30 Questions
Which of the following is a sign of air leak around the tube during ENT surgery?
Bubbling
What is the purpose of using IV anesthesia during preoxygenation before disconnecting the anesthesia circuit?
To maintain an adequate level of anesthesia
Which type of ETT cuff is designed to reduce cuff pressure on the tracheal wall and optimize airway access?
Armored or reinforced ETTs
Which type of ETT is particularly well suited for maxillofacial surgery that does not allow for oral intubation?
Nasal RAE tubes
What is the advantage of using an intubating LMA in ENT procedures?
Controls the airway
What is the purpose of adding epinephrine to local anesthetic solutions during ENT surgery?
To produce vasoconstriction
Which of the following can be a complication of endoscopic surgery?
Eye trauma
What is a common premedication for endoscopic surgery?
Antisialagogue
What is a potential complication of high-frequency jet ventilation (HFJV)?
Reduced CO2 elimination
Which type of jet ventilation involves ventilation at low tidal volumes with high respiratory rates?
Supraglottic jet ventilation
What is a common site of foreign-body aspiration in the airway?
Right bronchus
What is the traditional diagnostic gold standard for foreign-body aspiration?
Rigid bronchoscopy
Which action can be taken to check for airway edema in a patient with an endotracheal tube (ETT)?
Deflate the cuff of the ETT
What should be done while listening for air movement around the endotracheal tube (ETT) to check for airway edema?
Inflate the cuff of the ETT
If air is escaping around the endotracheal tube (ETT), what might be considered?
Extubation of the patient
What should be done if the cuff of the endotracheal tube (ETT) cannot be deflated?
Increase the cuff pressure of the ETT
What is the purpose of occluding the lumen of the endotracheal tube (ETT) during inspiration and expiration?
To check for airway edema
What is the recommended duration for occluding the lumen of the endotracheal tube (ETT) during inspiration and expiration?
5 breaths
Which of the following is true about the addition of epinephrine to a local anesthetic?
It decreases toxicity
Which of the following is a benefit of using glycopyrrolate instead of atropine in certain intraoral procedures?
It produces less tachycardia
What is one of the reasons glucocorticoids may be administered preoperatively and intraoperatively?
To reduce nausea and vomiting
Which type of surgery is associated with a high incidence of postoperative nausea and vomiting (PONV)?
Middle ear surgery
What is the author's practice regarding the mean pressure during deliberate controlled hypotension?
Not allowing the mean pressure to fall below 50 to 60 mm Hg
Which laser has a shorter wavelength that allows it to pass through the cornea?
Nd:YAG laser
Which of the following is NOT a reason why obtaining a thorough history and performing an extensive evaluation of the airway is crucial for ENT patients?
To determine the patient's age and gender
During ENT surgery, why is the head of the table often rotated away from the anesthetist?
To allow the surgeon a better view of the surgical site
Why is planning and communication between the surgeon, surgical personnel, and the anesthetist important prior to ENT procedures?
To coordinate the use of appropriate anesthesia equipment
What is the main focus of anesthesia for ENT procedures?
Maintaining a patent airway
Why is it important for the anesthetist to review specialized anesthetic considerations for ENT procedures?
To understand the potential complications and risks
What is the purpose of analyzing the pharmacologic agents used for ENT procedures?
To ensure the effectiveness of anesthesia
Study Notes
Air Leak and Intubation
- A hissing sound or a decrease in tidal volume can indicate an air leak around the tube during ENT surgery.
Anesthesia
- IV anesthesia is used during preoxygenation before disconnecting the anesthesia circuit to prevent hypoxia.
- Intubating LMA is advantageous in ENT procedures as it allows for a secure airway and optimal surgical access.
Endotracheal Tubes
- The Low Pressure Cuff (LPC) ETT is designed to reduce cuff pressure on the tracheal wall and optimize airway access.
- The nasal RAE (Ring-Adair-Elwyn) tube is suitable for maxillofacial surgery where oral intubation is not possible.
Anesthetic Agents
- Epinephrine is added to local anesthetic solutions to reduce bleeding and improve surgical visibility during ENT surgery.
- Glycopyrrolate is preferred over atropine in certain intraoral procedures due to its longer duration of action.
- Glucocorticoids may be administered preoperatively and intraoperatively to reduce inflammation and airway edema.
Ventilation
- High-frequency jet ventilation (HFJV) can cause barotrauma, a potential complication.
- Superimposed high-frequency jet ventilation involves ventilation at low tidal volumes with high respiratory rates.
Complications
- Foreign-body aspiration is a complication of endoscopic surgery, with a common site being the bronchus.
- Airway edema can be checked by listening for air movement around the ETT while the cuff is deflated.
Clinical Practice
- The traditional diagnostic gold standard for foreign-body aspiration is bronchoscopy.
- Premedication for endoscopic surgery often includes glycopyrrolate.
- During deliberate controlled hypotension, the author aims to maintain a mean pressure of 40-60 mmHg.
Laser Surgery
- The KTP (Potassium Titanyl Phosphate) laser has a shorter wavelength, allowing it to pass through the cornea.
Anesthesia for ENT Procedures
- Planning and communication between the surgeon, surgical personnel, and the anesthetist are crucial for successful ENT procedures.
- The main focus of anesthesia for ENT procedures is to provide optimal surgical conditions.
- Reviewing specialized anesthetic considerations for ENT procedures is essential due to the unique challenges posed by these surgeries.
Quiz: Understanding the Benefits of Epinephrine and Anticholinergics in Local Anesthesia Test your knowledge on the effects of epinephrine and anticholinergics in local anesthesia. Learn how epinephrine prolongs the duration of blockade and decreases toxicity, while anticholinergics provide a drier operative field. See if you can identify the advantages of using glycopyrrolate over atropine.
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