Surgical Specialties Exam: Questions With Expert-Level
Solutions
Common complications with sharing the airway Right Ans - disconnection
from circuit
kinking airway or sample line
surgical personnel leaning on chest (decreased Vt) or face (corneal shields)
ENT under MAC complications Right Ans - central depression from
sedation
obstruction d/t airway manipulation by surgeon
fire danger
preop eval for ENT cases Right Ans - concerns with distorted airway
need for special airway: laser tube, oral/nasal RAE, FOB intubation
determine if you want surgeon there for induction since they know anatomy
well
what can flexion/extension of neck do to ETT positioning? Right Ans - R
mainstem or herniated cuff
what can pressure on the sample line do to your EtCO2 Right Ans - it
becomes trapped and keeps your Et waveform high
other ETT concerns with ENT surgeries Right Ans - nasal RAE leading to
compression of nares
disconnection of circuit
circuit extenders for 180 degree turn
ensuring there's no compression on soft tissue
ETT may need to be sutured
nerve monitoring ENT surgeries preferences Right Ans - no tracheal
lidocaine
no muscle relaxant
NIM tube (neural integrity monitor)
BP issue (HoTN)
ear drum repair preferences Right Ans - no N2O, closed environment
, what medications to use in sensitive response areas of trachea in ENT
surgeries Right Ans - sufenta, precedex, remi to blunt surgical response to
tracheal being manipulated--may cause HoTN
have propofol and phenylephrine ready
tonsils and adenoids anesthesia implications Right Ans - regular ETT or
LMA
airway obstruction on induction
high likelihood of laryngospasm
blood in stomach leads to N/V--suction prior to extubation
post-op bleed can be an emergency
risks of hypertrophic tonsils Right Ans - airway obstruction, OSA
s/sx of cor pulmonale
longstanding hypoxemia/hypercarbia leads to increased airway resistance,
PVR constriction, PAH, R HF
what to assess for patients with hypertrophic tonsils Right Ans - increased
WOB, audible respirations, mouth breathing, chest retractions
inspiratory stridor/prolonged expiration may indicate partial airway
obstruction
T&A anesthesia Right Ans - standard induction
maintenance with volatile anesthetic +/- N2O
Tylenol 15mg/kg IV or 40mg/kg rectal
.5-1mcg/kg precedex -- emergence in kids
PONV prophylaxis: decadron, zofran
complications with T&A Right Ans - postop hemorrhage
75% of postop tonsillar hemorrhage occurs within 6 hours of surgery
what kind of anesthesia should be performed in postop hemorrhage T&A
Right Ans - RSI
considered as full stomachs because amount of blood can be swallowed
Solutions
Common complications with sharing the airway Right Ans - disconnection
from circuit
kinking airway or sample line
surgical personnel leaning on chest (decreased Vt) or face (corneal shields)
ENT under MAC complications Right Ans - central depression from
sedation
obstruction d/t airway manipulation by surgeon
fire danger
preop eval for ENT cases Right Ans - concerns with distorted airway
need for special airway: laser tube, oral/nasal RAE, FOB intubation
determine if you want surgeon there for induction since they know anatomy
well
what can flexion/extension of neck do to ETT positioning? Right Ans - R
mainstem or herniated cuff
what can pressure on the sample line do to your EtCO2 Right Ans - it
becomes trapped and keeps your Et waveform high
other ETT concerns with ENT surgeries Right Ans - nasal RAE leading to
compression of nares
disconnection of circuit
circuit extenders for 180 degree turn
ensuring there's no compression on soft tissue
ETT may need to be sutured
nerve monitoring ENT surgeries preferences Right Ans - no tracheal
lidocaine
no muscle relaxant
NIM tube (neural integrity monitor)
BP issue (HoTN)
ear drum repair preferences Right Ans - no N2O, closed environment
, what medications to use in sensitive response areas of trachea in ENT
surgeries Right Ans - sufenta, precedex, remi to blunt surgical response to
tracheal being manipulated--may cause HoTN
have propofol and phenylephrine ready
tonsils and adenoids anesthesia implications Right Ans - regular ETT or
LMA
airway obstruction on induction
high likelihood of laryngospasm
blood in stomach leads to N/V--suction prior to extubation
post-op bleed can be an emergency
risks of hypertrophic tonsils Right Ans - airway obstruction, OSA
s/sx of cor pulmonale
longstanding hypoxemia/hypercarbia leads to increased airway resistance,
PVR constriction, PAH, R HF
what to assess for patients with hypertrophic tonsils Right Ans - increased
WOB, audible respirations, mouth breathing, chest retractions
inspiratory stridor/prolonged expiration may indicate partial airway
obstruction
T&A anesthesia Right Ans - standard induction
maintenance with volatile anesthetic +/- N2O
Tylenol 15mg/kg IV or 40mg/kg rectal
.5-1mcg/kg precedex -- emergence in kids
PONV prophylaxis: decadron, zofran
complications with T&A Right Ans - postop hemorrhage
75% of postop tonsillar hemorrhage occurs within 6 hours of surgery
what kind of anesthesia should be performed in postop hemorrhage T&A
Right Ans - RSI
considered as full stomachs because amount of blood can be swallowed
