Exam3:abd/GU surgery, neuro, ENT/opthalmic surgery, geriatric Flashcards
(389 cards)
1
Q
what are omphalocele and gastroschisis associated with
A
latex allergy from expose to products
2
Q
which has a present sac holding abd contents omphalocele or gastroschisis
A
omphalocele
3
Q
omphalocele vs gastroschisis
A
4
Q
which occurs R of the umbilical cord gastroschisis or omphalocele
A
gastroschisis
5
Q
which comes out of umbilical cord area gastroschisis or omphalocele
A
OMPHALACELE
6
Q
what kind of evaluation do we need for surgery with omphalacele
A
cardiac
7
Q
what is omphalocele associated with
A
*Trisomy 21,
Diaphragmatic hernia,
cardiac/bowel malformation
*Beckwith-Wiedemann syndrome
8
Q
T/F use N2O on gastroschisis or omphalocele
A
false
9
Q
anesthetic managmet of gastroschisis or omphalocele
A
*Decompress stomach with NG before induction
*RSI vs awake intubation
*No nitrous oxide
*Muscle relaxation
*Keep intubated 1 - 2 days
*If PIP > 25-30cmH20 or intragastric pressure high à delayed closure
*Monitor glucose
*May have compromised ventilation
*Aggressive hydrate w/ BSS and 5% albumin to replace 3rd space losses
*Warm OR
10
Q
what do we do before induction for gastroschisis or omphalocele
A
NGT to decompress stomach
11
Q
what kind of induction for gastroschisis or omphalocele
A
RSI or awake
12
Q
what two complication would make us delay closure for gastroschisis or omphalocele
A
PIP> 25-30 or high intragastric pressure
13
Q
what lab do we monitor intraop for gastroschisis or omphalocele
A
glucose
14
Q
what do we aggressively hydrate gastroschisis or omphalocele with
A
BSS and 5% albumin
15
Q
what are s/s of diphragmatic hernia after birth
A
*dyspnea,
tachypnea,
cyanosis,
absence of breath sounds on the affected side,
severe retractions
scaphoid abdomen
barrel chest
16
Q
what is treatment for diaphragmatic hernia
A
surgical correction around day 4 when neonate is stabilized
17
Q
anesthetic managment of diaphragmatic hernia
A
*Awake intubation vs RSI
*Anticholinergic to prevent bradycardia
*NG Tube
*Affected side down (decrease compression on heart/lung)
*High RR, low TV ventilation
*Need to reduce PVR (or prevent further increase)
*Monitor left-to-right shunt
*SpO2 probe on RUE (pre-ductal) and lower extremity (post-ductal)
18
Q
what are tracheoesophageal fistula and esophageal atreasia associate with (VACTERL)
A
- Vertebral anomalies
- Anal atresia (imperforate anus)
- Cardiac anomalies
- Tracheoesophageal fistula and esophageal atresia
- Renal anomalies
- Limb malformation
19
Q
what are s/s tracheoesophageal fistula and esophageal atreasia
A
*choking on first feeding,
inability to place NGT,
excessive secretions,
respiratory distress with feedings
20
Q
how do we intubate Tracheoesophageal Fistula and Esophageal Atresia
A
awake
21
Q
what SpO2 monitors do we place for Tracheoesophageal Fistula and Esophageal Atresia
A
pre and post ductal
22
Q
how do we place ETT in Tracheoesophageal Fistula and Esophageal Atresia
A
R main stem then pull back until BBS, keep bevel anterior
23
Q
what procedures do we do with Tracheoesophageal Fistula and Esophageal Atresia
A
bronchoscopy
art line
24
Q
after Tracheoesophageal Fistula and Esophageal Atresia are corrected what is an important anesthetic managment
A
recruit alveoli
25
when do we extubate Tracheoesophageal Fistula and Esophageal Atresia
early
26
what population has necrotizing enterocolitis
premature
27
what are s/s necrotizig enterocolitis
* Increased gastric residuals with feeding
* Abdominal distention
* Bilious vomiting
* Lethargy
* Occult or gross rectal bleeding
* Fever
* Hypothermia
* Abdominal mass
* Oliguria
* Jaundice
* Apnea and bradycardia
* Fever
28
what are labs in necrotizing enterocolitis
hyperkalemia,
hyponatremia,
metabolic acidosis,
hyperglycemia,
hypoglycemia, and,
in the most serious cases, signs of disseminated intravascular coagulation.
29
what does imaging show us in necrotizing enterocolitis
Dilated intestinal loops,
pneumatosis intestinalis,
portal vein air,
ascites,
pneumoperitoneum.
