Not all casualties who need a cricothyroidotomy will be unconscious and unresponsive to painful stimuli. If your casualty is conscious, semi-conscious, or has exhibited responses to painful stimuli during the first part of your assessment, and a surgical airway is indicated, consideration should be given to using lidocaine to anesthetize the skin and neck structures prior to the procedure. However, the clinical or tactical situation may be a contraindication to anesthetizing the casualty prior to placing the airway. For example, a complete or near-complete obstruction with impending respiratory arrest should be addressed immediately, even if the casualty is conscious. Likewise, there may be tactical situations that require an immediate response due to time constraints in maintaining a safe environment for you and your casualty. Lidocaine is not always available, as some unit procedures and packing lists do not prioritize lidocaine for the medical aid bag.

When available, lidocaine should be used after identifying the anatomical landmarks and include the skin and the subcutaneous spaces without inserting the needle deep enough to go through the membranes or trachea.

If a patient becomes toxic, neurological symptoms such as dizziness, tinnitus, and peri-oral numbness usually precede cardiovascular manifestations. The most critical aspect of local anesthetic is appropriate dosing. The recommended maximum dose for subcutaneous infiltration of lidocaine without epinephrine is 4.5 milligrams per kilogram (mg/kg) and for lidocaine with epinephrine is 7 mg/kg.