ENT

airway protection respiration vocalization

9 total 3 paired: artenoids, corniculate, cuniform 3 unpaired: epiglottis, thyroid, cricoid

vocal cord tension open and close epiglottis

connects Larynx to hyoid bone elevates and depress larynx during swallow, phonation, inspiration

vagus nerve > superior and recurrent laryngeal nerves

afferent: sensory: glossopharlygeal 9 efferent: motor: vagus 10

maxillary V2 of trigeminal 5

sensory: below vocal cords and trachea motor: all except cricothyroid

paralysis of ipsilateral vocal cord abductors common with subtotal thyroidectomy hoarseness

emergency bilateral paralysis of vocal cord abductors and airway closure> strider > intubate

hoarseness

shared airway distorted airway airway fire establish and maintain patent airway drugs controlled hypotension safe and timely extubation

before airway reflex return: stage III why: reduce cough and bucking patency to surgical site reduce ICP severe asthma or bronchospasm risk peds contra: uncontrolled OSA unable to mask ventilate difficult airway/edema aspiration risk RSI 1. gas up to 0.8-1.0 MAC 2. spontaneous ventilation 3. deep suction 4. oral airway 5. remove ett 6. positive pressure 7. assist spont respiration ventilation 8. 100% fiO2

chronic ear and throat infections peds PRECORDIAL STETHIE Anesth: no IV mask GA of 50/50 Sevo:N20 HOB 90 monitor for spasm 5-15 min Concern: bad mask airway laryngospasm no IV too much anesthesia

1. repairs hold in membrane after trauma 2. chronic otitis media, inability to equalize ears, air filled spaces of mastoid process are dysfunctional 3. combo patient is turned 180 degree = field avoidance patient supine with extreme head turn postauricular incision long: 2-6 hours positioning: extensions and connectors, must be long long circuit and straight connector disconnect ett last for turn oral Rae ett avoid paralysis: doc using facial nerve monitor of CN 8

most common elective peds procedure 1. adenoidal hyperplasia 2. tonsils hypertrophy: % of oropharyngeal area occupied by the tonsils 3. OSA STAR: throat will get packed, remove before emergence IV or mask GA less narcs, more gas antiemetics: 35-60% emesis anes goals: safety secure airway: mask induction > GA then obtain IV access, rapid and smooth emergence problems: bleeding: 20-100cc intraop very richly vascular tissue 75% of bleeding occurs within 6 hours - always treat as full stomach and RSI