30
anesthetic managment of necrotizing enterocolitis
*Narcotic + muscle relaxant
*Avoid volatiles
*Inotropes: Dopamine
*Large volume replacement
*Blood products: FFP, PLT, blood
*Warmed OR and warmed fluids
*Post-Op ventilation
31
what is an olive shaped enlargement of the pylorus muscle
pyloric stenosis
32
what are s/s pyloric stenosis
*Nonbilious postprandial emesis that becomes more projectile with time,
a palpable pylorus,
visible peristaltic waves
33
what is anesthetic managment of pyloric stenosis
*Correct hypovolemia, acidosis, and electrolyte disorders
*Place NG tube BEFORE induction and suction
*Awake intubation or RSI
*Awake extubation
*Typically turned 90* on operating table
34
when do hernias become emergencies
when they are incarcerated, leads to bowel death and sepsis
35
what kind of block can we do for inguinal hernia
caudal
36
what kind of induction do we do for inguinal hernia
RSI
37
how happens if bowel obstruction is left untreated
bowel death and sepsis
38
what is anesthesia for bowel obstruction
awake intubation or RSI
39
what is tx for status epilepticus
lorazepam 0.1 mg/kg push over 2 minutes q10
diazepam 0.5/kg
40
what is a dysraphism (imcomplete fusion) of the head
encephalocele
41
what is a dysraphism (incomplete fusion) of the spine
meningocele
42
what vitamin helps prevent neural tube defects
folic acid/folate
43
what is NTHFR
folate deficiency
44
know the different pictures
spina bifida pictures
45
what do we avoid in chiari malformation
increased ICP (they are herniated)
46
what is the most common cause of hydrocephalus
tumors causing obstruction
(less common is overproduction of CSF)
47
what is an overproduction or impaired drainange of CSF from brain
hydrocephalus
48
what are s/s hydrocephalus
HA, vomiting, ataxia, seizures
49
what anesthetic drug do we avoid in myasthemia gravis
muscle relaxers
50
what muscle relaxer do patients with myotonic dystrophy have an increased sensitivity to
anectine
51
what are anesthetic concerns of myotonic dystrophy
1.Cardiomyopathy
2.Respiratory muscle weakness and sensitivity to respiratory depressants
3.Vulnerability to aspiration of gastric contents
4.Potential for abnormal responses to anesthetic drugs
52
what anesthetic technique do we avoid in cerebral palsy
regional
53
what is the hypothesis about intracranial contents
monroe kellie
CSF
blood
brain
54
what is CPP formula
CPP= MAP-CVP
55
where is CSF made
choriod plexus in two lateral ventricles and 3 and 4th ventricles
56
where is CSF reabsorbed
arachnoid villi
57
what happens if ICP> CPP
ischemia
58
what range of MAP is CBF autoregulated
50-150 mmHg
59
what is anesthetic management for increased ICP
*Induction goal for intracranial hypertension: AVOID INCREASE IN ICP
*Most anesthetic drugs decrease ICP, except ketamine
*Preoperative sedatives - Oral versed 0.5-1mg/kg
*Opioids, IV Lidocaine, Barbiturates
*Propofol (2 to 5 mg/kg) has similar effects on cerebral hemodynamics and maintains tight coupling of cerebral blood flow and cerebral metabolic rate
*RSI: rocuronium 1.2mg/kg
*Rapid intubation after full GA established and relaxation
*Avoid prolonged apnea
60
what anesthetic drug can increase ICP
ketamine
61
what drugs can mess with neuro exam
versed
62
how can we decrease ICP
*Hyperventilation
*Keep PaO2 > 100
*Use lowest possible ventilator pressures
*Maintain preintubation MAP
*Mannitol
*Adequate NMB - reduce tone, avoid coughing
*Lidocaine
*Sedation
*Check for venous occlusion
63
what is risk of opening cranial vault
VAE
64
what is treatment for VAE
*Flood surgical field with saline, jugular compression, bone wax, lower head, 100% O2, turn of nitrous, turn left lateral decubitus, central line to aspiration air, supportive measures
65
T/F burn injuries have declined over the past two decades
true
66
what home device is used more to help prevent burns?
