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931: Advanced Principles of Anesthesia I > Anesthesia for ENT surgeries part 2 > Flashcards

Anesthesia for ENT surgeries part 2 Flashcards

1
Q

Common ENT procedures include

A 
middle ear procedures
myringotomy
tonsillectomy & adenoidectomy
nasal procedures
thyroid surgery
cleft palate & lip
dental restoration
trauma
radical neck dissection
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2
Q

Describe nerve monitoring for ENT cases

A

meticulous identification and preservation of cranial nerves

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3
Q

Nerves most often monitored include

A

facial (VII)
recurrent & inferior laryngeal nerves (X)
vagus nerve (X)
spinal accessory nerve (IX)

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4
Q

When performing nerve monitoring, neuromuscular blocker can be used at

A

induction & intubation only

  • remifentanil 0.05-0.2 mcg/kg/min.
  • TIVA
  • nitrous oxide
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5
Q

Myringotomy is

A

tube placed in the tympanic membrane reducing middle ear pressure

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6
Q

The indication for myringotomy is

A

chronic otitis media- fluid in ear
recurrent otitis media- three or more acute infection in a six month period (four in a 1 year period)
accompanying URI are common

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7
Q

Do you cancel a myringotomy for rhinorrhea?

A

Typically sick kids so if they have some mild symptoms then it is okay to continue with surgery

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8
Q

Anesthetic considerations for myringotomy includes

A

short operations- sedatives may outlast procedure
mask induction- assisted ventilation throughout procedure
antibiotic and steroids placed in ear
-mild pain medications given orally or rectally

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9
Q

Indications for pediatric T&A include:

A

recurrent infections

airway obstruction

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10
Q

Indications for adult T&A include:

A

OSA
UPP (uvulopalatopharyngoplasty)
comorbidities- CHF

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11
Q

Induction for tonsillectomy & adenoidectomy include

A 
pediatric vs. adult- inhalation vs. intraveous
oral RAE tube- consider reinforced
Cuffed vs. un-cuffed
secure ETT midline
eye protection
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12
Q

Anesthetic considerations for T&A include

A 
mouth gag
HOB turned
medications
throat pack
orogastric suction
EBL- 4 mL/kg
IV fluids
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13
Q

Emergence considerations for T&A include:

A

protect airway reflexes
reduce risk of laryngospasm
minimize coughing- topical vs. intravenous lidocaine

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14
Q

Postoperative considerations for T&A include:

A

pediatric position- side lying with head slightly down

adult position- high sitting

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15
Q

Post-tonsillectomy can require surgery for

A

rebleeding (0.3-0.6% of cases)

75% occur within first 6 hours

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16
Q

Anesthetic considerations for return T&A bleed include:

A

hypovolemic- H&H, T&S, IV placement preop

Full stomach- RSI

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17
Q

Septoplasty can be performed to

A

correct deformities of nasal septum

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18
Q

Rhinoplasty can be performed to

A

repair or reshape the nose
cosmetic
airway restoration

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19
Q

Nasal fractures can be

A 
closed reduction (MAC)
open reduction (more invasive- ETT vs. LMA)
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20
Q

The “middle ear” refers to the

A

air-filled space between the tympanic membrane & oval window

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21
Q

Common surgeries of the middle ear in adults & children include:

A

tympanoplasty
staphedectomy or ossiculoplasty
mastoidectomy
cochlear implants

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22
Q

Surgical considerations for middle ear procedures include:

A

congenital defects, trauma, treatment of disease
-bloodless field
microsurgery

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23
Q

Anesthetic considerations for middle ear procedures include:

A

general anesthesia- avoid nitrous oxide, muscle relaxants are avoided
local anesthesia- ability to test hearing during surgery
PONV common
controlled hypotension
deep extubation

