TRANSLARYNGEAL BLOCK
Anesthetizes portions of the recurrent laryngeal nerve and the internal branch of the superior laryngeal nerve.  Recurrent laryngeal nerve provides sensory innervation to the vocal cords and trachea. Internal branch of the superior laryngeal nerve provides sensation above the vocal cords.
INDICATIONS
Translaryngeal block anesthetizes the trachea and vocal cords
Advantageous to avoid Valsalva-like straining
CONTRAINDICATIONS
Coughing: Avoid in patients that coughing would be hazardous
POSSIBLE COMPLICATIONS
Intravascular injection
Gastric aspiration
PEARLS
Placing a liter bag of fluids in-between the shoulder blades can assist in positioning
Neck extension assists in identifying structures
TECHNIQUE
Place patient in supine positon
Have the patient extend their neck
Starting midline move in a caudal direction until the cricoid cartilage is identified
Above the cricoid cartilage is the cricothyroid membrane
Prep the area
Using your thumb and third finger, stabilize the trachea at the level of the thyroid cartilage
A 22 or 20 gauge needle on a 10 mL syringe is inserted perpendicular to the skin
Advance needle through the cricothyroid membrane with continuous aspiration
Once bubbles are seen, stop advancing and inject local anesthetic
Remove needle