Bilateral Superior Laryngeal Nerve Block Research Articles

The Role of Bilateral Superior Laryngeal Nerve Block in Managing Refractory Chronic Cough.

The aim was to investigate the utilization and efficacy of bilateral superior laryngeal nerve block in patients with refractory chronic cough. A retrospective chart review of 164 patients with refractory chronic cough who underwent bilateral SLN block at a single institution between November 2018 and September 2022 was performed. Demographics, comorbidities, and patient-reported outcomes including pre- and postinjection Leicester Cough Questionnaire (LCQ) scores were collected and analyzed. The cohort underwent an average of 2.97 bilateral injections (range 1-22), containing either corticosteroid and local anesthetic or corticosteroid alone. Notably, 116 of 164 of patients reported an average of 67.3% reduction in their symptoms, with the treatment effect lasting 7.60 weeks on average. The average pre- and postinjection LCQ scores were 9.70 and 13.82, respectively. A lower LCQ score represents a greater impairment of health status due to cough, and the minimum important change is 1.3 points between questionnaires. The average improvement on LCQ following bilateral SLN block was 4.11 points for this cohort. The use of in-office bilateral SLN block is an effective treatment that can be used alone or in conjunction with oral medications for the treatment of refractory chronic cough. 4 Laryngoscope, 134:1773-1777, 2024.

Comparison of Ultrasound-Guided Superior Laryngeal Nerve Block with the Traditional Method for Direct Laryngoscopic Biopsy of Supraglottic Masses: A Clinical Trial.

A bilateral superior laryngeal nerve block (SLNB) can provide complete anesthesia for laryngeal sampling and by providing this block we can manage the biopsy of supraglottic masses without the complications of general anesthesia. This study aimed to compare 2 superior laryngeal nerve block (SLNB) methods using ultrasound and the traditional method for direct laryngoscopic surgery for the biopsy of supraglottic masses. In this single-blind clinical trial, 50 patients undergoing supraglottic laryngeal mass biopsy under direct laryngoscopy were divided into 2 groups. The first group was anatomical landmark bilateral SLNB (C group), and the second group was sono-guided bilateral SLNB (U group). Hemodynamic changes, pain, oxygen desaturation, surgeon satisfaction, and the complication obtained and noted. There was no significant difference in the success rate of the procedure (P = 0.99), as well as the surgeon's satisfaction with the procedure (P = 0.337). Mean arterial pressure (MAP), oxygen saturation, and their changes in the studied groups were compared before the block, after the block, after the biopsy, and in the recovery room, showing no significant difference between the 2 groups (P > 0.05). Only the heart rate (HR) after the biopsy and in the recovery room showed significant differences between the 2 groups (P < 0.05). There was no significant difference between the 2 groups in the level of patient and surgeon satisfaction and pain during and after the procedure (P > 0.005). SLNB for direct laryngoscopic surgery for biopsy of supraglottic masses using ultrasound was not significantly superior to the traditional method, and there was no significant difference between the 2 methods in terms of procedure success, surgeon's satisfaction, and patients' pain.

AIRWAY NERVE BLOCK VERSUS NEBULIZATION BY LIGNOCAINE DURING DIAGNOSTIC FLEXIBLE BRONCHOSCOPY UNDER MODERATE SEDATION: A RANDOMIZED CONTROLLED TRIAL

<h3>Background</h3> Flexible bronchoscopy is an important procedure for the diagnosis and management of patients with respiratory diseases. This study aimed to assess safety and effectiveness of local anesthetic nebulization versus airway nerve block for upper airway anesthesia during diagnostic fiberoptic bronchoscopy under moderate sedation. <h3>Methods</h3> This randomized, controlled trial enrolled 120 patients scheduled for diagnostic fiberoptic procedures. The patients received 5 ml of 10% lignocaine by air-driven jet nebulizer for 20 minutes (Group A, n = 60) or bilateral superior laryngeal nerve block and trans-tracheal instillation of 4 ml of 2% lignocaine along with viscous lignocaine gargles twice (Group B, n = 60). In the postoperative period, the patient tolerance was assessed. <h3>Results</h3> Both groups were comparable in all baseline characteristics. The pain score was significantly lower in the nerve block group. Cough and requiring lignocaine were significantly more frequent in the nebulization group. No significant differences between the studied groups regarding intraoperative and postoperative PaO2, PaCO2, heart rate and mean blood pressure except heart rate; were significantly higher in the nebulized group. PaO2 reductions at intraoperative and postoperative (compared with induction) were non-significantly higher in the nebulized group. PaCO2, heart rate and mean blood pressure elevations in intraoperative and postoperative (compared with induction) were higher in the nebulized group, and the differences were non-significant in heart rate only. <h3>Conclusion</h3> Airway nerve block was associated with reduced consumption of lignocaine and less cough episodes during the procedure compared to nebulized lignocaine.

