airway local blocks-Anesthesia

1. -AIRWAY LOCAL BLOCKS
-Dr Nisar Ahmed Arain
-Assistant Professor
-Anesthesia/Critical Care/ER

2. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
-INDICATIONS
--1-Co-morbidities
a-Cervical conditions
b-Intolerance to apnea
--2-Risk of Aspirations
--3-Difficult airway assesment
--4-Emergency situation

3. -AIRWAY LOCAL BLOCKS -AWAKE INTUBATION
--1-Explanation to the patient
--2-Pharmacological
--3-Equipment
--4-Personnel

4. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
--1-Antisialagogue
--2-Dilators
--3-Sedation
--4-Topical anesthesia
--5-Emergency
--PHARMACOLOGICAL

5. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
-Equipment Needed
--1-Airway visualization
--2-Adjuncts
--3-Monitors
--4-Emergency

6. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
-PERSONNEL
--1-Other Anesthesia Providers
--2-Surgeon/s
--3-Nurses

7. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
--1-Various Local Anesthetics(LA) can be
used for anesthetizing the airway
--2-Lidocain has an advantage because of
a-Availability of different formularies
and preparations
b-Wider margin of safety

8. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
-AIRWAY INNERVATION
--1-Nasopharynx
a-Trigeminal Nerve
(1)-Opthalmic branch
(2)-Maxillary branch
--2-Oro Pharynx CNIX
a-Glassopharyngeal nerve
--3-Laryngopharynx
a-Superior Laryngeal nerve
--4-Larynx and Trachea
a-Recurrent laryngeal nerve

9. -AIRWAY LOCAL BLOCKS
COMMON METHODS OF
ANESTHETIZING THE AIRWAY
-NASOPHARYNX
--1-Half Inch of Lidocaine 5% at each
nares(50 mg)
OR
--2-Two ml Lidocaine 4% aerosol
spray (80 mg)

10. -AIRWAY LOCAL BLOCKS
COMMON METHODS OF
ANESTHETIZING THE AIRWAY
OROPHARYNX
--1-Apply 1/2 inch of Lidocaine
ointment on a tongue depressor
(200 mg)
OR
--2-Instruct patient to gargle 5 ml of
Lidocaine 4% topical solution
(May need to do this twice)
( 200 mg to 400 mg )

11. -AIRWAY LOCAL BLOCKS
COMMON METHODS OF
ANESTHETIZING THE AIRWAY
-OROPHARUNX
--Place ½ Inch of 5% lidocaine at a cotton tip applicator
and apply it at the base of palatoglossal (5 min each side)
(100 mg)
OR
--Using a 22 g spinal needle, administer 2% of Lidocaine
injection solution to both bases of the palatoglossal
arch (80 mg)

12. -AIRWAY LOCAL BLOCKS
COMMON METHODS OF
ANESTHETIZING THE AIRWAY
LARYNGOPHARYNX
-SUPERIOR LARYNGEAL NERVE
--Administer 4 ml of 4% lidocaine
injection solution via nebulization
(200 mg)
OR
--Drip 5 ml of 2% lidocaine viscous
solution to the back of the patient’s
tongue (1 – 2 min) (200 mg)

13. -AIRWAY LOCAL BLOCKS
-LARYNGOPHARYNX
COMMON METHODS OF
ANESTHETIZING THE AIRWAY
-SUPERIOR LARYNGEAL NERVE
--Using a 23 G needle, administer
3 ml of 2% lidocaine injection
solution at both lateral sides of
the neck between the Thyroid
cartilage and Hyoid bone
(120 mg)

14. -AIRWAY LOCAL BLOCKS
COMMON METHODS OF
ANESTHETIZING THE AIRWAY
-RECURRENT LARYNGEAL NERVE
--Lidocaine nebulization may suffice
OR
--Using epidural catheter through the
fiberoptic, 5 ml of lidocaine 4% to the
Trachea (200 mg)
OR
--Using a 20 G needle, administer 5 ml
of 4% lidocaine injection solution to
the cricoid membrane (200 mg)

15. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
-Calculation of Lidocaine total
administer dose
--1-Nasopharynx (Ointment) = 50 mg
--2-Glassopharyngeal Nerve = 80 mg
--3-Superior Laryngeal Nerve = 120 mg
--4-Recurrent Laryngeal Nerve = 200 mg
--5-Total without Nasopharynx = 400 mg
--6-Total with Nasopharynx = 450 mg

16. -AIRWAY LOCAL BLOCKS
-AWAKE INTUBATION
-LIDOCAINE TOXICITY
-Legendary--------------------------------= 5 mg
-Normal therapeutic range
for ventricular arrythmias------------= 2 to 5 mcg/ml
-Various pharmacological factors
affect Lidocaine plasma level