regional anesthesia in otolaryngology · regional anesthesia in otolaryngology jacques peltier, md...
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Regional Anesthesia In Otolaryngology
Jacques Peltier, MD Faculty Advisor: Francis B. Quinn, Jr., MD The University of Texas Medical Branch
Department of Otolaryngology Grand Rounds Presentation
May 24, 2006
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Advantages of Local Anesthesia
• The patient is conscious during surgery.
• Smooth postoperative course.
• Patient awake and maintains his own airway.
• Less pain needs less narcotics, lighter anesthesia in general cases.
• Less nursing care after procedures, less admissions.
• Less expensive
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Disadvantages of Local Anesthesia
• The patient may prefer to be asleep
• Specialized skill necessary.
• Some blocks require up to 30 minutes to be fully effective.
• Analgesia may not always be totally effective, and general anesthesia may be required anyway.
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Disadvantages of Local Anesthesia
• Generalized toxicity may occur if local anesthetic drugs are given intravenously by mistake or an overdose is given.
• Widespread sympathetic blockade can result in hypotension.
• There is a small but definite incidence of prolonged nerve damage.
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Local Anesthetics
• Agent: Dose: Onset/Duration: • Lidocaine with epi (1 or 2%) 7mg/kg Fast/medium • Lidocaine without epi 4.5mg/kg Fast/short • Mepivacaine without epi (3%) 5.5mg/kg Fast/short • Bupivacaine with epi (0.5%) 1.3mg/kg Long/long • Articaine with epi (4.0%) 7mg/kg Fast/medium
*ADULT DOSES IN PATIENTS WITHOUT CARDIAC HISTORY
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Scalp Blocks
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Scalp Blocks
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Scalp Blocks
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Scalp Blocks
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Scalp Blocks
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Trigeminal Nerve Blocks
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Gasserian Ganglion Block
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Mandibular Nerve Blocks
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Inferior Alveolar Nerve Block
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Inferior Alveolar Nerve Block
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Inferior Alveolar Nerve Block
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Inferior Alveolar Nerve Block
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Inferior Alveolar Nerve Block
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Inferior Alveolar Nerve Block
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Mental Nerve Block
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Mental Nerve Block
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Mental Nerve Block
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Maxillary Nerve Blocks
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Maxillary Nerve Blocks
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Maxillary Nerve Blocks
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Maxillary Nerve Blocks
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Maxillary Nerve Blocks
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Maxillary Nerve Blocks
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Local Blocks
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Supraorbital Nerve Blocks
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Supratrochlear Nerve Blocks
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Infraorbital Nerve Blocks
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Nasociliary and Anterior Ethmoidal Nerve Blocks
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Local Blocks for Nasal Surgery
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Maxillary Nerve Blocks
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Local Blocks for Nasal Surgery
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Local Ear Blocks
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Local Ear Blocks
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Local Ear Blocks
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Local Ear Blocks
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Local Ear Blocks
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Cervical Blocks
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Cervical Blocks
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Cervical Blocks
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Cervical Blocks
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Cervical Blocks
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Cervical Blocks
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Cervical Blocks
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Spinal Accessory Nerve Block
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Glossopharyngeal Nerve Block
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Glossopharyngeal Nerve Block
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Glossopharyngeal Nerve Block
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Glossopharyngeal Nerve Block
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Airway and Laryngeal Blocks
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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Laryngeal Anesthesia
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References
• Atlas of Regional Anesthesia, Katz et. al, Multiple pages, Appleton and Lange 1994
• Techniques of Regional Anaesthesia, Scott et. al, Appleton and Lange, 1989
• Regional Anesthesia of the oral cavity, Jastak and yagiela, The Mosby Company 1981
• Illustrated Handbook in Local Anaesthesia, Eriksson, W.B. Saunders Company 1979