Superior laryngeal nerve block with in-line lignocaine nebulization for awake extubation response.

Background and Aims:Tracheal extubation is associated with various undesirable hemodynamic and airway responses. Various drugs are used effectively to curb these responses. But these drugs have limitations and produce side effects. Hence, the study was planned to assess the effects of superior laryngeal nerve block with inline lignocaine nebulization on awake extubation responses to suggest an alternative. The aim of this study was to assess the effect of bilateral superior laryngeal nerve block with inline lignocaine nebulization on awake extubation responses.Material and Methods:A study was conducted in 35 patients aged 18-60 years, posted for surgery less than 3 h under general anesthesia. The hemodynamic responses like heart rate, arterial blood pressure, and mean arterial pressure were recorded preoperatively and at 1, 5, and 10 min postextubation. Undesirable respiratory responses like bucking, severity of sore throat, and cough response were also assessed. Repeated measures analysis of variance followed by the Tukey HSD test was used to find the significance of hemodynamic parameters. Qualitative data were expressed as percentages.Results:Decrease in Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure was statistically significant at 5 mins (T2) and 10 mins (T3) postextubation as compared to baseline (T0). No cough was observed postextubation in 80% patients while 20% had mild Grade 1 cough.Conclusion:Superior laryngeal nerve block with in-line lignocaine nebulization for awake extubation is effective in curbing the haemodynamic and respiratory responses of extubation.

Airway nerve block versus nebulization by lignocaine during diagnostic flexible bronchoscopy under moderate sedation: A randomized controlled trial

ABSTRACT Background Flexible bronchoscopy is an important procedure for the diagnosis and management of patients with respiratory diseases. This study aimed to assess safety and effectiveness of local anesthetic nebulization versus airway nerve block for upper airway anesthesia during diagnostic fiberoptic bronchoscopy under moderate sedation. Methods This randomized, controlled trial enrolled 120 patients scheduled for diagnostic fiberoptic procedures. The patients received 5 ml of 10% lignocaine by air-driven jet nebulizer for 20 minutes (Group A, n = 60) or bilateral superior laryngeal nerve block and trans-tracheal instillation of 4 ml of 2% lignocaine along with viscous lignocaine gargles twice (Group B, n = 60). In the postoperative period, the patient tolerance was assessed. Results Both groups were comparable in all baseline characteristics. The pain score was significantly lower in the nerve block group. Cough and requiring lignocaine were significantly more frequent in the nebulization group. No significant differences between the studied groups regarding intraoperative and postoperative PaO2, PaCO2, heart rate and mean blood pressure except heart rate; were significantly higher in the nebulized group. PaO2 reductions at intraoperative and postoperative (compared with induction) were non-significantly higher in the nebulized group. PaCO2, heart rate and mean blood pressure elevations in intraoperative and postoperative (compared with induction) were higher in the nebulized group, and the differences were non-significant in heart rate only. Conclusion Airway nerve block was associated with reduced consumption of lignocaine and less cough episodes during the procedure compared to nebulized lignocaine.

Comparative effectiveness of topical lignocaine nebulization and airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis

Background: Awake fiber-optic nasal intubation is a gold standard management of difficult airway in temporal mandibular (TM) joint ankylosis. Aims and Objectives: We compared topical lignocaine nebulization with airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis. Materials and Methods: Fifty patients of either gender were randomly allocated into two groups of 25 each. Group I received 10 ml of 2% lignocaine nebulization over a period for 20 min. Group II received bilateral superior laryngeal nerve block and transtracheal recurrent laryngeal nerve block (each with 2 ml of 2% lignocaine). Awake fiber-optic bronchoscopy-guided nasal intubation was done in all patients. All the patients received sedation during the procedure. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student’s t-test was used to analyze parametric data, while the Mann–Whitney U-test was applied to non-parametric data and Fisher’s test to categorical data. P&lt;0.05 was considered statistically significant. Results: The time taken for intubation was significantly shorter in Group II [110.2 (14.6) s compared with Group I (211.0 [22.3] s) (P=0.028 ss). The intubating conditions and degree of patient comfort were better in Group II compared with Group I. Although all patients were successfully intubated, patient satisfaction was higher in Group II. Conclusion: Airway nerve block is a better way of anesthetizing airway as compared to nebulization for awake fiber-optic nasal intubation. However, nebulization with lignocaine may be an alternative in situations where nerve blocks are not feasible or may be used as an adjuvant to nerve blocks.

