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AP 1 > Test 3: HEENT (PT 1/2) > Flashcards

Test 3: HEENT (PT 1/2) Flashcards

1
Q

Which part of the nasal cavity is highly vascular and may lead to severe bleeding?

A

Turbinates

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2
Q

What are the functions of the larynx?

A

vocalization/articulation & protection of airway/allows respiration

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3
Q

What is innervated by the Internal Branch of the Superior Laryngeal Nerve?

A

laryngeal mucosa above vocal cords (inferior epiglottis

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4
Q

What is Sensory innervated by the Recurrent Laryngeal Nerve?

A

laryngeal mucosa below vocal cords

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5
Q

What is innervated by the Glossopharyngeal Nerve?

A

-superior aspect of epiglottis & base of tongue
-Motor + sensory for base of tongue, nasopharynx, & oropharynx
-Responsible for eliciting the gag reflex

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6
Q

What is innervated by the External Branch of the Superior Laryngeal Nerve?

A

Motor to the cricothyroid muscles (adduction-tension/elongation VC))

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7
Q

What is Motor innervated by the Recurrent Laryngeal Nerve?

A

all intrinsic muscles except cricothyroid (lots of actions)

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8
Q

What does the Facial Nerve supply innervation to?

A

motor and sensory supply to the muscles for facial expressions

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9
Q

What does the Trigeminal Nerve supply innervation to?

A

3 Branches: ophthalmic, maxillary, mandibular
sensory & motor to the nose, sinuses, palate, and tongue. Aid in motor control of face & in mastication

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10
Q

The RLN & SLN lie in close proximity to the _____

A

lateral lobe of the thyroid gland

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11
Q

What supplies innervation to the 6 extraocular muscles?

A

innervation by CN3 except SO4 LR6

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12
Q

How do you deal with the Shared Airway in ENT surgery?

A

-Requires planning and effective communication
-Maintenance of adequate ventilation and security/patency of ETT
-Constantly assess adequacy of ventilation (observe chest excursion, auscultation, SpO2, EtCO2, inspiratory pressures)
-Bubbling noises or smell of anesthetic gas = ETT cuff problem or migration above the vocal cords
-Surgeons may request periods of apnea, jet ventilation, or spontaneous respiration (may be difficult to maintain TIVA)
-Surgeons may insert throat packs to prevent blood/debris aspiration
-Must document time of insertion & removal!

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13
Q

Explain Deliberate Controlled Hypotension

A

-Reduce MAP to reduce blood loss
-Maintain MAP around 60mmHg or 20% decrease from baseline (chronic htn may require a higher MAP)
-Must maintain cerebral + renal autoregulation as well as coronary blood flow
-Arterial BP monitoring = required!

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14
Q

What agents are used to produce deliberate, controlled hypotension?

A

Vasodilating agents, BB, CCB, ultrashort-acting opioids (remifentanil), inhalational agents

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15
Q

What are the local anesthetics used in ENT surgery?

A

(most common = amide-based drugs)
Cocaine, Lidocaine, Benzocaine, Bupivacaine, Mepivacaine, Dyclonine
Common in nasal/sinus surgery. Topical/local anesthesia may be sole agent

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16
Q

What is the only local anesthetic with vasoconstrictive ability?

A

Cocaine (blocks catecholamine reuptake)

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17
Q

What vasoactive meds are commonly used in ENT surgery?

A

-Epinephrine: May be added to local anesthetic solutions to produce vasoconstriction
-Prolongs DOA of LA & decreases systemic absorption

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18
Q

What anticholinergic meds are used in ENT surgery?

A

Used for antisialagogue effects (dry secretions)
-Glycopyrrolate = better choice than atropine bc less tachycardia. Glyco does not cross BBB so no sedation

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19
Q

Why are corticosteroids used in ENT surgery?

A

-Ex: Dexamethasone
-Decrease laryngeal edema, reduce N/V, prolong analgesia of LA
-Administer as early as possible to reach peak prior to surgery

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20
Q

What PONV prophylaxis is used in ENT surgery?

A

-5HT3 antagonists (ondansetron)
-Dexamethasone
-TIVA vs inhalational (avoid N2O)
-Multimodal Pain mgmt/opioid sparing

21
Q

What is important to know about throat packs?

A

-Must document insertion & removal time
-Throat packs placed to prevent blood from entering the stomach causing N/V
-Used in a variety of settings…dental, cleft lip/palate

22
Q

Detail positioning concerns regarding ENT surgery?

A

-Head is prepped, draped, or wrapped in towels, limiting access to ETT & breathing circuit
-ETT is positioned and secured (tape or suture). RAE ETT = common.
-Disconnect tube prior to turning to prevent inadvertent disconnect
-OR table may be turned 90-180 degrees = HOB/airway away from you
-*Remember to add extensions and disconnect circuit when turning bed
-Added length placed prior to draping
-Signs of air leaks (bubbling, air escaping, smell of gas) = more sensitive indicators of leak than mechanical airway monitors
-Arms tucked at side
-Must ensure IV patency, consider 2 IVs for longer procedures

23
Q

What is important to monitor when using a RAE ETT?