smoke detectors
67
what is a major cause of death in burn patients
multiple organ failure and infection
68
what is the largest organ in the body
skin
69
what are two important functions of skin
-important sensory organ
-barrier to protect against pathogens
70
what percentage of burn injuries occur on 17 years of age
35%
71
what kind of injuries are predominant in small children
scald injuries
72
what are sources of chemical burns for children
household chemicals and/or cleaning products
73
what is the 2nd leading cause of accidental death among children ages 1-4
fires and burns
74
what is one of the most common injuries resulting from abuse amongst children
scald burns
75
what kind of burn often accompanies thermal burns
inhalation burns
76
when we have thermal burns what should we suspect until aggressively ruled out
inhalation burns
77
what temp of dry air leads to inhalation burn
300* C
78
what temp of steam leads to inhalation burn
100* C
79
what does brief exposure of the epiglottis or larynx to 300c dry or 100c steam lead to
massive edema and rapid airway obstruction
80
what are warning signs of respiratory injury
hoarseness
sore throat
dysphagia
hemoptysis
tachypnea
use of accessory muscles
wheezing
carbonaceous sputum production
elevated carbon monoxide levels
singed facial and nose hair
81
all burn patient must be considered at risk of ______ compromise
respiratory
82
with all burns we must aggressively rule out
upper airway injury
83
what is the best way to determine if their is upper airway injury from burn
direct visualization from laryngoscope or FOB
84
what is first treatment of upper airway burn injury
early ET intubation
85
what is timeline for giving succs for burns
safe before 24 hrs, unsafe after 24 hrs
86
when can we use succs again in burn patient
until complete wound closure has occurred and the patient is gaining weight
87
what is the safest way to secure airway with abnormal airways or upper airway obstruction
patient awake
88
what drugs do we use with caution in abnormal airways or upper airway obstruction
sedatives and narcotics
89
what drug is beneficial for sedation with abnormal airways or upper airway obstruction
Precedex
90
what VS do we watch with precedex
BP
91
what are methods to secure airway in abnormal airways or upper airway obstruction
glidescope
McGrath
FOB
direct laryngoscopy
LMA
blind nasal intubation
bullard laryngoscope
92
if upper airway is badly damaged and endotracheal intubation is not possible how do we secure airway
direct surgical approach
-needle cric
-surgical cric
-tracheostomy
93
when do we remove ETT
until laryngeal edema has subsided
94
what is presentation of carbon monoxide poisoning
cherry red appearance
pulse oximeter reads false high
ABG show normal PaO2 which does not correlated SaO2
95
how does pulse oximeter read with carboxyhemoglobin
false high (85%?)
96
how does 100% O2 affect CO half life
shortens it from 4 hrs to 40 minutes
97
when is fluid loss greatest from burn
within the first 12 hours
98
when does fluid loss from burns stabilize
after 24 hours
99
what is parkland formula for fluid replacement
4mL x kg (body weight) x % of total burned surface area
first half over 8 hours, 2nd half over next 16 hours
100
What is the Brooke Formula for burn resuscitation?
0.45mL x kg + 1.5 ml/kg colloid (body weight) x % of total burned surface area
first half over 8 hours, 2nd half over next 16 hours
101
what is the minimum urinary output in burn patients for children weighing less than 30 kg
1 ml/kg/hr
102
what phase is burn victim in after initial 48 hours
hypermetabolic hyperhemodynamic phase
103
what is manifestation of hypermetabolic phase
hyperthermia
tachypnea
tachycardia
increases serum catecholamine levels
increased oxygen consumption
increased catabolism
incresed BMR
104
how long does hypermetabolic phase last
several weeks until wound healing is well underway
105
what are the 4 patho effects of burns
hypothermia
hypovolemia
infection
trauma to other structures
106
what is goal of surgical debridement and grafting
rapidly restore skin integrity after the burn
107
what is common approach to skin grafting
-initial waiting period of fluid resuscitation and stabilization
-excision and grafting of the wound
108
what is goal of wound excision
control infection and remove sloughing burn eschar
109
when do we stop wound excision
after 2-3 hours
when patient temp decreases to 35c or less
blood loss of 10 u PRBCs
110
a full burn removal can loose _______ blood volumes
2-3
111
what is a consideration of debridement with sedation
very painful
112
what are anesthetic considerations for the burn patient
-warm up operating room
-check hgb hct, order blood
-have blood in room and checked
-have one blood warmer primed and ready
-if large burn have two blood warmers
-adequate IV access
-narcotics
-invasive line placement
113
what are parts of preop eval for burns
-complete medical hx
-laboratory studies
-brief physical exams
-lung auscultation
-assessment of chest compliance
-inspection of neck and oral cavity for intubation
114
what burn details do we include in history
time elapsed
type of burn
115
what kind of burns are most common in children
thermal burns
flame and scald
116
what do we ask about with any kind of burn
inhalation injury
117
what type of burn has more damage than can be observed
electrical
118
what injuries are often associated with burns
C spine injuries
fractures
119
what other burn information do we get preop for burns
-Underlying trauma
-Mechanism of burn
-Percentage of TBSA burned
-Location of burn sites
-Area and the amount that the surgeon intends to debride
-Whether the patient will be grafted during the perioperative course
120
what state are burn patients in
shock...
