This document discusses airway local blocks and awake intubation. It describes the indications for awake intubation including comorbidities, risk of aspiration, difficult airway assessment, and emergencies. It provides details on the pharmacological agents, equipment, personnel, and techniques used for anesthetizing different areas of the airway including the nasopharynx, oropharynx, laryngopharynx, and larynx/trachea. Specific local anesthetic methods are outlined for each area along with calculating total lidocaine doses and toxicity considerations.

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