A

Watch for pressure on nares/lips.
-Forehead padding

24
Q

What is a more sensitive indicator of an ETT leak than mechanical airway monitors?

A

Signs of air leaks (bubbling, air escaping, smell of gas)

25
Q

What nerves do you need to worry about identifying, isolating, and preserving during ENT surgery?

A

Motor branch of CN7, Recurrent/inferior laryngeal/CN10, CN11

26
Q

What allows for real time ID/functional assessment of vulnerable nerves?

A

EMG

27
Q

How can you perform Intraoperative neurophysiologic monitoring?

A

Via Brainstem evoked potentials, electrocochleogram, EMG

28
Q

Describe the “balanced anesthetic technique” utilized with neuromonitoring in ENT surgery?

A

-TIVA preferred, indifferent to opioids and nitrous oxide
-NMBA = only used for intubation
-LA are contraindicated (suppressant effect on muscle action)

29
Q

What does the SLN innervate?

A

mucosa above VC, cricothyroid muscle, tension/elongation of VC

30
Q

What does the RLN innervate?

A

mucosa below VC, all intrinsic m except cricothyroid, relaxes/abducts/adducts VC

31
Q

What does the Glossopharyngeal Nerve innervate?

A

epiglottis, tongue, gag reflex

32
Q

What is the motivation for using a different than normal ETT for ENT surgery?

A

Purpose of various ETT types = reduce cuff pressure on the tracheal wall

33
Q

What is a RAE ETT?

A

Preformed right-angled ETT prevents ETT kinking, but tip may rest too distal or proximal
Requires careful placement check

34
Q

What surgeries would utilize an Oral RAE?

A

cleft palate, T&A, UPPP, eye, upper face

35
Q

What surgeries would utilize a Nasal RAE?

A

maxillofacial surgery, cosmetic, oral cavity, malocclusion, mandible

36
Q

In what situations would you avoid nasal intubation?

A

Avoid nasal intubation in unconscious patient w facial trauma to prevent possible penetration of the brain

37
Q

What is the purpose of using an Armored or Reinforced ETT?

A

-Embedded coiled wire to produce greater flexibility and memory
-Resist kinking & retain original integrity
-Useful when acute neck flexion/severe angles of ETT required

38
Q

What is the purpose of using a Laser/Metal-Impregnated ETT?

A

-reduce risk of airway fire
-Cuff filled with methylene blue dyed saline to prevent ignition/early detection
-Reflective tape not adequate to prevent fires (bc dry & flammable)

39
Q

What is the purpose of using an LMA?

A

-Used to facilitate intubation & control the airway
-Does not produce tracheal stimulation, Incidence of coughing = lower than ETT, No need for NMB, Conduit for surgical access to the glottis & trachea, Means of isolating the glottis from pharyngeal bleeding

40
Q

What is the purpose of the NIM (Neural Integrity Monitor) ETT?

A

-Monitors electromyogram (EMG) → must be positioned correctly with markings on ETT between vocal cords
-Used for recurrent laryngeal nerve preservation
-If nerve is stimulated a response generated at the vocal cords gives an auditory alarm (beep)

41
Q

What is important to know regarding NMBA and the use of a NIM ETT?

A

-Surgical procedures cannot use NMBA
-Sch used for intubation, NDMR used for intubation/positioning
-Either let Sch wear off or may have to reverse NDMR

42
Q

What is the purpose of using a Microlaryngoscopy ETT?

A

-Used for vocal cord & tracheal stenosis surgeries
-Longer ETT w smaller diameter (increased resistance to ventilate)
-Assist with ventilation to decrease WOB

43
Q

What is the purpose of using Jet Ventilation?

A

-Used for laryngeal surgery when trachea is not intubated
-May be performed manually w hand valve attached to O2 source
-Mechanical device allows to adjust rate and O2 concentration

44
Q

What does LASER stand for?

A

“Light amplification by stimulated emission of radiation”

45
Q

What are the components that make up a Laser?

A

Energy source + material that excites to emit light

46
Q

What are the most common types of Lasers?

A

Each laser has specific medical application – CO2 & Nd:YAG most common

47
Q

What are the safety considerations to note when using Laser?

A

-Must use protective eyewear for patient & staff (lens color specific)
-Noxious fumes: particulate from suction plume can lead to pulmonary issues
-Staff wear special masks when laser HPV lesions
-Small ETT or MLT must be removed during laser (or use special laser ETT)
-Lowest concentration O2 possible, FiO2 <30% NO N2O!
-Post warning signs of laser use outside operating area
-Patient’s eyes protected with appropriate colored glasses/wet gauze
-Matte-finish surgical instruments reduce beam reflection/dispersion
-Lasers in STANDBY mode when not in use
-Inflate cuff w methylene blue saline
-Add adjacent tissues shielded w wet gauze
-Plume suctioned/evacuated from surgical field
-Stop supplemental O2 at least 1 min before & during use of ESU/laser

48
Q

Why do you avoid N2O when using Laser?

A

Avoid N2O bc it supports combustion

AP 1 (32 decks)

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