Regional & topical anaesthesia of upper airways

Nibedita Pani, Shovan Kumar Rath, Nibedita Pani, Shovan Kumar Rath

Abstract

A combination of techniques are required to adequately anaesthetise upper airway structures for awake intubation. The widest coverage is provided by the inhalational technique. This technique, however, does not always provide a dense enough level of anaesthesia for all patients. Supplementation of this technique with any of the specific nerve blocks is an excellent way to accomplish efficacious anaesthesia for awake inubation. Anaesthetising upper airway is not a difficult skill to master and should be in the armamentarium of all practising anaesthetist.

Keywords: Awake intubation; Fibre optic intubation; Laryngoscopy; Local anaesthetics; Nerve block; Topical anaesthesia.

Figures

Fig 1
Fig 1
Three major neural pathways supplying sensation to airway structures
Fig 2
Fig 2
Sensory supply of nose
Figure 3
Figure 3
Branches of the vagus nerve innervating the epiglottis and more distal airway structures.
Fig 4
Fig 4
Local anaesthetic can be sprayed directly onto the Desired mucosa.
Fig 5
Fig 5
Nebulization of lidocaine 2–4% via face mask
Fig 6
Fig 6
Glossopharyngeal block (Intraoral approach).
Fig 7
Fig 7
Glossopharyngeal block (Peristyloid approach)
Fig 8
Fig 8
Superior laryngeal block
Fig 9
Fig 9
Normal surface anatomy of Larynx:1) cricoids cartilage 2) thyroid cartilage 3) hyoid bone 4) cornu of hyoid
Fig 10
Fig 10
Recurrent Laryngeal Nerve Block Translaryngeal block of the recurrent laryngeal nerve at the level of the cricothyroidmembrane.

