Principles I - Final Exam - Anesthesia For Nose And Throat Surgeries

Front 1

what is the basic thing you should think about for someone with nose and throat surgeries

Back 1

surgery is being done because something is wrong with the airway so adjust for what is wrong as needed.

Front 2

basic considerations for ENT surgeries

Back 2

possible alterations in patient airway
maintenance of airway
sharing operative field with surgeon
appropriate drugs
appropriate and safe extubation

Front 3

things that you may not be able to see when evaluating an airway but will impact airway are

Back 3

infection, FB, tracheal stenosis, vocal cord dysfunction, tumors, goiters, edema, signs of airway obstruction

Front 4

signs of airway obstruction when evaluating the airway

Back 4

snoring
apnea
CPAP use
large tongue
extra tissue
large tonsils

Front 5

tracheal stenosis is seen in what patient populations

Back 5

neonatal babies that had trachs for a while
patients that were intubated or trached for a while

Front 6

another thing to consider when evaluating the airway

Back 6

how will the anatomy change when the patient is induced (relaxed)

Front 7

what questions do you ask yourself when planning your airway management technique

Back 7

do you anticipate any problems with mask ventilation (OBESE)
should the patient be easy to intubate with DVL
what are my back up plans?

Front 8

because the bed is often turned away from you, it is critically important that you constantly

Back 8

assess for circuit disconnect and loss of an airway

Front 9

assessment tools you should use in ENT surgeries include

Back 9

precordial or esophageal stethoscope, capnography, and pulse ox, machine alarms

Front 10

why is airway monitoring so important in ENT surgeries

Back 10

because surgeon may move ETT either intentionally or accidentally and that you are farther from the patient and have worse access if something goes wrong

Front 11

what about the supine position in ENT surgeries

Back 11

tuck arms at side to prevent brachial plexus injuries as surgeon may move head from side to side and out of neutral position

Front 12

what about rotating the bed for surgeon access

Back 12

make sure circuit is long enough and not under tension
make sure monitor wires will accommodate rotation
always disconnect circuit before moving bed
hold the ETT and head when positioning patient
extend IV lines

Front 13

signs of extubation or circuit disconnect

Back 13

loss of chest rise
loss of breathsounds through precordial stethoscope
loss of ETCO2
loss of airway pressures
alarming machine
decreasing saturation

Front 14

signs of loss of cuff seal

Back 14

loss of airway pressures
decreasing tidal volume
increasing inspiratory pressure
SMELL OF GAS

Front 15

narrowing, occlusion, or pinching of the airway tube will show up as

Back 15

rise in peak airway pressure
decrease in inhaled volume

Front 16

Oral RAEs are used for

Back 16

cleft palate repair
tonsillectomy
UPPP
and eye and upper face procedures

Front 17

UPPP stands for

Back 17

uvulopalatopharyngoplasty

Front 18

RAE stands for

Back 18

Ring Adair Elwynn

Front 19

the nasal RAE is used for

Back 19

maxillofacial surgery
some cosmetic surgeries
malocclusion or cases where jaw is wired shut

Front 20

nasal RAEs should not be used if

Back 20

cribiform plate is disrupted

Front 21

examples of special tubes for NT procedures

Back 21

anode
armored
reinforced

Front 22

read article about tubes

Back 22

read article about tubes

Front 23

anode tubes are

Back 23

armored tubes that are imbedded with a coiled wire to produce a very flexible tube that resists kinking

Front 24

anode tubes are useful when

Back 24

extreme neck flexion is required
prone cases sometimes

Front 25

what tubes should be placed with a stylet

Back 25

anode or armored tubes

Front 26

if pt is to be vented post op, the armored tube

Back 26

should be exchanged for a regular ETT

Front 27

a problem associated with the reinforced tubes

Back 27

if tube gets bit down, will not resume normal shape, so will have narrowed airway that can cause NPPE

Front 28

what should you use with reinforced tubes

Back 28

bite block
lidocaine spray since tubes are sticky

Front 29

laser stands for

Back 29

light amplification by stimulated emission of radiation

Front 30

4 types of lasers used in surgery

Back 30

CO2, YAG, KTP, Argon

Front 31

wavelength of CO2

Back 31

long - 10,600 nm

Front 32

wavelength of YAG

Back 32

short - 1060 nm

Front 33

wavelength of KTP

Back 33

short - 532 nm

Front 34

wavelength of Argon

Back 34

short - 488 nm

Front 35

the longer the wavelength, the greater the

Back 35

absorption by water and therefore the less tissue is penetrated

Front 36

does CO2 or YAG have a more superficial effect

Back 36

CO2

Front 37

YAG stands for

Back 37

yttrium aluminum garnet

Front 38

KTP stands for

Back 38

potassium titanyl phosphate

Front 39

a laser is

Back 39

a device capable of producing an intense beam of light that can be focused to produce precisely controlled coagulation, incision, or vaporization of tissues with minimal post op edema or pain

