Unable to continue recruit subjects

Awake tracheal intubation is the standard management for patients as risk for airway compromise. It is also commonly done in cases where there is significant cervical spine pathology i.e. cervical myelopathy or instability. The anesthetic technique used for the awake intubation is crucial to the patient's safety. One of the most important aspects of the anesthetic technique is airway anesthesia prior to placement of an endotracheal tube. The superior laryngeal nerve is responsible for mediating the cough reflex around the vocal cords. The investigators have developed an approach to reliably block the superior laryngeal nerve by injecting local anesthetic near the nerve in a unique approach. Injecting local anesthetic into or through the thyrohyoid membrane will effectively block the superior laryngeal nerve

Inclusion Criteria

1. Patients between the ages of 18-80 requiring an awake intubation for endotracheal intubation.
2. Ability to speak and understand English

Exclusion Criteria

1. Allergy to lidocaine
2. Emergent operative case
3. Therapeutic anticoagulation
4. Mouth opening less than 2 cm

Scheduled Surgery Patients who require an awake intubation