Anesthesia in Otorhinolaryngologic Surgery

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Questions and Answers

What is critical for ensuring hemostasis during microsurgery in ear surgery?

Head-up position and controlled hypotension (correct)

Using general anesthesia only

Placing the patient in a prone position

Increasing nitrous oxide levels

Which of the following statements regarding laser safety is accurate?

Saline-filled cuffs in ETT minimize fire risk (correct)

Nitrous oxide should be used to enhance laser effectiveness

Topical anesthesia is sufficient for laser procedures

Inspired oxygen concentration should be kept high

What is a key focus during the preoperative evaluation for endoscopic surgeries?

Visual inspection of the throat

Determining the need for antibiotic prophylaxis

Assessment of the airway (correct)

Patient's medical history only

In which type of surgery is the use of muscle relaxation particularly emphasized?

Endoscopic surgeries Signup and view all the answers

What are the absolute indications for tonsillectomy?

Upper airway obstruction and recurrent tonsillitis Signup and view all the answers

What is an important postoperative concern for patients who have undergone ear surgery?

Postoperative nausea and vomiting Signup and view all the answers

Which of the following surgical techniques is NOT commonly performed in ear surgery?

Laryngoscopy Signup and view all the answers

Which of the following is NOT a contraindication for tonsillectomy?

Excessive daytime sleeping Signup and view all the answers

What precaution should be taken to reduce the risk of endotracheal tube fire during laser surgery?

Limit the duration of laser exposure Signup and view all the answers

What position should the patient be in during extubation after surgery?

Left lateral position Signup and view all the answers

What is a significant complication that can occur post-tonsillectomy?

Post-operative bleeding Signup and view all the answers

What is an operative indication for performing endoscopic surgeries?

Vocal cord dysfunction Signup and view all the answers

Which tube is preferred for intubation during tonsillectomy?

Armored or reinforced intubation tube Signup and view all the answers

What is a primary symptom of obstructive sleep apnea related to adenotonsillar hypertrophy?

Fatigue during the day Signup and view all the answers

What should be assessed to gauge post-operative bleeding?

Conscious level and pulse rate Signup and view all the answers

What is an important preoperative consideration for patients undergoing head and neck cancer surgery?

Heavy tobacco and alcohol use Signup and view all the answers

What should be administered until the patient is fully recovered post-surgery?

Oxygen Signup and view all the answers

Which type of intubation may be crucial for patients with altered airway anatomy in head and neck cancer surgery?

Awake intubation Signup and view all the answers

What is a recommended monitoring practice for patients undergoing maxillofacial reconstruction surgery?

Monitoring of end tidal CO2 and peak airway pressure Signup and view all the answers

What type of anesthesia is considered a good choice for patients undergoing functional endoscopic sinus surgery?

General anesthesia with hypotension Signup and view all the answers

Which procedure may require intraoperative tracheostomy in head and neck cancer surgery?

Laryngectomy Signup and view all the answers

What should be avoided in the case of a coexisting basal skull fracture during maxillofacial surgery?

Nasal intubation Signup and view all the answers

During rhinoplasty, what is a notable concern associated with local anesthesia?

Hypertension and tachycardia Signup and view all the answers

Which of the following is an essential intraoperative monitoring technique for head and neck cancer surgery?

Invasive monitoring for vital signs Signup and view all the answers

Study Notes

Objectives of Anesthesia in Otorhinolaryngologic Surgery

Spans various surgeries including endoscopic procedures, ear surgeries, nasal and sinus procedures, laser applications, head and neck cancer surgeries, maxillofacial reconstructions, and tonsillectomies.

Endoscopic Surgeries

Include laryngoscopy, microlaryngoscopy, esophagoscopy, and bronchoscopy.
Key: Perform airway assessment preoperatively due to potential complications like foreign body aspiration and obstructing tumors.
Intraoperative anesthetic management involves profound muscle relaxation, careful oxygenation, ventilation strategies, and cardiovascular stability.

Ear Surgery

Types: Stapedectomy, tympanoplasty, mastoidectomy, myringotomy.
Critical aspects include avoiding nitrous oxide and ensuring hemostasis through a head-up position, epinephrine use, and controlled hypotension.
Postoperative nausea and vomiting (PONV) can be mitigated with dexamethasone, ondansetron, and propofol.

Laser Safety

Laser surgery enhances precision and hemostasis but poses unique risks including toxic fumes and eye injuries.
Preventive measures include maintaining low inspired oxygen, avoiding nitrous oxide, and using saline-filled endotracheal tube (ETT) cuffs to minimize fire risks.
Essential to have saline-soaked pledgets in the airway and readily available water sources during laser surgery.

Nasal and Sinus Surgery

Procedures involve polypectomy, endoscopic sinus surgery, rhinoplasty, septoplasty, and maxillary sinusotomy.
Preoperative concerns include challenging mask ventilation and risk of bleeding.
General anesthesia must ensure tube positioning, eye protection, and adequate neuromuscular block; hypotensive anesthesia is beneficial.
Post-extubation priority involves reducing coughing and gagging risks.

Head and Neck Cancer Surgery

Involves laryngectomy, glossectomy, pharyngectomy, parotidectomy, and radical neck dissection.
Preoperative evaluation focuses on altered airway anatomy due to pathologies or treatments like radiation.
Monitoring: Invasive lines and temperature; tracheostomy may be necessary.

Maxillofacial Reconstruction and Orthognathic Surgery

Addresses complexities like mask ventilation and intubation difficulties due to pathology.
Fiberoptic intubation is advised; avoid nasal intubation with basal skull fractures.
Close monitoring of end-tidal CO2 and peak airway pressure is essential to prevent accidental circuit disconnections.

Anesthesia for Tonsillectomy

Tonsils are comprised of lingual, pharyngeal (adenoid), and palatine tissues.
Absolute surgery indications: Upper airway obstruction, peritonsillar abscess, recurrent tonsillitis.
Contraindications: Bleeding diathesis, acute infection, anemia.

Preoperative Assessment for Tonsillectomy

Evaluate for acute infection, heart murmurs, and obstructive sleep apnea, often due to adenotonsillar hypertrophy.
Symptoms include nocturnal breathing issues and daytime fatigue.

Intraoperative Management for Tonsillectomy

Use an armored ETT to mitigate kinking or dislodging during surgery.
Postoperative care involves suctioning with care and ensuring adequate breathing before extubation, preferably in a left lateral position.

Postoperative Complications after Tonsillectomy

Common issues include pain, nausea, vomiting, and the risk of bleeding.
Post-tonsillectomy bleeding can occur immediately or hours later; assess consciousness, capillary refill, and pulse rate for monitoring.
Rapid sequence induction may be necessary, especially if significant blood loss is suspected.

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Description

This quiz covers the objectives and practices of anesthesia in otorhinolaryngologic surgery, including various procedures like endoscopic surgeries and ear surgeries. Key focuses include preoperative airway assessments, intraoperative anesthetic management, and postoperative care. Test your knowledge on the critical aspects involved in these specialized surgeries.