Head and Neck (exam 2) Flashcards
Technique for a superficial cervical plexus block. (position, what do you identify, where do you inject etc…)
Supine position with head turned away from side to be blocked
Identify the sternocleidomastoid muscle and mark it’s lateral edge
At the junction of the upper and middle thirds, insert a short (5 cm) block needle directed cephalad toward the mastoid process…Inject 5 mL of local anesthetic subcutaneously
The needle is then redirected caudally (along the posterior border of the sternocleidomastoid)… where 5 mL of solution is injected subcutaneously as well
Technique for Retrobulbar block? (position, needle, insertion site, etc…)
Patient supine, looking straight up (at ceiling)
25-27 gauge Retrobulbar needle (bevel opening towards globe)
Inserted into the inferolateral border of the orbit directed towards the apex of the orbit (needle depth- 0.75-1.25 inch)… (may feel 2 “pops”)
After negative aspiration, inject 2-4 ml of LA
The eye is then closed and positive digital pressure applied (pressure helps spread the LA and detect any increasing orbital pressure which may indicate retrobulbar hemorrhage)
What nerve supplies the sensory innervation to the larynx above the vocal cords and the lower part of the pharynx?
The internal laryngeal nerve, a branch of the superior laryngeal nerve.
what nerve provides motor innervation to the cricothyroid muscle?
The External laryngeal Nerve.
What is the role of the ILN?
supplies the larynx above the vocal cords and the lower part of the pharynx.
What is the role of the ELN?
provides motor innervation to the cricothyroid muscle
Which nerve supplies the larynx below the vocal folds and the upper part of the esophagus.
The RLN
Which nerve is primarily parasympathetic but also contains some cervical sympathetic fibers and motor fibers to the laryngeal muscles.
The vagus nerve
Tell me the role of the Vagus nerve?
primarily parasympathetic but also contains some cervical sympathetic fibers and motor fibers to the laryngeal muscles.
Tell me the role of the RLN?
supplies the larynx below the vocal folds and the upper part of the esophagus.
What bone do you want to locate with a SLN block, and what position is the neck in?
hyoid bone with neck fully extended.
What do you palpate and where do you insert your needled for a SLN block, then tell me the details following.
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
Withdraw it slightly and walk it off the hyoid bone in caudad direction and advance a couple of millimeters until it passes through the thyroid membrane (slight resistance should be felt).
For a SLN block:
How much LA deposited?
percentage and type of LA?
and where exactly is it being deposited?
Deposit 1-3 cc of 1% lidocaine above the thyrohyoid membrane, THEN pop through and deposit 2ml just below the membrane.
ASPIRATE always before injection of LA, with a SLN block if you aspirate and get air what does that mean?
you are too deep
Do you only do a SLN block on one side?
No, the block must be repeated on the other side.
