Three classes of drugs are typically used to prepare the patient for an awake intubation, an antisialagogue is given to minimize airway secretions, mild sedation is given to minimize the patient’s response to stimulation, and local anesthetic is used directly on the airway. The airway can be anesthetized using a variety of approaches either alone or in combinations. Nebulized lidocaine can be inhaled by the patient for several minutes, the superior laryngeal nerves can be blocked transcutaneously, the mouth and posterior pharynx can be sprayed transorally with local anesthetic.