Term
| What makes face masking more difficult in pts. undergoing sinus or nasal surgery? |
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Definition
| They often have obstructions such as: polyps, fractures, & mucosal congestion. |
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Term
| What are two disorders that nasal polyps are associated with? |
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Definition
| Asthma and cystic fibrosis. |
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Term
| What can be used to shrink nasal mucosa and decrease intraoperative bleeding? What are some other techniques to reduce bleeding? |
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Definition
| Epinephrine or cocaine(4mg/kg); Use a slight head up position and controlled hypotension. |
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Term
| Should the placement and removal of oral packing be documented? |
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Definition
| Hells yeah! Also, extubation without removal of the packing could be disastrous, bitches. |
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Term
| What are some reasons for endoscopic procedures? |
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Definition
| Evaluation of hoarseness, stridor, foreign body, trauma, tracheal stenosis, CA, etc.. |
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Term
| What are overall challenges to laryngo, esopho, and bronchoscopy? |
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Definition
| airway abnormalities, minimze secretions, suppress gag & couch, relax mandible, protect teeth, rapid return of reflexes. |
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Term
| What are anesthetic goals of endoscopic procedures? |
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Definition
| Muscle paralysis, adequate oxygenation/ventilation, and cardiovascular stability. |
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Term
| What are some considerations for laryngoscopy? |
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Definition
-GA with smaller diameter ETT (6.0)
-tape to left side
-use antisaligogue
-short acting drugs for muscle relaxation
-use of microscope = microdirect laryngoscopy
-manipulation=secretions,edema which = layrngospasm! |
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Term
| What are the goals of BRONCHOSCOPY? |
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Definition
| analgesia, unconscious pt, & quiet surgical environment (no coughing, bucking, straining) |
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Term
| If intubating on the floor, what size ETT facilitates bronchoscopy? |
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Definition
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Term
| What are the two types of bronchoscopy? |
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Definition
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Term
| Rigid bronchoscopies are done under GA. What must happen to the tube to perform and rigid bronchoscopy? |
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Definition
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Term
| What should you do to ventilate through the side port of the rigid bronchoscope? |
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Definition
| you need: high fresh flows, large tidal volumes, and increase in rate and high inspired gas concentrations to compensate for the leaks around the bronchoscope. |
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Term
| In an unsealed system, such as a bronchoscopy, it is possible to oxygenate but not adequately ventilate. What are indicators of poor ventilation and oxygenation? |
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Definition
| A rise in ETCO2 and a decrease in SPO2. |
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Term
| After completion of a bronchoscopy (assuming ETT removal), what has to be done? |
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Definition
| The pt. is either reintubated for emergence OR manually ventilated. |
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Term
| During a flexible bronchoscopy, what pressure of jet-O2 is used to enter the glottic opening and entrain room air? |
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Definition
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Term
| What are some serious issues with flexible bronchoscopy? |
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Definition
| Barotrauma and air trapping. (Also, there is an increase in ETCO2 d/t inadequate ventilation from jet ventilation) |
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Term
| Some kids come into the OR d/t jacked-up grills. What are some reasons? |
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Definition
-anxiety
-tooth neglect
-the parent factor
-bottle rot
-anxiety |
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Term
| What are some considerations when kids (or adults) have messed up teeth? |
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Definition
| There are intubation preferences (nasal or oral) and know that tubes will have to be moved several times during procedure. |
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Term
| What is a potentially life-threatening infection of the tissues of the floor of the mouth, usually occurring in adults with concomitant dental infections? |
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Definition
| Ludwig's angina (aka. angina ludovici) |
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Term
| Name two places where infection can lead to Ludwig's angina? |
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Definition
| Lower third-molars & the frenulum. |
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Term
| What are symptoms of Ludwig's angina? |
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Definition
-swelling,pain, and raising of the tongue
-swelling of neck, submandibular, and sublingual spaces.
-malaise, fever, dysphagia
-in the most severe cases: stridor or difficulty breathing. |
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Term
| What is a classical sign of Ludwig's angina in the submandibular and/or sublingual spaces? |
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Definition
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Term
| If a pt with Ludwig's angina has audible stidor and an inability to swallow own saliva, what does this suggest? |
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Definition
| That airway compromise is imminent, fool! |
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Term
| What is a mastoidectomy? What are the anesthetic concerns? |
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Definition
Mastoidectomies are performed to remove infected air cells within the mastoid. Common concerns for anesthesia include: -post-op N/V
-Facial Nerve injury
-use of N2O
-NDMR will block out facial nerve, so you don't know which nerve might be damaged. |
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