Stress-Free Intubation With Preserved Spontaneous Breathing for Cases With Difficult Airway Management: A Case Series...

Awake tracheal intubation (ATI) is a crucial technique for difficult airway management, particularly in patients with obesity, restricted neck movement, or upper airway abnormalities. Despite its efficacy, ATI is often avoided because of the technical challenges and stress it imposes on patients and anesthesiologists. We describe a new method, termed "intubation maintaining spontaneous breathing with three nerve blocks technique" (3N technique), which leverages nerve blocks to suppress reflexes, preserve spontaneous breathing, and facilitate smooth intubation. The 3N technique requires minimal equipment and staff, thus reducing procedural stress and time. This new approach combines ultrasound-guided selective glossopharyngeal nerve block, superior laryngeal nerve block, and translaryngeal block. The data collected included the time from anesthesia initiation to intubation, types and dosages of sedatives and analgesics, patient discomfort during induction, and memory at induction. In our retrospective analysis of 18 cases, no patient experienced discomfort or remembered the procedure, and intubation was completed in an average of 16 minutes. Although the 3N technique is not suitable for patients with a full stomach or pediatric cases, it is broadly applicable and offers a safer and simpler alternative to conventional ATI methods, especially in patients with difficult airway management.