Scoping Out the Airway
(Endoscopy Procedures)
(Endoscopy Procedures)
This may be an airway technique utilized by an anesthesia team to help facilitate direct laryngoscopy/bronchoscopy by an ENT provider.
What is:
- LMA (with "wings" cut if present)
- TIVA (meds)
This is a common anesthetic complication of many nasal and sinus surgeries, likely due to surgical field's proximity to affected site.
What are:
Corneal abrasions
This is a common type of ETT used in many head and neck surgeries
What is:
Neural Integrity Monitoring (NIMS) tube
Nasal intubation should NOT be performed in these types of fractures.
What are:
LeFort II and III, due to possible coexistence of a basilar skull fracture
What is:
Nitrous Oxide
This is a pitfall/complication if jet ventilation is used.
What is:
Air trapping/barotrauma
These nerves supply sensation to nasal septum and lateral walls.
What are:
anterior ethmoidal nerve and sphenopalatine nerves
This is an alternative management for securing an airway when dealing with large head and neck cancers causing airway distortion.
What is:
Maintenance of spontaneous ventilation, via awake fiberoptic (if cooperative), inhalational induction vs agent choice (if uncooperative).
These are postoperative considerations if intermaxillary fixation is to be utilized.
What are:
1) masking difficulties
2) Presence of suction and wire-cutting tools
This is a common postoperative complication seen in the post-anesthesia care unit for these types of procedures.
What is:
Postoperative nausea and vomiting (PONV)
These are the anesthetic goals for laryngeal endoscopy.
What are:
1) immobile surgical field, masseter relaxation if suspension required
2) adequate oxygenation and ventilation
3) cardiovascular stability with varying levels of surgical stimulation
These are considerations for emergence from nasal and sinus surgeries
What are (to name a few):
1) Avoidance of coughing/straining
2) Ability to properly mask patient if bandages will be applied
3) Somewhat increased risk of aspiration
These nerves may be damaged in anterior neck operations.
What are:
Superior larygeal, recurrent laryngeal, vagus nerves
These are some considerations in determining if a patient can be extubated.
What are:
- Amount of debris left in pharyngeal space
- Use of throat pack intraoperatively
- If possible postop edema is a risk to nearby structures (tongue, glottis, pharynx)
This structure can be damaged in some types of ear surgery, such as acoustic neroma resection, that can influence elements of the anesthetic.
What is:
the Facial Nerve
These are steps to *prevent* an airway fire.
What are:
1) Lower FiO2 (AND COMMUNICATE)
2) Avoid N2O
3) Consider saline in ETT cuff
4) Limit laser intensity/duration
5) Saline soaked pledgets in airway
6) Have source of water nearby
These are two techniques that can be used to minimize blood loss during large sinus surgeries.
What are:
1) Use of local anesthetic with vasoconstrictive properties (cocaine, local + epi)
2) Mild controlled hypotension
This is one of several comorbidities associated with head and neck cancers.
What are:
*Tobacco and alcohol use*, COPD, CAD, HTN, T2DM, malnutrition
This can be an increased risk of a surgery performed in the "head-up" tilt position.
What is:
Venous air embolus
This is the most commonly performed nerve block in dental surgery.
What is:
Inferior alveolar nerve block
These are the steps you should take if airway fire is suspected.
What are:
1. Stop ventilation and remove tube
2. Turn off O2 source, disconnect circuit
3. Submerge
4. Ventilate with face mask, reintubate
5. Assess airway damage
6. Consider bronchial lavage, steroids
This is a common goal of emergence in many nasal and sinus surgeries
What is:
Avoidance of coughing/straining to reduce increases in venous pressure/postoperative bleeding
This is your differential with increased peak inspiratory pressures following tracheostomy.
What are:
1) Malpositioned endotracheal tube/tracheostomy
2) Bronchospasm
3) Mechanical obstruction (via debris)
4) Pneumothorax
This is a complication if nitrous oxide is used in severe Lefort II and III fractures.
What is:
Pneumocephalus
These complications are at an increased risk with relation to dental surgery under anesthesia.
What is:
LAST, or intravascular injection of local anesthetic