Anesthesia Techniques and Patient Monitoring

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Questions and Answers

When performing a tonsillectomy, what laser type is typically used?

  • Ho:YAG (correct)
  • CO2
  • Argon
  • Excimer

Which of the following is NOT a common patient problem that would necessitate an endoscopic ENT procedure?

  • Vocal cord dysfunction
  • Esophageal reflux disease (correct)
  • Foreign body aspiration
  • Stridor

During an endoscopic procedure, the presence of a tumor is identified. What is the MOST important factor to assess preoperatively regarding the tumor?

  • The stage of the tumor
  • The size and location of the tumor (correct)
  • The color of the tumor
  • The patient's age

During a procedure involving electrocautery and an open oxygen delivery system, what is the MOST appropriate action to minimize fire risk?

<p>Stop supplemental oxygen for one minute prior to and during electrocautery use (A)</p> Signup and view all the answers

Which of the following laser types is LEAST likely to be used in an ENT procedure due to its clinical application?

<p>Semi-Conductor (B)</p> Signup and view all the answers

Which of the following is NOT considered a standard fire safety precaution during ENT procedures?

<p>Using a high flow/low FiO2 setting (C)</p> Signup and view all the answers

What is the PRIMARY reason for using a laser resistant and well-sealed ETT during an ENT procedure?

<p>To prevent airway fire (A)</p> Signup and view all the answers

During an airway fire, what is the initial MOST critical action?

<p>Stop ventilation and remove the ETT (C)</p> Signup and view all the answers

Which of the following is a SIGN of an airway fire?

<p>Orange or red glow to the ETT (C)</p> Signup and view all the answers

Which of the following laser types requires ORANGE eye protection during use?

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

What is the primary reason laser-resistant endotracheal tubes (ETTs) should be used during airway-laser procedures?

<p>They can withstand high temperatures from lasers. (A)</p> Signup and view all the answers

In the context of ventilation techniques, what is a significant disadvantage of using intermittent apnea?

<p>May cause difficulty in reintubating the patient. (C)</p> Signup and view all the answers

Which type of tubing is recommended for procedures involving CO2 and KTP lasers?

<p>Red rubber tubes, silicone tubes wrapped in aluminum, and stainless steel spiral ETT. (B)</p> Signup and view all the answers

Why should saline mixed with methylene blue be used to fill the pilot balloon cuff of a laser tube?

<p>It offers a color indicator for cuff integrity. (C)</p> Signup and view all the answers

What is a unique advantage of using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) during procedures?

<p>It can provide high FiO2 and helps prevent carbon dioxide accumulation. (D)</p> Signup and view all the answers

Which of the following is NOT a consideration when positioning a patient for surgery?

<p>Bed should be positioned towards the anesthesia provider (D)</p> Signup and view all the answers

What is the primary objective of controlled hypotension during surgery?

<p>To decrease bleeding and improve surgical visualization (A)</p> Signup and view all the answers

Which medication is NOT utilized in the induction of controlled hypotension?

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

How much should the mean arterial pressure (MAP) typically be reduced in controlled hypotension?

<p>20% from baseline (D)</p> Signup and view all the answers

Which of the following patients might require a higher MAP during controlled hypotension?

<p>Chronic hypertension patients (D)</p> Signup and view all the answers

PONV is known to be more common with which type of surgical procedure?

<p>Middle ear procedures (C)</p> Signup and view all the answers

Which topical local anesthetic has the potential side effect of methemoglobinemia?

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

Which of the following agents is specifically mentioned as a controlled hypotension method?

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

In the context of controlled hypotension, what does UO stand for and why is it monitored?

<p>Urinary output; to assess renal function and perfusion (C)</p> Signup and view all the answers

Which inhalational agent is commonly used in controlled hypotension?

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

Which of the following is a common patient problem frequently encountered prior to undergoing a tonsillectomy and adenoidectomy?

