Head and Neck

Question 1

cervical plexus is formed from

Answer 1

C1-C4

Question 2

where does the cervical plexus supply sensation

Answer 2

jaw
neck
occiput
areas of the chest and shoulder

Question 3

name some surgeries cervical plexus block can be used

Answer 3

various surgical procedures including 
neck
shoulders
thyroid 
carotid endarterectomies

Question 4

what is the benefit of using a cervical plexus block for carotid endarterectomies

Answer 4

neurologic assessment is desired

Question 5

name the 4 absolute contraindications of any nerve block

Answer 5

patient refusal
uncorrected coagulation deficiencies
infection at the site of the block
systemic anticoagulation

Question 6

relative contraindications (9)

Answer 6

Arbitrary values for platelet counts of less than 100,000
Prothrombin time (PT), activated partial thromboplastin time (aPTT), and bleeding times that are elevated
Severe bleeding with or without symptomatic hypovolemia or the potential for severe bleeding
Patient age
Uncooperative and/or Confused patients
Chronic neurological disorders
Local anesthetic allergy
Caution with patients that have history of Mobitz I, II, or third degree heart block
Peripheral neuropathy

Question 7

how is the patient positioned for superficial cervical plexus block

Answer 7

supine with head turned away from side to be blocked

Question 8

what muscle first identified and the lateral edges marked for superficial cervical plexus block

Answer 8

sternocleidomastoid muscle and mark its lateral edge

Question 9

where is the needle inserted for a superficial cervical plexus block

Answer 9

at the junction of the upper and middle thirds of the sternocleidomastoid muscle on the lateral boarder.

Question 10

how long is the needle for superficial cervical plexus block and how much LA do you inject

Answer 10

5x5x5

5cm needle
5ml cephalad
5ml caudal

Question 11

for superficial cervical plexus block- what direction do you point the needle

Answer 11

cephalad towards the mastoid process 5ml injected

then

redirected caudally-5ml of solution is injected subcutaneously

Question 12

Retrobulbar block patient position

Answer 12

supine looking straight up at the ceiling

Question 13

what size needle for retrobulbar block

Answer 13

25-27g

Question 14

what bevel position for the retrobulbar block

Answer 14

bevel opening towards globe

Question 15

what is the technique for inserting the needle for retrobulbar block

plus needle depth

Answer 15

insert into the inferolateral boarder of the orbit directed towards the apex of the orbit

needle depth 0.75-1.25inch may feel 2 pops

Question 16

once the la is injected into the eye-what is done next

Answer 16

the eye is closed and positive digital pressure applied

Question 17

why is pressure applied to the closed eye after la is injected

Answer 17

pressure helps spread the LA and detect any increasing orbital pressure which may indicate retrobulbar hemorrhage

Question 18

how much local anesthetic is injected AFTER NEGATIVE ASPIRATION into the retrobulbar block

Answer 18

2-4ml of la

Question 19

what would you give the patient to help them relax during a retrobulbar block

Answer 19

propofol

Question 20

what is a concerning complication of a retrobulbar block

Answer 20

total spinal

Question 21

after ocular block how soon can effectiveness be evaluated

Answer 21

2min after block placement

Question 22

what precedes akinesia of the eye muscle

Answer 22

analgesia of the globe

Question 23

can you have partial movement of one or more of the ocular muscles

Answer 23

yes

Question 24

what is the most common complication of retrobulbar blocks

Answer 24

local anesthetic toxicity from intra-arterial injection

Question 25

name the 5 other complications of retrobulbar blocks

Answer 25

Oculocardiac reflex
Retrobulbar hemorrhage
Trauma to optic nerve
Retrobulbar injection
Injection into optic nerve sheath-damage to nerve

Question 26

the vagus nerve supplies the airway mucosa from what two levels

Answer 26

level of the epiglottis to the distal airways.

Question 27

where does the internal laryngeal nerve branch from?

what does it supply?

Answer 27

The internal laryngeal nerve, a branch of the superior laryngeal nerve, supplies the larynx above the vocal cords and the lower part of the pharynx.

Question 28

what does the external laryngeal branch provide

Answer 28

motor innervation to the cricothyroid muscle

Question 29

where does the recurrent laryngeal nerve supply

Answer 29

larynx below the vocal folds and the upper part of the esophagus

Question 30

is the vagus nerve primarily parasympathetic or sympathetic

Answer 30

primarily parasympathetic- BUT also contains some cervial sympathetic fibers and motor fibers to the laryngeal muscles

Question 31

superior laryngeal nerve block position

Answer 31

locate hyoid bone with neck fully extended

Question 32

technique for superior laryngeal nerve block 1st step

Answer 32

Inferior border of corneau palpated and needle inserted perpendicular to skin approx 2.5 inch caudad and medially… Insert the needle until it rests on the lateral portion of hyoid bone

Question 33

once you have rested the needle on the lateral portion of hyoid bone

Answer 33

Withdraw it slightly and walk it off the hyoid bone in caudad direction and advance a couple of millimeters until it passes through the thyrohyoid membrane (slight resistance should be felt).

Question 34

how much lidocaine is injected into the superior laryngeal nerve block

Answer 34

1-3cc of 1% lidocaine above the thyrohyoid membrane.

pop through and deposit 2 ml just below membrane

Question 35

if you aspirate and get air from the superior laryngeal nerve block

Answer 35

aspirate before injection

Question 36

where does superior laryngeal nerve block provide blocks to

Answer 36

dense block of the supraglottic region

Question 37

once you do the block on one side for superior laryngeal nerve block

Answer 37

the block must be repeated on the other side

Question 38

what size translaryngeal block

Answer 38

22g-25g needle is inserted in the midline, aspirating as needle advanced.

Question 39

patient is supine - translaryngeal block in what position

Answer 39

supine with neck extended

Question 40

Translaryngeal (trans-tracheal) Block technique

Answer 40

Cricothyroid membrane between the thyroid and cricoid cartilages is palpated