Week 6 Electrocautery etc

Question 0

Where should you place the grounding pad?

Answer 0

Somewhere muscular or vascular, not anywhere bony, scarred, fat, or hairy.

Question 1

Do you need a grounding pad for a bipolar bovie?

Answer 1

NO, each tip of the forceps is an electrode

Question 2

What to do with a pacemaker or ICD?

Answer 2

Interrogation is the only reliable method for evaluating lead performance and obtaining current program information.

Question 3

Can you use a bovie with a pacemaker/ICD?

Answer 3

Use bipolar if possible, if not then use pure cut instead of blend or coag.
Use short bursts, not more often than every ten seconds, current as low as possible.

Question 4

Should you routinely place a magnet on your patient’s pacer?

Answer 4

No, not until electro cautery has caused it to fail, then place magnet.

Question 5

Your patient with a pacer develops severe bradycardia in the 30’s during surgery, what to do?

Answer 5

Give atropine and isoproterenol, then place and magnet and start transcutaneous pacing.

Question 6

What does a high pitched sound mean?

Answer 6

The AICD is disabled.

Question 7

What should you do before taking a patient with an AICD to OR?

Answer 7

Deactivate it by placing a magnet and confirming high pitched shrill tone. Why? Electro cautery could cause it to discharge.

Question 8

Can you use a bovie with a cochlear implant?

Answer 8

Do not use on the neck or head. Use bipolar only

Question 9

What two kinds of lasers are most commonly used during surgery on the upper airway?

Answer 9

Carbon dioxide and Nd-YAG (neodymium yttrium aluminum garnet)

Question 10

Five advantages of co2 and YAG lasers

Answer 10

Less bleeding
Coag small vessels
Maintain sterility
Less trauma
Precise dissection

Question 11

What absorbs co2 lasers, and what are they used for?

Answer 11

Absorbed by water and superficial cells, used for laryngeal lesions

Question 12

Lasers offer excellent precision and hemostasis with minimal postop pain and edema. Why is co2 the most common laser?

Answer 12

It has a longer wavelength, is absorbed by water, thus less tissue is penetrated.

Question 13

Why is co2 laser best for lesions on the vocal cords?

Answer 13

Strongly absorbed by water, so only penetrates 0.2 mm, so cleanly removes lesion without damaging underlying tissue

Question 14

Patient has recurrent papillomatosis caused by human papilloma virus. The most effective treatment is

Answer 14

Surgical removal by laser vaporization

Question 15

If your patient is getting their papilloma virus lasered, what three things should you worry about?

Answer 15

Airway fire
Burns from reflected lasers
Aerosolization of HPV

Question 16

What are the two most serious complications of laser surgery?

Answer 16

1- airway fire

2- eye damage

Question 17

When using YAG laser, keep fio2 as low as possible.

Answer 17

Barash says it’s more important to use low fio2 than a laser resistant ETT

Question 18

What are the safest gases to use during laser surgery?

Answer 18

30% o2 in nitrogen or helium

Question 19

YAG lasers have a wavelength of __ nanometers and can cause damage to __

Answer 19

400-1400 nanometers

Retinal damage

Question 20

co2 lasers have a wavelength of __ nanometers and can cause damage to __

Answer 20

3,000-10,000 nanometers

Corneal burns