Regional and Topical Anesthesia for Awake Endotracheal Intubation

Persistent Notes

Seems like this could be successful with experience. However, this requires 3 different site of needle injections and can carry complications.Seems like this could be successful with experience. However, this requires 3 different site of needle injections and can carry complications.

Rec lidocaine dose is 8 mg/kg

  • glossopharyngeal block: 25G spinal needle, 2cc each side, 2% lidocaine
  • SLN block: 24G needle, 3 cc each side, 2% lidocaine
  • transtracheal block: 22G needle, 5cc 4% lidocaine, inject after exhalation to decrease cough

Highlights

  • Lidocaine
  • than the recommended 2 mg/kg
    • double check this dose
  • Adding approximately 5 mL of 4% lidocaine to a nebulizer
  • It also allows the topicalization of patients with limited mouth opening, where atomizers cannot be passed into the mouth to topicalize the oropharynx.
  • Glossopharyngeal Nerve Block
  • They do carry a higher risk of complications, such as intravascular injection and nerve damage
  • the nerve blocks required to anesthetize the airway are the glossopharyngeal, superior laryngeal, and translaryngeal blocks.
  • Superior Laryngeal Nerve Block
  • This helps to abolish the gag reflex, but this block on its own will not provide adequate conditions for awake fiberoptic intubation.
  • Recurrent Laryngeal Nerve Block

Reference

Operater. Regional and Topical Anesthesia for Awake Endotracheal Intubation. NYSORA. September 12, 2018. Accessed July 26, 2025. https://www.nysora.com/techniques/head-and-neck-blocks/airway/regional-topical-anesthesia-awake-endotracheal-intubation/