References

    1. Benumof J. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology. 1991;75:1087–110.
    1. Popat M. State of the art . The airway. Anaesthesia. 2003;58:1166–72.
    1. An Updated Report by the ASA Task Force on Management of the Difficult Airway. Practice guidelines for the management of the difficult airway. Anesthesiology. 2003;98:1269–77.
    1. Ovassapian A, Yelich SJ, Dykes MHM, Brunner EE. Blood pressure and heart rate changes during awake fibreoptic nasotracheal intubation. Anesth Analg. 1983;62:951–4.
    1. Sutherland AD, Williams RT. Cardiovascular responses and lidocaine absorption in fiberoptic-assisted awake intubation. Anesth Analg. 1986;65:389–91.
    1. Hawkyard SJ, Morrison A, Doyle LA, Croton RS, Wake PN. Attenuating the hypertensive response to laryngoscopy and endotracheal intubation using awake fibreoptic intubation. Acta Anaesthesiol Scan. 1992;36:1–4.
    1. Telford RJ, Liban JB. Awake fibreoptic intubation. Br J Hosp Med. 1991;46:182–4.
    1. Ovassapian A, Yelich SJ, Dykes MHM, Brunner EE. Blood pressure and heart rate changes during awake fiberoptic nasotracheal intubation. Anesth Analg. 1983;62:951–4.
    1. Ovassapian A, Krejcie TC, Yelich SJ, Dykes MHM. Awake fiberoptie intubation in the patient at high risk of aspiration. Br J Anaesth. 1989;62:13–6.
    1. Raj PP, Foresmer J, Watson TD, Morris RE, Jenkins MT. Technics for fiberoptic laryngoscopy in anesthesia. Ancsth Analg. 1974;53:708–13.
    1. Reed AP, Han DG. Preparation of the patient for awake fiberoptic intubation. Anesthesiology Clinics of North America. 1991;9:69–81.
    1. Morris IR. Pharmacologic aids to intubation and the rapid sequence induction. Emerg Med Clin North Am. 1988;6:753–68.
    1. Faccenda KA, Finucane BT. Complications of regional anaesthesia: Incidence and prevention. Drug Saf. 2001;24:413–442.
    1. Auroy Y, Narchi P, Messiah A, et al. Serious complications related to regional anesthesia: Results of a prospective survey in France. Anesthesiology. 1997;87:479–486.
    1. Naguib M, Magboul MM, Samarkandi AH, Attia M. Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf. 1998;18:221–250.
    1. Cotter JT, Nielsen KC, Guller U, et al. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery: An analysis of 9,342 blocks. Can J Anaesth. 2004;51:810–816.
    1. Crosby ET, Lui A. The adult cervical spine: implications for airway management. Can J Anaesth. 1990;37:77–93.
    1. Morris IR. Techniques of endotracheal intubation andmuscle relaxation. In: Rosen P, editor. Emergency Medicine:Concepts and Clinical Practice. 2nd ed. St. Louis: The CV Mosby Co; 1988. pp. 69–82.
    1. Morris IR. Airway management. In: Rosen P, editor. Emergency Medicine: Concepts and Clinical Practice. 3rd ed. St. Louis: Mosby Yearbook; 1992. pp. 79–105.
    1. Dripps RD, Eckenhoff JE, VanDam L. 1) Introduction to Anesthesia: The Principles of Safe Practice. 6th ed. Philadelphia: WB Saunders Co; 1982.
    1. Ritchie JM, Greene NM. Local anesthetics. In: Gilman AG, Goodman LS, Gilman A, editors. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 6th ed. New York: MacMillan Publishing Co; 1980. pp. 300–20.
    1. Atkinson RS, Rushman GB, Lee JA. A Synopsis of Anaesthesia. 8th ed. Bristol, UK: John Wright and Sons Ltd; 1977.
    1. Donlon JV., Jr . Anesthesia for eye, ear, nose, and throat surgery. In: Miller RD, editor. Anesthesia. 2nd ed. New York: Churchill-Livingstone; 1986. pp. 1837–94.
    1. Snow JC. Manual of Anesthesia. Boston: Little Brown & Co; 1977.
    1. Sutherland AD, Williams RT. Cardiovascular responses and lidocaine absorption in fiberoptic-assisted awake intubation. Anesth Analg. 1986;65:389–91.
    1. Reed AP, Han DG. Preparation of the patient for awake fiberoptic intubation. Anesthesiology Clinics of North America. 1991;9:69–81.
    1. Donlon JV. Anesthetic management of patients with compromised airways. Anesthesiology Reviews. 1980;7:22.
    1. Kleeman P-P, Jantzen J-PAH, Bonfils The ultra-thin bronchoscope in management of the difficult paediatric airway. Can J Anaesth. 1987;34:606–8. t?
    1. Hill 1-1, Calder/ Safer fibreoptic intubation (Letter) Anaesthesia. 1988;43:1062.
    1. Krogh CME, editor. Compendium of Pharmaceuticals and Specialties. 29th ed. Ottawa, Canada: Canadian Pharmaceutical Association; 1994.
    1. Netter F. Atlas of Human Anatomy. Ciba-Geigy Corporation; 1989. Plate 56.
    1. Morris IR. Functional anatomy of the upper airway. Emerg Med Ciin North Am. 1988;6:639–69.
    1. Netter F. Atlas of Human Anatomy. Ciba-Geigy Corporation; 1989. pp. 83–5. Plates.
    1. Gotta AW, Sullivan CA. Superior laryngeal nerve block: an aid to intubating the patient with fractured mandible. J Trauma. 1984;24:83–5.
    1. Wheatley JR, Brancatisano A, Engel LA. Respiratory-related activity of cricothyroid muscle in awake normal humans. J Appl Physiol. 1991;70:2226–2232.
    1. Reasoner DK, Warner DS, Todd MM, et al. A comparison of anesthetic techniques for awake intubation in neurosurgical patients. J Neurosurg Anesthesiol. 1995;7:94–99.
    1. Kopman AF, Wallman SB, Ross K, Surks SN. Awake endotracheal intubation: a review of 267 cases. Anesth Analg. 1975;54:323–7.
    1. Meschino A, Devitt JH, Koch J-P, Szalai JP, Schwartz ML. The safety of awake tracheal intubation in cervicalspine injury. Can J Anaesth. 1992;39:114–7.
    1. Reasoner DK, Warner DS, Todd MM, et al. A comparison of anesthetic techniques for awake intubation in neurosurgical patients. J Neurosurg Anesthesiol. 1995;7:94–99.
    1. Ovassapian A. Fibreoptic tracheal intubation in adults. In: Ovassapian A, editor. Fibreoptic Endoscopy and the Difficult Airway. New York: Lippincott-Raven; 2 “a edition.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj