regional anesthesia in otolaryngology

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    Regional Anesthesia InRegional Anesthesia InOtolaryngologyOtolaryngology

    University of Texas Medical BranchUniversity of Texas Medical Branch

    Dept. of OtolaryngologyDept. of Otolaryngology

    Jacques Peltier MDJacques Peltier MDFrancis Quinn MDFrancis Quinn MD

    May 24, 2006May 24, 2006

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    Advantages of Local AnesthesiaAdvantages of Local Anesthesia

    The patient is conscious during surgery.The patient is conscious during surgery.

    Smooth postoperative course.Smooth postoperative course.

    Patient awake and maintains his own airway.Patient awake and maintains his own airway.

    Less pain needs less narcotics, lighterLess pain needs less narcotics, lighteranesthesia in general cases.anesthesia in general cases.

    Less nursing care after procedures, lessLess nursing care after procedures, lessadmissions.admissions.

    Less expensiveLess expensive

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    Disadvantages of Local AnesthesiaDisadvantages of Local Anesthesia

    The patient may prefer to be asleepThe patient may prefer to be asleep Specialized skill necessary.Specialized skill necessary.

    Some blocks require up to 30 minutes toSome blocks require up to 30 minutes to

    be fully effective.be fully effective.

    Analgesia may not always be totallyAnalgesia may not always be totallyeffective, and general anesthesia may beeffective, and general anesthesia may berequired anyway.required anyway.

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    Disadvantages of Local AnesthesiaDisadvantages of Local Anesthesia

    Generalized toxicity may occur if localGeneralized toxicity may occur if localanesthetic drugs are given intravenouslyanesthetic drugs are given intravenouslyby mistake or an overdose is given.by mistake or an overdose is given.

    Widespread sympathetic blockade canWidespread sympathetic blockade canresult in hypotension.result in hypotension.

    There is a small but definite incidence ofThere is a small but definite incidence ofprolonged nerve damage.prolonged nerve damage.

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    Local AnestheticsLocal Anesthetics

    Agent:Agent: Dose:Dose: Onset/Duration:Onset/Duration: Lidocaine withLidocaine with epiepi (1 or 2%)(1 or 2%) 7mg/kg7mg/kg Fast/mediumFast/medium Lidocaine withoutLidocaine without epiepi 4.5mg/kg4.5mg/kg Fast/shortFast/short

    MepivacaineMepivacaine withoutwithout epiepi (3%)(3%) 5.5mg/kg5.5mg/kg Fast/shortFast/short BupivacaineBupivacaine withwith epiepi (0.5%)(0.5%) 1.3mg/kg1.3mg/kg Long/longLong/long ArticaineArticaine withwith epiepi (4.0%)(4.0%) 7mg/kg7mg/kg Fast/mediumFast/medium

    *ADULT DOSES IN PATIENTS WITHOUT CARDIAC HISTORY*ADULT DOSES IN PATIENTS WITHOUT CARDIAC HISTORY

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    Scalp BlocksScalp Blocks

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    Scalp BlocksScalp Blocks

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    Scalp BlocksScalp Blocks

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    Scalp BlocksScalp Blocks

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    Trigeminal Nerve BlocksTrigeminal Nerve Blocks

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    GasserianGasserian Ganglion BlockGanglion Block

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular

    Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    MandibularMandibular Nerve BlocksNerve Blocks

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    Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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    Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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    Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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    Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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    Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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    Inferior Alveolar Nerve BlockInferior Alveolar Nerve Block

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    Mental Nerve BlockMental Nerve Block

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    Mental Nerve BlockMental Nerve Block

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    Maxillary Nerve BlocksMaxillary Nerve Blocks

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    Maxillary Nerve BlocksMaxillary Nerve Blocks

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    Maxillary Nerve BlocksMaxillary Nerve Blocks

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    Maxillary Nerve BlocksMaxillary Nerve Blocks

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    Local BlocksLocal Blocks

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    SupraorbitalSupraorbital

    Nerve BlocksNerve Blocks

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    SupratrochlearSupratrochlear

    Nerve BlocksNerve Blocks

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    NasociliaryNasociliary and Anteriorand Anterior

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    NasociliaryNasociliary and Anteriorand Anterior

    EthmoidalEthmoidal Nerve BlocksNerve Blocks

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    Local Blocks for Nasal SurgeryLocal Blocks for Nasal Surgery

    ll l k

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    Maxillary Nerve BlocksMaxillary Nerve Blocks

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    L l Bl k f N l SL l Bl k f N l S

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    Local Blocks for Nasal SurgeryLocal Blocks for Nasal Surgery

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    Local Ear BlocksLocal Ear Blocks

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    Local Ear BlocksLocal Ear Blocks

    Local Ear BlocksLocal Ear Blocks

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    Local Ear BlocksLocal Ear Blocks

    Local Ear BlocksLocal Ear Blocks

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    Local Ear BlocksLocal Ear Blocks

    Local Ear BlocksLocal Ear Blocks

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    Local Ear BlocksLocal Ear Blocks

    Local Ear BlocksLocal Ear Blocks

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    Local Ear BlocksLocal Ear Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Cervical BlocksCervical Blocks

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    Cervical BlocksCervical Blocks

    Spinal Accessory Nerve BlockSpinal Accessory Nerve Block

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    Spinal Accessory Nerve BlockSpinal Accessory Nerve Block

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    GlossopharyngealGlossopharyngeal Nerve BlockNerve Block

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    GlossopharyngealGlossopharyngeal Nerve BlockNerve Block

    GlossopharyngealGlossopharyngeal Nerve BlockNerve Block

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    GlossopharyngealGlossopharyngeal Nerve BlockNerve Block

    GlossopharyngealGlossopharyngeal Nerve BlockNerve Block

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    GlossopharyngealG ossop a y gea Nerve Blocke e oc

    Airway and Laryngeal BlocksAirway and Laryngeal Blocks

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    Airway and Laryngeal Blocksy y g

    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Laryngeal AnesthesiaLaryngeal Anesthesia

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    Special thanks toSpecial thanks to

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    Melinda QuinnMelinda Quinnfor help in scanning slides used infor help in scanning slides used in

    this presentation.this presentation.

    ReferencesReferences

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    Atlas of Regional Anesthesia, Katz et. al, Multiple pages,Atlas of Regional Anesthesia, Katz et. al, Multiple pages,

    Appleton and Lange 1994Appleton and Lange 1994 Techniques of RegionalTechniques of RegionalAnaesthesiaAnaesthesia, Scott et. al,, Scott et. al,Appleton and Lange, 1989Appleton and Lange, 1989

    Regional Anesthesia of the oral cavity,Regional Anesthesia of the oral cavity, JastakJastakandandyagielayagiela, The, The MosbyMosby Company 1981Company 1981

    Illustrated Handbook in LocalIllustrated Handbook in LocalAnaesthesiaAnaesthesia, Eriksson,, Eriksson,

    W.B. Saunders Company 1979W.B. Saunders Company 1979