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6901 > ENT, Laser, and Jet Ventilation > Flashcards

ENT, Laser, and Jet Ventilation Flashcards

1
Q

Turbinates divide nasal cavity in to how many different compartments?

A

3

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2
Q

What are the three compartments of the nasal cavity divided by the turbinates?

A

superior, middle, and inferior

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3
Q

What about the nasal turbinates has implications for CRNAs?

A

they’re highly vascular

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4
Q

What are the four paired sinuses of the nasal cavity?

A

frontal, ethmoidal, maxillary, and sphenoid

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5
Q

Function of the frontal, ethmoidal, maxillary, and sphenoid sinuses?

A

serve as resonators of the voice

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6
Q

Sinus that is superior to the eyes and front gona, which forms the hard part of the forehead?

A

frontal

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7
Q

Nasal sinus that is between the nose and eyes?

A

ethmoidal

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8
Q

Nasal sinus that is in the center of the skull base under the pituitary?

A

sphenoid

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9
Q

Nasal sinus that is under the eyes?

A

maxillary

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10
Q

Part of nose that is especially susceptible to facial trauma?

A

4 paired sinuses

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11
Q

4 parts of upper airway?

A

nose, mouth, pharynx, and larynx

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12
Q

Separates oropharynx by imaginary plane that extends posteriorly?

A

nasopharynx

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13
Q

Separates the oropharynx from the laryngopharynx?

A

epiglottis

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14
Q

Another name of the laryngopharynx?

A

hypopharynx

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15
Q

3 parts of the pharynx?

A

nasopharynx, oropharynx, and hypopharynx/laryngopharynx

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16
Q

4 functions of pharynx?

A

passage for air, food, voice modulator, and equalizes pressures that are built near ear drums

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17
Q

What is the structure of the pharynx like?

A

soft, it easily collapses

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18
Q

Sensory and motor (4) nerve supply to the airway?

A

trigeminal, facial, glossopharyngeal, and vagus

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19
Q

Cranial nerve which is divided in to 3 parts?

A

trigeminal nerve

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20
Q

Cranial nerve IX?

A

glossopharyngeal

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21
Q

Which branch of the vagus nerve divides in to internal and external?

A

superior laryngeal nerve

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22
Q

Unilateral damage to this branch of the vagus nerve causes ipsilateral vocal cord to remain midline during inspiration, resulting in hoarseness?

A

RLN

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23
Q

Bilateral injury to this branch of CNX causes dysfunction of both vocal cords and respiratory distress/emergency?

A

RLN

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24
Q

Very vascular organ, which can cause serious bleeding issues with tonsillectomies?

A

palatine tonsils

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25
Q

3 arteries which are in palatine tonsils?

A

external carotid, maxillary, and facial arteries

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26
Q

Function of palatine tonsils?

A

part of lymphatic system

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27
Q

If these are enlarged, which often happens in children, they can pose serious airway problems? Why would they be enlarged?

A

palatine tonsils; infection

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28
Q

This structure isolates the esophagus from trachea when swallowing?

A

epiglottis

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29
Q

Which nerves (3) mediate reflexes of the epiglottis?

A

SLN, RLN, glossopharyngeal

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30
Q

Epiglottis part of which upper airway structure?

A

laryngopharynx

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31
Q

3 benefits of cuffed tube in children?

A

decreases fire risk, decreases waste anesthetic gasses contaminating air, decreases aspiration risk

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32
Q

In children size down how much in comparison to noncuffed tube?

A

1/2 size

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33
Q

How much air leak do you want around the cuff when the cuff is down in a child?

A

20-25 mm

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34
Q

This structure forms the connection of the oropharynx to the trachea?

A

larynx

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35
Q

This structure functions as protection from foreign bodies, builds up subglottic air pressure to produce cough, give birth or excrete waste, swallows, and monitors and controls air in and out of lungs to control for phonation, and allows airflow

A

larynx

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36
Q

Narrowest part of larynx in children

A

cricoid

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37
Q

Narrowest part of larynx in children >8?

A

vocal cords

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38
Q

Landmark for larynx in children

A

C3-C5 (anterior and cephalad)

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39
Q

Landmark for larynx in adults?

A

C4-C6

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40
Q

Shape of larynx in children

A

funnel

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41
Q

Shape of larynx in those >8?

A

cylinder

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42
Q

Shape of epiglottis in those

A

long/narrow/floppy

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43
Q

Shape of epiglottis in those >8?

A

short/wide

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44
Q

Direction of vocal cords in those

A

angled

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45
Q

Direction of vocal cords in those >8?