121
when do we stop orojejunal or nasojejunal intake prior to sedation or induction
4 hours before
122
what can we use to monitor residuals from intake
NGT
123
what are components of physical exam for burns
examine airway
hoarseness and wheezing
carbonaceous sputum
extent and depth of burns
IV access sites
124
what temp should OR be for burn patients
97F or 37C
125
what can use use to help warm burn patients
multi-blankets
reflective warming blankets
radiant warmers
fluid/blood warmers
forced air warmers
sterile wrapping
126
what is O2 status of burn patients? what % O2 do we give
hypoxemic
give 100% O2
127
what kid of ETT do we use for burn patients
cuffed
128
is oral or nasal intubation better tolerated for long term
nasal
129
how do we secure ETT in burn
sutured to nasal septum
wired to maxilla
130
what do we place in burn patient to prevent aspiration
NG tube (post injury ileus)
131
what do we do since ECG leads are difficult to place/secure in burns
staple the leads or use needle electrodes
132
where do we place blood pressure cuffs on burn patients
unaffected limb or non surgical site
133
what line/monitor do we place for extensive surgical debridement, or if expecting rapid blood losses, have a potential for hemodynamic swings, and intraoperative labs needed
A line
134
what are alternative pulse ox sites
nose
ear
cheek
135
what can give false reading of pulse ox
carboxyhemoglobin
136
T/F DC preexisting lines such as aline, CVP, PA in OR
false
137
what is an alternative infusion route for burns if IV is not accessible
IO
138
what kind of temp monitor do we use in burns
esophageal stethoscope
139
who monitors VS during burn transport to and from OR
CRNA
140
what are some transport considerations for burn patients
multiple infusions
VS monitoring
portable Oxygen
intubated
consider comfort and privacy
admine amnestic and analgesic drugs
secure ETT
141
what is blood loss per cm2 on skin excised for skin graft
1-4ml
142
what guides our decision to replace blood
UO
HCT
hemodynamic parameters
143
what can we do as a local soak to provide hemostasis
epinephrine soaks
144
how do we titrate anesthetics in burns to prevent hypotension
slowly
145
what can we give to derease anxiety in stable patients
benzo or narcotic
146
what are psych complications burn patients often experience
anxiety
depression
pain
147
where do we sometimes induce burn patients
on pts bed then move to OR table
148
what kind of anesthesia can we use for burn trauma limited to a small area or extremity to provide prolonged postop analgesia
regional
149
when do we avoid regional anesthesia
on burned tissues
severe hypovolemia
coagulopathy
cardiorespiratory instability
extent of surgical field including donor site
150
what kind of neuraxial can we do on children for lower extremity burns
caudal injection
151
T/F standard induction drugs are all acceptable to use in burns
true
152
when do we limit use of propofol
hypotension
sepsis
during initial resuscitation
153
what sedative maintains hemodynamics and has less resp depression than barbiturates
etomidate
154
what does repeated doses of etomidate lead to
adrenocortical suppression
155
what anesthetic drug offers stable hemodynamics and analgesia
ketamine
156
what is a good drug for sedation during dressing changes
ketamine
157
what happens with ketamine and repeated dosages
tolerance
158
how do we minimize hallucinogenic episodes with ketamine
benzos in small doses
159
what drug class do we give to decrease secretions
anticholinergics
160
how do we induce pediatric patients
inhalation induction
161
what happens with narcotics and repeated burn procedures
tolerance development, will need more drugs with subsequent procedures
162
what is a good narcotic for dressing changes
remifentanyl
163
what pain med do we use cautiously in burns
NSAIDS
164
what is a good method of narcotic delivery in burns
PCA
165
what anesthetic gas is good for dressing changes
N2O
166
what is timeframe for avoiding succs in burns
24 hours to 1.5 years after thermal injury
167
when do burn patients develop resistance to NDMR
1 week post burn
168
how do dose NDMRs for patients with burns >20%
increased dose 2-5x
169
what is the phase after burn is "healed"
reconstructive phase
170
what are considerations during the reconstructive phase of a burn
visible scars remain
physical and occupational therapy
prevent contractures and deformity
reconstructive procedures
psychological issues
burn camps
171
what age does accidental ingestion of toxic substances usually occur
often in adolescents but also in toddlers
172
what do we look for in systemic toxicity from poisoning/overdose
airway protection
local skin and mucosal damage
173
what do we do to precent aspiration in poisoning/overdose
intubate if needed
174
what do corrosive materials cause
burn to GI tract, edema of airway
175
T/F induce vomiting in ingestion of corrosive substances
false
176
what do we do when assessing poisoning/overdose
gather as much hx of event as possible
