Airway local blocks

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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