Regional Quiz #5 Flashcards
What number is the Trigeminal Nerve and what area does it correspond too?
5
nasal
What number is the Glossopharyngeal nerve and what area does it correspond too?
9
oral
What number is the Vagus nerve and what area does it correspond to?
10
below level of cords/thyroid cartilage
Which nerve is responsible for gag reflex?
Glossopharyngeal
What are some benefits of nasal intubation?
easiest to place
simple to anesthetize
no gag reflex when you reach nasal turbinates(right above the glottis)
Which is the better anesthetic, lidocaine jelly or lidocaine ointment?
lidocaine ointment, its 5% as opposed to 2%
What nerves innervates the nasal cavity(3)?
greater palatine, lesser palatine, anterior ethmoid
Where do the palatine nerves come from?
Trigemianal(5), never via the pterygopalatine ganglion
What do the palatine nerves innervate?
nasal turbinates and most of the nasal septum
Where does the anterior ethmoid nerve innervate?
Olfactory(1) nerve
What does the anterior ethmoid nerve innervate?
nares and anterior 3rd of nasal septum
What nerves innervate the oropharynx?
Vagus(10), Facial(7), Glossopharyngeal(9)
How many branches does the glossopharyngeal have?
3
What does the glossopharyngeal innervate?
posterior 3rd of tongue, vallecula, epiglottis(lingual branch), walls of pharynx(pharyngeal branch), tonsils(tonsillar branch)
Internal branch of superior laryngeal nerve is responsible for what?
sensory innervation
The external branch of the superior laryngeal nerve is responsible for what?
motor innervation
The superior laryngeal nerve is a part of the ____ nerve.
Vagus
What does the vagus nerve(internal branch of the superior nerve) innervate?
base of tongue, posterior epiglottis, arytepiglottic folds and arytenoids
Where does the vagus nerve(internal branch of superior laryngeal nerve) originate?
lateral to the greater cornu of the hyoid bone
Sensory innervation of the recurrent laryngeal nerve includes…
vocal folds and trachea
Motor innervation of recurrent laryngeal nerve includes…
all intrinsic muscles EXCEPT cricothyroid
What is the motor nerve of the cricothyroid muscle?
exterior branch of superior laryngeal
What medication is imperative to give before an awake intubation?
benzodiazapam
What do you need to consider when giving benzos?
short acting, reversible
Which is favored-IV or IM antisialogues? What is the dose?
IM because they have delayed onset and longer duration(atropine, robinul), Dose is 0.4 mg of robinul in holding
What are some types of topical anesthesia that are included and used?
swabs, pledgets, spray and wash
What is viscous lidocaine 4% used for?
topical for scopes with distal ports
What can benzocaine be mixed with?
tetracaine, cetacaine “hurricane”
what are the antisialogues and their doses?
atropine 0.5 - 1 mg IV/IM
robinul 0.2 - 0.4 mg IV/IM
What are the sedatives and their doses?
dexmedetomidine; loading dose 1mcg/kg/min over 10 minutes then infusion of 0.2-0.7mcg/kg/min
midazolam: 0.5-4mg IV
What are the opioids and their dosages?
fentanyl 10-100 mcg IV
alfentanil 100-1000mcg IV
What are the advantages to LA added to nebulizer?
simple, little discomfort, requires little knowledge of anatomy
What are the disadvantages to adding LA to the nebulizer?
density of anesthesia is highly variable
doesn’t last long
What are 3 methods to block glossopharyngeal nerve?
topical spray
direct mucosal contact of soaked pledget
infiltration by injection
Golossopharyngeal nerve block will block what?
oropharynx, soft palate, posterior tongue, pharyngeal surface of epiglottis, gag reflex-good for facilitating nasal tube through posterior pharynx
Equipment for glossopharyngeal block?
3.5” #22 needle
2-5 mLs LA at base of palatoglossal fold bilaterally
LA should have epi!!!
Why should LA have epi in it for glossopharyngeal block?
highly vascular area, also need to aspirate frequently
Superior laryngeal nerve block will block?
(internal branch from vagus) sensory innervation to base of the tongue, posterior suface of epiglottis, aryepiglottic fold, arytenoids
Equipment for superior laryngeal block?
2 mLs 2% lidocaine
5/8” #25 needle
What is the technique for superior laryngeal nerve block?
inject needle lateral to greater cornu of hyoid bone bilaterally
order of neck anatomy from top to bottom
cornu of hyoid hyoid thyroid cartilage cricothyroid membrane cricoid cartilage
recurrent laryngeal nerve block will block?
sensory to vocal folds and trachea
pro to recurrent laryngeal block
prevents coughing will passing ETT through cords
2 kinds of recurrent laryngeal nerve block?
inhalation and trantracheal
Transtracheal recurrent laryngeal block equipment
18-22 needle, 10 mL syringe filled with 4 mLs 4% lidocaine
transtracheal block technique?
pass needle perpendicular to axis of trachea and pierce membrane, aspirate while advancing until air is aspirated, deliver LA rapidly and get out of the way quickly(pt will cough everywhere but this is what you want)
con to recurrent transtracheal block?
block density diminished quickly in the distal tracheobronchial tree so keep tip of FOB and ett above the carina
glossopharyngeal, superior laryngeal nerve and recurrent nerve can all be blocked how?
topically
whats the gold standard for difficult airways?
flexible FOB
which drug do you have to worry about refractory bradycardia and why?
dex, related to exhausted catecholamines
