Ultrasound-Guided Superior Laryngeal Nerve Block Combined with Cricothyroid Membrane Puncture for Awake Tracheal Intubation in a Patient with a Laryngeal Tumor: A Case Report and Literature Review

Mingming Chen,* Jin Luan,* Danqi Chen,* Ling Hu, Hui Long Department of Anesthesiology, Affiliated Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, Hubei Province, 430064, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ling Hu, Email 232836909@qq.com Hui Long, Email 1605109246@qq.comBackground: Airway management for laryngeal tumor surgery is challenging because conventional induction of general anesthesia may worsen dynamic obstruction, whereas prophylactic tracheostomy is more invasive. We describe a minimally invasive awake airway strategy using ultrasound-guided superior laryngeal nerve block (SLNB) combined with cricothyroid membrane puncture.Case Presentation: A 59-year-old man with a laryngeal tumor, hypertension, diabetes mellitus, and coronary artery stenosis underwent successful awake flexible bronchoscopy-guided tracheal intubation after ultrasound-guided bilateral SLNB combined with cricothyroid membrane puncture, with a front-of-neck surgical airway prepared as backup. At predefined peri-intubation time points, systolic/diastolic blood pressure ranged from 131– 183/68– 102 mmHg, heart rate from 44 to 78 beats/min, respiratory rate from 14 to 22 breaths/min, and SpO2 from 96% to 100%. No hypoxemia or airway-related complication occurred.Conclusion: In selected patients with high-risk laryngeal tumors, ultrasound-guided SLNB combined with cricothyroid membrane puncture may facilitate awake tracheal intubation while avoiding unnecessary surgical airway creation. This technique may serve as a useful alternative when conventional induction is considered hazardous.