Procedures on the upper airway in an awake patient are challenging because of local factors such as excessive salivation, presence of gag reflex, and activation of cough reflex, as well as because of the systemic hemodynamic response caused by the stimulation of autonomic nervous system.
Anesthesia of the airway is needed for attempts to access a difficult airway or for procedures performed through the airway in awake patients. In patients with recognized difficult airway, intubation under general anesthesia might lead to the risk of loss of control on the airway. Elective awake intubation is a safer option in these patients and is facilitated by abolishing airway reflexes by local anesthetic techniques. Local anesthesia of the airway is complicated due to the multiple nerves that are to be blocked. A thorough knowledge of the anatomy is essential for a successful procedure.