ENT

Question 1

Why is OSA important in T and As

Answer 1

1. Disposition
2. Type- whether amenable to surgery or not ( central v obstructive)
3. Airway obstruction re difficulty of bm ventilation / necessity of preop sedation weighed against risks

Question 2

How is sleep study useful and what’s the most useful info from a sleep study

Answer 2

1. Determine type and severity of osa which then alters disposition post op and whether surgery would help

Question 3

Issues with typical ent case

Answer 3

Shared airway
OSA
Kids age/behaviour and preservation

Question 4

Dose of cocaine for ent surgery

Answer 4

Max 3 mg/ kg or 300 mg

Ideally use less than 4 % solution to prevent cardiac toxicity

Question 5

Fess- important anaesthetic considerations

Answer 5

Bleeding ( often use cocaine and packing topically )
Protect airway - use south Rae
Sizing of Rae 0.5 smaller than age/4 + 4 equation
If sinus surgery - Tiva rather than has to reduce risk of gas embolus?? To maintain better wake up ie need to minimise increases in pressure ( I think) and ponv prophylaxis
Avoid nitrous because of risk of air embolus

Question 6

Key issues with mastoidectomy

Answer 6

1. Surgical access / head covered - south Rae
2. Ponv in 70% - tiva/ at least 2 antiemetic
3. Very stimulating procedure - remifentanyl good choice and also smooths extubation