Anesthesia For Head And Neck

Front 1

What does the optic foramen (orbital apex) transmit? 4

Back 1

optic nerve, optic artery, optic vein, (NAV) sympathetic nerves from carotid plexus

Front 2

Eye components-4

Back 2

sclera-adds rigidity
uvea-(iris, ciliary body, choroid)
retina-converts light to impulses
conjunctiva-covers globe and lines eylids

Front 3

Iris sphincter control-2

Back 3

iris dilator is sympathetic-mydriasis is dilation
iris constrictor is parasym.-myosis is constriction

Front 4

Arterial blood flow to eye

Back 4

internal and external carotid arteries

Front 5

Venous blood flow to eye-drainage of orbit and eye

Back 5

drainage of orbit via sup and inf opthalmic veins
drainage of eye via central retinal vein

Front 6

5 nerves that supply the eye

Back 6

oculomotor motor nerve, trochlear, abducens, trigeminal and facial nerves

Front 7

What produces aqueous humor?
production rate?

Back 7

ciliary body-2.5ul/min

Front 8

normal IOP?
positional changes?
when does it become atmospheric?

Back 8

10-22mmhg
1-6mmhg
once eye cavity is entered

Front 9

3 main factors that affect IOP

Back 9

ext pressure on eye, sceral rigidity, changes in intraocular contents

Front 10

What does laryngoscopy and intubation do to IOP?
hyper and hypoventilation?

Back 10

inc
hyper dec, hypo inc

Front 11

what does hypothermia do to IOP?
CNS depressants?
NDMBs?

Back 11

dec
dec
dec

Front 12

what does sux do to IOP? and how much?

Back 12

inc-by 10-20 mmhg

Front 13

when is sux contraindicated?
when should it be avoided?

Back 13

if no pretreatment
in strabismus surgery

Front 14

what do hypertonic solutions do to IOP? what are some?

Back 14

dec-dextran, mannitol, sorbitol, urea

Front 15

oculocardiac reflex definition

Back 15

pressure on globe or traction on extraocular muscles stim vagus nerve and cause brady

Front 16

in the oculocardiac reflex, what is the afferent and efferent nerve?

Back 16

trigeminal is afferend and vagus is efferent limb

Front 17

possible cause of oculocardiac reflex-3

Back 17

retrobulbar block, ocular trauma, direct pressure on remaining tissue following enucleation

Front 18

when is there an increased risk of oculocardiac reflex?

Back 18

hypoventilation, hypoxemia, acute onset, strong, sustained traction

Front 19

Tx of oculocardiac reflex

Back 19

stop stim, atropine, lido infiltration at site

Front 20

What's acetycholine used for?
What does it produce?
systemic effects?

Back 20

lens extraction
miosis
brady, salivation, sec, bronchosp, hypot

Front 21

Whats Echothiophate used for?
What does it produce?
Which anesthetic meds are affected?

Back 21

glaucoma tx
miosis-dec IOP
sux, ester locals--prolonged response

Front 22

What do you avoid with cocaine?

Back 22

sympathomimetics-epi and neo

Front 23

what does phenylephrine cause?
systemic effects?

Back 23

mydriasis, cap. decongestant
htn, tachy, h/a, tremors

Front 24

timolol moa?
systemic effects?

Back 24

decrease IOP by dec aqueous humor prod.
brady, hypot, myasthenia gravis exac

Front 25

Anesthetic requirements for eye surgery

Back 25

safety, akinesia(no movement of eye), profound analgesia, minimal bleeding, obtundation of oculocardiac reflex, smooth emergence

Front 26

Retrobulbar block-how?

Back 26

local anesthetic injected into muscle cone behind globe near ciliary nerve

Front 27

complications of retrobulbar block

Back 27

optic nerve trauma, retrobulbar hemorrhage, inc IOP, oculocardiac reflex, intravasc inj, apnea

Front 28

advantages of retrobulbar block

Back 28

dec incidence of coughing/strain, dec inc of PONV, analgesia, akinesia

Front 29

brainstem anesthesia-where is injection?
when does it usually resolve?
what should you have available?

Back 29

local anesth along optic nerve sheath to CSF
1 hr
emergency intubation equip.