A

perpendicular

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46
Q

Strength of cartilage in children

A

soft and pliable

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47
Q

Strength of cartilage in children >8?

A

rigid

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48
Q

What is the significance of the soft and pliable cartilage in children

A

it easily undergoes edematous change with trauma and inflammation which can lead to obstruction

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49
Q

Bone that makes up larynx?

A

hyoid

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50
Q

3 paired cartilages of larynx?

A

arytenoid, cuneiform, corniculate

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51
Q

3 unpaired cartilages of larynx?

A

thyroid, epiglottis, and cricoid

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52
Q

Provides structural support for larynx?

A

hyoid bone

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53
Q

How many cartilages make up the larynx?

A

9

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54
Q

Small, U shaped bone that joins larynx and tongue?

A

hyoid bone

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55
Q

Cartilages that shield and protect vocal cords?

A

thyroid, paired (arytenoid, cuneiform, corniculate)

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56
Q

Largest cartilage in larynx?

A

thyroid

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57
Q

This branch of the vagus nerve provides sensory innervation of the laryngeal mucosa above the vocal cords (inferior epiglottis)

A

internal laryngeal

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58
Q

This branch of the vagus nerve provides motor nerve innervation for all intrinsic muscles except the cricothyroid?

A

recurrent laryngeal

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59
Q

This branch of the vagus nerve provides motor nerve innervation for the cricothyroid muscles?

A

external laryngeal

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60
Q

This branch of the vagus nerve provides sensory innervation for the laryngeal mucosa below the vocal cords?

A

recurrent

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61
Q

Branch of the vagus nerve that is responsible for laryngospasm/glottic closure?

A

internal branch of SLN

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62
Q

Branch of the vagus nerve that innervates cricothyroids, which adduct and tense the true vocal cords?

A

external branch of SLN

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63
Q

This branch of the vagus nerve is responsible for laryngospasm?

A

external branch of SLN

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64
Q

What shape are the cartilages of the trachea?

A

U-shape

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65
Q

What spinal level is the cricoid?

A

C-6

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66
Q

The first complete tracheal ring is?

A

cricoid

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67
Q

What spinal level is the carina?

A

T-5

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68
Q

Distance from carina to incisors?

A

26 cm

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69
Q

Restricted use of what 2 things for ENT procedures?

A

muscle relaxants and N2O

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70
Q

Evidence of upper airway obstruction is early or late sign?

A

late

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71
Q

You should avoid use of N2O for what 3 procedures?

A

ear, laser, foreign body

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72
Q

Do you need to decrease FiO2 flows for ENT?

A

yes to

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73
Q

What do you need to do with O2 flows for bronchs or obstruction?

A

increase them bc losing O2 thru bronch

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74
Q

4 signs of air leak/ETT cuff issue?

A

decreased SaO2, increased PIP, decreased ETCO2, vent bellows not rising

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75
Q

What consideration about the size of an ETT may be used for ENT surgeries?

A

smaller ETT

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76
Q

Where is the head of the table for ENT procedures?

A

turned 90-180 degrees

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77
Q

What should you do to the circuit for 180 degree turns?

A

get long one

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78
Q

3 things NIM-EMG monitoring measures?

A

facial nerve function, RLN function, vocal cord ftn

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79
Q

What can you do to the HOB to minimize blood loss?

A

slight head up

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80
Q

2 parameters to go by for deliberate hypotension?

A

keep MAP> 60, decrease starting BP by 20%

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81
Q

What is done for vascular tumor surgeries that are projected to be long and why?

A

deliberate hypotension to minimize blood loss

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82
Q

Type of ETT for tonsil and adenoidectomy? Where do you tape it?

A

right angled ETT (RAE)/90 degrees right angle tube. tape in middle of mouth

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83
Q

What type of tube should be used for procedures where neck flexion is needed? And what are examples of those types of surgeries?

A

armored tube imbedded with coiled wire; base of skull or posterior aspect of neck

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84
Q

What type of tubes do you use for laser surgery?

A

metal impregnated and fille cuff with dye or saline

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85
Q

Type of airway used in spontaneously breathing pt?

A

LMA

86
Q

Type of airway used for surgeries involving pharyngeal pathology?

A

LMA

87
Q

Type of airway used when need to visualize vocal cords and their function?

A

LMA

88
Q

Why is there a high incidence of N/V for ENT surgeries and what do you do to prevent it?

A

swallow some blood, suction stomach with NGT/OGT

89
Q

Is it recommended for ENT surgeries to be generous with IVFs to prevent N/V?

