Ultrasound-guided airway blocks using a curvilinear probe

•We introduce a modified and simplified technique of ultrasound-guided airway blocks.•The curvilinear probe requires minimal pressure on the patient's neck.•The probe allows superior visualization of the procedure needle at steep angles.•This technique is ideal for patients with distorted neck anatomy.•This approach to airway anesthesia minimizes the amount of local anesthetic required.

We describe a novel technique of real-time ultrasound-guided superior laryngeal nerve and translaryngeal blocks in 4 patients with anticipated difficult airways. All patients had altered neck anatomy, and 1 had a prior unsuccessful awake fiberoptic bronchoscopic intubation. For block performance, an 11-mm broadband curved array transducer with a scanning frequency between 8 and 5 MHz (Sonosite, Bothell, WA) was used for anatomical structure identification, needle guidance toward each superior laryngeal nerve and through the cricothyroid membrane, and deposition of local anesthetic in the appropriate location. This was followed by successful awake fiberoptic bronchoscopic endotracheal intubation in all cases.