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Justin Lyle Cards > HEENT Part III > Flashcards

HEENT Part III Flashcards

1
Q

anterior and posterior chambers of the eye make up the ___________; which has a volume of about __________mL

A

globe; 7

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2
Q

which eye muscle causes supraduction (rolling) of the eyes

A

superior rectus

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3
Q

which muscle is responsible for infraduction of the eye

A

inferior rectus

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4
Q

which muscle is responsible for adduction of the eye

A

medial rectus

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5
Q

which muscle is responsible for abduction of the eye

A

lateral rectus

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6
Q

which muscle is responsible for intorsion/depression of the eye

A

superior oblique

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7
Q

which muscle is responsible for extorsion/elevation of the eye

A

inferior oblique

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8
Q

emergence consideration with opthlamic surgery

A
  1. no coughing or bucking 2. avoid hypercapnea 3. prevent PONV 4. remifentanil (prevents coughing with emergence)
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9
Q

when would you typically use GETA with opthlamic surgery

A
  1. peds 2. uncooperative pts 3. emergenceis
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10
Q

what is a primary clinical sign of increased IOP

A

nausea

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11
Q

t/f: stable facial fractures are not considered emergent

A

TRUE

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12
Q

anesthetic considerations with pharyngeal abscess

A
  1. careful with intubation 2. consider awake intubation
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13
Q

with thyroidectomy 2/2 hyperthyroidism, _________________ meds should be avoided

A

anticholinergics (except for reversing NMB)

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14
Q

during a thyroidectomy, if the pt becomes hypotensive, how should you tx?

A

with a direct acting vasoconstrictor (neo)

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15
Q

with thyroidectomy, what anesthetic drugs should be avoided

A

local anesthetics and paralytics

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16
Q

complications of thyroiectomy surgery

A
  1. RLN injury 2. neck hematoma –> tracheal deviation 3. infection 4. tracheomalasia 5. hypocalcemia
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17
Q

if you expect a neck hematoma post-thyroidectomy d/t tracheal deviation (causing compression of trachea) what should you do

A

call surgeon immediately, but if cannot wait cut the sutures to relieve the pressure

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18
Q

unilateral RLN injury sx

A

hoarsness

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19
Q

bilateral RLN injury sx

A

stridor d/t unopposed adduction –> emergent intubation

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20
Q

why is N2O avoided during ear surgery?

A
  1. N2O is 34x more soluble than nitrogen in blood –> increased middle ear pressure 2. cannot relieve the pressure via yawning or swallowing d/t anesthetic
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21
Q

N2O should be avoided with all ear surgeries, except __________________

A

myringotomy

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22
Q

why is myrigotomy the exception to not using N2O with middle ear surgeries

A
  1. it is a short procedure 2. placing a tube into middle ear to relieve pressure, thus N2O not an issue
23
Q

anesthetic considerations with acute epiglottitis

A
  1. secure airway immediately 2. do not manually manipulate airway until you are in the OR 3. Sevo/O2 for induction 4. fiberoptic intubation 5. use cuffed tube 1-2 sizes smaller 6. NO MUSCLE RELAXANTS
24
Q

what is the most common pulmonary location to find aspirated foreign bodies

A

right bronchus

25
Q

when do most post-tonsillectomy bleeds occur

A

6 hours up to 24 hours in those > 12 years of age

26
Q

post op bleeding post tonsillectomy bleeding can occur ____________ days up to _________________

A

5-10; 2 weeks

27
Q

management of post-tonsillectomy bleed (anesthetic considerations)

A
  1. assess airway, HD status 2. plan 2 IVs 3. labs: CBC, coags, T&C; consider PRBC, FFP, and plts 4. full stomach: RSI 5. succinylcholine 6. oral RAE, glidescope 7. consider awake intubation 8. consider TXA 9. put in lateral position when take the PACU
28
Q

what is the best position for the pediatric pt post-tonsillectomy/adenoidectomy after extubation and transport to PACU

A

lateral, with head slightly down

29
Q

what are the cardiovascular effects of topical cocaine and epi

A
  1. cocaine is absorbed into the plasma –> blocking the uptake of epi systemically 2. can cause toxic effects of epi
30
Q

what are the toxic effects of epi (if topical makes is systemic)

A
  1. HA 2. HTN 3. Tachycardia 4. dysrthymias
31
Q

what is the primary purpose of vuvlopalatopharyngoplasty (UPPP)

A
  1. opens the airway by removing excess tissue in the throat
32
Q

when is a UPPP surgery indicated?