urine and serum drug screen
177
what is a geriatric patient
>65
178
what saying do we follow for geriatrics
start low and go slow
179
what drug class do we avoid in geriatrics during induction (and throughout case)
narcotics
180
what can we replace narcotics with for pain in geriatrics
tylenol and ibuprofen
181
what are the 4 main factors of surgical risk for geriatrics
age
patients status/co-existing disease
elective or emergent surgery
type of procedure
182
what is anesthesia implication of myocardial hypertrophy
Failure to maintain preload leads to an exaggerated decrease in CO;
excessive volume more easily increases filling pressures to congestive failure levels;
dependence on sinus rhythm and low-normal HR
AKA be fluid conservative and keep NSR
183
what are anesthetic implications of Reduced B receptor responsiveness
Hypotension from anesthetic blunting of sympathetic tone;
altered reactivity to vasoactive drugs; increased dependence on Frank-Starling mechanism to maintain CO;
labile BP,
more hypotension
184
what are anesthetic implications of conductive system abnormalities
Severe bradycardia with potent opioids;
decreased CO from decrease in end-diastolic volume
185
what are anesthetic implications of stff arteries
Labile BP;
diastolic dysfunction;
sensitive to volume status
186
what are anesthetic implications of stiff ceins
Changes in blood volume cause exaggerated changes in cardiac filling
187
what is the most common complication and the leading cause of death in the postop period
myocardial infarction
188
what are parts of the periop cardiac risk calculator
surgical procedure
functional status
creatinine level
ASA classification
age
189
what are the 6 variables of the revised cardiac risk index
hx ischemic heart disease
hx of CHF
hx of cerebrovascular disease
hx of DM requiring preop insulin
CDK with creatinine >2
undergoing suprainguinal vascular, intraperitoneal, or intrathoracic surgery
190
what does the revised cardiac risk index predict
30 day risk of death, MI, or cardiac arrest
191
how much is each point on revised cardiac risk index increase risk by
each item is 15%
192
what is a MET
metabolic equivalent
the amount of energy it cost to complete a task
193
1 MET = _______ ml/kg/min O2
3.5
194
MET score
195
what is met score for watching tv
1
196
what is met score for gardening
2
197
what is met score for getting dressed
2-3
198
what is met score for housework
3-4
199
what is met score for taking a shower
3-4
200
what is met score for brisk walking
3.3 met
201
what is met score for golfing
4-5 met
202
what is met score for strenuous hiking
6-7 met
203
what is met score for swimming
9-10 met
204
know this image
205
how is chest wall compliance in geriatrics
decreased
206
how is alveloar surface area in geriatric
decreased, so decreased gas exchange
207
how is PO2 in geriatrics
lower
208
how is TV in geriatrics
same
209
how is Residual volume in geriatrics
increased
210
how is ERV in geriatrics
less
211
how is IRV i geriatrics
less
212
how is FRC in geriatrics
increased
213
how is VC in geriatrics
decreased
214
what are some surgical related factors that lead to postop pulmonary complications
* Prolonged operation (> 3 hours)
* Surgical site
* Emergency operation
* General anesthesia
* Perioperative transfusion
* Residual neuromuscular blockade after an operation
215
what are some patient related factors that lead to postop pulmonary complications
* Age greater than 60 years
* Chronic obstructive pulmonary disease
* ASA class II or greater
* Functional dependence
* Congestive heart failure
* Obstructive sleep apnea
* Pulmonary hypertension
* Current cigarette use
* Impaired sensorium
* Preoperative sepsis
* Weight loss greater than 10% in 6 months
* Serum albumin level less than 3.5 mg/dL
* Blood urea nitrogen level greater than or equal to 7.5 mmol/L (≥ 21 mg/dL)
* Serum creatinine level greater than 133 mol/L (> 1.5 mg/dL)
216
what fluid can we give to older patients who are dehydrated
albumin
217
what 4 risks does a decrease in renal function lead to
1.Fluid overload
2.Accumulation of drugs excreted by kidneys
3.Decreased drug elimination
4. Electrolyte imbalances (cardiac arrhythmias
218
the decline of what two systems lead to prolonged action of drugs in oldies
kidneys and liver
219
what do we keep blood sugar under for surgery
<150
220
hypothermia lasts (longer/shorter) in oldies
longer
221
why do old people get cold
less body mass
thin dermis
reduced BMR
higher surface area
222
what temp do old people shiver
35 C
95 F
223
how do old people handle CNS effects of anesthesia
increased confusion, can last days
224
what drugs cause more confusion in older adults
benzos
versed
scopalamine
benadryl
ketamine
atropine
reglan
225
how is baroreceptor response in neuraxial for oldies
impaired baroreceptor response leads to severe hypotension
226
T/F regional is the best option for older adults
False
227
how is dose for oldies in spinal and epidural
decreased
228
what kind of herbals cause bleeding
g ones like garlic...