Front 40

color of eye protection for YAG laser

Back 40

green

Front 41

color of eye protection for CO2

Back 41

clear plastic

Front 42

color of eye protection for KTP

Back 42

orange - red

Front 43

color of eye protection for argon

Back 43

orange

Front 44

hopefully, the circulating nurse in the laser room has

Back 44

the appropriate eye protection for you

Front 45

pg 10s chart i don't think we really need to know but feel free to look it over because I'm not putting it in here

Back 45

pg 10s chart i don't think we really need to know but feel free to look it over because I'm not putting it in here

Front 46

advantages of laser surgery

Back 46

hemostatic operative environment
decreased - blood loss, edema, scarring, post op pain, recovery time, hospital stay, sick time
no touch technique, potential cost savings

Front 47

what is critical in laser surgeries

Back 47

that patients remain completely immobile

Front 48

what is common during and after laser surgery in the larynx and pharynx

Back 48

bronchospasm and laryngospasm

Front 49

hazards of lasers

Back 49

transmission of disease via inhaled particulate
misdirected laser beam cutting other internal organs or blood vessels
ocular injury with energy transfer if not wearing goggles

Front 50

in laser surgeries remember to help patient by

Back 50

protecting their eyes with saline soaked pads after taping them shut
or putting goggles on them too

Front 51

example of disease caught from inhalation of smoke plume

Back 51

genital herpes are burned off but the particulate has been inhaled by GYN providers to result in herpetic lesions in the lungs

Front 52

risk of disease transmission from lasers is reduced by

Back 52

wearing high efficiency masks (brown)
efficient smoke evacuator systems

Front 53

are airway fires common

Back 53

they are not uncommon

Front 54

what type of tube should you not use with a laser

Back 54

PVC ETT are highly flammable

Front 55

airway fires can be caused by

Back 55

laser or cautery use
flammable ETTs

Front 56

2 methods of reducing flammability of ETT

Back 56

wrap tube with Merocel (a metallic foil that Gayle hasn't seen used in years)
Xomed tube - has a laser resistant coating of aluminum powder

Front 57

even if the tube isn't burning

Back 57

it could retain heat that will burn the patients airway

Front 58

describe a laser tube

Back 58

double balloon so outer balloon is filled with a dye so you know if the cuff ruptures and it will also help put fire out

Front 59

why don't most people use laser tubes with laser surgeries

Back 59

too expensive
uses regular tube but fills cuff with saline and a little bit of blue

Front 60

what can you do to reduce risk of airway fires

Back 60

decrease oxygen concentration to less than 40% (ideally 30%)
avoid nitrous
apneic technique
substitute helium for air

Front 61

advantage of helium

Back 61

permits smaller ETT use without turbulence and high resistance because has a lower viscosity

Front 62

describe the apneic technique

Back 62

ventilate
disconnect ETT to let surgeons work
reconnect and ventilate
and continue to alternate with surgeon

Front 63

what to remember with apneic technique and in general to prevent airway fires

Back 63

cuff should be fully inflated
patient should not be breathing

Front 64

because cuff is vulnerable to puncture, you should

Back 64

inflate cuff with methylene tinted saline
color lets surgeon know it's ruptured
saline absorbs the heat and may quench the fire

Front 65

airway fire protocol

Back 65

stop ventilation
pull ETT
turn off oxygen and disconnect circuit
extinguish fire
ventilate with mask and reintubate

Front 66

once patient is reintubated after an airway fire, you should

Back 66

assess airway damage with bronchoscopy and ABG
assess oropharynx and face
consider bronchial lavage and steroids
obtain CXR

Front 67

general safety tips for lasers and fire safety

Back 67

OR fires are closed claims
put warning signs on doors if laser in use
patient and staff eye protection
matte finish instruments reduce beam dispersion
laser in standby mode if not in use

Front 68

other anesthesia safety tips

Back 68

volatile agents can potentiate a fire
balanced technique is considered
short acting muscle relaxants are good for table glue
length of case