A

pickwickian syndrome and OSA

33
Q

anesthetic considerations with UPPP

A
  1. increased bleeding (consider transfusion) 2. ensure all protective reflexes have returned 3. ensure airway is free of blood and debris 4. ensure adequate breathing pattern is present before removal of ETT 5. topical anesthesia on glottic/supraglottic areas before intubation can prevent postextubation stridor or laryngospasm 6. lateral position post op; adults prefer middle/high fowler
34
Q

wht are some factors that contrbute to the development of pneuoencephalus/pneumorachis

A
  1. positioning/duratino of neuro surgery 2. barotrauma, hemopneumothorax,penumomediastinum 3. subarachnoid block, epidural 4. N2O 5. continuous CSF drainage 6. hydrocephalus, infection, neoplasm
35
Q

pneumoencephalus and pneumorachis usually resolves within ______________

A

1-2 weeks

36
Q

under what circumstance would surgical intervention be necessary for pneumoencephalus/pneumorachis

A

decreasing neuro status

37
Q

pneumoencephalus/pmeumorachis is most common after what?

A
  1. neurosurgical repair 2. craniofacial trauma 3. skull based tumors
38
Q

complications with endoscopic procedures

A
  1. bleeding 2. eye injury 3. bronchospasms
39
Q

endoscopic procedure examples:

A
  1. removal of foreign body in airway (bronchoscopy) 2. esophagosxopy 3. laryngoscopy 4. FESS - fx’al endoscopic sinus surgery
40
Q

T/F: the scope used for endoscopic procedures is only flexible

A

false; can be rigid or flexible

41
Q

what medications are contraindicated with flaps/neck dissections

A

neo, epi, and vasopressin (they can cause spasm and decrease flow to the flap)

42
Q

anesthethesia implications for thyroidectomy secondary to hyperthyroidism

A
  1. tracheal deviation 2. hyperdynamic circulation 3. hypovolemia 4. exopthalamus - careful with eye s 5. hyperthermia
43
Q

what is the most common pediatric surgery

A

tonsillectomy and adenoidectomy

44
Q

tonsillar hypertrophy is highest in ages ______________

A

6-Mar

45
Q

anesthetic technique with tonsillectomy/adenoidectomy

A
  1. mask induction vs awake (dep on how nervous you are about airway occlusion) 2. +/- NMBA 3. ETT in kids over 8-10; 4. decadron 0.5mg/kg (max) 5. PONV
46
Q

considerations for tonsillectomy and adenoidectomy for sleep obstruction

A
  1. will do UPPP with it 2. high mallampati (3/4) 3. lg neck circumfrenece 4. increase risk of post-op hypoxia
47
Q

s/sx of epiglottitis

A
  1. sore throat 2. difficulty swallowing 3. muffled voice 4. inspiratory stridor
48
Q

anesthetic technique with cochlear implant surgery

A
  1. GETA + ETT 2. facial nerve monitoring (no NMB) 3. no N2O
49
Q

anesthetic technique with myringotomy

A
  1. mask induction: O2, N2O, & inhal agent
50
Q

epiglottitis (incl acute) is most commonly presented in children aged ____________

A

6-Feb

51
Q

enucleation

A

surgical removal of globe and optic nerve, leaves structure for prosthetic eye placment

52
Q

evisceration of the eye

A

removal of contents of the eyeball, leaving sclera intact

53
Q

exteneration

A

all orbital tissue including surrounding supportive structure

54
Q

intraconal + extraconal portions of the eye make up the ______________, which has a volume of about __________ mL

A

orbit; 30

Justin Lyle Cards (27 decks)

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