It is possible to induce local anesthesia for certain diagnostic and surgical procedures by percutaneous topical analgesia of the larynx and trachea. This is done by an injection through the skin, subcutaneous fat, pretracheal fascia, and cricothyroid membrane (or cricotracheal ligament or soft tissues between the first and second tracheal rings). The anesthetic solution used was 2 to 3 cc. of 5% hexylcaine hydrochloride. The ensuing cough spreads the hexylcaine over the tracheolaryngeal mucous surfaces. The method has been used successfully in all but 54 of 10,204 cases. Failures were usually due to inexperience or poor technique. Severe coughing and occasional laryngospasm were the most frequent complications. The method is less cumbersome and time consuming than instillation of topical anesthesia via the mouth and rima glottidis, and it facilitates the passing of an endotracheal tube under difficult conditions.
Boyan CP, Howland WS. PERCUTANEOUS TOPICAL ANALGESIA OF LARYNX AND TRACHEA. JAMA. 1959;171(13):1822–1825. doi:10.1001/jama.1959.03010310054014
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