A

yes

90
Q

Why is glycopyrrolate recommended over atropine for ENT surgeries to prevent secretions?

A

increases hr slightly less and doesn’t cross BBB to get sedative effects

91
Q

What type of med can be given intraop to decrease laryngeal edema, reduce pain, decrease N/V, and prolong analgesic effects of local anesthetics?

A

corticosteroids

92
Q

Systematic reviews have reported that what drug and only this drug increases postop bleeding?

A

ASA

93
Q

2 drugs to consider giving to decrease requirement of opioids for ENT?

A

ketamine, acetaminophen

94
Q

Max dose of lido and lido with epi?

A

4mg/kg plain; 7mg/kg with epi; (250-300 mg)

95
Q

Most common classification of local anesthetics?

A

amides

96
Q

Total dose of epi that can be given with LA?

A

200 mg/ 1.5 mcg/kg

97
Q

How does cocaine work to decrease bleeding?

A

vasoconstriction, blocks reuptake of epi and norepi

98
Q

What type of onset does lido have?

A

rapid

99
Q

What type of duration does benzocaine have and what side effect?

A

short; methemoglobinemia

100
Q

Some specifics about myringotomy and tube placement surgery?

A

mask induction, no IV, have anectine (suxxs) and atropine (IM) ready, children with RTIs prone to laryngospasm, short procedure

101
Q

Pathophysiology as a result of long standing tonsil and adenoid issues that lead to nasal and pharyngeal upper airway obstruction?

A

long standing hypoexmia and hypercarbia–> increased airway resistance –> pulmonary arteriolar venule constriction–> pulmonary artery HTN–> right sided heart failure –> cor pulmonale

102
Q

Indications for this surgery are recurrent acute tonsillitis, peritonsillar abscess, tonsillar hyperplasia, and OSA?

A

tonsillectomy and adenoidectomy/uvuloplasty

103
Q

Evaluate size of what to determine ease of mask ventilation and tracheal intubation?

A

tonsillar size

104
Q

This increases the risk of post op bleeding and laryngospasm?

A

URI

105
Q

2 types of airways used for T&A/uvuloplasty?

A

cuffed RAE, reinforced LMA

106
Q

Throat pack placed for which surgery?

A

T&A

107
Q

Tonsil position is?

A

placed on side post op for drainage of residual oozing

108
Q

Some considerations for T&A/uvuloplasty?

A

position-shoulder roll, head extended, table turned 90-180 degrees, throat pack and mouth gag, quick and smooth emergence, general vs inhalation induction

109
Q

Should you do controlled or spontaneous ventilation for a T&A?

A

depends, can do either

110
Q

Advantages and disadvantages for controlled vent during T&A, uvuloplasty?

A

guarantee immobility during surgery, need to reverse MR-N/V, residual muscle blocakde, unable to gauge titration of post op analgesia

111
Q

Advantages and disadvantages of spontaneous breathing during T&A/uvuloplasty?

A

use RR and ETCO2 to titrate opioid to achieve smoother emergence, theoretically faster emergence because no need to wait for return of spontaneous respirations; may require deeper level of anesthesia to prevent movement, may not be option if paralysis was necessary on induction

112
Q

Treatment for laryngospasm?

A

positive pressure (decrease pop off valve, increase positive pressure and hold), Larsen maneuver, IV Lido, Suxxs if sats dropping

113
Q

Complications of T&A/uvuloplasty?

A

laryngospasm, bleeding tonsil

114
Q

Most common pediatric emergency?

A

bleeding tonsil

115
Q

S/S bleeding tonsil?

A

decrease BP, increased RR, pallor, increased HR

116
Q

What should you do with induction drugs if bleeding tonsil?

A

decrease dose

117
Q

How should bleeding tonsil pt be extubated?

A

fully awake

118
Q

Airway for cleft palate repair?

A

oral RAE

119
Q

What is used to hold ETT and mouth open for cleft palate/lip repair?

A

mouth gag

120
Q

If need a non advanced airway on cleft palate repair, what do you use?

A

nasal airway

121
Q

Why is a laryngospasm common post op for cleft palate repair?

A

copious secretions

122
Q

Age group for acute epiglottitis?

A

2-7

123
Q

What causes epiglottitis?

A

Haemophilus influenza type B

124
Q

S/s epiglottitis?

A

drooling, sitting position with head extended and leaning forward, sudden onset fever, dysphagia, drooling, thick muffled voice, retractions, labored breathing, cyanosis

125
Q

Epiglottitis can quickly progress to what?

