Airway - Blocks Flashcards
innervates the roof of the pharynx, the tonsils, and the soft palate
glossopharyngeal nerve
supplies sensory innervation to the back of the tongue
glossopharyngeal nerve lingual branch
sensory innervation to the epiglottis, and the interior of the larynx down to the vocal cords
superior laryngeal internal branch
motor innervation to the cricothyroid muscles effecting pitch of the voice
superior laryngeal external branch
sensory innervation below the vocal cords and all remaining motor innervation to the larynx
recurrent laryngeal
what structure are the vagus and recurrent laryngeal nerve close to?
carotid artery
Performed when topical anesthesia does not completely obliterate the gag reflex.
glossopharyngeal block
where are lingual branches of the glossopharyngeal nerve most easily accessed
as they transverse the palatoglossal folds
side effects of glossopharyngeal nerve block?
painful and persistent hematoma
where does anesthetist stand for a glossopharyngeal block?
contralateral side with pt mouth open
opposite side of block
for a glossopharyngeal block, what is identified and how is the tongue displaced
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.
what does it mean if air is aspirated during glosp nerve block
the needle has passed through the membrane (through and through).
what does it mean if blood is aspirated during glosp nerve block
needle is in vessel, needs to be pulled back some and redirected more medially
what do you do after aspiration test of glosp nerve block
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
Paralysis of the pharyngeal muscles and relaxation of the tongue may cause
obstruction of the upper airway.
what block should be done last to avoid obstruction
glosp nerve block
Superior Laryngeal Nerve Block anesthetist position
ipsilateral side
same side
The cornu of the hyoid bone is palpated where
the side of the neck immediately beneath the angle of the mandible and anterior to the carotid artery.
how would you facilitate identification of the hyoid bone
the hyoid bone is displaced toward the side being blocked; with the same hand displace the carotid artery laterally and posteriorly.
after finding and displacing the hyoid bone during sl nerve block, what do you do
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.
after aspiration proven neg, what is injected for sl nerve block?
At a depth of 1-2 cm, 2 ml of 2% lidocaine with epinephrine is injected
where is the 2% lidocaine injected?
into the space between the thyrohyoid membrane and the pharyngeal mucosa.
as you withdraw needle what should you do
inject additional 1 ml
what does the Superior Laryngeal Nerve Block anesthetize?
all laryngeal mucous membranes above the rima glottidis including the epiglottis and the arytenoepiglottic folds
should be used with caution in patients with a full stomach.
Superior Laryngeal Nerve Block bc it removes protective reflexes
potential complications Superior Laryngeal Nerve Block
local anesth toxicity
hematoma formation
aspiration
The maximum safe dose of topical lidocaine
4 mg/kg
what is tropical thunder used for
awake fiberoptic intubation, video laryngoscopy
how should you educate patient before tropical thunder?
lidocaine tastes bad and coughing is normal
what position should pt be in for tropical thunder procedure?
sitting position
