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Principles-ENT & Maxillofacial Procedures Flashcards

1
Q

What are the seven issues concerning all ENT cases

A
  1. airway competition
  2. premedication
  3. endotracheal tube & sizes
  4. muscle relaxation
  5. positioning
  6. controlled (deliberate) hypotension
  7. fluid management & replacement
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2
Q

What overall organ complication is associated with increased ENT procedures

A

Pulmonary

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3
Q

Pre-anesthetic evaluation of ENT/MF procedures should include

A 
Airway assessment
Check for immobile tongue
Check for cranial nerve dysfunction 
Communication with surgeon
Detection of upper airway obstruction
Prior surgeries
Look for edema
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4
Q

What specific cranial nerves should be evaluated for dysfunction

A

IX-glossopharyngeal nerve
X-vagus
XII-Hypoglossal nerve

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5
Q

Name eight S&S that may increase risk of airway obstruction

A 
SOB
Excercise intolerance
Hoarseness
OSA
Dyspnea
Secretions
Voice changes
Trouble lying flat
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6
Q

For unanticipated difficult airway

A

follow difficult airway algorithm

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7
Q

Name the three steps taken for an anticipated difficult airway

A

Explain to patient
Awake fiberoptic intubation
Prepare the airway

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8
Q

Name the three steps taken to prepare the airway for an awake fiberoptic intubation

A

Antisialagogue
Local anesthetic
Airway blocks

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9
Q

What three drugs are used as an antisialagogue

A

Atropine-faster onset
Scopalamine
Glycopyrrolate-lasts longer

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10
Q

What three airway nerve block techniques are used for anticipated difficult airway

A

Superior laryngeal nerve block
Translaryngeal (transtracheal) nerve block
Glossopharyngeal nerve block

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11
Q

What does a superior laryngeal nerve block anesthetize

A

inferior aspect of the epiglottis to the cords

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12
Q

What position should patient be placed in for a superior laryngeal nerve block

A

supine with neck extended

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13
Q

What needle size should be used on a patient getting a Sup. laryngeal nerve block

A

25 guage

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14
Q

What bone is displaced Laterally TOWARD the side of the block

A

Hyoid bone

*25 ga “walked off” greater cornu of the hyoid bone and advanced 2-3 mm.

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15
Q

When do you inject 3 mL of LA and where for a patient receiving a sup. laryngeal nerve block

A

when loss of resistance felt, inject LA superficially and deep

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16
Q

What must you ALWAYS do prior to injection

A

Aspirate

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17
Q

What does a translaryngeal nerve block anesthetize

A

The trachea below the cords

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18
Q

What anatomical structue must be located for a translaryngeal nerve block

A

cricothyroid membrane

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19
Q

What guage needle should be used for a translaryngeal nerve block

A

20 guage or smaller

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20
Q

What confirms correct placement of catheter for translaryngeal nerve block

A

Aspiration of air

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21
Q

What medication is injected for translaryngeal blockade

A

3-5 ml of 4% lidocaine injected rapidly

*stimulates cough reflex that spreads LA

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22
Q

The glossopharyngeal nerve (IX) block blocks

A

sensation to posterior 1/3 of the tongue, pharynx, & superior surface of the epiglottis

