Showing posts with label ENT. Show all posts
Showing posts with label ENT. Show all posts
Tuesday, June 14, 2011
anaesthesia for laryngectomy
http://books.google.com/books?id=qCN6PfjWWmwC&pg=PA370&lpg=PA370&dq=laryngectomy+anaesthesia&source=bl&ots=O3qHGmG9e-&sig=q49dguzy_8KaUOhFPi4ehdd-3nw&hl=en&ei=Y2H3TZTuC4uyrAe19ZmuCA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBkQ6AEwAA#v=onepage&q=laryngectomy%20anaesthesia&f=false
Monday, June 13, 2011
laser
(May-2008 Q9) A 25 yo man is to have laser surgery for a vocal cord papilloma. What are the hazards associated with the use of laser in this situation and how can they be minimsed?
Laser defined as: Light Amplification by Stimulated Emission of Radiation
Hazards of use are mainly related to airway fire due to ignition by heat generated from the laser beam.
It can be minimized by surgical preparation and anaesthesia factors
Surgical preparation: use laser in short bursts
Sterile water for irrigation should always be available.
OT preparation
In the event of an airway fire, irrigation with saline or sterile water
Anaesthesia factors: use as low an FiO2 as possible (as low an oxygen concentration to maintain adequate oxygenation)
Vigilance
Use of ETT with ? wire/armoured tube
Laser may cause airway papillomas?
LASER officers, fire drill
types of laser: CO2, Yag, ?
Laser defined as: Light Amplification by Stimulated Emission of Radiation
Hazards of use are mainly related to airway fire due to ignition by heat generated from the laser beam.
It can be minimized by surgical preparation and anaesthesia factors
Surgical preparation: use laser in short bursts
Sterile water for irrigation should always be available.
OT preparation
In the event of an airway fire, irrigation with saline or sterile water
Anaesthesia factors: use as low an FiO2 as possible (as low an oxygen concentration to maintain adequate oxygenation)
Vigilance
Use of ETT with ? wire/armoured tube
Laser may cause airway papillomas?
LASER officers, fire drill
types of laser: CO2, Yag, ?
recurrent laryngeal nerve function
(Sep-2003 Q13) How can recurrent laryngeal nerve function be assessed in the postoperative period?
RLN function can be assessed via invasive and non-invasive means
invasive test: nasoendoscopy to see weakness of unilateral glottis- inability to abduct? (remains adducted)
EMG?
non invasive: -clinical tests: presence of a leak if the patient is intubated and if the cuff is allowed to deflate, presence of stridor
RLN function can be monitored intra-op : conventional: needle electrode into cricoarytenoid. New: endoscopic visualisation (eg LMA)
The RLN (branch of the Vagus) is a mixed motor, sensory and autonomous nerve thatinnervates all intrinsic muscles of the larynx with the exceptionof the cricothyroid muscle, which is innervated by the superiorlaryngeal nerve.
ops at risk: thyroidectomy (<5%)/ACDF, carotid endarterectomy
http://www.omjournal.org/images/59_M_Deatials_Pdf_.pdf retrospective review
good review article
RLN function can be assessed via invasive and non-invasive means
invasive test: nasoendoscopy to see weakness of unilateral glottis- inability to abduct? (remains adducted)
EMG?
non invasive: -clinical tests: presence of a leak if the patient is intubated and if the cuff is allowed to deflate, presence of stridor
RLN function can be monitored intra-op : conventional: needle electrode into cricoarytenoid. New: endoscopic visualisation (eg LMA)
The RLN (branch of the Vagus) is a mixed motor, sensory and autonomous nerve thatinnervates all intrinsic muscles of the larynx with the exceptionof the cricothyroid muscle, which is innervated by the superiorlaryngeal nerve.
ops at risk: thyroidectomy (<5%)/ACDF, carotid endarterectomy
http://www.omjournal.org/images/59_M_Deatials_Pdf_.pdf retrospective review
good review article
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