A

upper airway obstruction

126
Q

What type of induction for epiglottitis?

A

inhalation induction while sitting up

127
Q

Avoid what 2 things for induction of epiglottitis?

A

DL, N20

128
Q

How should one do epiglottitis induction?

A

inhalation induction sitting up, keep spontaneous vent on 100% FiO2, insert IV, insert ETT smaller by 1 size

129
Q

Why are increased allergies in sinus and nasal surgery important?

A

can lead to possible reactive airways

130
Q

Why are those with sinus and nasal surgery prone to OSA?

A

redundant tissue

131
Q

What type of ETT do you use for general surgery in sinus and nasal surgery?

A

oral RAE

132
Q

Where do you tape oral RAE for sinus and nasal surgery?

A

opposite side of surgical site

133
Q

Why is local anesthesia used for sinus and nasal surgery?

A

increased bleeding/highly vascular area

134
Q

Why would you use TIVA for endo procedures?

A

gas won’t get to them if not ventilating

135
Q

4 complications of endoscopy procedures?

A

eye trauma, epistaxis, laryngospasm, bronchospasm

136
Q

Anesthetic considerations for endoscopy procedures?

A

TIVA, MR, smaller ETT, minimize secretions, relaxed mandible, protect the teeth

137
Q

Signs of this are coughing, tachycardia, aphonia, cyanosis, wheezing?

A

foreign body aspiration

138
Q

How do you retrieve a foreign body at the level of larynx?

A

DLV and use Magill forceps

139
Q

How do you retrieve a foreign body that is distal to the larynx or trachea?

A

rigid bronch

140
Q

Preferred induction technique for foreign body aspiration retrieval?

A

gentle mask induction without cricoid or positive pressure and pt sitting up, keep spontaneously breathing

141
Q

Some helpful meds to give with foreign body aspiration induction?

A

antisisalagogue, H2 blocker, metoclopramide

142
Q

What can you do to compensate for leak with foreign body aspiration?

A

increase FGF, large TV, 100% FiO2

143
Q

What should you prevent the pt from doing during bronch for a foreign body aspiration?

A

bucking, coughing

144
Q

Anesthesia best to use for foreign body aspiration?

A

TIVA

145
Q

What can extreme neck extension cause?

A

bradycardia

146
Q

What 3 meds can help with foreign body aspiration?

A

steroid, inhaled racemic epi, bronchidilators

147
Q

Edema can persist for how many hours post removal of object from airway?

A

24 hours

148
Q

To check for airway edema, you should listen to air movement around ETT for how many breaths during inspiration and expiration?

A

2

149
Q

Nerve isolation can be accomplished with what 2 things for procedures of the face and ear?

A

brainstem auditory evoked potentials and EMG monitoring

150
Q

What does radiation to the neck do to the tissues?

A

makes them soft and less mobile so more difficult intubation

151
Q

Usual size Shiley for male and female?

A

8 and 6

152
Q

Why do you have to watch the fluid intake for radical neck procedures?

A

can cause congestion and edema to flap which would cause vascular compromise

153
Q

What’s another complication you have to be on the look out for during radical neck procedures and why?

A

venous embolism bc HOB up and sometimes neck veins exposed

154
Q

Something you can do to decrease the risk of venous air embolism in radical neck patient?

A

positive pressure ventilation

155
Q

Which nerve is commonly damaged in radical neck procedure?

A

RLN

156
Q

What cardiac issue can be caused by radical neck dissection?

A

QT prolongation

157
Q

What’s a potential complication with low neck dissection?

A

pneumothorax

158
Q

Stimulation of this during radical neck dissection can elicit the vagal response?

A

carotid sinus

159
Q

What may cause high anesthesia circuit pressure in radical neck surgery?

A

if surgeon retracting the trachea too much

160
Q

3 signs that NGT insertion could go in to brain?

A

CSF in nose, blood behind the tympanic membrane, and periorbital edema/racoon eyes

161
Q

Le Fort fracture that is triangular and runs thru bridge of nose thru medial and inferior wall of orbit?

A

Le Fort II

162
Q

What should you avoid with ventilation when have Le Fort II or III fracture?

A

+ pressure ventilation

163
Q

Le Fort fracture that is a horizontal fracture of the maxilla extending from the floor of the nose to the hard palate thru nasal septum?

A

I

164
Q

Le Fort fracture where have total separation of the mid facial skeleton from cranial face transverse root of nose, F1 bone, and in to eye orbits?

A

III

165
Q

Patients with facial trauma should be thought to have what until proven otherwise?

