Advanced Anesthesia 2 > ENT - Midterm Wrap Up > Flashcards

ENT - Midterm Wrap Up Flashcards

(51 cards)

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1
Q

What is a major side effect from Inner Ear surgery?

A

PONV

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2
Q

What kind of Anesthesia is used for Bilateral Myringotomy & Tubes (BMT)

A

General w/ LMA

or

Mask

(Flexible LMA better for Head Flexion & Rotation)

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3
Q

What are the advantages of using N2O for BMTs?

A

↑Middle Ear Pressure that relieves via Reabsortion or Eustachian Vent

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4
Q

What is a disadvantage of N2O for ear surgery?

A

Graft Displacement from Negative Pressure Reabsorption

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5
Q

What are the Facial Nerve Monitoring considerations for Ear Surgery?

A

Nerve Integration Monitor (NOT NIM Tube)

May need to Reverse Paralytics

Use RemiFentanyl Instead of NMBs

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6
Q

Which Nerve is monitored for the Middle Ear, Medial Tampanic, and Mastoid Air Cells?

A

CN IX - Glossopharyngeal

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7
Q

Which Nerve is monitored for the Lateral Tympanic, External Acoustic Meatus, and Concha?

A

CN X - Vagus Nerve

CN V - Auriculotemporal Nerve

CN VII - Nervus Intermedius

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8
Q

Which Nerve is monitored for the Temporal Scalp, Pre-Auricular Tragus, TMJ?

A

CN V - Auriculotemporal Nerve

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9
Q

Which Nerve is monitored for the Posterolateral Scalp, Supra-auricular Scalp, and Superior Pinna?

A

C2 & C3 - Lesser Occipital Nerve

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10
Q

What Nerve is monitored for the Angle of Jaw, Pinna, Lateral Neck, Parotid Skin, and Mastoi Process?

A

C2 & C3 - Great Auricular Nerve

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11
Q

What are ways to keep the surgical field from being bloody for Ear Surgery?

A

Head Up to reduce Venous Pressure

&

Deliberate HYPOtension

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12
Q

What can be used for Dilberate HYPOtension for Ear Surgery?

A

Beta Blockers

Clonidine

Opioids (Remi Drip)

Keep MAP 50-60 & HR

Intra-Op SBP > Pre-Op DBP

HR 60

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13
Q

What can be used for PONV Prophylaxis?

A

Serotonin Antagonists

Butyrophenones

Scopolamine

Decadron

Reglan

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14
Q

What is Maxillary Antrostomy?

A

Procedure to clear Sinus Opening

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15
Q

What is a Uncinectomy?

A

Procedure to clear Osteomeatal Complex

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16
Q

What is a Caldwell-Luc procedure for?

A

Fenestration of Anterior Maxillary Sinus & Drainage into nose

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17
Q

What can happen if a patient moves during Nasal Surgery?

A

Blindness

Carotid Damage

Intracranial Damage

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18
Q

What should be assessed in a patient for Nasal Surgery?

A

OSA

NSAID Use

CV Status for Pressor Usage

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19
Q

What is Samter’s Triad?

A

Asthma, Sinus Disease, and Nasal Polyps r/t ASA & NSAIDs

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20
Q

What are common Nasal Vasoconstrictor meds?

A

Phenylephrine

Cocaine

Epi

Lido w/ Epi

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21
Q

How does a little Cocaine compare with a lot of Cocaine?

Study These Flashcards
A

Small Dose: Vagotonic & ↓HR

Big Dose: Tachycardia, V-TACH/Fib, MI

22
Q

How should patients be extubated for Nasal surgery?

Study These Flashcards
A

Awake after thorough suctioning

23
Q

Why should the oral passage be assesed for blood clots after nasal surgery?

Study These Flashcards
A

Clot can be inhaled and lead to total airway obstruction & death

24
Q

What structures are a part of Waldeyer’s Ring?

Study These Flashcards
A

Palatine Tonsils

Nasopharyngreal Tonsil (Adenoid)

Lingual Tonsil

25
Adult Tonsillectomy is _______ painful than kids
Adult Tonsillectomy is **MORE** painful than kids
26
How soon can Pulmonary Edema develop after Airway Obstruction relief?
Minutes to Hours after relief
27
Why is Decadron used for Nasal Surgery?
Less PONV Better Diet Tolerance Reduced Pain
28
Post-Op bleeding tonsils ________ with age with a ______ occurence in Adults & Males
Post-Op bleeding tonsils **INCREASES** with age with a **HIGHER** occurence in Adults & Males
29
How soon can Bleeds occur after Tonsil Procedures?
Within 6 Hrs or 7-8 Days Post-Op after scab falls off
30
What are indications of Post-Op Tonsillar Bleed?
Unexplained Tachycardia Excessive Swallowing Pallor Restlessness Sweating ↑Cap Refill
31
What is a _Late_ sign of a Tonsillar Bleed?
HYPOtension
32
What equipment should be available for Bleeding Tonsils?
Experienced Help Extra Airway Supplies Two Suctions RSI w/ Head Down Lateral Mask Induction
33
What are Vocal Cord Papillomas?
Benign, but can be Malignant lumps that cause hoarseness & resp obstruction
34
What is Reinke's Edema?
Sac-Like, Fluid-Filled swelling of Vocal Cords
35
How closed is the airway if Stridor is present?
\< 4-5 mm
36
Which Goggles should be worn for YAG Lasers?
Green Goggles
37
Which goggles should be worn for Argon Lasers?
Amber Goggles
38
Which goggles should be worn for CO2?
Clear Goggles
39
How should an Airway Fire be managed?
D/C Circuit Extubate & Put ETT in Water Ventilate w/ Mask or New Circuit Maintain Anesthesia w/ IV Extensive Pulmonary Care
40
When should Non-Intubation techniques be AVOIDED?
Obese Patients Emphysema Large Tumors
41
What are the risks associated w/ **_Supra_**glottic Ventilation?
Poor Ventilation Debris Blown into Trachea Pneumomediastinum PTX SQ Emphysema Vocal Cord Movement Can't Monitor End Tidal
42
How does **_Sub_**glottic Jet Ventilation compare to **_Supra_**glottic?
Minimal Vocal Cord Movement More Barotrauma Risk Reduced Driving Pressures
43
What is the respiratory rate for High Frequency Positive Pressure Ventilation?
60 - 120 bpm
44
What is the respiratory rate for High Frequency Jet Ventilation?
100 - 400 bpm w/ volumes \< dead space
45
For Rigid Bronchscopy Ventilation, how should adequacy of ventilation be assesed?
Chest Rise since EtCO2 will not return via circuit and might be inaccurate
46
During Rigid Bronchoscopy, how long should Apneic Oxygenation be limited to?
2 min, the remove scope and ventilate patient or anytime PaO2 drops
47
How fast does PCO2 accumulate per minute during apnea?
3-4 torr/minute
48
What are the complications of Bronchoscopy?
Bronchospasm Hypoxemia CO2 Retention Resistance to Ventilation PTX, Pnuemomediastinum, SQ Emphysema Awareness
49
Organic Foreign Bodies are ______ than Inorganic when inhaled
Organic Foreign Bodies are **WORSE** than Inorganic when inhaled since they can soften & expand
50
How is Urgent Foreign Body removal managed?
Give Robinul / Atropine No Pre-Op Sedation No N2O Awake Laryngoscopy
51
How should LESS Urgent Foregn Body removal be managed?
IV/Mask Induction Maintain spont. respiration until FB is seen Lateral Position if Organic

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