ENT - Midterm Wrap Up Flashcards
What is a major side effect from Inner Ear surgery?
PONV
What kind of Anesthesia is used for Bilateral Myringotomy & Tubes (BMT)
General w/ LMA
or
Mask
(Flexible LMA better for Head Flexion & Rotation)
What are the advantages of using N2O for BMTs?
↑Middle Ear Pressure that relieves via Reabsortion or Eustachian Vent
What is a disadvantage of N2O for ear surgery?
Graft Displacement from Negative Pressure Reabsorption
What are the Facial Nerve Monitoring considerations for Ear Surgery?
Nerve Integration Monitor (NOT NIM Tube)
May need to Reverse Paralytics
Use RemiFentanyl Instead of NMBs
Which Nerve is monitored for the Middle Ear, Medial Tampanic, and Mastoid Air Cells?
CN IX - Glossopharyngeal
Which Nerve is monitored for the Lateral Tympanic, External Acoustic Meatus, and Concha?
CN X - Vagus Nerve
CN V - Auriculotemporal Nerve
CN VII - Nervus Intermedius
Which Nerve is monitored for the Temporal Scalp, Pre-Auricular Tragus, TMJ?
CN V - Auriculotemporal Nerve
Which Nerve is monitored for the Posterolateral Scalp, Supra-auricular Scalp, and Superior Pinna?
C2 & C3 - Lesser Occipital Nerve
What Nerve is monitored for the Angle of Jaw, Pinna, Lateral Neck, Parotid Skin, and Mastoi Process?
C2 & C3 - Great Auricular Nerve
What are ways to keep the surgical field from being bloody for Ear Surgery?
Head Up to reduce Venous Pressure
&
Deliberate HYPOtension
What can be used for Dilberate HYPOtension for Ear Surgery?
Beta Blockers
Clonidine
Opioids (Remi Drip)
Keep MAP 50-60 & HR
Intra-Op SBP > Pre-Op DBP
HR 60
What can be used for PONV Prophylaxis?
Serotonin Antagonists
Butyrophenones
Scopolamine
Decadron
Reglan
What is Maxillary Antrostomy?
Procedure to clear Sinus Opening
What is a Uncinectomy?
Procedure to clear Osteomeatal Complex
What is a Caldwell-Luc procedure for?
Fenestration of Anterior Maxillary Sinus & Drainage into nose
What can happen if a patient moves during Nasal Surgery?
Blindness
Carotid Damage
Intracranial Damage
What should be assessed in a patient for Nasal Surgery?
OSA
NSAID Use
CV Status for Pressor Usage
What is Samter’s Triad?
Asthma, Sinus Disease, and Nasal Polyps r/t ASA & NSAIDs
What are common Nasal Vasoconstrictor meds?
Phenylephrine
Cocaine
Epi
Lido w/ Epi
How does a little Cocaine compare with a lot of Cocaine?
Small Dose: Vagotonic & ↓HR
Big Dose: Tachycardia, V-TACH/Fib, MI
How should patients be extubated for Nasal surgery?
Awake after thorough suctioning
Why should the oral passage be assesed for blood clots after nasal surgery?
Clot can be inhaled and lead to total airway obstruction & death
What structures are a part of Waldeyer’s Ring?
Palatine Tonsils
Nasopharyngreal Tonsil (Adenoid)
Lingual Tonsil
Adult Tonsillectomy is _______ painful than kids
Adult Tonsillectomy is MORE painful than kids
How soon can Pulmonary Edema develop after Airway Obstruction relief?
Minutes to Hours after relief
Why is Decadron used for Nasal Surgery?
Less PONV
Better Diet Tolerance
Reduced Pain
Post-Op bleeding tonsils ________ with age with a ______ occurence in Adults & Males
Post-Op bleeding tonsils INCREASES with age with a HIGHER occurence in Adults & Males
How soon can Bleeds occur after Tonsil Procedures?
Within 6 Hrs
or
7-8 Days Post-Op after scab falls off
What are indications of Post-Op Tonsillar Bleed?
Unexplained Tachycardia
Excessive Swallowing
Pallor
Restlessness
Sweating
↑Cap Refill
What is a Late sign of a Tonsillar Bleed?
HYPOtension
What equipment should be available for Bleeding Tonsils?
Experienced Help
Extra Airway Supplies
Two Suctions
RSI w/ Head Down
Lateral Mask Induction
What are Vocal Cord Papillomas?
Benign, but can be Malignant lumps that cause hoarseness & resp obstruction
What is Reinke’s Edema?
Sac-Like, Fluid-Filled swelling of Vocal Cords
How closed is the airway if Stridor is present?
< 4-5 mm
Which Goggles should be worn for YAG Lasers?
Green Goggles
Which goggles should be worn for Argon Lasers?
Amber Goggles
Which goggles should be worn for CO2?
Clear Goggles
How should an Airway Fire be managed?
D/C Circuit
Extubate & Put ETT in Water
Ventilate w/ Mask or New Circuit
Maintain Anesthesia w/ IV
Extensive Pulmonary Care
When should Non-Intubation techniques be AVOIDED?
Obese Patients
Emphysema
Large Tumors
What are the risks associated w/ Supraglottic Ventilation?
Poor Ventilation
Debris Blown into Trachea
Pneumomediastinum
PTX
SQ Emphysema
Vocal Cord Movement
Can’t Monitor End Tidal
How does Subglottic Jet Ventilation compare to Supraglottic?
Minimal Vocal Cord Movement
More Barotrauma Risk
Reduced Driving Pressures
What is the respiratory rate for High Frequency Positive Pressure Ventilation?
60 - 120 bpm
What is the respiratory rate for High Frequency Jet Ventilation?
100 - 400 bpm w/ volumes < dead space
For Rigid Bronchscopy Ventilation, how should adequacy of ventilation be assesed?
Chest Rise since EtCO2 will not return via circuit and might be inaccurate
During Rigid Bronchoscopy, how long should Apneic Oxygenation be limited to?
2 min, the remove scope and ventilate patient
or
anytime PaO2 drops
How fast does PCO2 accumulate per minute during apnea?
3-4 torr/minute
What are the complications of Bronchoscopy?
Bronchospasm
Hypoxemia
CO2 Retention
Resistance to Ventilation
PTX, Pnuemomediastinum, SQ Emphysema
Awareness
Organic Foreign Bodies are ______ than Inorganic when inhaled
Organic Foreign Bodies are WORSE than Inorganic when inhaled since they can soften & expand
How is Urgent Foreign Body removal managed?
Give Robinul / Atropine
No Pre-Op Sedation
No N2O
Awake Laryngoscopy
How should LESS Urgent Foregn Body removal be managed?
IV/Mask Induction
Maintain spont. respiration until FB is seen
Lateral Position if Organic
