Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Four. Blocks of the Head & Neck > Chapter 19. Regional & Topical Anesthesia for Endotracheal Intubation Leroy Sutherland, MD, David Misita, MD

Regional & Topical Anesthesia for Endotracheal Intubation: Introduction

"Recent developments in regional anesthesia have resulted in a number of innovative and refined options to practitioners, often allowing regional techniques to be used for patients with presumed difficult airways. However, not every surgery can be performed under regional anesthesia. In addition, even in the hands of the most skilled regional anesthesiologist, blocks are subject to a certain rate of complications or failure.^1–4 In addition, there are many situations in which the anesthesiologist is called on to secure an airway in less than ideal circumstances. Expertise with regional anesthesia of the airway allows intubation in awake patients with suspected difficult intubation, upper airway trauma, or cervical spine fractures. Therefore, it is essential that every regional anesthesiologist be skilled in the administration of general anesthesia and especially in the management of the difficult airway.To decide on a proper approach to an awake fiberoptic intubation, one must determine what structures need to be anesthetized along the two basic routes of intubation (oral or nasal) to facilitate optimal surgical conditions in the context of patient-specific anatomic considerations. Each of these routes has a well-defined pattern of innervation that can be specifically blocked to provide adequate anesthesia...."