ENT randomness from handouts Flashcards
what is the most freq indication for laryngectomy?
squamous cell cancer - which is highly correlated with etoh and tobacco use.
what is the most common site of laryngectomy? second? third?
glottis — supraglottic — subglottic
what is the fx of the larynx?
support and protect the airway, create voice
what are the 3 unpaired cartilages
epiglottis, thyroid, cricoid
what are the 3 paired cartilages
arytenoid, corniculate, cuneiform
what makes up the supraglottic region?
epiglottis, arytenoid, false cords
what makes up the glottis?
true VC and glottis opening
extrinsic muscles move the larynx __ and ___
up and down (sternothyroid, thyohypoid, inferior constrictor of the pharynx)
intrinsic muscles provide vocal cord ____ and ____
tension and relaxation
the RLN provides sensory to……..??????
everything below the level of the vocal cords
the RLN provides motor to….?????
all laryngeal muscles except the cricothyroid
SLN ____ branch provides ___ above vocal cords
internal, sensory above vocal cords
SLN ____ branch provides motor ___
external, cricothyroid
where does the blood supply for the SLN come from
external carotid
where does the blood supply for the inferior laryngeal artery come from?
subclavian
venous return is via ___ and _____ laryngeal veins
superior, inferior
what is associated with stiffening and scarring of tissues, making intubation more problematic?
radiation therapy
what are the most common complications of laryngectomy?
pharyngocutaneous fistula and wound infection
T/F There is an increased risk for aspiration with partial laryngectomy.
TRUE
T/F The most important prognostic factor for squamous cell cancer in the head and neck is the status of the lymph nodes and the extent of the lymphadenopathy.
TRUE
what structures foes radical neck dissection include?
complete cervical lymphadenectomy, resection of the sternocleidomastoid muscle, the IJ vein, spinal accessory nerve, and the submandibular gland
RND: Head of bed will be ___ to ameliorate the effects of jugular vein ligation, increase venous return and decrease blood loss.
elevated
what is the greatest risk of RND?
damage to nerve, muscles, veins
RND - horner’s syndrome is a concern d/t cervical sympathetic chain interruption.. what are the 3 characteristics?
ptosis, myosis, anhydrosis
Following RND, the patient has stooped shoulders, decreased ability to lift their arm on the operative side, and limited head and neck rotation and flexion from removal of nerves and muscles. what is your plan?
nothing , this is expected
RND: ____ may form at the end of dissected nerves, causing chronic paresthesias and pain
neuromas
___ ____ nerve trauma results in painful shoulder syndrome, weakness, limited ROM, and winging of scapula.
Spinal accessory
what produces lower lip weakness after RND?
facial nerve injury to small branch (marginal mandibular branch)
Post op htn and lack of hypoxic drive after a BILATERAL RND may indicate????
damage to the carotid bodies and sinuses.
RND: vocal cord paralysis and sensory dysfunction may also indicate???
vagus nerve damage d/t the innervation of the larynx.
what are the s/s of a VAE
cyanosis, hotn, dysrhythmias, ST segment elevation, drop in ETCO2, increase in ETN2, and mill wheel, charring sound murmur over lower borders of the sternum
what are the anesthetic interventions for VAE
inform surgeon so he can flood site with saline and compress the vessels to prevent further entrapment of air. anesthesia must increase FIO2 1.0, turn patient to left side head down and support circulation. aspiration of air from the heart via a central venous catheter and cardiac massage may be required.
venous air embolism is a risk due to a large vein being opened in the neck. it passes to ____ and causes an airlock at the level of the ____ and the ____.
right atrium, right atrium, SVC
why should you be careful with fluids for a patient who has had a previous RND
they have derangements of their lymphatic drainage patterns. their tissues do not tolerate the edema produced by the insult of surgery.
if you have delayed awakening in an RND patient, what do you suspect?
cephalic venous obstruction —- result of central apnea syndrome d/t acutely elevated ICP.
what are 3 signs of cephalic venous obstruction?
significant facial edema, facial cyanosis despite normal pulse ox, rhinorrhea.
how should you treat cephalic venous obstruction
measures that decrease ICP and preserve intracranial flow
some examples would be: hyperventilation, propofol, avoid htn, avoid NTG/SNP, elevate head >30 degrees to facilitate venous drainage from the brain, reduce intrathoracic pressure (PEEP increases it!), diuretics, steroids
if there is muscular effort to breathe during apnea, it is termed ____
obstructive
UPP is done for patient with ____
OSA that can’t tolerate CPAP BIPAP
hypopnea: abnormal resp event with a >___% drop in airflow compared to baseline), lasting at least ____s, with a __% drop in O2 sat
30% drop in airflow.
at least 10s
>4% drop in O2 sat
Apnea Hypopnea Index: \_\_\_ events = none \_\_\_ events = mild \_\_\_ events = mod \_\_\_ events = severe
0-5 events = none.
6-20 events = mild
21-40 events = mod
>40 events = severe
difficult airway: < __ fingers thyromental, >__cm intercisor
3fingers, 3cm
OSA patients - sleep patterns are deranged for ___ following surgery?
one week
The thyroid produces and secretes thyroid hormones T3 and T4 in a ratio of :
10:1
what is stronger… T3 or T4?
T3 has 4x the potency of T4
graves disease is ____, hasimotos is _____
hyperthyroid, hypothyroid
myxedema coma is ___ , thyroid storm is ___
hypo, hyper
what does a NIM tube monitor?
RLN function
what are two things that can effect NIM tube monitoring during thyroid surgery
NMB and laryngotracheal lidocaine.
when does thyroid storm usually occur
6-18h post-op. it’s most common in people with Graves and not euthyroid prior to surgery
what are drugs given to theat thyroid storm
sodium iodide to block realize of hormone from the gland, tylenol, metoprolol/esmolol, decadron/hydrocortisone,
Methimazole (PTU) or propylthiouracil to inhibit further synthesis of thyroid hormone
unilateral RLN damage results in?
horseness
bilateral RLN damage results in ?
aphonia, stridor or resp distress
hematoma usually occurs ___h after thyroid surgery
6-24
thyroid surgery- what causes acute hypocalcemia?
inadvertent removal of parathyroids. most likely to occur 24-48h later.
