Transverse approach for ultrasound-guided superior laryngeal nerve block for awake fiberoptic intubation

Kumar, Amarjeet; Sinha, Chandni; Kumar, Ajeet; Bhadani, Umesh Kumar

doi:10.4103/sja.sja_78_17

Cited by 14 publications

(5 citation statements)

References 3 publications

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“…Therefore, preoperative and intraoperative spraying of local anesthetic is necessary for anesthesia to suppress the reflex of the trachea. The superior laryngeal nerve runs posterior to the carotid artery, passing through the lateral side of the hyoid bone, and the medial branch passes just below the greater horn of the hyoid bone, approaching the thyrohyoid muscle with the superior laryngeal artery [13,14], and then penetrates the thyrohyoid membrane [12,15,16]. Autopsy results have demonstrated that there is a space between the hyoid bone and the thyroid cartilage, which contains the internal branch of the superior laryngeal nerve [17].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: a case report

Okada,

Yoshida,

Matsushita

et al. 2023

Preprint

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Anesthetic management of endobronchial stent placement by rigid bronchoscopy requires the maintenance of spontaneous breathing while suppressing upper airway reflexes. The combination of superior laryngeal nerve block (SLNB) can reduce the respiratory depression that occurs during management under total intravenous anesthesia. The patient was diagnosed as having lung cancer with invasion into the right middle bronchus and stenosis of the right main bronchus on chest computed tomography, and emergency airway stent placement was performed. Sedation was initiated with propofol and dexmedetomidine, and ultrasound-guided SLNB was performed after local anesthetic spraying into the oral cavity and trachea. Bucking was minimally controlled during insertion of the rigid bronchoscope. The patient's intraoperative hemodynamics remained Posted on

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Section: Discussionmentioning

confidence: 99%

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: a case report

Okada,

Yoshida,

Matsushita

et al. 2023

Preprint

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“…Owing to a distinct adjustment of the internal branch of the superior laryngeal nerve in which it runs mostly within a distance of 10 mm from the greater horn of the hyoid, [ 10 ] ultrasound-guided SLN exhibits a high success rate and rare incidence of complications when the greater horn of the hyoid is used as a sonographic landmark. [ 10 , 29 ] Under a transverse view of the hyoid, considering the greater horn rather than the thin SLN as a sonographic landmark is a simpler technique.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure

Liao¹,

Hsieh³

et al. 2020

Medicine

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Introduction: Evolving techniques in the field of therapeutic bronchoscopy have led to the return of rigid bronchoscopy in the treatment of complex central airway disease. Rigid bronchoscopy is typically performed under general anesthesia because of the strong stimulation caused by metal instruments. Anesthesia for rigid bronchoscopy is challenging to administer because anesthesiologists and interventionists share the same working channel: the airway. Previously reviewed anesthetic methods are used primarily for short procedures. Balanced anesthesia with ultrasound-guided superior laryngeal nerve (SLN) block and total intravenous anesthesia might provide anesthesia for a prolonged procedure and facilitate patient recovery. Patient concerns: A patient with obstructed endobronchial stent was referred for therapeutic rigid bronchoscopy, which requires deeper anesthesia than flexible bronchoscopy. There were concerns of the stronger stimulation of the rigid bronchoscopy, lengthy duration of the procedure, higher risk of hypoxemia, and the difficulty of mechanical ventilation weaning after anesthesia due to the patients co-morbidities. Diagnosis: A 66-year-old female patient presented with a history of breast cancer with lung metastases. Right main bronchus obstruction due to external compression of lung metastases was relieved through insertion of an endobronchial stent, but obstructive granulation developed after 4 months. Presence of the malfunctioning stent caused severe cough and discomfort. Removal of the stent by using a flexible bronchoscope was attempted twice but failed. Interventions: Regional anesthesia of the upper airway through ultrasound-guided SLN block combined with intratracheal 2% lidocaine spray was performed to assist in total intravenous anesthesia (TIVA) during rigid bronchoscopy. Outcomes: The patient maintained steady spontaneous breathing throughout the procedure without laryngospasm, bucking, or desaturation. Emergence from anesthesia was smooth and rapid after propofol infusion was discontinued. The surgery lasted 2.5 hours without discontinuity, and no perioperative pulmonary or cardiovascular complications were noted. Conclusion: Ultrasound-guided SLN block is a simple technique with a high success rate and low complication rate. Application of SLN block to assist TIVA provides sufficient anesthesia for lengthened therapeutic rigid bronchoscopy without interruption and facilitates patient recovery.

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“…Both groups used a high-frequency 5-13 MHz linear transducer to perform a nerve block (EDGE; SonoSite, USA). In group T, the transverse approach was used [14]. The transducer was positioned transversely between the hyoid bone and the thyroid cartilage to locate the superior laryngeal artery or nerve.…”

Section: Ultrasound-guided Transverse Approach Sln Blockmentioning

confidence: 99%

Ultrasound-guided superior laryngeal nerve block: a randomized comparison between parasagittal and transverse approach

Shan,

Tan,

Bao

et al. 2024

Preprint

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Background Different approach ultrasound-guided superior laryngeal nerve block was used to aid awake intubation, but little is known which approach was superior. We aimed to compare the parasagittal and transverse approaches for ultrasound-guided superior laryngeal nerve block in adult patients undergoing awake intubation. Methods Fifty patients with awake orotracheal intubation were randomized to receive either a parasagittal or transverse ultrasound-guided superior laryngeal nerve block. The primary outcome was patient’s quality of airway anesthesia grade during insertion of the tube into the trachea. The patients’ tube tolerance score after intubation, total procedure time, mean arterial pressure, heart rate, Ramsay sedation score at each time point, incidence of sore throat both 1 h and 24 h after extubation, and hoarseness before intubation, 1 h and 24 h after extubation were documented. Results Patients’ quality of airway anesthesia grade was significantly lower in the parasagittal group than in the transverse group (median grade[IQR], 0 [0–1] vs 1 [0–1], P = 0.036). Patients in the parasagittal approach group had lower tube tolerance scores (median score [IQR], 1[1–1] vs 1 [1–1.5], P = 0.042) and shorter total procedure time (median time [IQR], 113 seconds [98.5–125.5] vs 188 seconds [149.5–260], P < 0.001) than those in the transverse approach group. The incidence of sore throat 24 h after extubation was lower in the parasagittal group (8% vs. 36%, P = 0.041). Hoarseness occurred in more than half of the patients in parasagittal group before intubation (72% vs 40%, P = 0.023). Conclusions Compared to the transverse approach, the ultrasound-guided parasagittal approach showed improved efficacy in terms of the quality of airway topical anesthesia and shorter total procedure time for superior laryngeal nerve block. Trial registration This prospective, randomized controlled trial was approved by the Ethics Committee of Nanjing First Hospital (KY20220425-014) and registered in the Chinese Clinical Trial Registry (19/6/2022, ChiCTR2200061287) prior to patient enrollment. Written informed consent was obtained from all participants in this trial.

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Transverse approach for ultrasound-guided superior laryngeal nerve block for awake fiberoptic intubation

Cited by 14 publications

References 3 publications

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: a case report

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: a case report

Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure

Ultrasound-guided superior laryngeal nerve block: a randomized comparison between parasagittal and transverse approach

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