Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles > Principles-ENT & Maxillofacial Procedures > Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What overall organ complication is associated with increased ENT procedures

A

Pulmonary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What specific cranial nerves should be evaluated for dysfunction

A

IX-glossopharyngeal nerve
X-vagus
XII-Hypoglossal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

For unanticipated difficult airway

A

follow difficult airway algorithm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name the three steps taken for an anticipated difficult airway

A

Explain to patient
Awake fiberoptic intubation
Prepare the airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

Antisialagogue
Local anesthetic
Airway blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What three drugs are used as an antisialagogue

A

Atropine-faster onset
Scopalamine
Glycopyrrolate-lasts longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does a superior laryngeal nerve block anesthetize

A

inferior aspect of the epiglottis to the cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

supine with neck extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

25 guage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What must you ALWAYS do prior to injection

A

Aspirate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does a translaryngeal nerve block anesthetize

A

The trachea below the cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What anatomical structue must be located for a translaryngeal nerve block

A

cricothyroid membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What guage needle should be used for a translaryngeal nerve block

A

20 guage or smaller

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What confirms correct placement of catheter for translaryngeal nerve block

A

Aspiration of air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What medication is injected for translaryngeal blockade

A

3-5 ml of 4% lidocaine injected rapidly

*stimulates cough reflex that spreads LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The glossopharyngeal nerve (IX) block blocks

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Because airway blocks abolish airway reflexes, caution should be used in which patient populations

A

Full stomachs, Trauma, Pregnancy, etc

26
Q

Anxiolytic (benzos) must be use with caution and many times is contraindicated in ENT/MF procedures due to

A

increased risk of airway obstruction

27
Q

Premedicate the patient with ______medication for increased tolerance to awake airway procedures

A

Opioids

*titrate slowly

28
Q

Use of muscle relaxants for ENT/MF procedures

A

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
Q

Controlled (deliberate) hypotension is indicated for

A

minimizing surgical blood loss & better surgical visualization

*elective lowering of arterial blood pressure

30
Q

What three ways is controlled hypotension achieved

A

patient positioning
positive-pressure ventilation
hypotensive drugs, depth of anesthesia

31
Q

Intraoperative monitoring of what two things are STRONGLY recommended in controlled hypotension strategies

A

Arterial bp monitoring

ECG with ST-segment analysis (suggestive of ischemia)

32
Q

What is considered a safe level of controlled hypotension

A

It’s patient specific and is dependent upon pt’s predisposing illness

33
Q

Complicatons of ear procedures are usually associated with

A

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
Q

T&A patients are usually premedicated with with

A

glcyopyrrolate
titrated opioids
+/- anxiolysis

35
Q

T&A patients undergo rapid

A

Emergence

36
Q

_____is obligatory for T&A patients

A

antiemetic prophylaxis

37
Q

Positioning of a T&A patient includes

A

Rose position

*supine, shoulder roll, head extended

38
Q

Four major complications associated with T&A procedures include

A

bleeding

retention of throat pack

laryngospasm/bronchospasm

Reoperation

39
Q

What are the seven symptoms of stridor

A 
Tachypnea
Tachycardia
Wheezing
Cyanosis
Chest retraction
Nasal flaring
Altered LOC
40
Q

Name the three types of obstruction

A

complete-no airflow

partial-stridor, or narrowing of airway

potential, impending- r/t altered resp physiology or LOC

41
Q

Stridor is evaluated by what three assessments

A

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
Q

What tube size is required for a laryngoscopy

A

small ETT

  • male < 8.0
  • female < 7.0
43
Q

What tube size is required for a bronchoscopy

A

larger ETT

44
Q

What tube size is required for a esophagoscopy

A

smaller ETT

45
Q

Epiglottitis occurs in which population

A

pediatric (2-7)

46
Q

What causes epiglottitis

A

Haemophilus influenza Type B

47
Q

What physiologic pathology is involved with epiglottitis

A

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
Q

What is the “thumb sign”

A

radiological finding showing thickening of the aryepiglottic folds & swelling of the epiglottis

49
Q

S&S of epiglottitis

A 
Sudden onset of fever
Dysphagia (difficulty swallowing)
Drooling
Muffled voice 
Dyspnea
Tripod position 
Thumbprint on XRAY
50
Q

Should you perform direct visualization of the epiglottis in the unanesthetized patient

A

NOOOOOO!

51
Q

Goal of treatment of epiglottitis patients

A

Remain calm and keep patient calm

  • All interventions performed in OR
  • keep child in sitting position in the OR through induction
52
Q

Key anesthetic considerations for epiglottitis patients

A 
Airway emergency
Minimize stimulation
Inhalation induction
Downsize ETT
NO MUSCLE RELAXATION
53
Q

List the physical findings associated with foreign body aspiration

A 
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
Q

Key anesthetic consideration for foreign body aspiration

A

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
Q

Key anesthetic considerations for Nasal & Sinus surgeries

A 
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions