Anatomic

Awake intubation candidate / anticipated difficult airway

Before / During / After / Pitfalls

Before

• If oxygenation is stable but anatomy is high-risk, consider awake/maintained-spontaneous-ventilation strategy with expert help.
• Topicalization, antisialagogue, sedation plan, and backup surgical airway must be explicit.
• Discuss Plan A/B/C and rescue trigger before starting.

During

• Keep patient oxygenated and cooperative; avoid oversedation that converts an awake plan into a crash airway.
• Use the device/operator most likely to succeed: fiberoptic, VL-assisted, or combined technique.
• Stop and re-oxygenate/reassess rather than pushing through failure.

After

• Secure tube, document difficult-airway details, and communicate extubation risk.
• Arrange ICU/anesthesia/ENT follow-up when appropriate.
• Capture teaching pearl and successful technique.

Pitfalls

• Using RSI because awake setup feels slow despite stable oxygenation.
• Oversedation before topicalization and rescue readiness.
• No surgical airway backup.