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Any of you guys/gals doing cervical blocks for awake carotids? Curious as to your technique.
Any of you guys/gals doing cervical blocks for awake carotids? Curious as to your technique.
I was going to describe the technique but then I remembered:
http://www.nysora.com/techniques/deep_cervical_plexus_block/
Why go through the trouble when its right here for you.
Its a great technique with the right surgeon and pt.
And if you hook the bulb to a turbine and a generator he can produce electricity to run the anesthsia machine, totally free energy.I actually give the patient a bulb to squeeze attached to a manometer and ask him/her to squeeze - not as annoying as a rubber ducky .
And if you hook the bulb to a turbine and a generator he can produce electricity to run the anesthsia machine, totally free energy.
Any of you guys/gals doing cervical blocks for awake carotids? Curious as to your technique.
so, it says to hit the branches of the glossopharyngeal n. by injecting into the carotid sheath. is this done with US guidance?? obviously, you don't want to inject the local INTO the carotid a (or hit the jugular or vagus n.)..... can someone shed some light on this?
Why would you want to block the glosso-pharyngeal nerve for carotid surgery?
You need a superficial + deep cervical plexus block, they are pretty easy and don't really require ultrasound although you could use ultrasound for the deep block.
There is no way I would ever have that done awake. I don't want to be aware that I'm stroking out, either. Do you think the guy does not know what's going on when he can no longer squeeze the squeaky toy? I want the tube down the throat with EEG or evoked potential monitoring.
But we have BIS now.
Why would you want to block the glosso-pharyngeal nerve for carotid surgery?
You need a superficial + deep cervical plexus block, they are pretty easy and don't really require ultrasound although you could use ultrasound for the deep block.
I'm a med student, but since glossopharyngeal carries back afferents from the carotid body, it seems that without anesthetizing IX it could be inappropriately stimulated during the procedure.
For a refresher, if afferents of IX would be stimulated, it would likely cause an increase in respiration, as IX from carotid body are only stimulated when P02 levels fall. I'm pretty sure you guys are up on this stuff, but for educational purposes, the peripheral chemoreceptors (carotid body and aortic arch) are secondary to the central chemoreceptors which are primarily sensitive to CO2 levels, versus O2 levels.
What do you guys think? Is this the correct logic for anesthetizing IX n.??
Why would you want to block the glosso-pharyngeal nerve for carotid surgery?
You need a superficial + deep cervical plexus block, they are pretty easy and don't really require ultrasound although you could use ultrasound for the deep block.
Sure, you could do it with a superficial block or even just local infiltration.You really only need the superficial block. 10 ml of local under the lateral border of the SCM blindly. Surgeon can supplement if needed, but its usually not.
Sure, you could do it with a superficial block or even just local infiltration.
The bottom line, regardless what technique you use for awake carotids
You need a patient who is willing and capable of staying still with head turned to one side for an hour, none of my patients fits the criteria.