229
what narcotic do we avoid in elderly
demerol 2/2 toxic metabolite
230
some polypharmacy considerations
1.Discontinuing or substituting medications that have potential drug reactions with anesthesia
2.Discontinuing nonessential medications that increase surgical risk
3.Identifying medications that should be discontinued based on Beer's Criteria
4.Continuing medications with withdrawal potential
5.Avoid starting new benzodiazepines and reducing the dose prescribed to patients at risk for POD
6.Avoid administering meperidine for analgesia
7.Using caution with antihistamines and medications with strong anticholinergic effects
8.Consider starting medications that decrease perioperative cardiovascular adverse events per ACC/AHA guidelines for β-blockers and statins
9.Adjusting dosing of medications that undergo renal excretion based on estimated GFR
231
how is mac affected by age
MAC decreases with increasing age
232
how is VD in oldies
increased
233
what patients are we cautious on anectine
immobile patient, may be at more risk of hyperkalemia
234
how doe propofol affect oldies
Hypotension; prolonged recovery; increased brain sensitivity
235
who do we adjust prop dose for oldies
decrease by 50% (1-1.5 mg/kg)
236
how does etomidate affect older adult
Increased brain sensitivity; greater hemodynamic stability
237
how do we adjust etomidate dose for oldies
decrease by 50%
238
how do opioid affect oldies
Increased brain sensitivity; profound physiologic effects; slower onset and delayed recovery; consider route of metabolism and metabolites; avoid meperidine
239
how do we adjust opioid dose for oldies
decrease by 50%
240
how does midazolam affect oldies
Increased brain sensitivity; avoid per Beers Criteria
241
how do we adjust midazolam for oldies
decrease by 75%
242
T/F decrease our dose of MR in elderly
F, keep it the same
243
what is haldol dose for oldies
1-2 mg
.25-.5 q2
244
what are risk factors for posop cognitive dysfunction
* Genetic disposition
* Lower educational level
* High alcohol intake or alcohol abuse
* Increasing age
* High ASA status
* Preexisting mild cognitive impairment
* History of cerebrovascular accident
* Major operations, redo operations
* Cardiac surgery
* Longer duration of surgery and anesthesia
* Intraoperative cerebral desaturation
* Postoperative delirium
* Postoperative infection
245
occulodexter is the ______ eye
right
246
oculosinister is the ____ eye
left
247
oculi uteque is ________ eye
both eyes
248
what is normal IOP
10-20
249
what drugs increase IOP
ketamine
succs
250
what nerves are involved in the oculocardiac reflex
trigeminal
vagal
251
what is most common sign of oculocardiac reflex
sinus brady
252
what is the afferent oculocardiacs nerve
trigeminal (5)
253
what is the efferent occulocardiac nerve
vagus (10)
254
what conditions can trigger the ocular cardiac reflex
traction on extraocular muscles
direct pressure on globe
ocular trauma
retrobulbar block
255
what is a complicaiton of a continous increase in IOP
blindness
256
what is first action to fix oculocardiac reflex
ask surgeon to stop
257
what medication do we give to treat brady from oculocardiac reflex
atropine 0.01-0.02 mg/kg IC
258
what is affect of robinol and atropine on IOP
increase it
259
what is deviation of one eye relative to the visual axis of the other eye
strabismus
260
what is the tendency of one eye to turn inward
esophoria
261
what is the tendency of one eye to turn outward
exophoria
262
what is the inward deviation of both eyes "crossed eyes"
esotropia
263
when does visual maturation occus
age 5
264
when should strabismus surgery be completed
early childhood
265
what anesthetic complication is linked to strabismus
MH
266
how do extubate in strabismus
deep
267
what do want to avoid in strabismus sx
coughing and bucking
268
what complication has a high incidence in strabismus surgery
NV
269
what is surgical correction for strabismus
repositioning of extra occular muscles
270
what anomalies are associated with glaucoma
sturge-weber syndrome
craniofacial abnormalities
271
what is congenital glaucoma caused by
inadequate outflow of aqueous humor
272
what procedure is for glaucoma
goniotomy- facilitates drainage of aqueous humor through normal channels
273
what causes retinopathy of prematurity
abnormal proliferation of vascular tissue
274
when does temporal retina reach maturation
44 weeks post conception
275
where does ROP most commonly occur
temporal retina
276
what population does ROP most commonly occur in
LBW infants
277
infants weighing __________ have an 80% chance of developing ROP
<1000g
278
