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Awake intubation has been a staple of difficult airway management since the first American Society of Anesthesiologists difficult airway guidelines were developed in the 1980s. In current anesthetic practice, use of second generation supraglottic airways and video laryngoscopy are ubiquitous. The goal of this review is to examine the impact that these airway advances have had on the use of awake intubation and the need to maintain this skill.

Despite advancements, evidence suggests that the rate of awake intubation has changed little over the last two decades. Recent literature has focused on the use of alternatives to the flexible intubation scope, including awake intubation with video laryngoscopy, combined video laryngoscopy-flexible intubation, and combined supraglottic airway-flexible intubation.

Awake intubation remains an essential technique in airway …