Superior Laryngeal Nerve Block for Intubation in Patients With COVID-19.

Coronaviruses are thought to primarily spread via respiratory droplets and close or direct contact. Transmission is also possible through prolonged exposure to high concentrations of virally infected aerosols in a relatively closed environment.1 Once generated, these aerosols reportedly remain suspended in the air for up to 3 hours.2 Certain clinical procedures such as intubation and extubation are particularly known to generate potentially contagious aerosols that could infect medical personnel.3 Canelli et al4 recently invented an “aerosol box,” a barrier that can be easily fabricated, to reduce the risk of viral transmission and infection via exposure to contaminated aerosols for clinicians performing intubation- and extubation-related procedures. This barrier consists of a transparent plastic cube that encases the patient's head, with 2 circular ports through which clinicians can insert their hands to manage the airway with minimal exposure. However, this box restricts hand mobility and requires prior training before use in actual clinical procedures.5Ponnappan et al6 analyzed their preliminary experience using the aerosol box during 30 endotracheal intubations performed by anesthesiologists at the Institute of Liver and Biliary Sciences, New Delhi. The mean experience of the anesthesiologists involved in that study was 5.3 years after completion of anesthesia training. Successful intubation was achieved in 38.1% of cases during the first attempt. A second attempt was required in 28.6% of cases, and removal of the aerosol box was required in 28.6% of cases because of poor vision and/or inadequate space to facilitate proper airway management. In difficult intubation cases in which it was necessary to intubate while spontaneous ventilation was maintained, success rates while using the aerosol box would have likely decreased significantly.Reducing coughing during intubation could contribute to a reduction in viral transmission and exposure among health care workers. Coughing can be reduced by several techniques such as the administration of nebulized lidocaine to anesthetize the airway or intravenous boluses of opioid agonists for cough suppression, among others. In our hospital, we use moderate sedation with midazolam and fentanyl for patients with suspected difficult intubation or airway management. Once the patient is adequately sedated, a bilateral superior laryngeal nerve (SLN) block (SLNB) can be performed to further reduce coughing during intubation, because the block effectively prevents contraction of the cricothyroid muscle. The block can be performed percutaneously without ultrasound guidance (Figure). Therefore, even when the need for emergent intubation unexpectedly becomes apparent, it can be performed relatively easily and quickly. The SLN provides sensation to the upper part of the larynx (and lower part of the pharynx).7–10 SLNB has been used to facilitate awake endotracheal intubations during endoscopic laryngeal surgeries.11,12 Alessandri et al13 reported that SLNB reduced cough and discomfort during awake fiber-optic intubations. However, this block can be associated with potential complications, including intravascular injection and nerve damage. Nevertheless, we believe that cough suppression via bilateral SLNB can be a useful approach for reducing aerosol generation during airway management (ie, intubation). It must be mentioned that appropriate personal protective equipment still remains necessary for adequate protection at all times, particularly during this pandemic.We do not have any experience intubating patients infected with SARS-CoV-2, the virus that causes the novel coronavirus disease 2019 (COVID-19). However, we are of the opinion that SLNB is likely to be effective in reducing coughing and aerosol generation during difficult airway management in patients with COVID-19.

Awake fiberoptic orotracheal intubation: a protocol feasibility study.

ObjectiveTo assess the feasibility of an awake fiberoptic intubation (AFOI) protocol.MethodsWe enrolled 40 patients with simulated difficult intubation. The protocol consisted of conscious sedation (midazolam, 0.03 mg/kg and sufentanil, 0.1 µg/kg), regional anesthesia, and intubation. The time, first-attempt intubation success rate, hemodynamic parameters, blood oxygen saturation (SpO2), intubation amnesia rate, patient satisfaction, and relative complications were recorded.ResultsAFOI was completed in all patients. The average total AFOI time was 14.17 ± 1.47 minutes, and the time to placing the landmark-guided bilateral superior laryngeal nerve block was 1.24 ± 0.42 minutes. The first-attempt intubation success rate was 97.5%, and patient satisfaction was 90%. Blood pressure changed (<20%) briefly after administering conscious sedation. Heart rates did not change significantly, and SpO2 remained stable and ≥95%. Three patients had a sore throat, which resolved on postoperative day 1 without other complications. On postoperative day 1, 82.5% (33/40) of the patients had no recall of AFOI, and 17.5% (7/40) had only an indistinct memory.ConclusionsThe protocol was feasible with a high first-attempt intubation success rate and low complications rate. Hemodynamic parameters and respiration remained stable, with high patient satisfaction and effective amnesia.

Intubation Quality and Hemodynamic Response in Endotracheal Intubation with Ultrasound-Guided Bilateral Superior Laryngeal Nerve Block

Abstract General anesthesia works centrally, causing loss of consciousness and blocking the pain response. Some of the general anesthesia techniques are using laryngoscopy and intubation. The side effects of endotracheal intubation, for instance, are stimulating cough reflex, laryngospasm, and sympathetic nervous system response that increases catecholamine levels. The side effects are increases in blood pressure and heart rate. Hereby, a big consent for anesthesiologists thus intravenous, topical, and regional drugs are usually needed to facilitate this action. Using a muscle relaxant to facilitate intubation is often performed but does not suppress the hemodynamic responses. Intubation with superior laryngeal nerve block technique has an equivalent quality compare with muscle relaxant uses. This technique can prevent hemodynamic responses from laryngoscopy endotracheal intubation.

Upper Airway Nerve Block for Rigid Bronchoscopy in the Patients with Tracheal Stenosis: A Case Serie.

BackgroundRigid bronchoscopy is often used to diagnose and treat the location of resection of the tracheal stenosis. It is a selective procedure for the dilatation of tracheal stenosis, especially when accompanied by respiratory distress.ObjectivesWe introduced patients who were diagnosed with tracheal stenosis and candidate for rigid bronchoscopy dilatation by the upper airway nerve blocks.MethodsThis prospective observational study was conducted on 17 patients who underwent dilatation with rigid bronchoscopy in tracheal stenosis at Hospitals affiliated with Babol University of Medical Sciences from 2002 to 2017. The patients were given three nerve blocks, 6 bilateral superior laryngeal nerve block, bilateral glossopharyngeal nerve block, and recurrent laryngeal nerve block (transtracheal) before awake rigid bronchoscopy using 2% lidocaine. We evaluated the demographic data, the cause of tracheal stenosis, the quality of the airway nerve block (Intubation score), patients’ satisfaction from bronchoscopy and thoracic surgeons’ satisfaction. Complications of nerve blocks were recorded.ResultsFrom 2002 to 2017, 17 patients (14 were male and 3 were) female with tracheal stenosis who were candidates for dilatation with bronchoscopy and accepted the upper nerve block were included. The quality of the block was acceptable in 16 (94%) patients. 15 patients received fentanyl, and only two patients did not need to intravenous sedation. The mean age of patients was 29.59 ± 11.59. The average satisfaction of the surgeon was 8.82 ± 1.13 and the satisfaction of patients with anesthesia was 8.89 ± 1.16. There was one serious complication (laryngospasm) in one patient.ConclusionsThe upper airway nerve block method is a suitable anesthesia technique for patients with tracheal stenosis who are candidates for the tracheal dilatation with rigid bronoscopy, especially when the patient has respiratory distress and has not been evaluated before surgery.

Intraoperative Awakening from Endotracheal General Anesthesia for Brain Mapping with Tracheal Tube In Situ

AbstractAwake craniotomy (AC) is indicated to excise a lesion close to an eloquent area of the brain. Success of this procedure depends upon the patient’s active participation during the awake phase of the surgery, especially for brain mapping. Occasionally, a patient may refuse to remain awake during the surgical procedure and demand general anesthesia (GA). A 27-year-old male with uncontrolled seizures from recurrent brain tumor near motor area refused to consent for AC citing his past unpleasant experience; so, the decision to administer GA was taken. To avoid straining/coughing on tracheal tube, his airway was anesthetized with transtracheal xylocaine, bilateral superior laryngeal nerve block, and inflation of tracheal tube cuff with xylocaine. GA was maintained with sevoflurane, infusion of fentanyl, and rocuronium. To awaken him, anesthetics were discontinued and rocuronium antagonized with sugammadex. Intravenous lignocaine and midazolam were administered to supress cough reflex and produce amnesia, respectively. He tolerated the entire duration of 30 minutes of brain mapping with electrocorticography and neurological testing comfortably. Upon completion of brain mapping, GA was reintroduced and the lesion excised. The surgical outcome was good with no neurological deficit. When interviewed postoperatively, the patient had no recall of the awake phase.

