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Anaesthesiology
Anesthesia for Otolaryngologic Surgery
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
5 sections · 198 slides
Overview
- Scope of this topic
- Key themes across the topic
- Evaluating the Airway
- Normal airflow and the work of breathing
- Consequences of upper airway obstruction
- Recognising and imaging a compromised airway
- Tonsillectomy and Adenoidectomy
- Challenges of pediatric ear, nose and throat surgery
- Adenoidal hyperplasia and its surgical indications
- Indications for tonsillectomy
- Consequences of tonsillar hyperplasia
- Obstructive sleep apnea syndrome
- Treatment goals and levels of obstruction
- Tonsil size grading by oropharyngeal area
- Cor pulmonale in chronic airway obstruction
- Events leading to cor pulmonale
- Cardiovascular effect of each apneic episode
- History in the preoperative evaluation
- Physical examination findings in airway obstruction
- Auscultation findings and their meaning
- Preoperative investigations
- Spectrum of sleep-disordered breathing
- Methods of assessing obstructive sleep apnea
- Screening questionnaires for obstructive sleep apnea
- Role of polysomnography in children
- Clinical features of obstruction during sleep
- Two types of obstructive sleep apnea syndrome
- Age distribution and obesity as risk factors
- Craniofacial and anatomic risk factors
- Anatomic balance and neural compensation
- Loss of pharyngeal dilator tone in sleep and anesthesia
- Manoeuvres that relieve pharyngeal obstruction
- Neurocognitive and metabolic consequences of sleep apnea
- Cardiovascular comorbidities of sleep apnea
- Surgical management of obstructive sleep apnea
- Mandibular distraction osteogenesis in craniofacial syndromes
- Tonsillotomy versus tonsillectomy
- Cochrane evidence on tonsillotomy in children
- Drug-induced sleep endoscopy
- Sedation and airway rescue during sleep endoscopy
- Choice of anesthetic agent for sleep endoscopy
Anesthetic Management for Tonsil Surgery
- Goals of anesthesia for adenotonsillectomy
- Premedication in children with airway obstruction
- Induction and tracheal intubation
- Multimodal analgesia and acetaminophen
- Timing of non-steroidal anti-inflammatory drugs
- Opioid dosing in obstructive sleep apnea
- Protecting the trachea from blood
- Intraoperative monitoring
- Emergence and tracheal extubation
- The laryngeal mask airway in adenotonsillectomy
- Standard versus flexible laryngeal mask airway
- Airway fire risk with the laryngeal mask airway
- Insertion and ventilation with the laryngeal mask airway
- Manoeuvres for difficult laryngeal mask insertion
- Advantages of the laryngeal mask over intubation
- Removal of the laryngeal mask airway
Complications of Tonsil Surgery
- Post-tonsillectomy mortality
- Postoperative nausea and vomiting
- Antiemetic therapy after tonsillectomy
- Incidence, timing and site of post-tonsillectomy hemorrhage
- The bleeding tonsil as a full stomach
- Volume assessment and equipment for the bleeding tonsil
- Pain after adenoidectomy and tonsillectomy
- Peritonsillar abscess
- Peritonsillar abscess with uvular displacement
- Neck radiograph in peritonsillar abscess
- Computed tomography of peritonsillar abscess
- Airway management in peritonsillar abscess
- Negative-pressure pulmonary edema
- Intrapleural pressures with and without obstruction
- Mechanism of negative-pressure pulmonary edema
- The expiratory grunt as a protective mechanism
- Contributing factors and prevention
- Recognising and treating negative-pressure pulmonary edema
- Same-day discharge after tonsil surgery
- Purpose of the inpatient admission criteria
- Tonsillectomy and Adenoidectomy Inpatient Guidelines: Recommendation of the American Academy of Otolaryngology-Head and Neck Surgery
- Tonsillectomy and Adenoidectomy Inpatient Guidelines: Recommendation of the American Academy of Otolaryngology-Head and Neck Surgery (continued)
- Postoperative monitoring and intensive care
Laryngology and Ear Surgery
- Voice disorders, papillomatosis and vocal fold paralysis
- Anesthesia for medialization laryngoplasty
- Myringotomy and ventilation tube insertion
- Anesthetic technique and upper respiratory infection in myringotomy
- Analgesia for myringotomy tubes
- Positioning for tympanoplasty and mastoidectomy
- Facial nerve monitoring during ear surgery
- Muscle relaxants with facial nerve monitoring
- Deliberate hypotension in middle ear surgery
