13. Airway Block Flashcards
superior laryngeal nerve is a branch of
vagus nerve
internal branch superior laryngeal nerve innervates
sensory only
above the vocal cords
external branch of superior laryngeal nerve innervates
motor only
cricothyroid muscle
reccurent laryngeal nerve is a branch of the
vagus nerve
RLN innervates
motor
intrinsic laryngeal muscles (not cricothyroid)
larynx below the vocal cords
trachea
unilateral injury to SLN SE
minor side effects
bilateral injury to SLN SE
hoarseness
unilateral injury to RLN SE
hoarseness
bilateral damage to RLN SE
dyspnea
stridor
aphonia
branches of trigeminal nerve
opthalmic (V1)
maxillary (V2)
mandibular (V3)
the mandibular nerve branches into
lingual nerve
lingual nerve innervation
anterior 2/3 of tongue
glossopharyngeal nerve (IX) innervation
posterior 1/3 of tongue
posterior pharynx
tonsils
epiglottis
blocking glossopharyngeal nerve SE
suppress gag reflex
blocking SLN anesthetizes
larynx above vocal cords:
base of tongue
epiglottis
arytenoids
blocking RLN anesthetizes
vocal cords
below vocal cords (trachea)
which nerves must be blocked to completely anesthetize airway for awake intubation
glossopharyngeal nerve
SLN
RLN
glossopharyngeal nerve block complications
dysphagia
loss of taste
hoarseness
2 methods for glosspharyngeal nerve block
lidocaine spray
lidocaine injection
lidocaine spray dosing
10% lidocaine
lidocaine spray onset
1-3 mins
lidocaine spray duration
10-15 mins
how many seconds between each lidocaine spray
3 swallows or 15-30 seconds
glossopharyngeal injection location
submucosa of posterior tonsillar pillar
glossopharyngeal injection needle size
25ga
glossopharyngeal injection drug
2% lidocaine
glossophargyneal injection volume
2-5 mL
glossopharyngeal injection onset
10-20 mins
glossopharyngeal injection duration
2-5 hrs
SLN block patient positioning
extend neck
displace hyoid bone
SLN block needle insertion
greater cornu of hyoid bone
SLN block needle size
25ga
why do you aspirate before injecting SLN?
to aovid injection into superior laryngeal artery
SLN block needle advance
walk needle off bone inferiorly
SLN block drug dose
2mL of 2% lidocaine
SLN nerve block anesthetizes
internal SLN (sensory)
external SLN (motor)
RLN/transtracheal block indication
glottic closure reflex
which pts are direct RLN blocks CI
all pts due to risk of bilateral vocal cord paralysis and airway obstruction
transtracheal block needle insertion
through cricothyroid membrane
transtracheal block needle gauge
22 ga
when do you stop advancing needle for transtracheal block
aspirate on syringe while advancing
stop advancing when you see bubbles
transtracheal block drug/dose
5 mL of 4% lidocaine
how should you inject the LA for transtracheal?
rapid to encourage coughing and spread of the anesthetic
transtracheal block onset
5-15 mins
transtracheal block duration
2 hrs
sedation options for awake intubations
dexmedetomidine
remi
robinul (dry mouth out)
ketamine (preserve respiratory drive)
awake DL sedation
versed
remifentanil bolus
cetacaine gargel
