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Application for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Background: Bronchoscopy in high-risk patients like lung tumor associated respiratory distress often presents anesthetic challenges due to comorbid conditions that increase the risk of complications from general anesthesia. Aims: We describe a case series involving patients with respiratory distress due to lung tumors who underwent diagnostic bronchoscopy facilitated by upper airway nerve blocksMethods This study was conducted on 3 patients who underwent diagnostic bronchoscopy at Dr. Saiful Anwar General Hospital. The patients were given three nerve block, bilateral superior laryngeal nerve block, glossopharyngeal nerve block via lidocaine 2% oral spray, and recurrent laryngeal nerve block (transtracheal) before awake bronschoscophy using 2% lidocaine. We evaluates the patients pain score, complication, gag reflex, glotic closure reflex, and cough reflexResults All procedures were completed successfully with minimal complications. Patients demonstrated excellent pain tolerance with effective suppression of the cough, gag, and glotic closure reflex. Intraoperative hemodynamics remained stable throughoutAbstract P128 Figure 1Plain chest x-ray patients of Mrs.S, a 65-year-old patient (left). Plain chest x-ray patient of Mrs.S, a 41-year-old patient (right). Plain chest x-ray patients of Mrs.R, a 31-year-old patient (bottom)Abstract P128 Figure 2Bronchoscophy in respiratory distress patients was performed in the sitting position (left). Superior laryngeal block was performed in sitting position (right)Abstract P128 Table 1Cough reflex, gag reflex, and glotic closure reflexConclusions Regional airway blocks offer a safe, effective alternative for lung tumor associated respiratory distress patients requiring diagnostic bronchoscopy.