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