Intra-Operative Discussion Topics for ENT Anesthesia Rotation

 

 

1.                  Detailed discussion of the ASA difficult airway algorithm and alternative techniques of airway management.

 

2.                  Airway anatomy, innervations, clinical effects of various laryngeal nerve injuries.

 

3.                  Airway examination - the various ways of evaluating difficult airways, their positive and negative predictive values, and limitations.

 

4.                  Discuss (including the indications and contraindications) and/or demonstrate the application of various fundamental intubation techniques:

 

    1. Fiberoptic (oral and/or nasal) intubation
    2. LMA and Fastrach LMA (including the issues with PPV through the LMA)
    3. Gummed elastic bougie
    4. Nasotracheal intubation
    5. Lightwand intubation
    6. Awake intubation
    7. Others (tube changer, Siker blade, Bullard laryngoscope, Combitube … etc)

 

5.                  Discuss the use of retrograde intubation, percutaneous cricothyrotomy, and surgical tracheostomy for emergency airway management.

 

6.                  Laser surgery – types of medical laser used, indications, hazards (airway fire, unintentional tissue damage, inappropriate energy transfer, atmospheric contamination, ocular damage), anesthetic considerations, and management of complications.

 

7.                  Ear and sinus surgeries – anesthetic considerations, techniques for minimizing PONV and peri-operative bleeding, indications and contraindications of neuromusclular blockade usage, and ways to prevent emergence agitation/stimulation

 

8.                  Adenotonsillectomy and uvulopalatopharyngoplasty (UPPP) - what are the indications/contraindications, pre-operative evaluation issues, pre-medications, airway management issues, and post-operative complications (i.e. bleeding and airway obstruction).

 

9.                  Radical neck dissection - the possible hemodynamic responses (especially bilateral dissection), airway management issues, and the impact of anesthetic management on skin/muscle graft viability.

 

10.              Discuss the anesthetic techniques for panendoscopy (goals and different ways to achieve them).

 

11.              Tracheostomy devices (metal vs Shiley, cuffed vs uncuffed, fenestrated, etc) – know the various types and the management of these devices peri-operatively.

 

 

12.              LeFort fracture – understand the different types and how they affect your airway management strategies as well as anesthetic technique (including criteria for extubation).

 

13.              Ludwig’s angina - know the anesthetic considerations in managing patients with this condition.

 

14.              What are different techniques (i.e. local anesthetics with vasoconstrictor, head up position, deliberate hypotension) to minimize intra-operative blood loss for ENT surgeries? 

 

15.              Deliberate hypotension for ENT surgeries - the indications and contraindications, the evidence-based intra-operative outcome (i.e. improved surgical condition, minimization of bleeding and/or transfusion requirement … etc), techniques to achieve this condition, and potential adverse effects.

 

16.              Anesthetic considerations in managing patients with facial trauma or wired jaw.

 

17.              Patients with bleeding after tonsillectomy – what are the peri-operative issues and anesthetic considerations?

 

18.              Pharmacokinetics of opiate infusions and clinical applications of Total IntraVenous Anesthesia (TIVA) for ENT surgeries.