Awake intubation should be considered when it is appropriate to perform.


Awake iintubation may involve:

(1) fiberoptics (awake fiberoptic intubation or AFOI)

(2) video laryngoscopy

(3) direct laryngoscopy

(4) other (blind nasal inubation, intubating laryngeal mask, etc)


Reasons to consider awake intubation:

(1) difficult mask ventilation

(2) difficult tracheal intubation


Absolute contraindications:

(1) patient refusal to consent (after adequate counseling)

(2) patient uncooperative


Relative contraindications:

(1) operator inexperience

(2) lack of adequate equipment

(3) allergy to local anesthetic

(4) active hemorrhage into the airway, sufficient to obscure procedure


Caution (may require an expert):

(1) upper airway tumor

(2) other conditions associated with risk for total airway obstruction


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