<p>Tonsillar and adenoidal atrophy leading to potential airway obstruction (A)</p> Signup and view all the answers

In the context of bilateral myringotomy tube insertion, why are N2O and sevo preferred for mask induction and maintenance?

<p>Both A and C are correct. (A)</p> Signup and view all the answers

Which of the following scenarios would necessitate a comprehensive pre-operative evaluation using the STBUR questionnaire in a patient scheduled for tonsillectomy and adenoidectomy?

<p>Patient with a known history of sleep-disordered breathing. (D)</p> Signup and view all the answers

What is an appropriate approach to administering anesthetics during bilateral myringotomy tube insertion?

<p>Use a general anesthetic agent with intermittent boluses throughout the procedure. (B)</p> Signup and view all the answers

During a tonsillectomy and adenoidectomy, the anesthesia provider should prioritize which of the following?

<p>All of the above. (D)</p> Signup and view all the answers

What is the rationale for avoiding pre-operative sedatives in patients undergoing bilateral myringotomy tube insertion?

<p>All of the above. (D)</p> Signup and view all the answers

When planning for a tonsillectomy and adenoidectomy, which of the following aspects should be considered regarding the patient's history?

<p>All of the above. (D)</p> Signup and view all the answers

What is a crucial consideration when managing a pediatric patient for a tonsillectomy?

<p>A cuffed endotracheal tube is advised for patients aged 8 or older. (B)</p> Signup and view all the answers

Why is meticulous oropharyngeal suctioning important after anesthesia in tonsillectomy?

<p>To maintain airway patency and prevent laryngospasm. (B)</p> Signup and view all the answers

Which factor is NOT a risk for post-tonsillectomy hemorrhage?

<p>Previous respiratory issues (C)</p> Signup and view all the answers

What is a correct statement about the anesthesia technique for adults?

<p>IV induction with a balanced technique is commonly used. (B)</p> Signup and view all the answers

What position is recommended when transferring a patient to the post-anesthesia care unit (PACU) after a tonsillectomy?

<p>Left lateral position (B)</p> Signup and view all the answers

What is the 'Rule of 10' in the context of cleft lip and palate repair?

<p>Age over 10 weeks, weight over 10 kg, hematocrit over 10%, white blood cell count over 10,000 cells/uL. (C)</p> Signup and view all the answers

Which condition requires extreme care during direct laryngoscopy (DL) after a tonsillectomy?

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

What airway management technique is not typically employed for children during anesthesia induction?

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

What should be monitored after extubation to prevent post-operative complications?

<p>Signs of bleeding and airway complications (C)</p> Signup and view all the answers

Flashcards

Perioperative management

A strategy to optimize patient care before, during, and after surgery.

Airway management plan

A detailed approach for managing a patient's airway during anesthesia.

Prevention of complications

Strategies to avoid adverse events during surgical procedures.

Common problems for BMT patients

Frequent issues include chronic otitis media and recurrent URIs.

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Ultrashort procedure

A short surgical procedure requiring minimal anesthetic duration.

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Preoperative eval

An assessment done to identify potential complications before surgery.

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STBUR Questionnaire

A tool to assess sleep-disordered breathing symptoms.

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Postop vigilance

Monitoring for complications like laryngospasm or stridor after surgery.

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Patient Positioning

Placing the patient to ensure optimal access for anesthesia and surgery.

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ETT placement

Securely positioning the endotracheal tube and confirming its placement.

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Controlled Hypotension

Intentional reduction of Mean Arterial Pressure (MAP) to minimize bleeding during surgery.

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A-Line

An arterial line used to continuously monitor blood pressure during surgery.

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PONV

Postoperative nausea and vomiting, often increased after certain ENT procedures.

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Labetalol

A beta-blocker used to manage blood pressure during controlled hypotension.

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Dexmedetomidine

An alpha-2 adrenergic agonist that can help maintain controlled hypotension.

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Methemoglobinemia

A potential side effect from benzocaine causing reduced oxygen delivery.

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Multimodal Approach

Combining different methods to prevent PONV effectively.

