air way blocks 3/15 Flashcards
(29 cards)
what is the sensory innervation head, face and neck:
- cranial nerve that services the face and head?
- –a. what are the 3 branches?
- –b. what is the 1 branch that services the nose?
- –c. what are its 2 branches - cranial nerve that services mouth?
- cranial nerve that services larynx and stomach?
- –what are its 2 branches in the larynx?
Sensory Innervation
- Trigeminal Nerve (CN V)
- –a. opthalmic (v1),maxillary (v2), mandibular (v3)
- –b. Maxillary V2
- –c. anterior ethmoidal & sphenopalatine ganglion - Glossopharyngeal Nerve (CN IX)
- Vagus Nerve (CN X)
- -Superior Laryngeal nerve & Recurrent Laryngeal nerve
what is the trigeminal distribution (3 parts)?
- opthalmic (V1)
- maxillary (V2)
- mandibular (V3)
what areas does the V2 branch of the trigeminal nerve serve?
nose, nasopharynx (upper)
what areas does the glossopharyngeal serve?
the mouth, tongue, oropharynx
- what areas does the vagus nerve serve?
2. what are 2 of its branches?
- the epiglottis down to stomach
2. recurrent and superior laryngeal nerves
superior laryngeal nerve services:
- mucosa above vocal cords
- (External branch services cricothyroid muscle)
recurrent laryngeal nerve services:
mucosa below vocal cords
(Also controls 4 of the 5 intrinsic larynx muscles: posterior, lateral & thyroarytenoid, and arytenoides muscles.
- Nerve V2 is a branch of the ___ nerve?
- nerve V2 is called the ___ nerve? what does it innervate?
- what nerves does it branch into?
- V2 is a branch of the TRIGEMINAL NERVE
- called the MAXILLARY NERVE; supplies innervation to nose
- branches into the:
- –ANTERIOR ETHMOIDAL
- –SPHENO-PALATINE GANGLION
sphenopalantine nerves
- how many branches
- what do they service
- what is it a branch of?
- 2 branches (long and short)
- – Long: inside of nose and soft palate;
- -Short: sphenoid tissue - sphenopalating ganglion via maxillary nerve branch (V2) of the trigeminal nerve (CN V)
glossopharyngeal nerve-what branch services everything?
lingual branch of glossopharyngeal services posterior section 1/3 the tongue (dont confuse it with lingual nerve (from v3))
-also services vallecula of oropharynx
vagus nerve superior laryngeal nerve 1. what does it innervate 2. how many branches 3. what do branches do and service
- area above vocal cords;
- 2 branches
3a. internal branch which dives thru thyrohyoid membrane and innvervates the mucosa
3b. external branch- descends on top of the larynx under the sternothyroid muscle and provides motor to crycothyroid muscle
vagus nerve
recurrent laryngeal nerve:
1. where does each loop run under?
2. where does it enter and what does it control?
- loops under subclavian (inominate artery) on right and aorta on left
- enters below thyroid cartilage and gives motor innervation to rest of vocal cord muscles (arytenoides, posterior areytenoid, lateral areytenoid & and thyroaretynoid)
what is the gold standard for airway management (preemptorally)
fiberoptic bronchoscope
when the SLN nerve is blocked, sensory innervation to what is blocked?
Provides Sensory block to: -base of tongue ‐ posterior surface of epiglottis ‐ aryepiglottic folds ‐ arytenoids (i.e. mucosa above vocal cords).
SLN block:
what is the needle size, drug (&%), and dose?
-Needle / Drug / Dose
5/8 ” 25‐g needle
2% lidocaine
2 – 3 mL bilaterally
glossopharyngeal nerve block provides sensory block to ?
GPN Block provides Sensory block to: - posterior 1/3 of tongue ‐ vallecula ‐ anterior surface of epiglottis ‐ walls of the pharynx ‐ tonsils
- what block is an abrams needle used for?
- what is special about this needle?
- why is this needle infrequently used?
- refersher course: what is the order of pillars, tonsils, nerves and arteries in the mouth?
- Glossopharyngeal block (more proximal)
- it is a bent needle to get around the pillar of fauces
- because the block is very hard to do, the nerve sits behind palatopharyngeal pillar of fauces (it is near (behind) the internal carotid artery).
- palatoglossal pillar>palatine tonsil> palatopharyngeal pillar>internal carotid artery<glossopharyngeal nerve
if you are using spray to anesthetize the airway (instead of airway blocks), what should you expect?
patient will probably still gag with spray
how to block the lingual branch of GPN:
- 5 cc syringe on a 3.5 inch 25 g spinal needle
2. inject 2 cc in the band of tissue on the side of the tongue
Clinical Caveats (GPN Block):
- GPN can be blocked intra‐orally in 2‐different areas by injection, what are they?
- what other ways can it be anesthetized (a,b)?
- behind the palatoglossal pillar or along the side of the tongue
- Other options are direct topical application of sprays
Tongue blade with gauze soaked in lidocaine cream at base of tongue
Clinical Caveats to (RLN Block) recurrent laryngeal block:
- what does it do?
- where is the injection level?
- what is an alternative?
- what is a good needle type to use?
- RLN provides sensory to vocal cords & trachea
- Injection at the level of the cricothyroid membrane works well as long as the clinician is mindful of patient selection/comfort
- RLN can also be blocked by instillation via the FOB
- use an angiocath so that when the patient coughs, they wont get scraped up.
anesthetizing the mouth and nose via Nebulizers:
- what is the amount and dose of the anesthetic? what is the o2 flow?
- what factors affect efficacy of the nebulized block?
- what is the the flow that gives the optimal droplet size? what is the droplet size?
- what are caveats to nebulized anesthetic?
- a) 5 ‐ mL of 4% lidocaine; b)O2 6 – 8 L/min
- size of droplet, flow and nebulizer type
- Flow < 6 L/min O2 = 30 – 60 micrometer droplet size (smaller is better)
- takes time & cooperative patient necessary
what are the 2 types of specialty atomizers (that go down throat)?
-2 types of Atomizers
DeVilbiss Atomizers & ’MAD’ Atomizers
MAD (or MADgic)
- -It is a long angled straw like attachment that attaches to a 3 cc syringe
- -draw up 4% into the syringe
- -depress into larynx