A

cervical injury

166
Q

Intermaxillary fixation has what implications for CRNA?

A

always have wire cutters!!

167
Q

Do you need an ETT for jet ventilation?

A

no

168
Q

4 types of patients where jet ventilation should be avoided?

A

full stomach, hiatal hernia, trauma, pregnancy

169
Q

An ENT surgery jet vent might be used for because it allows direct view of larynx, immobility of cords, and complete control of airway?

A

diagnostic laryngoscopy

170
Q

How could you use jet ventilation in emergency situation?

A

placement of needle thru cricothyroid membrane

171
Q

Type of HFJV where jet pipe is situated above the vocal cords and usually connected to the surgeon’s laryngoscope?

A

supraglottic, endopharyngeal

172
Q

Type of HFJV where oxygen jet is blown in to trachea distally to vocal cords or stenotic area?

A

infraglottic, intratracheal

173
Q

What kind of device blows oxygen for HFJV infraglottic/intratracheal?

A

rigid bronchoscope

174
Q

What can help facilitate exhalation with HFJV?

A

OA or NA

175
Q

What type of exhalation is HFJV?

A

passive

176
Q

During HFJV, O2 is delivered under pressure thru a what gauge catheter attached to O2 source?

A

14-16

177
Q

What type of flow is HFJV?

A

intermittent

178
Q

The index safety system for HFJV?

A

DISS

179
Q

An obstruction to passive exhalation?

A

excessively large TV

180
Q

> __ PSI can cause barotrauma in HFJV?

A

50

181
Q

What type of TV and RR are used with HFJV?

A

low TV, high RR

182
Q

Inspiration of HFJV is up to __ PSI?

A

60

183
Q

HFJV is on for __ sec and off for __ sec?

A

1;2

184
Q

3 things that can happen if jet stream is not accurately aimed in HFJV?

A

barotrauma, SQ emphysema, gastric distension

185
Q

Patients with decreased lung compliance-obese, COPD, bronchospasm are at risk for what during HFJV?

A

hypoventilation

186
Q

What type of anesthesia must be used for HFJV?

A

TIVA

187
Q

What do you ask the surgeon about at the end of HFJV procedure?

A

vocal cord movement

188
Q

Laser stands for?

A

light amplification by stimulated emission of radiation

189
Q

2 qualities of laser light?

A

moves in one direction and is one wavelength

190
Q

3 functions of lasers?

A

cut, coagulate, vaporize

191
Q

The 3 components of a laser?

A

laser medium, laser/optical cavity, pump source

192
Q

Component of laser which enhances the efficacy of the laser by providing feedback (mirrors)

A

optical cavity

193
Q

Component of laser which contains the atoms used to create the laser light (solid, liquid, or GAS)?

A

laser medium

194
Q

Component of laser which provides the external energy source that raises the energy of the atoms enough to produce laser light?

A

pump source

195
Q

Component of the laser that determines wavelength?

A

laser medium

196
Q

The amplifying medium of a laser is usually?

A

gas

197
Q

Wavelength or color of laser depends on what?

A

laser medium (gas)

198
Q

The effect the laser has on tissue depends on?

A

wavelength

199
Q

Type of laser which is visible blue green light and main effect is photocoagulation?

A

argon-gas

200
Q

Type of laser which is green light and used to cut tissue and remove vascular lesions?

A

KTP-gas

201
Q

Most widely used laser?

A

CO2

202
Q

This laser produces infrared light undetected by the human eye?

A

CO2

203
Q

What type of wavelength is produced by CO2 laser and what does that mean for surrounding tissues?

A

long; absorbed almost entirely by the surface of the tissue

204
Q

Benefit and disadvantage of CO2 laser?

A

very precise; can cause corneal injury

205
Q

Laser mostly used in otolaryngology surgery?

A

CO2

206
Q

Type of laser that is shorter wavelength?

A

Nd-YAG

207
Q

Nd-YAG used commonly in which 2 type of procedures?

A

ENT, opthalmology

208
Q

Shorter wavelength with Nd-YAG allows for what type of penetration?

A

deeper

209
Q

What do you have to be careful about with the Nd-YAG laser?

A

it can burn the retina

210
Q

Lasers which produce the most and least smoke?

A

CO2; Nd-YAG

211
Q

2 ways to eliminate atmospheric contamination of toxic fumes?

A

smoke evacuator and special masks

212
Q

Color glasses for CO2, Nd: YAG, and argon, KTP lasers?

A

clear for CO2; green for Nd: YAG; argon and KTP are amber orange

6901 (18 decks)

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