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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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This block is most effectively utilized after the patient has been appropriately sedated. There has long been a belief that the block should be used cautiously, if at all, in patients at high risk for gastric aspiration. My own belief is that the block is more frequently misused by not being applied in appropriate situations than by being applied when the patient is at risk for gastric aspiration.

Another hint is to perform the local anesthetic injection after asking the patient to exhale forcefully. This forces the patient to inspire initially before coughing, making distal airway anesthesia predictable.

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