Triad of safety, efficacy and patient comfort: videolaryngoscopic awake nasotracheal intubation using a lignocaine and propofol based technique

Currently there is a paucity of guidelines for anticipated difficult airways but awake intubation holds a pivotal position in all of these. Although awake fiberoptic intubation has long been considered the gold standard for difficult airway, awake videolaryngoscopic intubation is a promising alternative which is safe and effective, with myriad benefits like shorter duration of intubation, lesser technical skills required, shorter learning curve and better visualization when blood, copious secretions, tenacious sputum or debris obscures the glottic view. A detailed description of a lignocaine-topicalization with adjunctive propofol-sedation based technique for awake C-Mac D-Blade videolaryngoscopic intubation for anticipated extremely difficult airways in three patients follows.