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Advanced Anesthesia 2 > ENT - Midterm Wrap Up > Flashcards

ENT - Midterm Wrap Up Flashcards

1
Q

What is a major side effect from Inner Ear surgery?

A

PONV

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2
Q

What kind of Anesthesia is used for Bilateral Myringotomy & Tubes (BMT)

A

General w/ LMA

or

Mask

(Flexible LMA better for Head Flexion & Rotation)

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3
Q

What are the advantages of using N2O for BMTs?

A

↑Middle Ear Pressure that relieves via Reabsortion or Eustachian Vent

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4
Q

What is a disadvantage of N2O for ear surgery?

A

Graft Displacement from Negative Pressure Reabsorption

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5
Q

What are the Facial Nerve Monitoring considerations for Ear Surgery?

A

Nerve Integration Monitor (NOT NIM Tube)

May need to Reverse Paralytics

Use RemiFentanyl Instead of NMBs

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6
Q

Which Nerve is monitored for the Middle Ear, Medial Tampanic, and Mastoid Air Cells?

A

CN IX - Glossopharyngeal

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7
Q

Which Nerve is monitored for the Lateral Tympanic, External Acoustic Meatus, and Concha?

A

CN X - Vagus Nerve

CN V - Auriculotemporal Nerve

CN VII - Nervus Intermedius

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8
Q

Which Nerve is monitored for the Temporal Scalp, Pre-Auricular Tragus, TMJ?

A

CN V - Auriculotemporal Nerve

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9
Q

Which Nerve is monitored for the Posterolateral Scalp, Supra-auricular Scalp, and Superior Pinna?

A

C2 & C3 - Lesser Occipital Nerve

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10
Q

What Nerve is monitored for the Angle of Jaw, Pinna, Lateral Neck, Parotid Skin, and Mastoi Process?

A

C2 & C3 - Great Auricular Nerve

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11
Q

What are ways to keep the surgical field from being bloody for Ear Surgery?

A

Head Up to reduce Venous Pressure

&

Deliberate HYPOtension

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12
Q

What can be used for Dilberate HYPOtension for Ear Surgery?

A

Beta Blockers

Clonidine

Opioids (Remi Drip)

Keep MAP 50-60 & HR

Intra-Op SBP > Pre-Op DBP

HR 60

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13
Q

What can be used for PONV Prophylaxis?

A

Serotonin Antagonists

Butyrophenones

Scopolamine

Decadron

Reglan

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14
Q

What is Maxillary Antrostomy?

A

Procedure to clear Sinus Opening

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15
Q

What is a Uncinectomy?

A

Procedure to clear Osteomeatal Complex

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16
Q

What is a Caldwell-Luc procedure for?

A

Fenestration of Anterior Maxillary Sinus & Drainage into nose

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17
Q

What can happen if a patient moves during Nasal Surgery?

A

Blindness

Carotid Damage

Intracranial Damage

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18
Q

What should be assessed in a patient for Nasal Surgery?

A

OSA

NSAID Use

CV Status for Pressor Usage

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19
Q

What is Samter’s Triad?

A

Asthma, Sinus Disease, and Nasal Polyps r/t ASA & NSAIDs

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20
Q

What are common Nasal Vasoconstrictor meds?

A

Phenylephrine

Cocaine

Epi

Lido w/ Epi

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21
Q

How does a little Cocaine compare with a lot of Cocaine?

A

Small Dose: Vagotonic & ↓HR

Big Dose: Tachycardia, V-TACH/Fib, MI

22
Q

How should patients be extubated for Nasal surgery?

A

Awake after thorough suctioning

23
Q

Why should the oral passage be assesed for blood clots after nasal surgery?

A

Clot can be inhaled and lead to total airway obstruction & death

24
Q

What structures are a part of Waldeyer’s Ring?

A

Palatine Tonsils

Nasopharyngreal Tonsil (Adenoid)

Lingual Tonsil

25
Q

Adult Tonsillectomy is _______ painful than kids

A

Adult Tonsillectomy is MORE painful than kids

26
Q

How soon can Pulmonary Edema develop after Airway Obstruction relief?

