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WHat nerve may be damaged during middle ear or mastoid cell surgeries?
The facial nerve
What is the anesthetic concerns for preservation and monitoring of the facial nerve for otologic surgery?
1. Avoid use of musle relaxants intraop
-minimum of 10-20% of a muslce response must be present to check nerve
How are facial nerve preserved during otologic surgery?
evoked facial electromyocgraphic activity
What happens if N2O is used in middle ear surgery?
1. Tympanic rupture due to N2O expanding in closed space
2. When used in open space that is closed the withdrawl of N2O produces negative pressure in middle ear
What are methods to minimizing bleeding during otologic surgery?
1. HOB to 10-15 degrees to inc venous drainage
2. Induced HOTN
-SBP 80-90, MAP 60
What equipment required for induced HOTN?
1. A-line
2. ABG
3. Capnography
4. Foley if > 2 hours
When elevating the head at what degree of elevation is cerebral venous pressure reduced?
15-30 degrees
What postop complication must be avoided in middle ear surgery? tx?
PONV

Treatment: Antiemetics, propofol, droperidol, trans scopolamine
What is the major concern with acoustic neuroma Evacuation?
Major blood loss
What type of anesthesia is used for Rhinoplasty and other major nasal surgeries?
GA due to surgical manipulation time and potential for blood loss
What may happen if patient moves during nasal or sinus surgery?
1. Entry into intracranial space
2. blindness
3. Internal carotid artery damage
What may blood in the oropharynx cause?
coughing and laryngospasm
What ventilation strategy is not possible in rhinoplasty?
BMV w/ PPV, no pressure is allowed on the nose
What is the difference between false vocal cord and true vocal cord damage?
False cords- prevent air from going out, reacts to PPV

True cords- allow air to go out, prevent air from coming in
What laryngeal muscles have unopposed contraction with bilateral recurrent laryngeal nerve injury?
unopposed cricothyroid muscle contraction
Stimulation of what nerve causes a laryngospasm?
spasm of the glottic musculature mediated by superior laryngeal nerve, the false cords and epiglottis come together
Treatment of a laryngospasm?
1. 100% FiO2
2. Deepen depth of anesthetic
3. PPV with mask and bag
4. Sch 10% of intubating dose
What pulmonary complication can occur as a result of laryngospasm?
Negative pressure pulmonary edema
- inhaling against closed glottis generates a strong negative force that draws fluid inward towards lungs
What happens to a laryngospasm as a result of hypxemia/hypercarbia?
Decrease in postsynaptic potentials and brainstem output to SLN
- decrease glottic closure
- cease of laryngospasm
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