Front 30

Tx of retrobulbar hemorrhage

Back 30

gentle pressure for 20 min, lateral canthotomy

Front 31

In topical anesthesia, where is local anesthetic absorbed?
disadvantages?

Back 31

through conjunctiva
eye movement, anxiety, allerg rx

Front 32

What drug do you avoid in GA with eye surgery?
goal of GA?

Back 32

ketamine
deep anesthesia, smooth emergence

Front 33

What happens to IOP during open globe injury?
What kind of anesthesia is req?

Back 33

atmospheric
GA-full stomach-cric, awake ext

Front 34

What's most common ped opthalmic procedure?
2 risks?

Back 34

strabismus surgery
triggers oculocardiac reflex and inc incidence of MH

Front 35

What do you avoid in strabismus surgery and why?

Back 35

Sux-interferes with forced duction test--testing muscle tone in eye

Front 36

What's important with oculogastric reflex in strabismus surgery?

Back 36

PONV-give antiemetics, limit narcs, adeq hydration, lido infilt

Front 37

What and how much can you give at end of intraocular surgery to prevent coughing?

Back 37

lido 1-1.5 mg/kg

Front 38

What do they do in retinal detachment surgery?

Back 38

inject air, gas, or silicone bubble to tamponade retinal break

Front 39

How long do you avoid N2O with air, sulfur hexafluoride, perfluoropropine, and octafluorocyclobutane and when do you shut it off?

Back 39

5 days, 10 days, 30 days, 14 days
always shut off 15 min prior to inj

Front 40

What kind of obstruction do inspiratory and expiratory stridor indicate? can you have both?

Back 40

ins-upper airway obst
exp-lower airway obst
yes

Front 41

How is jet ventilation used?

Back 41

manual ventilation thru side port on rigid bronchoscope

Front 42

Risks of jet ventilation-2

Back 42

barotrauma and pneumo

Front 43

What's the venturi effect and when does it come into play?

Back 43

entrains room air into jet ventilation

Front 44

Why do you have to monitor the chest wall during jet ventilation?

Back 44

for passive expiration

Front 45

When is jet ventilation contraindicated? -3

Back 45

peds, obese, bullous emphysema

Front 46

What's used for refractory hypoxemia?

Back 46

high freq jet ventilation(80-300x/min)-not contraindicated

Front 47

What should you do during laser laryngoscopy?

Back 47

no N2O and reduce FiO2 <30%*

Front 48

In case of airway fire-6

Back 48

stop vent., turn off O2, remove ETT, extinguish fire, reintub and ventilate, CXR

Front 49

What should you anticipate in tonsillectomy and adenoidectomy? and what's most common postop complication?

Back 49

large EBL
postop bleeding

Front 50

For a bleeding tonsil, what's important prior to induction?
What drugs should you used for induction?

Back 50

rehydration
ketamine or etomidate

Front 51

Bleeding tonsil induction

Back 51

RSI c cric, head down pos., look for bubbles, OG, awake intubation

Front 52

What can cause dysrhythmias in neck dissection?-2 specific areas and result

Back 52

manipulation of neck structures
carotid sinus-vagal reflex
right stellate ganglion-prolong QT

Front 53

Pain control for myringotomy tubes-3

Back 53

rectal tylenol, IM morphine or fent, intranasal fent

Front 54

What should you have ready on a needle for myringotomy tubes?

Back 54

sux and atropine

Front 55

What should you ask the surgeon about for tympanoplasty and tympanomastoidectomy?

Back 55

muscle relaxatin--usually sux
avoid N2O

Front 56

What kind of tube should you use for bilateral mandible fx?
What's also very important as far as meds?

Back 56

nasal rae
antiemetics

Front 57

What's limited in ORIF mandible surgery?
What's bid deal about bilat mand. fx?

Back 57

mouth opening
tongue displaced into pharynx

Front 58

In ORIF mandible sx, whats' the most important thing to do b4 leaving the OR?

Back 58

Do not leave w/o wire cutters or scissors

Front 59

Lefort I

Back 59

horizontal fx of lower maxilla

Front 60

Lefort II

Back 60

triangular extension of Lefort I
2 oblique fx lines along maxillary suture to floor of orbit and base of tongue

Front 61

Lefort III

Back 61

Transvers fx above malar bone and thru both orbits-complete separation of maxiall from skull

Front 62

What 2 Lefort fxs have a dural tear and what's result? %?

