Airway Blocks

Question 1

Greatest predictors for difficult intubation

Answer 1

Age >55

OSA

Beard

Endentulous

Loose/missing teeth

Mandible fracture

Question 2

Predictors for difficult mask ventilation

Answer 2

Age >55

Beard

Loose/missing teeth

Protuberant teeth

Mandible fracture

C-spine abnormality

Mouth opening < 3cm

Question 3

3 branches for nasal/facial innervation

Answer 3

Branches of trigeminal nerve

V1 ophthalmic

V2 maxillary

V3 mandibular

Question 4

Innervates nasal turbinates and posterior 2/3 of nasal septum

Answer 4

Greater and lesser palatine V1

Question 5

Innervates anterior 1/3 of nasal septum

Answer 5

Anterior ethmoidal V1 and V2

Question 6

Innervates posterior 1/3 of tongue, vallecula, anterior surface of epiglottis, wall of pharynx, and tonsils

Answer 6

Glossopharyngeal CN IX

Question 7

Innervates laryngopharynx, intrinsic muscles of larynx

Answer 7

Vagus CN X

Question 8

Recurrent laryngeal nerve is branch off

Answer 8

Vagus

Question 9

Responsible for gag reflex

Answer 9

CN IX glossopharyngeal

Question 10

4 nerves r/t airway that are branches of Vagus nerve

Answer 10

Superior laryngeal

Internal laryngeal

Recurrent laryngeal

External laryngeal

Question 11

Gag reflex

Afferent innervation

Efferent innervation

Answer 11

Afferent- CN IX Glossopharyngeal

Efferent motor arc- CN X Vagus

Question 12

Glottis closure reflex

Afferent

Efferent

Answer 12

Afferent- superior laryngeal

Efferent- recurrent laryngeal

Question 13

Cough reflex

Afferent

Efferent

Answer 13

Both are CNX (recurrent laryngeal)

Question 14

Premedication for airway blocks

Answer 14

Antisialogues

Sedatives (precedex best)

Question 15

4 methods of LA application for airway blocks

Answer 15

Topicalization

Nebulization

Atomization

Injected nerve blocks

Question 16

Best antisialogues

Give _______ prior

Answer 16

Scopolamine

15-30 minutes prior

(Scoop>glyco>atropine)

Question 17

Precedex dosing for sedation for airway block

Answer 17

Bolus 1 mcg/kg over 10-20minutes

Infusion 0.2-0.7 mcg/kg/min

Question 18

If precedex unavailable what drugs should you use?

Which to avoid?

Answer 18

Ketamine 20-30mg
Versed 1-2mg

AVOID propofol (no reversal)

Question 19

LA for airway blocks fastest to shortest

Answer 19

Benzocaine (shortest duration)

Lidocaine

Cocaine

Question 20

Gold standard for topical anesthesia of nasopharynx

Answer 20

Cocaine

Max dose 1.5 mg/kg or 100mg

Question 21

Benzocaine has potential of causing

Answer 21

Methemoglobinemia

Question 22

If pt HTN or CAD what should you use for airway LA

Answer 22

Affinity (less tachycardia and HTN)

Question 23

Lidocaine for airway LA

Answer 23

2-4% with epi 1:200,000

Question 24

Atomization of LA gets

Answer 24

Nasopharynx and oropharynx

Question 25

Nebulized lidocaine gets what structures

Answer 25

Airway and trachea

Question 26

Injected airway nerve blocks Nasopharynx

Answer 26

Topicalization only Neosynephrine/Afrin Cocaine or lidocaine soaked gauze

Question 27

Injected airway nerve blocks Glossopharyngeal

Answer 27

Intra-oral approach Covers upper airway

Question 28

Injected airway nerve blocks Superior laryngeal nerve block bilaterally

Answer 28

Covers epiglottis, base of tongue, and cords

Question 29

Injected airway nerve blocks Transtracheal recurrent laryngeal nerve block covers

Answer 29

Below the cords and carina

Question 30

Glossopharyngeal intra-oral approach method

Answer 30

Base of palatopharyngeal pillars 2-3 cc each side in gutter Highly vascular so aspirate CONTRAINDICATED IN COAGULOPATHIC PATIENTS

Question 31

Landmarks for airway blocks

Answer 31

Cricoid cartilage Thyroid cartilage Hyoid bone Comu of hyoid bone

Question 32

Superior laryngeal nerve block method

Answer 32

Make contact with greater Cornu of hyoid bone, walk off inferior and direct caudal 2ml LA bilat Aspirate (if air withdraw until in cartilage then inject)

Question 33

Transtracheal block provides anesthesia for

Answer 33

Sensory fibers below vocal cords including carina

Question 34

Transtracheal block methods

Answer 34

Enter cricothyroid membrane 20G angiocath placed Aspirate for air Inject 4-5 ml 4% Lidocaine

Question 35

Step by step method for orotracheal fiberoptic intubation

Answer 35

Antisialogogue Judicious sedation Benzocaine or 4% lido for oral cavity and pharynx 2% lido on nasal trumpet in mouth - advance Q2-3 minutes Advance bronchoscope until see cords Inject 2 ml LA epiglottis wait 15 sec Inject 1 ml when through cords Inject 2 ml when under cords Advance until see carina Advance ETT