The gold standard for awake intubation is by flexible fiberoptic scope. With good reason. In trained hands, the fiberoptic scope is the best and most flexible and versatile method. But it takes practice. With modern technology, there’s an easier way.
We know how to do laryngoscopy. And these days, most departments have a video laryngoscope available. It lets you see around corners, so you don’t have to lift the laryngoscope so much to get a good view. Less lifting gives less discomfort for the patient.
So with a standard awake intubation preparation with topical anaesthesia and low dose remifentanil infusion, the patient has good analgesia, is sedated, but arousable, and self ventilating. And you are ready for video laryngoscopy. Go ahead carefully and slowly. If the patient reacts, withdraw and give more topical anaesthesia or increase the remifentanil infusion. Usually, you will easily get a good view.
Alternatively, the awake intubation can be done with topical anaesthesia only, add a little opioid or add a little sedation, like propofol or midazolam to lessen the discomfort by taking the edge off the nervousness (the patient’s, not yours).
Finish off in the standard fashion: Put down the tube with a stylet or bougie, inflate the cuff, verify the position with capnography and induce with propofol.
Do a thorough pre-operative assessment before going ahead with this, and inform the patient carefully. You might also want to have a fiberscope and fiberscope operator available. Follow standard awake intubation procedure. If you can’t get a good view, stop the remifentanil infusion to wake up the patient and abort the procedure.
It’s an elegant way to do an awake intubation with less fuzz than the fiberscope way, and no fiberscope to clean afterwards.
On PubMed I could only find case reports and small series of awake intubations using video laryngoscopes, which is the same sort of experience I have myself. But do a search if you want to read some case reports