Upper Airway Blocks for Awake Difficult Airway Management

Abstract

SUMMARY -Airway anesthesia is pivotal for successful awake intubation provided either topically or by blocks. Airway blocks are considered technically more difficult to perform and carry a higher risk of complications. However, in experienced hands, they can be useful as they provide excellent intubating conditions. For complete upper airway anesthesia, bilateral glossopharyngeal and superior laryngeal nerve blocks with translaryngeal injection are required. Superior laryngeal nerve block and translaryngeal injection can be performed easily, safely and with a high success rate in patients with normal anatomy. In those with difficult landmarks, ultrasound can be of assistance. For the superior laryngeal nerve block, other targets than the nerve itself must be established to make the technique consistently successful, easy to teach, learn and perform. The same applies to the translaryngeal injection, where the use of ultrasound is necessary for correct midline identification. Intraoral glossopharyngeal nerve block is also safe and easy to perform, but associated with long lasting discomfort. Bilateral extraoral peristyloid approach should be discouraged since inadvertent blocks of the closely adjacent vagus nerve cannot be prevented in this location. A safe and easy method of blocking the distal portions of the glossopharyngeal nerve for awake intubation is therefore required.

Flexible nasal bronchoscopy vs. Airtraq® videolaryngoscopy for awake tracheal intubation: a randomised controlled non‐inferiority study

“…Airway blocks can be performed easily and safely in patients with normal anatomy. In those with difficult landmarks, ultrasound can be of assistance [23]. We did not use ultrasound at the time of the study but have since implemented this for difficult cases.…”

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

“…5 In a difficult airway scenario, when combined with topical anesthesia of the nasal passages, superior laryngeal nerve block, transtracheal block, and appropriate decongestion of the airway, it is probably the safest and easiest technique. 6 However, its use has since declined because it is a blind procedure that needs more time than the better alternatives that came on the scene, like flexible fiberscope-guided techniques. All this led to a lack of appropriately skilled and trained personnel, bringing it further down in the preference order.…”

Clinical Application of Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block in Patients with Severe COPD Undergoing Awake Fibreoptic Nasotracheal Intubation: A Randomized Controlled Clinical Trial

“…[20][21][22] Previous studies have shown that sufficient airway anaesthesia is essential to suppress gag, swallow and cough reflexes prior to awake endotracheal intubation, and with the development of ultrasound visualisation technology, ultrasound-guided internal branch of the superior laryngeal nerve block (UGISLNB) has many benefits for awake nasotracheal intubation guided by an FB. 15,[23][24][25][26][27] However, the clinical application of UGISLNB in patients with COPD who develop severe respiratory failure and require fibreoptic nasotracheal intubation has not been studied. Hence, the purpose of this randomised controlled clinical trial is to assess the time for intubation, adverse events, comfort score and stress response to UGISLNB in patients with severe COPD undergoing awake fibreoptic nasotracheal intubation; to verify its safety and efficacy; and to provide a clinical reference.…”