• Topical application of local anesthetic agent can be accomplished orally (as a swish and swallow) or by transtracheal deposition into the tracheal lumen. However, these techniques may blunt the glottic and cough reflex, increasing the patient’s susceptibility to aspiration. The gag reflex can be further controlled by supplementary nerve blocks to the lingual branch of the glossopharyngeal nerve and the superior laryngeal nerve. The glossopharyngeal nerve block requires the bilateral deposition of local anesthetic agent into the caudad portion of the tonsillar pillar. The superior laryngeal nerve block is accomplished by deposition of local anesthetic agent into the thyrohyoid membrane.