

Answer 13

NO not if they are bleeding, need to protect airway

Question 14

complications of endoscopy procedures?

Answer 14

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

Question 15

how can you relax vocal cord during bronchs?

Answer 15

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

Question 16

HFJV complications

Answer 16

saO2 and CO2 levels
air trapping = subcu emphysema/pneumo

Question 17

how does HFJV work?

Answer 17

pushing in lowest O2 possible without ETT at fast intermittent rates

Question 18

HFJV contraindication?

Answer 18

full stomach (relatively)

Question 19

how to anesthetize pt HFJV?

Answer 19

TIVA, dont want to blow volatiles in room

Question 20

type of foreign body most problematic?

Answer 20

tracheal, can move to total obstruction

Question 21

gold standard foreign body?

Answer 21

rigid bronch with GA

Question 22

symptoms foreign body?

Answer 22

Wheezing, coughing, aphonia, cyanosis

Question 23

complications rigid bronch?

Answer 23

Severe laryngeal edema, pneumothorax, pneumomediastinum, hypoxic brain injury

Question 24

best way to deal with foreign body cases?

Answer 24

inhalation induction with spontaneous ventilation best

Question 25

what to avoid with foreign body?

Answer 25

Positive pressure!

Question 26

most common nerve problem

Answer 26

unilateral facial paresis

Question 27

nerve preservation methods

Answer 27

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

Question 28

Nerve stimulators common in middle ear procedures meaning:

Answer 28

no muscle relaxers after intubation

Question 29

N2O implications with middle ear procedures?

Answer 29

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

Question 30

Myringotomy (tubes) implications

Answer 30

no IV N2O ok nasal fent and dext used

Question 31

Most common pediatric surgery

Answer 31

Tonsillectomy & Adenoidectomy

Question 32

implications of NSAIDS with T&A?

Answer 32

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

Question 33

anesthesia implications for T&A

Answer 33

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

Question 34

Bleeding Tonsil can present

Answer 34

hypovolemic, tachycardic, hypotensive give crystalloid bolus pre-op

Question 35

all bleeding tonsils are

Answer 35

full stomachs

Question 36

induction for bleeding tonsils?

Answer 36

rapid sequence induction

Question 37

anesthesia implications bleeding tonsils?

Answer 37

rapid sequence Suction stomach before emergence Extubate FULLY awake!!

Question 38

thyroid procedure implications

Answer 38

myesthenia gravis meds taken am steroid stress dose

Question 39

Inadvertent resection symtpoms

Answer 39

unilateral or bilateral VC paralysis = airway emergency after extubation

Question 40

motor innervation to vocal cords?

Answer 40

recurrent laryngeal and external branch of superior laryngeal

Question 41

type of MR used for thyroid procedures

Answer 41

sux or short acting

Question 42

gold standard for thyroid procedures?

Answer 42

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

Question 43

thyroid storm signs?

Answer 43

Increasing core temp and/or hyperdynamics

Question 44

caution in thyroid procedure?

Answer 44

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

Question 45

huge anesthesia implication thyroid surgery?

Answer 45

post op hematoma!! ER a/w obstruction

Question 46

anesthesia implications cleft lip/palat

Answer 46

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

Question 47

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

Answer 47

Le fort fracture I

Question 48

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

Answer 48

le fort frature II

Question 49

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

Answer 49

le fort III

Question 50

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

Answer 50

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

Question 51

anesthesia implications facial fractures

Answer 51

full stomachs nasal ETT extubate awake PONV

Question 52

important post op facial fractures?

Answer 52

wire cutters at bedside

Question 53

history of radiation leads to

Answer 53

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

Question 54

head up position and open neck veins could result in

Answer 54

VAE

Question 55

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

Answer 55

ocular LA (retrobulbar or peribulbar)

Question 56

what cranial nerves have to be blocked ophthalmic surgery?

Answer 56

III, IV, V, VI, VII

Question 57

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

Answer 57

If yes, use rocuronium.

Question 58

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

Answer 58

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

Question 59

oculocardiac reflex afferent and efferent?

Answer 59

afferent trigeminal (V), efferent vagal (x)

Question 60

OCULOCARDIAC REFLEX

Answer 60

Sudden, profound bradycardia (can cause other dysrhythmias)

Question 61

OCULOCARDIAC REFLEX txt

Answer 61

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

Question 62

Max sub-cu lidocaine

Answer 62

35 mg/kg

Question 63

max sub cu epi

Answer 63

70 mcg/kg

Question 64

major cause of mortality in liposuction

Answer 64

VTE

Question 65

highest incidence of death from VTE?

Answer 65

abdominoplasty, especially combo lipo

Question 66

ways to decrease risk of fires?

Answer 66

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