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23
Q

LA is injected into what oral structure for a CN IX block

A

5 ml in base of each posterior tonsillar pillar

24
Q

What size needle is used to block the CN IX

A

Angled 22 gauge, 9 cm needle

25
Because airway blocks abolish airway reflexes, caution should be used in which patient populations
Full stomachs, Trauma, Pregnancy, etc
26
Anxiolytic (benzos) must be use with caution and many times is contraindicated in ENT/MF procedures due to
increased risk of airway obstruction
27
Premedicate the patient with ______medication for increased tolerance to awake airway procedures
Opioids *titrate slowly
28
Use of muscle relaxants for ENT/MF procedures
depends on case and surgeon's preference | *surgeon may want to know if he's close to nerve to preserve it so no muscle relaxant will be given
29
Controlled (deliberate) hypotension is indicated for
minimizing surgical blood loss & better surgical visualization *elective lowering of arterial blood pressure
30
What three ways is controlled hypotension achieved
patient positioning positive-pressure ventilation hypotensive drugs, depth of anesthesia
31
Intraoperative monitoring of what two things are STRONGLY recommended in controlled hypotension strategies
Arterial bp monitoring ECG with ST-segment analysis (suggestive of ischemia)
32
What is considered a safe level of controlled hypotension
It's patient specific and is dependent upon pt's predisposing illness
33
Complicatons of ear procedures are usually associated with
during emergence * graft may dislodge, consider deep extubation (2 MAC), so SEVO= 4.2% * RSI patients cannot be extubated deep due to aspiration risk.
34
T&A patients are usually premedicated with with
glcyopyrrolate titrated opioids +/- anxiolysis
35
T&A patients undergo rapid
Emergence
36
_____is obligatory for T&A patients
antiemetic prophylaxis
37
Positioning of a T&A patient includes
Rose position *supine, shoulder roll, head extended
38
Four major complications associated with T&A procedures include
bleeding retention of throat pack laryngospasm/bronchospasm Reoperation
39
What are the seven symptoms of stridor
``` Tachypnea Tachycardia Wheezing Cyanosis Chest retraction Nasal flaring Altered LOC ```
40
Name the three types of obstruction
complete-no airflow partial-stridor, or narrowing of airway potential, impending- r/t altered resp physiology or LOC
41
Stridor is evaluated by what three assessments
characteristics of breathing -High pitched, inspiratory, monophonic (HIM) Inspiratory vs. Expiratory - inspiratory stridor suggests lesion extrathoracic - expiratory stridor suggests lesion is intrathoracic Awake vs. Asleep - obstruction worse while awake suggests laryngeal, tracheal, or bronchial origin - obstruction worse while asleep suggests pharyngeal origin
42
What tube size is required for a laryngoscopy
small ETT * male < 8.0 * female < 7.0
43
What tube size is required for a bronchoscopy
larger ETT
44
What tube size is required for a esophagoscopy
smaller ETT
45
Epiglottitis occurs in which population
pediatric (2-7)
46
What causes epiglottitis
Haemophilus influenza Type B
47
What physiologic pathology is involved with epiglottitis
swelling of this structure can interfere with breathing, and constitutes a medical emergency. Infection can cause the epiglottis to obstruct or completely close off the windpipe.
48
What is the "thumb sign"
radiological finding showing thickening of the aryepiglottic folds & swelling of the epiglottis
49
S&S of epiglottitis
``` Sudden onset of fever Dysphagia (difficulty swallowing) Drooling Muffled voice Dyspnea Tripod position Thumbprint on XRAY ```
50
Should you perform direct visualization of the epiglottis in the unanesthetized patient
NOOOOOO!
51
Goal of treatment of epiglottitis patients
Remain calm and keep patient calm * All interventions performed in OR * keep child in sitting position in the OR through induction
52
Key anesthetic considerations for epiglottitis patients
``` Airway emergency Minimize stimulation Inhalation induction Downsize ETT NO MUSCLE RELAXATION ```
53
List the physical findings associated with foreign body aspiration
``` Decreased breath sound ipsilaterally tachypnea stridor & wheezing fever Radiologic findings show AIR TRAPPING, infiltrates, and atelecatasis ``` *90% of Foreign bodies are radiolucent, 10% are not visible via xray
54
Key anesthetic consideration for foreign body aspiration
Airway emergency All foreign bodies must be removed in OR NEVER SEDATE before removing foreign body AVOID Nitrous Oxide Ventilate via bronchoscope (large ETT) Maintain Deep anesthetic level-prevent bronchospasms Use bronchodilators
55
Key anesthetic considerations for Nasal & Sinus surgeries
``` Difficult mask ventilation common GETA Oral airway during mask ventilation ORAL RAE tube MUSCLE RELAXANTS Throat pack Antiemetic prophlaxis MUST EXTUBATE smoothly! ```

Principles (8 decks)

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