premature neonates requiring ________ have an increase risk of ROP
O2 therapy
279
what is treatment of ROP aimed at
preventing progression and repair of existing retinal defects
280
what procedure is indicated for a posterior retinal detachment
scleral bulking procedure
281
if neovascularization has progressed into the vitreous, what may be performed
vitrectomy
282
what is the condition of bone blocking nasal passage
choanal atresia
283
T/F patients with choanal atresia can breath nasaly
no
284
what do we do for chaonal atresia to maintain oral airflow
oral airway
285
what is CHARGE syndrome
colobomas
heart abnormalities
choanal atresia
growth or mental retardation
genitourinary anomalies
ear abnormalities
286
when does bilateral choanal atresia need to be fixed
first few days of life
287
when does unilateral choanal atresia need to be fixed
school age
288
what is bilateral choanal atresia associated with
crouzon syndrome
CHARGE syndrome
289
T/F crying is a major issue in choanal atresia
F, promotes mouth breathing which is good
290
what is important in managing choanal atresia
maintain oral airway
291
what are s/s choanal atresia
stridor
paroxysmal cyanosis
pink when crying
292
T/F you can delay unilateral choanal atresia sx
T, can be when school aged
293
what are indications for PE tubes (myringotomy and tympanostomy tubes)
chronic otitis media
RAOME
acute otitis media
unresponsive to treatment with toxicity signs
294
what other symptoms to PE tube patients usually have
URI
fever
295
what are risk factors for needing ear tubes
daycare
siblings
suboptimal breastfeeding
ill health in pregnancy
cleft pallate
296
what to PE tubes allow
fluid to drain from ear
297
how are ear tubes removed
usually fall out on their own
298
what can chronic otitis media lead to
hearing loss
299
what are symptoms of otitis media
HA
earaches
300
T/F cancel PE cases for URI
false
301
how long do tube cases take
5 minutes
302
what is common anesthetic for tubes
maybe preop anxiolytic
inhalational induction with sevo 8%
N2O 70/30
no IV
spontaneous ventilation
maybe oral airway
303
when do we start ear tube surgery
until out of stage 2 and loss of lid reflex
304
what is common pain/anesthetic meds for tube cases
rectal APAP 30 mg/kg
intranasal precedex (1-4 mcg/kg)
intranasal fentanyl (1-2 mcg/kg)
305
why does ear tube patient need to be deep
movement can cause damage to ear
if stage two can cause laryngospasm
306
what is important for masking ear tube patients
keep tight seal so patient doesn't get light on anesthesia
307
what is the repair of reconstruction of tympanic membrane with or without grafting
tympanoplasty
308
what are indications for tympanoplasty and mastoidectomy
tympanic perforation
removal adhesions
improve hearing
removal of cholesteatoma
309
what is a mastoidectomy
expose and remove infected mastoid air cells within the mastoid process
310
what anesthetic do we avoid in tympanoplasty and mastoidectom
nitrous oxide N2O
311
what is anesthetic management for tympanoplasty and mastoidectomy
IV or inhalation induction
ET tube
LTA
deep gas
312
what do we avoid in tympanoplasty and mastoidectomy to decrease bleeding
hypercarbia, HTN
313
what meds do we give intympanoplasty and mastoidectomy for PONV prevention
zofran
decadron
propofol TIVA
314
what is positioning to watch for in tympanoplasty and mastoidectomy
watch neck position to avoid damage
bed is turned 90 -180*
315
what do you watch when changing patients position
airway
ETT
circuit
ETCO2
IV
316
do you use NMB for tympanoplasty and mastoidectomy
short-acting or none at all to allow monitoring of CN7 (communicate with surgeon)
317
when do we use an IV for tympanoplasty and mastoidectomy
>100 lbs OR
>10 year olds
318
what are ways to blunt airway response in tympanoplasty and mastoidectomy since you are not paralyzed
LTA
deep with gas
bump with propofol
alter triggers on vent (low trigger)
drop CO2 (increase RR)
319
what are indication for tonsillectomy and adenoidectomy
recurrent infections and OSA
320
what can hyperplasia of tonsils and adenoids lead to
CO2 retention
cor pulmonale
FTT
321
characteristics of OSA
322
what are risk factors of OSA
trecher collins
goldenhars aperts
arnold-chiari
achondroplasia
obesity
CP
trisomy 21
323
what kind of OSAS require tonsillectomy
lymphoid hypertrophy
324
what are the three forms of TA surgery
snare
cold or hot knife
cautery
325
what is benefit and risk of cautery for TA
less bleeding, but is more painful
326
what do we do for O2 concentration and cautery
turn down O2 2/2 fire risk
327
what can bleeding from TA surgery leed to
vomiting from blood in stomach, so use OG to suction stomach after case, give antiemetics
