Awake fiberoptic intubation is the recommended technique for anticipated difficult airway management which requires effective local anesthesia for patient's comfort and co-operation. However, it is often an unpleasant procedure to the patient because sensation of passage of the instrument through the nose and larynx, pain and coughing is the main complaints, while endoscopists usually attribute difficulty in laryngeal visualization to secretions and inadequate local anesthesia. Spraying of local anesthetic can be achieved in different ways, including the use of commercially prepared aerosol spray cans, atomizers and nebulizers. Successful awake tracheal intubation (ATI) requires an adequate level of sedation, in which the patient is able to respond to verbal commands while maintaining spontaneous ventilation and hemodynamic stability. An ideal sedation technique for ATI should include anxiolysis, amnesia, appropriate analgesia, and suppression of the cough and gag reflexes. When attempting sedation for ATI, the Standard American Society of Anesthesiology monitors, oxygen via nasal cannula, and capnography should be in place. Several classes of drugs have been described, from benzodiazepines (e.g., diazepam and midazolam), to opioids (e.g., morphine, fentanyl, and remifentanil), to intravenous induction agents (e.g., ketamine and propofol), and to alpha2 agonists (e.g., clonidine and dexmedetomidine)