Anesthetizing Airway (Exam 1)

Question 1

What are the risk of cotton soaked pledgets in the nairs specifically when cocaine is used as a constrictor?

Answer 1

Caution with PChE deficiency, increased SNS tone, MAOI drugs

Question 2

What methods can be used to anesthetize the upper airway

Answer 2

1. cotton soaked pledgets (4% lido + vasoconstrictor)
2. instill topical anesthetic into each nare
3. swish and swallow (4% viscous lidocaine risk of n/v)
4. local anesthetic spray (20% benzocaine methemoglobinemia)
5. Nebulization
6. atomization (better than neb)

Question 3

How do you anesthetize the vocal cords?

Answer 3

1. inject LA through nasal airway or ETT positioned just above the vocal cords
2. “spray as you go” w/ flexible fiberoptic scope
3. inject LA through multi orifice epidural catheter thats inserted through suction port of a flexible fiberoptic catheter

Question 4

Where is the needle inserted for a glossopharyngeal block? What depth? How much LA is injected?

Answer 4

• At the base of the palatoglossal arch (anterior tonsilar pillar)
• 0.25 - 0.5cm
• 1-2ml

Question 5

During a glossopharyngeal block air is aspirated. What does this mean

Answer 5

Needle is too deep

Question 6

During a glossopharyngeal block blood is aspirated. What does this mean? What structure is very close by?

Answer 6

Needle should be withdrawn and redirected medially.

Carotid artery

Question 7

what is the risk of intracarotid injection duirng a glossopharyngeal block?

Answer 7

5%

Question 8

Where is LA inserted for a superior laryngeal nerve block?

Answer 8

Inferior border of the greater cornu of the hyoid bone

Question 9

How do you know the needle is too deep during a superior laryngeal nerve block?

Answer 9

aspiration of air

Question 10

Where do you inject the LA during a SLN block?

Answer 10

one mL is injected outside the thyrohyoid membrane
two mL is injected 2-3mm deep into the thyrohyoid membrane

Question 11

What membrane do you puncture to do a transtracheal recurrent laryngeal nerve block ? what direction should your approach be?

Answer 11

cricothyroid membrane
caudal

Question 12

During the RLN block you should aspirate and get air, before injecting what should you instruct the patient to do?

Answer 12

Take a deep breath

Question 13

During a RLN block how many CCs of LA is injected? What should the patient be doing during the injection

Answer 13

3-5ml
inhaling

Question 14

During a RLN block coughing after LA inection is good.. why?

Answer 14

sprays LA up towards the cords