The aim of this study is to compare patient satisfaction and intubating conditions with fiber optic intubation under sevoflurane sedation versus airway blocks in difficult airway patients

Awake fiberoptic intubation (AFOI) is a suitable option for anticipated difficult intubation. The ideal condition for AFOI requires a calm, cooperative patient with blunted airway reflexes to facilitate easy intubation, especially if there is difficulty with laryngeal anatomy and/or pathology.

For this purpose, sedative and anxiolytic agents such as benzodiazepines, sevoflurane, remifentanil, ketamine, propofol, and dexmedetomidine are almost always required to relieve the patients from comfort without impairing ventilation. Patient responsiveness and cooperation are almost always required.

Inclusion Criteria:

• Age from 18 to 50 years.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status I-II.
• Patients with difficult airway (Mallampati grade 3 and 4 with mouth opening less than 5 cm).

Exclusion Criteria:

• Patient refusal.
• Patients with bleeding disorders and nasal mass.
• Allergy or intolerance to one of the study medications.
• Patients with uncontrolled systemic diseases.
• patients with gastro-esophageal reflex.
• history of nasopharyngeal surgery or drug abuse.

The data will be available upon a reasonable request from the corresponding author after the end of study for one year.

After the end of study for one year.

The data will be available upon a reasonable request from the corresponding author.