Airway Blocks Flashcards
Greatest predictors for difficult intubation
Age >55
OSA
Beard
Endentulous
Loose/missing teeth
Mandible fracture
Predictors for difficult mask ventilation
Age >55
Beard
Loose/missing teeth
Protuberant teeth
Mandible fracture
C-spine abnormality
Mouth opening < 3cm
3 branches for nasal/facial innervation
Branches of trigeminal nerve
V1 ophthalmic
V2 maxillary
V3 mandibular
Innervates nasal turbinates and posterior 2/3 of nasal septum
Greater and lesser palatine V1
Innervates anterior 1/3 of nasal septum
Anterior ethmoidal V1 and V2
Innervates posterior 1/3 of tongue, vallecula, anterior surface of epiglottis, wall of pharynx, and tonsils
Glossopharyngeal CN IX
Innervates laryngopharynx, intrinsic muscles of larynx
Vagus CN X
Recurrent laryngeal nerve is branch off
Vagus
Responsible for gag reflex
CN IX glossopharyngeal
4 nerves r/t airway that are branches of Vagus nerve
Superior laryngeal
Internal laryngeal
Recurrent laryngeal
External laryngeal
Gag reflex
Afferent innervation
Efferent innervation
Afferent- CN IX Glossopharyngeal
Efferent motor arc- CN X Vagus
Glottis closure reflex
Afferent
Efferent
Afferent- superior laryngeal
Efferent- recurrent laryngeal
Cough reflex
Afferent
Efferent
Both are CNX (recurrent laryngeal)
Premedication for airway blocks
Antisialogues
Sedatives (precedex best)
4 methods of LA application for airway blocks
Topicalization
Nebulization
Atomization
Injected nerve blocks
Best antisialogues
Give _______ prior
Scopolamine
15-30 minutes prior
(Scoop>glyco>atropine)
Precedex dosing for sedation for airway block
Bolus 1 mcg/kg over 10-20minutes
Infusion 0.2-0.7 mcg/kg/min
If precedex unavailable what drugs should you use?
Which to avoid?
Ketamine 20-30mg
Versed 1-2mg
AVOID propofol (no reversal)
LA for airway blocks fastest to shortest
Benzocaine (shortest duration)
Lidocaine
Cocaine
Gold standard for topical anesthesia of nasopharynx
Cocaine
Max dose 1.5 mg/kg or 100mg
Benzocaine has potential of causing
Methemoglobinemia
If pt HTN or CAD what should you use for airway LA
Affinity (less tachycardia and HTN)
Lidocaine for airway LA
2-4% with epi 1:200,000
Atomization of LA gets
Nasopharynx and oropharynx
Nebulized lidocaine gets what structures
Airway and trachea
Injected airway nerve blocks
Nasopharynx
Topicalization only
Neosynephrine/Afrin
Cocaine or lidocaine soaked gauze
Injected airway nerve blocks
Glossopharyngeal
Intra-oral approach
Covers upper airway
Injected airway nerve blocks
Superior laryngeal nerve block bilaterally
Covers epiglottis, base of tongue, and cords
Injected airway nerve blocks
Transtracheal recurrent laryngeal nerve block covers
Below the cords and carina
Glossopharyngeal intra-oral approach method
Base of palatopharyngeal pillars
2-3 cc each side in gutter
Highly vascular so aspirate
CONTRAINDICATED IN COAGULOPATHIC PATIENTS
Landmarks for airway blocks
Cricoid cartilage
Thyroid cartilage
Hyoid bone
Comu of hyoid bone
Superior laryngeal nerve block method
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)
Transtracheal block provides anesthesia for
Sensory fibers below vocal cords including carina
Transtracheal block methods
Enter cricothyroid membrane
20G angiocath placed
Aspirate for air
Inject 4-5 ml 4% Lidocaine
Step by step method for orotracheal fiberoptic intubation
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
