HEENT Part III Flashcards
anterior and posterior chambers of the eye make up the ___________; which has a volume of about __________mL
globe; 7
which eye muscle causes supraduction (rolling) of the eyes
superior rectus
which muscle is responsible for infraduction of the eye
inferior rectus
which muscle is responsible for adduction of the eye
medial rectus
which muscle is responsible for abduction of the eye
lateral rectus
which muscle is responsible for intorsion/depression of the eye
superior oblique
which muscle is responsible for extorsion/elevation of the eye
inferior oblique
emergence consideration with opthlamic surgery
- no coughing or bucking 2. avoid hypercapnea 3. prevent PONV 4. remifentanil (prevents coughing with emergence)
when would you typically use GETA with opthlamic surgery
- peds 2. uncooperative pts 3. emergenceis
what is a primary clinical sign of increased IOP
nausea
t/f: stable facial fractures are not considered emergent
TRUE
anesthetic considerations with pharyngeal abscess
- careful with intubation 2. consider awake intubation
with thyroidectomy 2/2 hyperthyroidism, _________________ meds should be avoided
anticholinergics (except for reversing NMB)
during a thyroidectomy, if the pt becomes hypotensive, how should you tx?
with a direct acting vasoconstrictor (neo)
with thyroidectomy, what anesthetic drugs should be avoided
local anesthetics and paralytics
complications of thyroiectomy surgery
- RLN injury 2. neck hematoma –> tracheal deviation 3. infection 4. tracheomalasia 5. hypocalcemia
if you expect a neck hematoma post-thyroidectomy d/t tracheal deviation (causing compression of trachea) what should you do
call surgeon immediately, but if cannot wait cut the sutures to relieve the pressure
unilateral RLN injury sx
hoarsness
bilateral RLN injury sx
stridor d/t unopposed adduction –> emergent intubation
why is N2O avoided during ear surgery?
- N2O is 34x more soluble than nitrogen in blood –> increased middle ear pressure 2. cannot relieve the pressure via yawning or swallowing d/t anesthetic
N2O should be avoided with all ear surgeries, except __________________
myringotomy
why is myrigotomy the exception to not using N2O with middle ear surgeries
- it is a short procedure 2. placing a tube into middle ear to relieve pressure, thus N2O not an issue
anesthetic considerations with acute epiglottitis
- secure airway immediately 2. do not manually manipulate airway until you are in the OR 3. Sevo/O2 for induction 4. fiberoptic intubation 5. use cuffed tube 1-2 sizes smaller 6. NO MUSCLE RELAXANTS
what is the most common pulmonary location to find aspirated foreign bodies
right bronchus
when do most post-tonsillectomy bleeds occur
6 hours up to 24 hours in those > 12 years of age
post op bleeding post tonsillectomy bleeding can occur ____________ days up to _________________
5-10; 2 weeks
management of post-tonsillectomy bleed (anesthetic considerations)
- assess airway, HD status 2. plan 2 IVs 3. labs: CBC, coags, T&C; consider PRBC, FFP, and plts 4. full stomach: RSI 5. succinylcholine 6. oral RAE, glidescope 7. consider awake intubation 8. consider TXA 9. put in lateral position when take the PACU
what is the best position for the pediatric pt post-tonsillectomy/adenoidectomy after extubation and transport to PACU
lateral, with head slightly down
what are the cardiovascular effects of topical cocaine and epi
- cocaine is absorbed into the plasma –> blocking the uptake of epi systemically 2. can cause toxic effects of epi
what are the toxic effects of epi (if topical makes is systemic)
- HA 2. HTN 3. Tachycardia 4. dysrthymias
what is the primary purpose of vuvlopalatopharyngoplasty (UPPP)
- opens the airway by removing excess tissue in the throat
when is a UPPP surgery indicated?
pickwickian syndrome and OSA
anesthetic considerations with UPPP
- increased bleeding (consider transfusion) 2. ensure all protective reflexes have returned 3. ensure airway is free of blood and debris 4. ensure adequate breathing pattern is present before removal of ETT 5. topical anesthesia on glottic/supraglottic areas before intubation can prevent postextubation stridor or laryngospasm 6. lateral position post op; adults prefer middle/high fowler
wht are some factors that contrbute to the development of pneuoencephalus/pneumorachis
- positioning/duratino of neuro surgery 2. barotrauma, hemopneumothorax,penumomediastinum 3. subarachnoid block, epidural 4. N2O 5. continuous CSF drainage 6. hydrocephalus, infection, neoplasm
pneumoencephalus and pneumorachis usually resolves within ______________
1-2 weeks
under what circumstance would surgical intervention be necessary for pneumoencephalus/pneumorachis
decreasing neuro status
pneumoencephalus/pmeumorachis is most common after what?
- neurosurgical repair 2. craniofacial trauma 3. skull based tumors
complications with endoscopic procedures
- bleeding 2. eye injury 3. bronchospasms
endoscopic procedure examples:
- removal of foreign body in airway (bronchoscopy) 2. esophagosxopy 3. laryngoscopy 4. FESS - fx’al endoscopic sinus surgery
T/F: the scope used for endoscopic procedures is only flexible
false; can be rigid or flexible
what medications are contraindicated with flaps/neck dissections
neo, epi, and vasopressin (they can cause spasm and decrease flow to the flap)
anesthethesia implications for thyroidectomy secondary to hyperthyroidism
- tracheal deviation 2. hyperdynamic circulation 3. hypovolemia 4. exopthalamus - careful with eye s 5. hyperthermia
what is the most common pediatric surgery
tonsillectomy and adenoidectomy
tonsillar hypertrophy is highest in ages ______________
6-Mar
anesthetic technique with tonsillectomy/adenoidectomy
- mask induction vs awake (dep on how nervous you are about airway occlusion) 2. +/- NMBA 3. ETT in kids over 8-10; 4. decadron 0.5mg/kg (max) 5. PONV
considerations for tonsillectomy and adenoidectomy for sleep obstruction
- will do UPPP with it 2. high mallampati (3/4) 3. lg neck circumfrenece 4. increase risk of post-op hypoxia
s/sx of epiglottitis
- sore throat 2. difficulty swallowing 3. muffled voice 4. inspiratory stridor
anesthetic technique with cochlear implant surgery
- GETA + ETT 2. facial nerve monitoring (no NMB) 3. no N2O
anesthetic technique with myringotomy
- mask induction: O2, N2O, & inhal agent
epiglottitis (incl acute) is most commonly presented in children aged ____________
6-Feb
enucleation
surgical removal of globe and optic nerve, leaves structure for prosthetic eye placment
evisceration of the eye
removal of contents of the eyeball, leaving sclera intact
exteneration
all orbital tissue including surrounding supportive structure
intraconal + extraconal portions of the eye make up the ______________, which has a volume of about __________ mL
orbit; 30
