Quiz 8 (Greg Study Guide) Flashcards
What intrinsic laryngeal muscles adduct the vocal cords?
lateral cricoarytenoid, transverse arytenoid
What muscle moves the eyes laterally/abducts?
lateral rectus
What extrinsic laryngeal muscle aids in swallowing?
inferior pharyngeal constrictor
What kind of approaches can you use for a peribulbar block?
superior temporal, medial, inferior temporal
What are some ways to prevent ETT fire during ENT procedures?
deliver minimum O2 concentration necessary (30%); for unavoidable open O2 delivery, deliver 5-10 L/min of air under drapes to wash out O2; stop O2 at least 1 minute before electrocautery/laser, coat head hair and facial hair with water soluble lubricating jelly, suction oropharynx with metal cannula to catch leaking O2 and N2O
What intrinsic laryngeal muscles relax the vocal cords?
thyroarytenoid and vocalis
What muscle moves the eye upward/supraducts and is located above the eye?
superior rectus
What is a consideration when surgeons are using a laser in the throat?
limit FiO2 to less than 30%
What extrinsic laryngeal muscle causes inversion of the aryepiglottic fold?
thyroepiglottic
What extrinsic laryngeal muscles draw the hyoid inferiorly?
sternohyoid, thyrohyoid
Why might you do a peribulbar block versus a retrobulbar?
patients at risk for globe puncture (high myopia, significant enopthalmos, previous scleral buckling procedures, staphylomas)
What nerves provide sensory innervation to the larynx?
SLN internal (branch of vagus)- above vocal cords, RLN-below vocal cords, glossopharyngeal- superior epiglottis and base of tongue
What muscle moves the eye nasally/adducts?
medial rectus
What should you ensure before extubating after a tonsillectomy?
that throat packs have been removed, airway has been suctioned, and patient is fully awake
What is the oculocardiac reflex?
trigeminal-vagal reflex generated by pressure on the globe, orbital structures, or conjunctiva, or by traction on the EOMs- results in bradycardia, dysrythmias
What are some ways to minimize blood loss during ear surgery?
epinephrine containing solutions, elevation of patients head (but increases risk of VAE)
If using nitrous, how soon should it be stopped before graft placement?
30 minutes
What muscle moves the eye downward/infraducts and is located below the eye?
inferior rectus
what is a common undesired effect of middle ear surgery, and what can you use to prevent it?
PONV; scopalamine patch
Describe a peribulbar block
Needle is directed outside of muscle cone and the anesthetic is injected- the extraconal pressure spreads the agent inside the muscle cone- requires more volume of LA than retrobulbar block
What extrinsic laryngeal muscle draws the thyroid cartilage caudad?
sternothyroid
What could you do to minimize the incidence of postextubation stridor and laryngospasm after a tonsillectomy?
topical spray of 2% lidocaine on the glottic and supraglottic areas
What extrinsic laryngeal muscle folds the thyroid cartilage?
stylopharyngeus
Describe a retrobulbar block
Pt looks up and needle inserted through the skin in infratemporal area above inferior orbital rim- needle advanced into muscle cone (retrobulbar space) and 2-4 mL of LA injected after negative aspiration
What are some potential complications of a retrobulbar block?
trauma to optic nerve, blood vessels, or globe which can lead to loss of vision; respiratory arrest if anesthetic agents enter CSF of optic nerve, seizures
What should you always assume in a patient with PTH?
full stomach- should do RSI
What gas should you avoid in middle ear procedures?
nitrous
How do you resolve an oculocardiac reflex?
remove stimulus, ensure adequate depth of anesthesia, 2-3 mg of atropine for complete vagal blockade or glycopyrrolate (can pretreat)
After injecting local anesthetic for a retrobulbar block, what happens next?
eyelids are closed, digital pressure is applied, and after a few minutes the eyelids are open and the globe is inspected for akinesia
What is PTH?
post-tonsillectomy hemorrhage- most common emergency pediatric airway surgery
What intrinsic laryngeal muscle tenses and elongates the cords?
cricothyroid
Can you use an LMA for tonsil surgery?
yes
What intrinsic laryngeal muscle abducts the vocal cords?
posterior cricoarytenoid
What intrinsic laryngeal muscles close the glottis?
aryepiglottic, oblique arytenoid
How should you transport a patient to PACU who has had a tonsillectomy?
in the “tonsil position”- 1 side of head slightly down to allow secretions to drain out of mouth (adults may prefer high fowler)
Which muscle rotates the eyeball on its horizontal axis temporally (extorts the eye and elevates the eyeball)?
inferior oblique
What are the paired cartilages of the larynx?
arytenoid, corniculate, cuneiform
What provides motor innervation to the larynx?
RLN- all intrinsic muscles except cricothyroid, SLN- cricothyroid
Which muscle rotates the eyeball on its horizontal axis toward the nose (intorts and depresses)?
superior oblique
How should a patient be positioned if intubating due to PTH?
slight head down to protect trachea and glottis from aspiration of blood
Why might surgeons want you to limit NMB use in ENT procedures?
they want to evaluation function of nerves intra-op
What are the unpaired cartilages of the larynx?
thyroid, cricoid, epiglottis
What medication is contraindicated for post op pain after a tonsillectomy?
codeine- potential for metabolic conversion to high levels of morphine
What are some considerations when doing ear surgery?
patient may be turned 180 degrees, avoid coughing (consider remifentanil), avoid muscle relaxant if nerve monitoring, varying time frame of surgery