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24
Q

Tympanoplasty is performed for

A

a perforated eardrum

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25
The approach for tympanoplasty can be
post auricular- posterior auditory canal or temporal fascial graft- ossicular chain abnormalities repaired with prosthesis
26
Mastoidectomy is performed for
mastoid cells are "open air" | -indications: cholesteatoma or mastoiditis
27
The approach for mastoidectomy include
entry through post auricular region
28
Anesthetic considerations for mastoidectomy include
avoid nitrous oxide & muscle relaxation
29
The largest endocrine gland in the body is the
thyroid | -blood supply is via carotid arteries
30
Indications for thyroid surgery include
thyrotoxicosis | malignancies
31
RLN & external branch of SLN course along _____ of the thyroid
lateral lobes | -associated with movement of intrinsic muscles of the larynx
32
Anesthetic considerations of thyroid surgery (preop) include
preop- euthyroid, airway assessments b/c goiters can compromise airway status, medications- thyroid & beta blockers
33
Anesthetic considerations for thyroid surgery include:
regional anesthetic- combined deed & spinal cervical plexus block direct acting vasopressor- phenylephrine "Rose" position with arms tucked- second IV eye protection- goggles
34
Intraoperative anesthetic considerations for thyroid surgery include
general endotracheal anesthesia - nerve integrity monitor (NIM) EMG endotracheal tube - electrodes contact right & left vocal cords
35
Postoperative anesthetic considerations for thyroid surgery involve
hypocalcemia- signs & symptoms develop within 24-96 hours - perioral numbness & tingling - abdominal pain - extremity paresthesia - tetany - laryngospasm - QT prolongations - mental status changes & seizures - Chvostek sign
36
Postoperative anesthetic considerations for thyroid surgery include:
RLN damage- unilateral more common -hoarseness bilateral more serious- biphasic stridor, dyspnea, respiratory distress, aphonia hematoma- airway obstruction & asphyxiation
37
One of the most common craniofacial abnormalities is
cleft palate & lip | 1:7000
38
The facial bones fuse by
9th week of development
39
Up to 30% of those with cleft palate & lip have other congenital anomalies such as
Down syndrome Pierre Robin Treacher Collins These present airway issues d/t small mouth opening, large tongue, micrognathia
40
Cleft palate & lip involve a
two-stage repair three months- cleft lip repair with primary tip rhinoplasty eight months- closure of the hard palate
41
Preoperative anesthetic considerations for cleft palate & lip include
``` Rules of ten: >10 weeks of age weight- 10 pounds hemoglobin 10 g WBCs <10,000 ```
42
Intraoperative anesthetic considerations for cleft palate & lip include
standard induction oral RAE tube (laryngoscopy can be tricky) remove air from all lines eye protection
43
Postoperative anesthetic considerations for cleft palate & lip include
suture placed through tip of the tongue -acts as an oral airway -prevents damage to palatal repair suction prior to extubation- reduce oral secretions & potential for laryngospasm consider mittens or arm boards so they don't disruption suture lines or surgery
44
Dental restoration can be performed under
``` general anesthesia for multiple reasons: not appropriate for office visit rampant cavities history of cerebral palsy or Down syndrome uncooperative ```
45
Anesthetic considerations for dental restoration include preoperative
``` oral midazolam (0.5 mg/kg) intramuscular ketamine (3-4 mg/kg) ```
46
Intraoperative anesthetic considerations for dental restoration include
``` standard induction nasal intubation-oxymetazoline spray, warmed RAE tube, nasal trumpet dilation throat pack orogastric suction deep extubation ```
47
The goal of trauma is to
secure the airway without causing additional damage or compromising ventilation
48
Airway obstruction in trauma can be related to:
edema, bleeding, intraoral fractures, nasal passage injury, foreign bodies
49
Airway management for trauma depends on
the situation
50
In cases of severe face or neck trauma, consider
retrograde intubation jet ventilation via cricothyrotomy emergent tracheostomy
51
Injuries to the head & neck may include
cervical or cranial injury as well so consider in-line stabilization
52
LeFort determined common fracture lines along the
maxilla & face
53
A LeFort 1 fracture is a
horizontal fracture extending from the floor of the nose and hard palate through the nasal septum
54
A LeFort II fracture is 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 maxillar
55
A LeFort III fracture
separates the midfacial skeleton from the cranial base, traversing the root of the nose, ethmoid bone, eye orbits & sphenopalatine fossa
56
Anesthetic considerations for trauma include
avoid nasotracheal intubation consider other trauma (cervical, thoracic, & abdominal) correct ABCs before addressing facial trauma consider remaining intubated awake intubation- maintain airway reflexes cutting tools attached to the patient or available at the bedside anticipate extensive blood loss- T&C patient, deliberate hypotension if tolerated
57
Radical neck dissection is the
resection of cancerous tumors from head & neck
58
Frequent comorbidities of radical neck dissection include
elderly, smoking, ETOH abuse, cardiovascular disease, history of radiation therapy
59
Anesthetic considerations for radical neck dissection include
airway management- CT results, consul surgeon, preoperative exam preoperative labs- including type & cross two large bore IVs (consider central venous access) arterial line- tight blood pressure control, lab analysis
60
Additional anesthetic considerations for radical neck dissection includes
``` muscle paralysis controlled hypotension minimize vasoconstrictors- flap perfusion intake & output- colloid vs. crystalloid vagal response- anticholinergic ```
61
Radical neck dissection may require an
intraoperative tracheostomy or laryngectomy | hyper-oxygenate patient
62
When performing a radical neck dissection it is important to move
ETT to level above transection - once tracheostomy is in place verify ventilation & remove ETT - connect tracheostomy to ventilator - surgeon will suture in place
63
Postoperative considerations for a radical neck dissection include
``` tracheostomy care controlled ventilation chest radiography- rule out pneumothorax monitor for laryngeal edema ICU- potential edema, fluid shifts, altered ventilation, & extensive anesthesia time ```
64
The essential goals of ENT surgery include:
1. thorough knowledge of airway anatomy 2. selecting & preparing for the appropriate airway technique 3. preventing & managing airway complications 4. producing brief & selective relaxation with potential for rapid recovery 5. omitting neuromuscular relaxation for select cases 6. maintaining cardiovascular stability 7. preventing and/or containing airway fires 8. minimizing intraoperative blood loss 9. minimizing adverse responses from carotid sinus manipulation 10. prevent & treat postsurgical airway obstruction 11. avoid and/or limit use of nitrous oxide

931: Advanced Principles of Anesthesia I (22 decks)

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