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Advanced anesthesia 2 > Trauma and ophthalmic procedures > Flashcards

Trauma and ophthalmic procedures Flashcards

1
Q

lefort 1 fracture description

A

horizontal fracture from the maxilla extending from the floor of the nose and hard palate through the nasal septum and pterygoid plates

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2
Q

lefort 2 fracture description

A

triangular fracture running from the bridge of the nose through the medial and inferior wall of the orbit beneath the zygoma through the lateral wall of the maxilla and the pterygoid plates

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3
Q

lefort 3 fracture description

A

totally separates the midfacial skeleton form the cranial base, transversing the root of the nose, ethmoid bone, eye orbits, and sphenopalatine fossa

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4
Q

signs of lefort 1 fracture

A
  • malocclusion
  • buccal ecchymosis
  • epistaxis
  • maxillary crepitus
  • maxilla mobile
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5
Q

signs of lefort 2 fracture

A
  • midface crepitus
  • facial lengthening
  • bilateral epistaxis
  • infraorbital paresthesia
  • ecchymosis
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6
Q

signs of lefort 3 fracture

A
  • caved-in, flattened, or lengthened face
  • CSF rhinorrhea
  • bilateral epistaxis
  • lateral orbital rim defect
  • ecchymosis
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7
Q

anesthesia considerations with lefort fractures

A
  • do not nasally intubate a lefort 2 or 3 fracture
  • airway edema, pretreat with steroid
  • awake extubation, pt will be wired shut
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8
Q

ocular cardiac reflex

A
  • bradycardia, AV block, ventricular ectopy, asystole from manipulation of the eye
  • trigeminovagal reflex (ophthalmic division of trigeminal nerve)
  • more common in peds vs adults
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9
Q

anesthesia and OCR

A
  • seen during topical and general anesthesia
  • less common during retrobulbar blocks
  • orbital injections can stimulate
  • response worsened by hypoxemia and hypercarbia
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10
Q

treatment of OCR

A
  • stop manipulation of eye
  • assess ventilation adequacy
  • lido localization or deepen anesthetic
  • atropine for bradycardia
  • response fatigues with repeated stimulation
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11
Q

IOP

A
  • MAP needs to be > IOP
  • high IOP impairs optic nerve function
  • volume in eye is relatively fixed except for aqueous fluid and choroid blood volume
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12
Q

normal IOP

A
  • 10-22 mmHg
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13
Q

Arterial pressure and IOP

A
  • sudden increases in BP increase IOP but this soon dissipates d/t drainage system
  • sudden decreases, BP<90 will decrease IOP d/t loss of autoregulation
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14
Q

venous pressure and IOP

A
  • increases in CVP, increase IOP more than increases in BP by obstructing drainage
  • coughing, straining, breathholding, vomiting
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15
Q

Co2 tension and IOP

A
  • decreased PaCo2 results in decreased IOP from choroidial vasoconstriction
  • fast respiratory rate may increase IOP from insufficient drainage
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16
Q

acidosis/ alkalosis and IOP

A
  • metabolic acidosis decreases the choroid vessel volume, decreasing IOP
  • metabolic alkalosis increases the choroid volume, increasing IOP
17
Q

anesthetic agents and IOP

A
  • most lower or have no effect on IOP
  • ketamine may increase IOP d/t increased BP
  • etomidate is associated with myoclonus
  • opioids decrease IOP
18
Q

muscle relaxants and IOP

A
  • intubation increases IOP if depth is not adequate, regardless of NMB
  • nondepolarizing NMB do not alter IOP
  • Sch increases IOP
19
Q

carbonic anhydrase inhibitors (acetazolamide)

A
  • decreases IOP, acts within minutes
20
Q

osmotic diuretics (mannitol)

A
  • decreases IOP and increases circulating blood volume
  • max effect in 35-40 minutes
21
Q

complications of a retrobulbar block

A
  • hemorrhage is the most common
  • proptosis (downward displacement)
  • subconjunctival ecchymosis
  • arterial injection leads to CNS excitation
22
Q

retrobulbar block

A
  • IOP monitoring is mandatory
  • produces anesthesia of the globe
  • akinesia of the extraocular muscle
  • decreased production of aqueous humor = decreased IOP
23
Q

retrobulbar block, injection into optic nerve

A
  • leads to obtundation
  • respiratory arrest
  • vascular collapse
  • contralateral amaurosis (complete lack of vision)
24
Q

contraindications for RBB

A
  • bleeding disorders
  • extreme myopia
  • open eye injury (pressure behind the eye, forces contents of eye out the wound)
25
Q

peribulbar block

A
  • less hemorrhage risk
  • longer onset and less complete akinesia
  • increase likelihood of ecchymosis
26
Q

sub-tenon’s block

A
  • no sharp needle, LA placed under tenon’s fascia
  • least amount of complications
27
Q

topical anesthesia medications

A
  • tetracaine 0.5%
  • lidocaine 4%
28
Q

risk of general anesthesia

A
  • emesis from vagal stimulation
  • avoid N2O before and after procedure
29
Q

open globe procedure

A
  • emergent, RSI, GETT
  • NDNMB because they don’t increase IOP
  • keep pt deep for intubation to not increase IOP
30
Q

strabismus surgery

A
  • 16% related to muscle disorder (MH risk)
31
Q

lacrimal apparatus surgery risks

A
  • defective drainage leads to excess tears
  • suction well (spasm risk)

Advanced anesthesia 2 (10 decks)

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