Back 62

type II and III-CSF leak
25%

Front 63

Anesthesia consid for airway foreign body-2

Back 63

gentle intubation and be prepared for emergency trach or cricothyrotomy(ENT surgeon av)

Front 64

Anesthesia consid for tracheostomy-2

Back 64

FiO2<30% when using cautery
assure patency of trach tube b4 pulling ETT all way out

Front 65

Complications of temperomandibular joint surgeries-6

Back 65

extracapsular extravasation of fluid, hearing loss, infection, hemorrhage, 5th(trigeminal) cranial nerve pathology, 8th(acoustic) cranial nerve path.

Front 66

What's Ludwig's angina?

Back 66

submandibular abscess, laryngeal edema, high risk for aspiration

Front 67

Sx of Ludwig's angina-5

Back 67

induration of neck, drooling, protruding tongue, difficulty speaking, fever and chills

Front 68

Where is TSH released from and what's it regulated by?

Back 68

ant. pituitary
thyrotropin releasing hormone in hypothalamus

Front 69

Other name for T4, 1/2 life, and how much does thyroid secrete?

Back 69

thyroxine, 6-7 days, 100%

Front 70

Other name for T3, 1/2 life, how is 80% of it produced, 20% produced?

Back 70

tri-iodothyronine, 24-30 hrs, deiodination of T4, direct thyroid secretion

Front 71

Which thyroid hormone is more potent?
Which one is less protein bound?

Back 71

T3

Front 72

CV systemic effects of thyroid

Back 72

inc contractile state of cardiac muscle, inc B rec, dec @ rec

Front 73

Which thyroid hormone is solely produced and which one is converted?

Back 73

T4 solely prod and T4 is converted to T3

Front 74

Which thyroid disorder is involved with Grave's dx? and who does it affect more?

Back 74

Hyperthyroidism-females 20-40

Front 75

S/S of Grave's dx

Back 75

weight loss, diarrhea, heat intol, tachy, htn

Front 76

Anesthetic mgmt of hyperthyroidism (Grave's)-most important part

Back 76

euthyroid preop**-propylthiouracil 6-8 weeks of therapy

Front 77

How does PTU work?

Back 77

inhibits synthesis of thyroid hormone--dec conversion of T4 to T3

Front 78

2 other meds for hyperthyroidism anesthesia mgmt

Back 78

B blockers and glucocorticoids

Front 79

what meds do you avoid in hyperthyroidism-4

Back 79

ketamine, panc, ephedrine, epi
**use neo

Front 80

What's thyroid storm

Back 80

life threatening exacerbation of hyperthyroidism

Front 81

S/S of thyroid storm

Back 81

hyperthermia, tachy, dysr, myocardial ischemia, chf, confusion

Front 82

Postop complications of thyroidectomy

Back 82

recurrent laryngeal nerve damage*, hematoma, hypoparathyroidism

Front 83

Unilateral and bilateral recurrent laryngeal nerve damage

Back 83

uni-hoarseness
bilat-aphonia

Front 84

Hypoparathyroidism S/S-4

Back 84

laryngeal stridor, laryngospasm, chvostek's sign, trousseau's sign

Front 85

what's chvostek's and trousseau's signs?

Back 85

C=abn response of facial nerve
T=spasm of muscle of hand and forearm c tourniquet up

Front 86

S/S of hypothyroidism

Back 86

lethargy, slow mental fx, cold intol, brady, blunted resp to hypercap and hypoxia

Front 87

What's myxedema coma?-6

Back 87

severe hypothyroidism, coma, hypovent, hypothermia, hypot, hyponatremia

Front 88

function of the sclera
anterior portion?

Back 88

adds rigidity to eye
transparent (cornea)

Front 89

What 3 things does the uvea contain?

Back 89

iris, ciliary body, and choroid

Front 90

What has sphincter control in the uvea?

Back 90

iris

Front 91

what does the retina do?

Back 91

converts light into neural impulses

Front 92

what produces aqueous humor?

Back 92

ciliary body

Front 93

flow of aqueous humor-4

Back 93

ciliary body, posterior chamber via pupil, anterior chamber, drains into venous sys through canal of Schlemm