Airway - Blocks

Question 1

innervates the roof of the pharynx, the tonsils, and the soft palate

Answer 1

glossopharyngeal nerve

Question 2

supplies sensory innervation to the back of the tongue

Answer 2

glossopharyngeal nerve lingual branch

Question 3

sensory innervation to the epiglottis, and the interior of the larynx down to the vocal cords

Answer 3

superior laryngeal internal branch

Question 4

motor innervation to the cricothyroid muscles effecting pitch of the voice

Answer 4

superior laryngeal external branch

Question 5

sensory innervation below the vocal cords and all remaining motor innervation to the larynx

Answer 5

recurrent laryngeal

Question 6

what structure are the vagus and recurrent laryngeal nerve close to?

Answer 6

carotid artery

Question 7

Performed when topical anesthesia does not completely obliterate the gag reflex.

Answer 7

glossopharyngeal block

Question 8

where are lingual branches of the glossopharyngeal nerve most easily accessed

Answer 8

as they transverse the palatoglossal folds

Question 9

side effects of glossopharyngeal nerve block?

Answer 9

painful and persistent hematoma

Question 10

where does anesthetist stand for a glossopharyngeal block?

Answer 10

contralateral side with pt mouth open

opposite side of block

Question 11

for a glossopharyngeal block, what is identified and how is the tongue displaced

Answer 11

palatopharyngeal fold (posterior tonsillar pillar) is identified and a tongue blade, held with the non-dominant hand, is introduced into the mouth to displace the tongue medially (contralateral side) creating a gutter between the tongue and the teeth.

Question 12

what does it mean if air is aspirated during glosp nerve block

Answer 12

the needle has passed through the membrane (through and through).

Question 13

what does it mean if blood is aspirated during glosp nerve block

Answer 13

needle is in vessel, needs to be pulled back some and redirected more medially

Question 14

what do you do after aspiration test of glosp nerve block

Answer 14

2 ml of 1% Lidocaine can be injected into the anterior tonsillar pillar 0.5 cm lateral to the base of the tongue (This most readily blocks the lingual branch

Question 15

Paralysis of the pharyngeal muscles and relaxation of the tongue may cause

Answer 15

obstruction of the upper airway.

Question 16

what block should be done last to avoid obstruction

Answer 16

glosp nerve block

Question 17

Superior Laryngeal Nerve Block anesthetist position

Answer 17

ipsilateral side

same side

Question 18

The cornu of the hyoid bone is palpated where

Answer 18

the side of the neck immediately beneath the angle of the mandible and anterior to the carotid artery.

Question 19

how would you facilitate identification of the hyoid bone

Answer 19

the hyoid bone is displaced toward the side being blocked; with the same hand displace the carotid artery laterally and posteriorly.

Question 20

after finding and displacing the hyoid bone during sl nerve block, what do you do

Answer 20

With the other hand, a 22 or 23 guage - 25 mm needle is “walked off” the cornu (cartilage) of the hyoid bone in an anterior caudad direction, aiming in the direction of the thyroid ligament, until it can be passed through the ligament.

Question 21

after aspiration proven neg, what is injected for sl nerve block?

Answer 21

At a depth of 1-2 cm, 2 ml of 2% lidocaine with epinephrine is injected

Question 22

where is the 2% lidocaine injected?

Answer 22

into the space between the thyrohyoid membrane and the pharyngeal mucosa.

Question 23

as you withdraw needle what should you do

Answer 23

inject additional 1 ml

Question 24

what does the Superior Laryngeal Nerve Block anesthetize?

Answer 24

all laryngeal mucous membranes above the rima glottidis including the epiglottis and the arytenoepiglottic folds

Question 25

should be used with caution in patients with a full stomach.

Answer 25

Superior Laryngeal Nerve Block bc it removes protective reflexes

Question 26

potential complications Superior Laryngeal Nerve Block

Answer 26

local anesth toxicity
hematoma formation
aspiration

Question 27

The maximum safe dose of topical lidocaine

Answer 27

4 mg/kg

Question 28

what is tropical thunder used for

Answer 28

awake fiberoptic intubation, video laryngoscopy

Question 29

how should you educate patient before tropical thunder?

Answer 29

lidocaine tastes bad and coughing is normal

Question 30

what position should pt be in for tropical thunder procedure?

Answer 30

sitting position