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80 Cards in this Set

  • Front
  • Back

When do they repair a Cleft Palate and a Cleft Lip?

Cleft Lip 3-6 months




Cleft Palate 9-18 months

Pierre Robin Syndrome

What is the Clinical Triad of Pierre Robin Syndrome?

1. Retrognathia (receding jaw, in relation to forehead) or Micrognathia

2.Glossoptosis (backward & downward displacement of the tongue)


3.Airway obstruction

What are the four syndromes associated with Pierre Robin Syndrome?

•Fetal alcohol syndrome

•Stickler syndrome


•Treacher Collins syndrome


•Velocardiofacial syndrome

What is Mandibular Distraction and how is it used to treat Pierre Robin Syndrome

•Distraction is performed at a rate of 2mm/day for 5 days, followed by 1mm/day as needed to achieve a 2mm overjet

•After 5 days and approx. 6-10mm distraction, patient may be extubated


Extubated in OR in case of Airway emergency


Distractors stay in place for 12-16 weeks to allow consolidation of new bone

What are the important considerations for Pierre Robin Syndrome?

Inteligence is normal




May have hearing loss




Airway obstruction and difficulty of intubation usually improve with age.

Treacher Collins Syndrome

What characterizes Treacher Collins Syndrome?

•Poorly developed supraorbital ridges•Ophthalmic abnormalities •Ear deformities •Hearing loss •Cleft lip or palate

•Macrostomia (unusually large mouth)•Malocclusion of the teeth•Maxillary hypoplasia •Mandibular hypoplasia


•Midface hypoplasia

What is Choanal atresia and Glossoptosis?

•Choanal atresia - narrowing or blockage of the nasal airway by tissue

•Glossoptosis - downward displacement or retraction of the tongue

When is the majority of the reconstructive surgery done for Treacher Collins Syndrome?

Occurs during childhood or adolescence when the cranio-orbital zygomatic body development is nearly complete



Direct laryngoscopy becomes more difficult with increasing age

Goldenhars Syndrome

What makes Goldenhars syndrome difficult to manage?

Difficult Intubation (airway anomolies, Sm mouth openning)


Difficult Mask Ventilation


Difficult airway gets worse with age

What is key for anesthetic management for all three Cranofacial abnormalities?

Maintain spontaneous respirations (until airway secured) no paralytics




Decadron




Acetaminophen/Fentanyl




Extubate when awake & prepared to reintubate

What does the OMENS acronym stand for related to Goldenhars syndrome?

O-Orbit


M-Mandible


E-Ear


N-Facial Nerve


S-Soft Tissue




Unilateral

Describe the anatomy of the outer, middle, and inner ear:

What are the Ossicles?

malleus (or hammer) long handle attached to the eardrum

incus (or anvil) the bridge bone between the malleus and the stapes


stapes (or stirrup) the footplate; the smallest bone in the body

What nerve can be affected by surgeries of the ear?

Facial Nerve

What is a Myringotomy or BMT?

Ear Tubes (Bilateral Myringotomy Tubes)




Can start with NO2 induction (off for the case)




Intranasal Fentanyl

What is a Tympanoplasty, and what can be used for it?

Repair of the ear drum, can use cartilage from the Tragus.




May include ossicular reconstruction

What is a Labyrinthectomy?

Complete removal of the inner ear.




Used to treat Meniere's Disease

How long does it take for a cochlear implant to be effective?

1-2 months post op to fine tune the input

What are special considerations for ear surgeries?

•Table turned 90-180 degrees away will be from anesthesia (AIRWAY, monitoring considerations)•TIVA

•N2O usually avoided


•No paralysis (facial nerve identification)


•Deep Extubation


•PONV prevention

How long before the placement of a tympanic membrane graft does NO2 need to be turned off?

30 minutes

What are the two primary functions of the nasal cavity?

Olfaction (smell)




Filtration

What are the four parts of the nasal anatomy?

Nasal Septum


Turbinates


Adenoids


Paranasal Sinuses

What is the first line of defense (for Kids) to trap and kill Micro-organisms?

The adenoids

Where are the four paranasal sinuses?

•Maxillary: in the cheekbones on either side of the nose

•Ethmoid (6-10): beside the upper nose, between the eyes


•Sphenoid (1-2): behind the nose, in the center of the skull, surrounded by pituitary


•Frontal: lower forehead above the nose

A nose bleed from which area is life threatening (Woodriff Area, Kisselbach Area)?




Which area is responsible for 80% of nose bleeds?

Woodriff area is a life threatening bleed (Sphenopalatine artery (from the maxillary) Anterior ethmoidal artery(from the opthalmic))




Kisselbach area is responsible for 80% of nose bleeds.

What nerve innervates the nose, and is it sensory, motor, or both?

Trigeminal-sensory

What is Samter's Triad?

Nasal Polyps




ASA allergy




Asthma




Likely caused by COX pathway (Cyclooxygenase Pathway)

What sinus is used to access the pituitary gland in pituitary surgeries?

Sphenoid Sinuses

What are pre-op, intra-op, and post-op implications of sinus surgeries?

What are the six muscles of the eye?

4 rectus muscles (superior, inferior, lateral, medial)




2 Oblique muscles (superior, inferior)

What is a Trabeculectomy?

Trabecular meshwork - mesh-like drainage canals all around the iris responsible for draining aqueous humor from the eye.




Used to treat glaucoma

What is a Radioactive plaque placement used to treat?




What are anesthetic considerations for this procedure?