Direct Laryngoscopy under Topical Anaesthesia and Superior Laryngeal Nerve Block for Laryngeal and Hypopharyngeal Lesions in ENT Patients

Introduction: Direct laryngoscopy is a common procedure being done by otolaryngologists under general anaesthesia for various pathologies of the larynx and hypopharynx. Regional anaesthesia using topical spray and bilateral superior nerve block is an alternative for the direct laryngoscopy. Aim: To evaluate the effect of bilateral block of superior laryngeal nerve (SLN) and topical anesthesia in direct laryngoscopy for diagnostic purpose as well as for taking biopsies from the larynx and hypopharynx. Materials And Methods: This is a prospective study done on 20 patients in age group of 50 to 70 years with laryngeal and hypopharyngeal growth. All these patients underwent diagnostic direct laryngoscopy with biopsy under regional block which include bilateral superior laryngeal nerve block with 2% lignocaine and topical anaesthesia of oral cavity and transtracheal through cricothyroid membrane with 10% lignocaine spray and 4% lignocaine respectively. Result: Success rate in our study was 85% in supraglottic, transglottic, pyriform growth and only 15% in glottis and postcricoid growth based on assessment of hemodynamic stability and patients comfortable score before and after the procedure under regional block. Conclusion: Direct Laryngoscopy under topical anesthesia and superior laryngeal nerve block for biopsy is a good alternative to general anesthesia for the patients presenting in ENT with laryngeal and hypopharyngeal pathologies.

Wire guided fibreoptic retrograde intubation in a case of glottic mass.

Wire guided fibreoptic retrograde intubation in a case of glottic mass.

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation.

Aims of Study:To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks.Materials and Methods:In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I–II, Mallampati Grade I–IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine.Results:Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades.Discussion:The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique.Conclusion:A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.

Superior laryngeal nerve block as an adjuvant to General Anesthesia during endoscopic laryngeal surgeries

BackgroundDirect rigid endoscopic laryngosurgery is a short procedure usually performed under general anesthesia. This is a double blinded randomized placebo-controlled trial, which was designed to evaluate the effect of bilateral block of the internal branch of superior laryngeal nerve (SLN) as an adjuvant to general anesthesia during endoscopic laryngeal surgery when smaller dose of muscle relaxant is used.MethodSeventy-six patients required endoscopic laryngosurgery in whom general anesthesia was preceded by bilateral superior laryngeal nerve block either with 2% lidocaine (L-group) or with saline (C-group).ResultsThe reaction to endotracheal tube insertion was better in L-group as less frequent cough occurred in L-group (one patient) compared to (8 patients) C-group (P value <0.05). The maximum pressor response was observed immediately after intubation, at which the increase in MAP from baseline in C-group (24.4%) was significantly higher than in L-group (6.4%) (P < 0.05) and the increase in HR from baseline in C-group (29.5%) was significantly higher than in L-group (14.8%) (P < 0.05). The MAP and HR remain significantly higher in C-group than that of the L-group all through the intraoperative period. The incidence of severe cough was significantly higher in C-group just before extubation (bucking), 5 min and 30 min postextubation. Incidence and severity of postoperative sore throat was significantly higher in C-group in the first 4 h postoperatively.ConclusionDuring endoscopic laryngeal surgeries, using bilateral block of the internal branch of superior laryngeal nerve as an adjuvant to general anesthesia was associated with better intubation conditions, better intraoperative hemodynamic response to intubation and surgical procedure and better recovery profile in the form of improved postoperative cough and sore throat.