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Topical Local Anesthetics

Anesthetics like cocaine, lidocaine, and benzocaine used for localized pain control.

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Anesthetic goals

Objectives include minimizing bleeding, airway reflexes, and managing pain and nausea.

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Perioperative management in kids

Inhalation induction with or without parental presence; often uses cuffed ETT if age 8 or older.

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Cuffed ETT age requirement

Cuffed endotracheal tube used for children aged 8 or older to ensure proper ventilation.

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Perioperative management in adults

IV induction combined with a balanced technique; relaxation is not routinely needed.

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Post-tonsillectomy hemorrhage

A surgical emergency; look for hypovolemia and tachycardia following surgery.

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Laryngospasm

A reflexive closure of the vocal cords; watch for it during emergence from anesthesia.

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“Rule of 10” for cleft repair

Criteria include age >10 weeks, weight 10 kg, hematocrit >10%, and WBC count appropriate.

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Postoperative care position

Patients are taken to PACU in a left lateral or 'tonsil' position for monitoring.

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Emergence and suctioning

Suctioning of the oropharynx is critical during emergence to prevent airway obstruction.

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Risk factors for post-tonsillectomy hemorrhage

Age over 15, male gender, frequent infection, and technique with hot cautery increase risks.

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Laser Types

Different types of lasers are used in medical procedures based on their medium.

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CO2 Laser

A laser commonly used for procedures in and around the larynx, known for precision and shallow burn depth.

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Ho:YAG Laser

Laser often used in nasal surgeries and tonsillectomies, provides deep tissue penetration.

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Suction Evacuation

A safety measure to evacuate toxic fumes produced during laser procedures.

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Fire Triad

The three elements required for a fire: an ignition source, fuel source, and oxidizer.

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Airway Fire Signs

Indicators of an airway fire include darkening of tubes and flames around devices.

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Fire Risk Levels

Categories of fire risk in procedures range from low to high, based on safety measures.

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Preoperative Evaluation

Assessment conducted before surgery to identify potential airway problems.

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Safety Precautions in Surgery

Measures such as eye protection and suction evacuation to ensure safety during laser use.

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Common ENT Procedures

Procedures like laryngoscopy or bronchoscopy used to evaluate and treat ear, nose, and throat conditions.

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Laser-resistant ETT

Endotracheal tubes designed for use during airway-laser procedures.

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Intermittent Apnea

Technique where the ETT is temporarily removed to allow a surgeon to operate while mask ventilation occurs.

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Transnasal Humidified Rapid-Insufflation Ventilation (THRIVE)

Nasal high flow oxygen method for oxygenation in breathing or apneic patients.

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Jet Ventilation

High-pressure ventilation technique without ETT, allowing passive exhalation.

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LMA advantages

Less tracheal stimulation, no need for neuromuscular blockers, and allows surgical access.

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Study Notes

Patient Positioning

  • Patients are often turned 90-180 degrees away from the anesthesia provider
  • Precise attention to ETT placement and securement is critical
  • Confirm ETT placement during every repositioning
  • Vigilant monitoring is needed

Controlled Hypotension

  • MAP is reduced to a predetermined acceptable level
  • Aim: decrease bleeding and improve surgical visualization
  • For certain patients, not appropriate
  • Usually no more than 20% decrease from baseline
  • Requires an arterial line (A-Line)
  • Chronic hypertension patients may need higher MAP
  • Monitor urine output, MAP, cerebral and cardiac perfusion pressures, and ABGs
  • Methods include:
    • Inhalational agents
    • Vasodilating agents:
      • Beta blockers (Labetalol, Esmolol)
      • Alpha 2 adrenergic agonists (Dexmedetomidine)
      • Calcium channel blockers -Ultra-short acting opioids (Remifentanil) -Magnesium sulfate

PONV

  • ENT procedures can have a higher PONV incidence
  • Middle ear procedures are associated with increased PONV risk
  • Pediatric strabismus procedures also associated with increased risk

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