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Basics of Anesthesia II > Quiz 8 (Greg Study Guide) > Flashcards

Quiz 8 (Greg Study Guide) Flashcards

1
Q

What intrinsic laryngeal muscles adduct the vocal cords?

A

lateral cricoarytenoid, transverse arytenoid

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2
Q

What muscle moves the eyes laterally/abducts?

A

lateral rectus

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3
Q

What extrinsic laryngeal muscle aids in swallowing?

A

inferior pharyngeal constrictor

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4
Q

What kind of approaches can you use for a peribulbar block?

A

superior temporal, medial, inferior temporal

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5
Q

What are some ways to prevent ETT fire during ENT procedures?

A

deliver minimum O2 concentration necessary (30%); for unavoidable open O2 delivery, deliver 5-10 L/min of air under drapes to wash out O2; stop O2 at least 1 minute before electrocautery/laser, coat head hair and facial hair with water soluble lubricating jelly, suction oropharynx with metal cannula to catch leaking O2 and N2O

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6
Q

What intrinsic laryngeal muscles relax the vocal cords?

A

thyroarytenoid and vocalis

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7
Q

What muscle moves the eye upward/supraducts and is located above the eye?

A

superior rectus

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8
Q

What is a consideration when surgeons are using a laser in the throat?

A

limit FiO2 to less than 30%

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9
Q

What extrinsic laryngeal muscle causes inversion of the aryepiglottic fold?

A

thyroepiglottic

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10
Q

What extrinsic laryngeal muscles draw the hyoid inferiorly?

A

sternohyoid, thyrohyoid

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11
Q

Why might you do a peribulbar block versus a retrobulbar?

A

patients at risk for globe puncture (high myopia, significant enopthalmos, previous scleral buckling procedures, staphylomas)

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12
Q

What nerves provide sensory innervation to the larynx?

A

SLN internal (branch of vagus)- above vocal cords, RLN-below vocal cords, glossopharyngeal- superior epiglottis and base of tongue

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13
Q

What muscle moves the eye nasally/adducts?

A

medial rectus

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14
Q

What should you ensure before extubating after a tonsillectomy?

A

that throat packs have been removed, airway has been suctioned, and patient is fully awake

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15
Q

What is the oculocardiac reflex?

A

trigeminal-vagal reflex generated by pressure on the globe, orbital structures, or conjunctiva, or by traction on the EOMs- results in bradycardia, dysrythmias

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16
Q

What are some ways to minimize blood loss during ear surgery?

A

epinephrine containing solutions, elevation of patients head (but increases risk of VAE)

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17
Q

If using nitrous, how soon should it be stopped before graft placement?

A

30 minutes

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18
Q

What muscle moves the eye downward/infraducts and is located below the eye?

A

inferior rectus

19
Q

what is a common undesired effect of middle ear surgery, and what can you use to prevent it?

A

PONV; scopalamine patch

20
Q

Describe a peribulbar block

A

Needle is directed outside of muscle cone and the anesthetic is injected- the extraconal pressure spreads the agent inside the muscle cone- requires more volume of LA than retrobulbar block

21
Q

What extrinsic laryngeal muscle draws the thyroid cartilage caudad?

A

sternothyroid

22
Q

What could you do to minimize the incidence of postextubation stridor and laryngospasm after a tonsillectomy?

A

topical spray of 2% lidocaine on the glottic and supraglottic areas

23
Q

What extrinsic laryngeal muscle folds the thyroid cartilage?

A

stylopharyngeus

24
Q

Describe a retrobulbar block

A

Pt looks up and needle inserted through the skin in infratemporal area above inferior orbital rim- needle advanced into muscle cone (retrobulbar space) and 2-4 mL of LA injected after negative aspiration

25
Q

What are some potential complications of a retrobulbar block?

A

trauma to optic nerve, blood vessels, or globe which can lead to loss of vision; respiratory arrest if anesthetic agents enter CSF of optic nerve, seizures

26
Q

What should you always assume in a patient with PTH?

A

full stomach- should do RSI

27
Q

What gas should you avoid in middle ear procedures?

A

nitrous

28
Q

How do you resolve an oculocardiac reflex?

A

remove stimulus, ensure adequate depth of anesthesia, 2-3 mg of atropine for complete vagal blockade or glycopyrrolate (can pretreat)

29
Q

After injecting local anesthetic for a retrobulbar block, what happens next?

A

eyelids are closed, digital pressure is applied, and after a few minutes the eyelids are open and the globe is inspected for akinesia

30
Q

What is PTH?

A

post-tonsillectomy hemorrhage- most common emergency pediatric airway surgery

31
Q

What intrinsic laryngeal muscle tenses and elongates the cords?

A

cricothyroid

32
Q

Can you use an LMA for tonsil surgery?

A

yes

33
Q

What intrinsic laryngeal muscle abducts the vocal cords?

A

posterior cricoarytenoid

34
Q

What intrinsic laryngeal muscles close the glottis?

A

aryepiglottic, oblique arytenoid

35
Q

How should you transport a patient to PACU who has had a tonsillectomy?

A

in the “tonsil position”- 1 side of head slightly down to allow secretions to drain out of mouth (adults may prefer high fowler)

36
Q

Which muscle rotates the eyeball on its horizontal axis temporally (extorts the eye and elevates the eyeball)?

A

inferior oblique

37
Q

What are the paired cartilages of the larynx?

A

arytenoid, corniculate, cuneiform

38
Q

What provides motor innervation to the larynx?

A

RLN- all intrinsic muscles except cricothyroid, SLN- cricothyroid

39
Q

Which muscle rotates the eyeball on its horizontal axis toward the nose (intorts and depresses)?

A

superior oblique

40
Q

How should a patient be positioned if intubating due to PTH?

A

slight head down to protect trachea and glottis from aspiration of blood

41
Q

Why might surgeons want you to limit NMB use in ENT procedures?

A

they want to evaluation function of nerves intra-op

42
Q

What are the unpaired cartilages of the larynx?

A

thyroid, cricoid, epiglottis

43
Q

What medication is contraindicated for post op pain after a tonsillectomy?

A

codeine- potential for metabolic conversion to high levels of morphine

44
Q

What are some considerations when doing ear surgery?

A

patient may be turned 180 degrees, avoid coughing (consider remifentanil), avoid muscle relaxant if nerve monitoring, varying time frame of surgery

Basics of Anesthesia II (9 decks)

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