Abstract
BACKGROUND: 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 SpO(2) 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.