27 Airway Block Anatomy

If there is one set of regional blocks that an anesthesiologist should master, it is airway blocks. Even those anesthesiologists who prefer to use general anesthesia for the majority of their cases will be faced with the need to provide airway blocks before anesthetic induction in patients who may have airway compromise, trauma to the upper airway, or unstable cervical vertebrae. As illustrated in Figure 27-1, innervation of the airway can be separated into three principal neural pathways: trigeminal, glossopharyngeal, and vagus. If nasal intubation is planned, some method of anesthetizing the maxillary branches from the trigeminal nerve will need to be carried out. As our manipulations involve the pharynx and posterior third of the tongue, glossopharyngeal block will be required. Structures more distal in the airway to the epiglottis will require block of vagal branches.

Figure 27-1. Airway blocks: simplified functional anatomy.

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