Ultrasound-assisted translaryngeal block for awake fibreoptic intubation

  • Gildasio S. De OliveiraJr
  • Paul Fitzgerald
  • Mark Kendall

To the Editor,

The difficulty of identifying landmarks can preclude the success of airway blocks and awake tracheal intubation in patients with challenging airways.1 We describe a case wherein the use of ultrasound made it possible to perform a translaryngeal block successfully by injection of local anesthetic into the tracheal lumen.2 This technique allowed subsequent awake intubation in a super morbidly obese patient. Informed consent was obtained from the patient prior to submission of this correspondence.

The patient was a 38-yr-old female with a body mass index of 57.4 kg·m−2 who was scheduled to undergo a Roux-en-Y gastric bypass. Due to a potential difficult airway, the anesthetic plan was to perform an awake fibreoptic intubation. Preoperatively, the patient’s pharynx was sprayed with a combination of 14% benzocaine and 2% tetracaine. In the operating room, the patient was sedated with midazolam 3 mg iv and ketamine 20 mg iv. She was positioned with her neck extended. An...


Lidocaine Vocal Cord Thyroid Cartilage Tetracaine Benzocaine 


Financial support


Conflicts of interest

None declared.


  1. 1.
    Elliott DS, Baker PA, Scott MR, Birch CW, Thompson JM. Accuracy of surface landmark identification for cannula cricothyroidotomy. Anaesthesia 2010; 65: 889-94.CrossRefGoogle Scholar
  2. 2.
    Translaryngeal block. In: Brown DL (Ed.). Atlas of Regional Anesthesia, 2nd ed. Philadelphia, PA: Saunders; 1999: 215-6.Google Scholar
  3. 3.
    Simmons ST, Schleich AR. Airway regional anesthesia for awake fiberoptic intubation. Reg Anesth Pain Med 2002; 27: 180-92.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2011

Authors and Affiliations

  • Gildasio S. De OliveiraJr
    • 1
  • Paul Fitzgerald
    • 1
  • Mark Kendall
    • 1
  1. 1.Northwestern UniversityChicagoUSA

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