328
what is biggest concern of TA surgery
rebleeding
329
T/F TA surgeries often have URi
true
330
how long is a TA surgery
15 min
331
what is steps of TA surgery
inhalation induction
place IV
IV induction
332
what are meds for TA surgery induction
sevo 8% and N2O 70/30
333
what kind of intubation do we do for TA surgery
atraumatic
videoscope
334
how do we place ETT for TA surgery
taped down center of mouth to chin
335
T/F use ibuprofen and toradol for TA surgery
false
avoid due to bleeding
336
what are positioning techniques for TA sx
remove pillow and place towel for head turban
337
what are some meds for TA surgery
IV APAP 15 mg/kg
IV fentanyl/precedex
Decadron
zofran
338
what are adverse affects of Local with EPI in TA surgery
tachycardia
HTN
abscess formation
medullopntine infarct
bulbar paralysis
339
what do we do prior to emergence to decrease NV after TA
OGT to suction stomach of blood (gently suction)
340
T/F TA surgery has a high incidence of laryngospasm
true
341
where does rebleeding usually occur after TA
PACU or after discharge
342
what bleeds after TA
Internal and EXTERNAL carotid artery branches
343
what do we avoid food wise after TA
red drinks or food
344
what can high BP lead to after TA
bleeding, so give labetalol or carcoti at end of case, or bump with propofol
345
what kind of induction do we do for FESS
IV or inhalation
346
what kind of ETT do we use for FESS
RAE ETT
347
what is a common complication of FESS? how do we intervenese
Bleeding
use throat pack
nose pack
vasoconstrictors
348
what is th surgical debridement of sinus cavity
FESS
Functional Endoscopic Sinus Surgery
349
what are indications for FESS
deviated septum
turbinates?
350
what are useful anesthethetic adjuvants for FESS
precedex
fentanyl
tylenol
351
what is benefit of precedex
proved sedation and decreases BP
352
what are S/S foreign body aspiration
coughing
dyspnea
stridor
cyanosis
353
when foreign body is located in the ___________ you are more likely to have wheezing, coughing, dyspnea, air trapping, and chronic infection
bronchus
354
what kind of induction do we do for foreign body aspiration
inhalational with sevo and O2
or TIVA?
355
what are important parts of anesthetic plan for foreign body aspiration
maintain spontaneous ventilation
local anesthetic at vocal cords and trachea
356
what do we do to remove foreign body aspiration
rigid bronchoscope
357
what kind of foreign body aspiration is an emergency
button batteries
358
what are s/s epiglottitis
looks ill
febrile
drooling
severe sore throat
sits up while leaning forward to promote patent airway
359
what is radiographic sign of epiglottitis
thumb sign
360
thumb sign
361
epiglottitis
362
what causes epiglottitis
Haemophilus influenzae type B
Group A beta-hemolytic streptococci
363
croup vs epiglottitis
364
where does croup occur (subglottic, supraglottic)
subglottic
365
where does epiglottitis occur (subglottic, supraglottic)
supraglottic
366
what age does croup occur at
<3 years
367
what age does epiglottitis occur at
3-6 years
368
is croup bacterial or viral
viral
369
is epiglottitis bacterial or viral
bacterial
370
what are s/s croup
barking cough
hoarse voice
recumbent position
rapid RR
non-tender larynx
high fever
steeple sign on AP radiograph
371
what are S/S epiglottitis
drooling
marked dysphagia
tripod sitting position
normal RR
normal larynx
low grade fever
thumb sign on radiograph
372
T/F airway support is need in croup
F, only in <3%
373
T/F airway support is needed in epiglottitis
T, always indicated
374
Do we use narcs or muscle relaxers in epiglottitis
no
375
what tools do we have for epiglottitis intubation
glidescope
blades
different size tubes
FOB
tracheostomy kit
376
how do we transport epiglottitis
face mask and pulse ox
377
how do we induce epiglottitis
sevo and oxygen induction, maintain spontaneous breathing
378
what airway support do we use for epiglottitis
CPAP 10-15 mmHg
379
what size/type of tube do we use for epiglottitis
cuffed tube 1-2 sizes smaller than normal
380
what is a rare condition that causes tissue to partially or completely obstruct the glottic opening
laryngeal web
381
what can be required in laryngeal web
can cause resp distress requiring an emergency airway
382
subglottic stenosis grades
383
what is subglottic stenosis 0-50%
grade 1
384
what is subglottic stenosis 51-70%
grade 2
385
what is subglottic stenosis 71-99%
grade 3
386
what is subglottic stenosis 100%
grade
387
what is treatment for subglottic stenosis
airway dilation
388
what size ett do we use for subglottic stenosis
smaller ETT
389
subglottic stenosis vs normal