Neostigmine/rocuronium versus TIVA for tracheal stenting and dilatation

Background Usage of airway stents in cases with tracheobronchial stenoses or obstruction has evolved rapidly. General anaesthesia has become less hazardous, particularly with recent developments in total intravenous anaesthetic agents and nondepolarizing neuromuscular blocking drugs. This study aimed at comparing the effectiveness of neostigmine/rocuronium technique to TIVA technique for tracheal stenting and dilatation. Patients and methods This prospective study was carried out on 80 patients scheduled for tracheal dilatation and stenting. Cases were randomly categorized into two equal groups. Group I (TIVA) received fentanyl and propofol with bilateral superior laryngeal nerve block. Group II (muscle relaxant) received rocuronium and sevoflurane 2% in 100% O 2 . Heart rate, mean arterial pressure and oxygen saturation were assessed, and PaCO 2 readings were taken through arterial blood gases at regular intervals intraoperatively. Recovery profile, perioperative complications and patient and doctor satisfaction were recorded in both groups. Results Both techniques offered haemodynamic stability. PaCO 2 readings were significantly higher ( P P P > 0.05), except hypotension (higher in group I; P P > 0.05). Conclusion Both the TIVA and neostigmine/rocuronium techniques were used successfully. The TIVA technique had the advantages of earlier recovery, less hypercapnia, desaturation, distal total obstruction and stridor on recovery, whereas the muscle relaxant technique offered less hypotension and hemoptysis. Thus, we strongly recommend the TIVA technique for such operations.

An awake double lumen endotracheal tube intubation using the Clarus Video System in a patient with an epiglottic cyst: a case report

A 54-year-old male patient was scheduled for an elective pylorus-preserving pancreaticoduodenectomy combined with video-assisted thoracic surgery at our hospital. This patient had a history of intubation failure in other institutions due to an epiglottic cyst. An airway assessment of the patient was normal. A preoperative laryngoscopy revealed a bulging epiglottic mass covering most of the epiglottis and occupying most of the pharyngeal space. The patient was administered intravenous midazolam 1 mg, fentanyl 50 µg, and glycopyrrolate 0.2 mg. A bilateral superior laryngeal nerve block was then performed with 2% lidocaine 2 ml on each side. A 10% lidocaine spray was applied on to the oropharynx. After preoxygenation with 100% oxygen over 10 minutes, a rigid fiberscope with an optical stylet loaded with a 37 Fr double lumen endotracheal tube was inserted orally and passed into the glottic aperture. The patient was fully awakened after surgical procedure and was transferred to the recovery room after extubation.

Ultrasound-Guided Bilateral Superior Laryngeal Nerve Block to Aid Awake Endotracheal Intubation in a Patient with Cervical Spine Disease for Emergency Surgery

Ultrasound has been widely used to locate nerves for various nerve blocks. The potential advantages of using ultrasound imaging for nerve blocks include reduction in the amount of local anaesthetic required, improved success rate, reduced time to perform the block and reduced complication rate. We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibreoptic intubation in a patient presenting for emergency surgery on the cervical spine.

Evaluation Of Airway Blocks Versus General Anesthesia For Diagnostic Direct Laryngoscopy And Biopsy For Carcinoma Of The Larynx. A Study Of 100 Patients

BACKGROUND;-A prospective randomised study of 100 patients divided into two groups was done to compare the effects of regional airway nerve blocks versus general anaesthesia to evaluate intr-aoperative hemodynamic changes and compare the level of post op analgesia and sedation in both groups. METHODS;-In group I whole airway block including bilateral superior laryngeal nerve block with bilateral glossopharyngeal block and recurrent laryngeal nerve block was given and in group II general anesthesia was given. RESULTS:The mean duration was 27+_5 minutes in all cases, all patients were of ASA grade 3 or 4.Baseline and pre operative values of pulse and blood pressure were noted and were recorded at 0,5,7,9,10 and 15 minutes. Post operative sedation and VAS scores were recorded at 0,5 ,15 and 30 minutes initially and then hourly. Our study showed significant hemodyanamic changes in group2 with significant rise in mean arterial pressure and pulse rate during perioperative period. Whereas in group1there was a stability in mean arterial pressure and pulse rate perioperatively. The post op analgesia was significantly higher in group 1 and lasted longer as compared to group 2 and patients were less agitated and calm as assessed by the sedation score ,in group2 patients most of the patients required post op nebulisation as compared to group1 where no patient needed nebulisation.CONCLUSION :In conclusion we suggest that regional airway block for anesthesia in the short procedures of upper airways and also in cases of predicting difficult airway cases for securing the safe airway can be very useful alternate to the general anesthesia

Superior Laryngeal Nerve Block

Awake nasotracheal intubation in the patient with a fractured mandible may be facilitated by combining bilateral superior laryngeal nerve block with topical application of local anesthetic to the nose, mouth, and trachea. Successful use of this technique is described in two such patients.