Awake tracheal intubation: a narrative review

Background and Objective: Awake tracheal intubation (ATI) is considered the gold standard for managing the anticipated difficult airway. However, ATI occurs in only 0.2% of all anaesthetics and evidence shows this is declining further, eroding skill retention and putting patients at risk of harm. The Difficult Airway Society (DAS) recently published ATI guidelines but focused largely on two techniques: awake video laryngoscopy and awake flexible bronchoscopy. This narrative review aims to summarise all techniques described for ATI, discuss controversies in methods of optimizing intubating conditions as well as patient experience and clinician training.