It is important to maintain spontaneous breathing, provide anxiolysis, ensure adequate comfort, and minimize secretions
Antisialagogue
Glycopyrrolate - typically preferred over atropine, provide 0.2 mg IV (onset 1-2 minutes)
Local anesthetics - though may require time, adequate local anesthesia significantly increases success rate and patient compliance
Lidocaine - various formulations, such as topical, atomized, or nebulized to allow for numerous delivery techniques
Cocaine - potent topical anesthetic and vasoconstrictor, useful in blind or<unk>  nasal intubations
Cetacaine - topical combination anesthetic, useful to provide adjunct anesthesia to the mucosal surfaces of nares or posterior pharynx
Sedation/anxiolysis - must be mild to avoid respiratory depression or apnea. Sedation is frequently required for patient tolerance
Midazolam - used in small boluses, but has no analgesic properties (may use fentanyl in addition)
Propofol - challenging to balance sedation
Dexmedetomidine
Remifentanil - rapid offset of action
Ketamine - titrate to effect with 10-20mg doses
Consider ondansetron 4mg IV to blunt gag reflex
Glycopyrrolate - typically preferred over atropine, provide 0.2 mg IV (onset 1-2 minutes)
Lidocaine - various formulations, such as topical, atomized, or nebulized to allow for numerous delivery techniques
Cocaine - potent topical anesthetic and vasoconstrictor, useful in blind or<unk>  nasal intubations
Cetacaine - topical combination anesthetic, useful to provide adjunct anesthesia to the mucosal surfaces of nares or posterior pharynx
Midazolam - used in small boluses, but has no analgesic properties (may use fentanyl in addition)
Propofol - challenging to balance sedation
Dexmedetomidine
Remifentanil - rapid offset of action
Ketamine - titrate to effect with 10-20mg doses
Awake intubation
Rapid sequence intubation
Blind digital intubation
Delayed sequence intubation
Nasal intubation
Advanced airway adjuncts
Bag valve mask ventilation
Needle cricothyrotomy