Elisa Chapter 3 Laryngectomy

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Questions and Answers

What is the most important landmark for the anesthetist in the larynx?

  • Cricothyroid membrane (correct)
  • Hyoepiglottic ligament
  • Cricothyroid muscle
  • Superior laryngeal nerve

Which nerve provides all sensory innervation below the level of the vocal cords?

  • Vagus nerve
  • Superior laryngeal nerve
  • Internal branch of the superior laryngeal nerve
  • Recurrent laryngeal nerve (correct)

What is the primary motor innervation to the larynx provided by?

  • Inferior laryngeal artery
  • Superior laryngeal nerve
  • Vagus nerve
  • Recurrent laryngeal nerve (correct)

Where does the arterial blood supply to the larynx come from?

<p>External carotid artery (C)</p> Signup and view all the answers

Which muscle in the larynx is supplied by the external branch of the superior laryngeal nerve?

<p>Cricothyroid muscle (D)</p> Signup and view all the answers

What are the extrinsic muscles of the larynx responsible for?

<p>Shifting the larynx upward and downward (D)</p> Signup and view all the answers

What is the definitive surgical procedure for laryngeal surgery dependent on?

<p>The degree of invasion of the tumor (B)</p> Signup and view all the answers

In which stage of laryngeal cancers is microlaryngeal surgery typically performed?

<p>Stage 0 (A)</p> Signup and view all the answers

What does hemilaryngectomy involve?

<p>Removal of one vertical half of the larynx (C)</p> Signup and view all the answers

Which structures are removed during a supracricoid laryngectomy?

<p>Supra-glottic structures, true and false vocal cords, and thyroid cartilage (A)</p> Signup and view all the answers

What proportion of patients undergoing supracricoid laryngectomy may continue to be dependent on a tracheotomy?

<p>Approximately 50% (A)</p> Signup and view all the answers

What is the primary goal of laryngeal surgery?

<p>Maintenance of superior postoperative laryngeal function (B)</p> Signup and view all the answers

Which structures are resected during a supraglottic laryngectomy?

<p>False vocal cords and laryngeal cartilage (B)</p> Signup and view all the answers

In which patients is total laryngectomy performed?

<p>Patients with T3 or T4 cancerous involvement of the larynx (A)</p> Signup and view all the answers

What is involved in total laryngectomy?

<p>Complete removal of the larynx, thyroid cartilage, cricoid cartilage, hyoid bone, and potentially several upper tracheal rings (B)</p> Signup and view all the answers

What is created during a laryngectomy to ensure a patent airway?

<p>Permanent tracheostomy (A)</p> Signup and view all the answers

What are potential complications associated with a laryngectomy?

<p>Fistula development between the trachea and esophagus (A)</p> Signup and view all the answers

What is the primary initial concern for the anesthetist during a laryngectomy?

<p>Securing a patent airway (C)</p> Signup and view all the answers

What is the typical intraoperative period for a laryngectomy dependent on?

<p>The type of laryngectomy being performed (C)</p> Signup and view all the answers

What is frequently unnecessary during a laryngectomy due to low blood loss?

<p>Packed red blood cell transfusion (B)</p> Signup and view all the answers

What can operative times exceed if a radical neck dissection is performed in conjunction with a laryngectomy?

<p>10 hours (B)</p> Signup and view all the answers

What structures are involved in creating a permanent tracheostomy during a laryngectomy?

<p>Tracheal stump and lower portion of the neck (A)</p> Signup and view all the answers

What position is the patient typically placed in for laryngectomy, unless there is preexisting airway obstruction?

<p>Semi-Fowler position (D)</p> Signup and view all the answers

What is the primary goal of thorough preoxygenation before intubation during laryngectomy?

<p>To establish ventilation (B)</p> Signup and view all the answers

Why may video laryngoscopy be a viable option for the initial attempt at intubation during laryngectomy?

<p>To avoid bleeding post radiation therapy (A)</p> Signup and view all the answers

What should be available in several sizes in the event of difficulty with intubation during laryngectomy?

<p>Endotracheal tubes (ETT) (D)</p> Signup and view all the answers

What may the surgeon wish to perform before endotracheal tube (ETT) placement during laryngectomy?

<p>Direct laryngoscopy (C)</p> Signup and view all the answers

What are at risk of bleeding during airway instrumentation in patients who have received radiation therapy?

<p>Cancerous tissue (D)</p> Signup and view all the answers

Why might consideration be given to using a reinforced endotracheal tube (ETT) during laryngectomy?

<p>To prevent damage to the airway during surgery (B)</p> Signup and view all the answers

What is the reason for tucking the patient's arms at his side during laryngectomy surgery?

<p>To provide security and access for drug and fluid therapy (A)</p> Signup and view all the answers

Why might central line placement be indicated for some laryngectomy patients?

<p>To monitor blood pressure changes continuously (D)</p> Signup and view all the answers

Why should the patient be placed on a pillow or shoulder roll during laryngectomy surgery?

<p>To achieve good operative exposure of the head and neck (B)</p> Signup and view all the answers

What is the primary reason for providing patient warming via a lower body or underbody Bair Hugger during laryngectomy surgery?

<p>To maintain stable core body temperature (A)</p> Signup and view all the answers

Why is arterial line placement recommended for laryngectomy patients?

<p>To detect hemodynamic changes associated with this patient population (D)</p> Signup and view all the answers

What is the potential complication related to vagal nerve stimulation during laryngectomy surgery?

<p>Bradycardia (D)</p> Signup and view all the answers

Why is the placement of an esophageal stethoscope important during laryngectomy surgery?

<p>To monitor core temperature accurately (C)</p> Signup and view all the answers

What is the average duration of laryngectomy surgery?

<p>4-6 hours (A)</p> Signup and view all the answers

Why should careful attention be given to safely covering and protecting the eyes during laryngectomy surgery?

<p>To minimize the risk of corneal abrasions or injury (B)</p> Signup and view all the answers

Why is it important to have extension tubing for intravenous lines and breathing circuit during laryngectomy surgery?

<p>To provide access for drug and fluid therapy easily (A)</p> Signup and view all the answers

What is the primary purpose of using a shoulder roll or pillow to create head and neck extension during laryngectomy surgery?

<p>To achieve good operative exposure of the head and neck (D)</p> Signup and view all the answers

Which postoperative complication is a direct result of laryngectomy?

<p>Chyle leak (C)</p> Signup and view all the answers

What is the most common postoperative complication associated with laryngectomy?

<p>Pharyngocutaneous fistula (B)</p> Signup and view all the answers

What is a significant risk associated with partial laryngectomy?

<p>Increased risk of aspiration (C)</p> Signup and view all the answers

Which postoperative complication is NOT commonly associated with laryngectomy?

<p>Pneumonia (B)</p> Signup and view all the answers

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