Treatment of melanoma




LMA (usually placed on Monday and removed on Friday)


Sevo at a MAC of 1.5


Propofol infusion


PSV-PRO

What is a Dacryocystorhinostomy?

Restores the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function due to blockage.

What do you need to have prepared and consider when doing a scleral buckle?

Have Glyco and Atropine ready, Deep extubation to avoid coughing, limit fluids, antiemetics

Can you use NO2 with retinal cases?

No, surgeons dont know if they will use air bubble.

What is Enucleation, Evisceration, and Exenteration

Enucleation



Evisceration-removing all intraocular contents


Exenteration-all orbital tissue, often including surrounding orbital bone and adjacent sinuses

Why do you avoid Ketamine and Succinylcholine with foreign body removal of the eye?

They increase IOP.

What is a Blepharoplasty?

Surgery of the eyelid (lift)




Small risk of blindness from bleeding


May not be able to close eyelids when sleeping

What is the Oculocardiac Reflex (OCR)?

Decrease in heart rate associated with traction on the extraocular muscles or compression of the eyeball



administer atropine 0.007mg/kg, it is eventually self limiting

What nerves conduct the Oculocardiac Reflex (afferent and efferent)

Afferent-Trigeminal nerve (V)




Efferent-Vagus nerve (X)

What nerves are blocked in a retrobulbar block?

II, III, IV, V, VI Blocked by injecting 6-10 cc of Lidocaine/Bupivicaine

What is the most common complications of a retrobulbar block?

If patient has an air bubble placed for and Retinal procedure what is the timeframe to avoid NO2?

5 days for Air bubble




10 days for sulfur hexafluoride




30 days for perfluoropropane

What are anesthetic considerations for open globe surgeries?

Deep anesthesia 1.5 MAC Sevo


ETT for all open Globe cases


Ensure appropriate paralysis


Use sevo for deep extubation


Strongly consider Remifentanyl gtts

What are contraindications for a Nasal Intubations?

LaFort II and III- may have a possible basilar skull fracture.

What do you need to do before nasal intubation, and what sizes do you use?

Afrin spray


Male 7 (27-29 cm)


Female 6 (25-27)




Tall patients may need to use a regular tube with a bend connector

What is an ODONTECTOMY?

Teeth removal.


Emergence


Suction well, oral and gastric


Extubate when fully awake

Odontectomy with Downs syndrome special consideration?

Small oropharynx with large tongue & tonsilsAtlanto-occipital instability

Co-existing cardiac disease


Potential for bradycardia upon induction

How should you treat bleeding tonsils?

As an emergency

What necessitates an awake fiberoptic intubation?

Inspiratory Stridor at rest.

LaFort I

What are the guidelines for hypotensive technique?

Keep MAP 50-60 in normotensive patients




For HTN do not go below 20% of baseline

When you have stridor at rest, what percentage of occlusion is suspected?

Greater than 50-60%

What are considerations for direct laryngoscopy?

Suspension results in severe sympathetic stimulation-use fast acting narc




Need vocal cord paralysis-use fast acting paralytic

What is involved in a panendoscopy?

triple endoscopy

•Laryngoscopy


•Bronchoscopy


•Esophagoscopy

What is important with bronchoscopies?

Maintain spontaneous respirations




Use topical analgesics

What is important with rigid bronchoscopy?

Patient cannot move, could cause significant trauma.

What is a Microlaryngeal Tube (MLT)?

A smaller diameter tube with a bigger cuff

How do you perform low frequency Jet ventilation?

Connect pressure reducing valve to wall O2


Hand ventilate at a rate of 10-30


I:E ratio of 1:3


Exhalation is passive (risk of breath stacking)

What is Intermittent Apnea Technique?

Periods of ventilation, extubation, periods of apnea, reintubation



First muscles to come back are the cords & diaphragm may need to redose paralytic even with 0/4 twitches.

What do you fill the balloon of a laser safe tube with?

Saline (has a blue dye to see if perforated)

What is the fire triangle in ENT surgery?

What steps should be taken to prevent an airway fire?

Which nerve supplies all the intrinsic muscles of the larynx except cricothyroid and sensation to larynx below vocal cords?

Recurrent Laryngeal Nerve

Which provides motor innervation to the crycothyroid muscle and sensory above the vocal cords?

Superior Laryngeal Nerve

What is the Pneumonic to remember what the only muscle pulls the vocal cords apart is?

PCA-Posterior Crycoarytenoids

How many levels of lymph nodes are there?

Where is the Stellae Ganglion Located?

At the level of C7, anterior to the transverse process, superior to the first rib, below subclavian artery.

What does injury to the stellae ganglion cause?

Horners syndrome-Decreased sweating, drooping eyelid, constricts pupil, difficulty swallowing, and hoarseness

Where is the Carotid sinus located?

at the level of C3-4.

What level is the Larynx located in adults and infants?

Adults C6




Infants C4

What are cardiovascular complications of a radical neck dissection?

Bradycardia


Wide swings in BP


Dysrhythmia


Sinus Arrest


Prolonged QT

What are Respiratory Complications of Neck Dissection, signs, and treatments?

Air emboli-Risk when wound is above heart


Signs-Decreased (ETCO2, CO, SPO2) Sudden hypotension, Increase PAP


Interventions-Flood Field, 100% O2, Left Lateral Decubitus position, Support Pressure

What is the most common cause of airway obstruction within 20 hours of neck surgery?

Hemorrhage with tracheal compression