A

Minutes to Hours after relief

27
Q

Why is Decadron used for Nasal Surgery?

A

Less PONV

Better Diet Tolerance

Reduced Pain

28
Q

Post-Op bleeding tonsils ________ with age with a ______ occurence in Adults & Males

A

Post-Op bleeding tonsils INCREASES with age with a HIGHER occurence in Adults & Males

29
Q

How soon can Bleeds occur after Tonsil Procedures?

A

Within 6 Hrs

or

7-8 Days Post-Op after scab falls off

30
Q

What are indications of Post-Op Tonsillar Bleed?

A

Unexplained Tachycardia

Excessive Swallowing

Pallor

Restlessness

Sweating

↑Cap Refill

31
Q

What is a Late sign of a Tonsillar Bleed?

A

HYPOtension

32
Q

What equipment should be available for Bleeding Tonsils?

A

Experienced Help

Extra Airway Supplies

Two Suctions

RSI w/ Head Down

Lateral Mask Induction

33
Q

What are Vocal Cord Papillomas?

A

Benign, but can be Malignant lumps that cause hoarseness & resp obstruction

34
Q

What is Reinke’s Edema?

A

Sac-Like, Fluid-Filled swelling of Vocal Cords

35
Q

How closed is the airway if Stridor is present?

A

< 4-5 mm

36
Q

Which Goggles should be worn for YAG Lasers?

A

Green Goggles

37
Q

Which goggles should be worn for Argon Lasers?

A

Amber Goggles

38
Q

Which goggles should be worn for CO2?

A

Clear Goggles

39
Q

How should an Airway Fire be managed?

A

D/C Circuit

Extubate & Put ETT in Water

Ventilate w/ Mask or New Circuit

Maintain Anesthesia w/ IV

Extensive Pulmonary Care

40
Q

When should Non-Intubation techniques be AVOIDED?

A

Obese Patients

Emphysema

Large Tumors

41
Q

What are the risks associated w/ Supraglottic Ventilation?

A

Poor Ventilation

Debris Blown into Trachea

Pneumomediastinum

PTX

SQ Emphysema

Vocal Cord Movement

Can’t Monitor End Tidal

42
Q

How does Subglottic Jet Ventilation compare to Supraglottic?

A

Minimal Vocal Cord Movement

More Barotrauma Risk

Reduced Driving Pressures

43
Q

What is the respiratory rate for High Frequency Positive Pressure Ventilation?

A

60 - 120 bpm

44
Q

What is the respiratory rate for High Frequency Jet Ventilation?

A

100 - 400 bpm w/ volumes < dead space

45
Q

For Rigid Bronchscopy Ventilation, how should adequacy of ventilation be assesed?

A

Chest Rise since EtCO2 will not return via circuit and might be inaccurate

46
Q

During Rigid Bronchoscopy, how long should Apneic Oxygenation be limited to?

A

2 min, the remove scope and ventilate patient

or

anytime PaO2 drops

47
Q

How fast does PCO2 accumulate per minute during apnea?

A

3-4 torr/minute

48
Q

What are the complications of Bronchoscopy?

A

Bronchospasm

Hypoxemia

CO2 Retention

Resistance to Ventilation

PTX, Pnuemomediastinum, SQ Emphysema

Awareness

49
Q

Organic Foreign Bodies are ______ than Inorganic when inhaled

A

Organic Foreign Bodies are WORSE than Inorganic when inhaled since they can soften & expand

50
Q

How is Urgent Foreign Body removal managed?

A

Give Robinul / Atropine

No Pre-Op Sedation

No N2O

Awake Laryngoscopy

51
Q

How should LESS Urgent Foregn Body removal be managed?

A

IV/Mask Induction

Maintain spont. respiration until FB is seen

Lateral Position if Organic

Advanced Anesthesia 2 (8 decks)

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