- Epinephrine concentration for local vasoconstriction
- Nitrous oxide pressure in the middle ear
- Negative middle ear pressure after nitrous oxide
- Nitrous oxide and postoperative vomiting after ear surgery
Airway Surgery
- Principles of shared airway surgery
- Methods of oxygenation during shared airway surgery
- Stridor and the level of obstruction
- Causes of Stridor
- History in the evaluation of stridor
- Acquired vocal cord paralysis and stridor investigation
- Clinical Component of the Evaluation of Patients with Stridor
- Laryngomalacia
- Unilateral vocal cord paralysis
- Diagnosis of laryngomalacia and vocal cord paralysis
- Sequence of rigid and flexible airway examination
- Treatment of laryngomalacia and vocal cord paralysis
- Premedication and anesthetic goals for bronchoscopy
- Induction and positioning for bronchoscopy
- Bronchoscope sizing and airway trauma
- Comparison of External Diameter of Standard Endotracheal Tubes Versus Rigid Bronchoscope
- Ventilation through the rigid bronchoscope
- Jet ventilation and planning around the surgical question
- Airway management after rigid bronchoscopy
- Pediatric Airway Emergencies
- Epidemiology of acute epiglottitis
- Rate of progression in epiglottitis
- Signs and symptoms of acute epiglottitis
- Supraglottitis as the anatomic description
- Dynamic airway collapse in the agitated child
- Interventions to avoid before the airway is secure
- Radiology and transfer in epiglottitis
- Operating room preparation for epiglottitis
- Induction and intubation in epiglottitis
- Postoperative care and extubation in epiglottitis
- Laryngotracheobronchitis and its radiologic sign
- Epiglottitis compared with croup
- Treatment of croup
- Presentation of foreign-body aspiration
- Radiologic findings in foreign-body aspiration
- Radiopaque foreign body in the right mainstem bronchus
- Complications specific to the aspirated material
- Induction for foreign-body removal
- Nitrous oxide and air trapping
- Spontaneous versus controlled ventilation for foreign-body removal
- Ventilation problems during bronchoscopic retrieval
- After the foreign body is removed
- Laser Surgery of the Airway
- Advantages of the laser in airway surgery
- Applications of the carbon dioxide laser
- Mechanism of laser tissue destruction
- Eye protection for staff and patient
- Fire, burn and smoke hazards of the laser
- Carrier gas selection during laser surgery
- Endotracheal tube selection for laser surgery
- Purpose-built laser endotracheal tubes
- Size penalty of metal laser tubes
- Comparison of Standard Plastic Versus Metal Endotracheal Tubes
- Apneic technique for airway laser surgery
- Jet ventilation during laser surgery
- Spontaneous ventilation without an endotracheal tube
- Surgical laryngoscope and jet ventilator set-up
- Disadvantages of the spontaneous-ventilation laser technique
- Nasal and Skull Base Surgery
- Functional endoscopic sinus surgery and the surgical field
- Cardiovascular assessment before sinus surgery
- Systemic effects of intranasal vasoconstrictors
- Positioning and maintenance for sinus surgery
- Skull base surgery: population, imaging and embolization
- Airway consequences of previous surgery and radiation
- Anesthetic implications of prior chemotherapy
- Systemic effects of prior radiation therapy
- Airway route, tube fixation and facial nerve integrity
- Blood conservation strategies in skull base surgery
- Adult Upper Airway Infections
- Adult upper airway infection and Ludwig's angina
- Airway management and postoperative course in adult neck infection
- Maxillofacial Trauma
- Anesthetic tasks in maxillofacial trauma
- Thirds of the facial skeleton
- Fracture patterns of the mandible
- Mechanism of injury and fracture distribution
- Midface force transmission and skull base fracture
- LeFort classification of midface fractures
- LeFort I and LeFort II fractures
- LeFort III fracture lines
- Clinical signs of a LeFort III fracture
- Contraindication to nasotracheal intubation
- Associated cervical spine and head injuries
- Airway technique and the surgical airway in trauma
- Causes of restricted mouth opening
- Mechanical interference and trismus limiting mouth opening
- Summary
- Key points on the shared airway
- Key points on sleep apnea and opioids
- Key points on bleeding and air-filled cavities
- Key points on vasoconstrictors and previous treatment
- Key points on facial trauma
- References
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition