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 ChinaThese 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.Keywords: difficult airway, awake tracheal intubation, ultrasound-guided nerve block, superior laryngeal nerve block, laryngeal tumor