Oto and Ophtho Flashcards
How much opioid should be given to patients undergoing tonsillectomy?
For patients with known OSA, opioid dose should be reduced by 50%
What are the advantages to using an LMA for tonsillectomy?
Decreased postop stridor and laryngospasm
increased immediate postop SpO2
What are the most common symptoms of a peritonsillar abscess?
Fever, pain, and trismus (pain or inability to open jaw)
Is a peritonsillar abscess a risk factor for difficult intubation?
Actually no. It usually doesn’t obstruct the airway and DL is usually possible
While anesthetizing a patient for tonsillectomy, frothy pink sputum is noted in the ETT. What should the anesthesiologist suspect?
Negative pressure pulmonary edema
If chronic obstruction has led to pulmonary hypertension or cor pulmonale, they develop “auto PEEP”. When the obstruction is rapidly removed, they lose that PEEP and the pulmonary vascular bed is flooded with fluid.
Why does nitrous cause PONV?
It increases pressure within the inner ear, and when it’s discontinued it rapidly reabsorbs, creating a vacuum effect
It’s this negative middle ear pressure that causes vestibular nausea
What causes inspiratory stridor?
What causes expiratory stridor?
Inspiratory: upper airway obstruction
Expiratory: lower airway obstruction
What is the most common cause of stridor in infants?
Laryngomalacia
long epiglottis that prolapses and extra arytenoid folds that obstruct the glottis during inspiration
Which pathogen causes epiglottitis?
Haemophilus influenzae B
Which vaccine protects against Epiglottitis?
Hib
A 4 year old with suspected epiglottitis comes into the ER. While you’re evaluating them, a nurse comes in to start an IV. What should you do?
Ask them to delay any stressful procedures until the airway is secure. Otherwise they may obstruct.
How should you go about securing the airway in a patient with epiglottitis?
It will always be done in the OR
Breathe the kid down, then DL without NMBA
Intubate orally and let the surgeon look around
Then switch to a nasal ETT
Send them to the ICU on ABX
What is laryngotracheobronchitis?
Croup
Any kid presenting to the ER with refractory wheezing should be suspected of:
foreign body aspiration
How reliable is a CXR in assessing the presence of a foreign body?
90% of foreign bodies are radiolucent and you won’t see them
What is the anesthetic approach for a patient with a foreign body?
No pre-procedure sedation
Intubate via RSI if full stomach
Breathe them down if fasted
No nitrous
Surgeon will remove the object with bronchoscope
Maintain spontaneous breathing until object is removed (PPV may push it further in)
Do CO2 lasers cause retinal injury?
No they can only injure the cornea because they have limited penetration
Nd:YAG lasers can injure the retina
How are the eyes of the patient protected during laser surgery?
wet gauze taped over the eyes
Does nitrous oxide support combustion
yes
What is produced when standard ETTs encounter a laser?
Hydrochloric acid
Why is it so important to do a thorough cardiac evaluation prior to nasal surgery?
Extensive amounts of vasoconstrictors are used to keep bleeding to a minimum and allow visualization of the field
Given that phenylephrine, epinephrine, and cocaine are often used as local anesthetics in nasal surgery, which medication on a patients med rec would be alarming?
Beta blockers
If they’re beta blocked, you’ll get unrestricted alpha 2 vasoconstriction and it could lead to heart failure and pulmonary edema
An adult is having skull base surgery to remove a malignant tumor. What should you anticipate during intubation?
They will most likely have had radiation and chemo. The airway will likely be more compromised than you’d anticipate from looking at the patient
During skull base surgery, should NMBAs be used?
the facial nerve is at high risk for injury, so it has to be frequently tested. You can’t fully paralyze the patient.
A nurse asks if the patient undergoing a skull base tumor resection needs a type and cross. Do they?
Yes! They are at very very high risk for bleeding
What is Ludwig angina?
Infection in the submandibular space
