Preanesthetic evaluation will be conducted with thorough airway examination including modified Mallampati grading, thyromental distance and upper lip bite test. The procedure of awake fiberoptic intubation will be explained to all patients and informed consent will be obtained. After shifting the patient to preoperative room, an intravenous line will be secured with 18 G IV cannula and baseline parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure(DBP), mean arterial blood pressure(MAP) and oxygen saturation (SpO2 ) will be measured. Inj. Glycopyrrolate 0.2mg IV will be given 30 minutes before surgery and two drops of Xylometazoline 0.1% will be instilled in both nostrils. Patients will be nebulized for 20 mins before nasal intubation along with oxygenation with face mask @ 4 L/min flow. All patients will receive Inj. Midazolam 1 mg intravenously at 15th minute of nebulization. To ensure double blindness, patients will be nebulized by an anesthesiologist who is not involved in further study. Another anesthesiologist will perform the procedure and record the data. Continuous monitoring of vitals will be done at baseline, at 5, 10, 15, 20 min during nebulization, just before procedure, at 1, 2, 3, 4, 5 min during procedure and post procedure at 1, 3, 5, 10 and 15 mins. Sedation level will be assessed at baseline, at 5, 10, 15, 20 min during nebulization and just before procedure with Ramsay Sedation score.Adequacy of local anaesthesia will be confirmed by heaviness of the tongue and dryness of posterior pharynx of patients. Patient will be pre-oxygenated with 100% oxygen at 8L/min for 3-5 minutes. After application of lignocaine gel, Awake fiberoptic intubation will be performed using flexible videoendoscope , 5.0 mm outer diameter preloaded with 7.0 mm ID ET tube for female patient and 7.5 mm ID ET tube for male patient respectively. During videoendoscopy, 2 ml lignocaine 4% will be administered by spray as you go technique. Patient tolerance during and after AFOI will be assessed by grading system. ET tube position will be confirmed by auscultation and capnography. The amount of total lignocaine required in each patient will be also noted. 

Intubation time was defined as the time from passing the videoendoscope tip through the nostril to the first reading obtained by the capnograph after endotracheal intubation. The mean intubation time will be assessed. A Grading system will be used for assessing intubating conditions, vocal cord positions and patient tolerance during and after intubation. General anaesthesia will be administered with Inj. Fentanyl 2-3 mcg/kg IV, Inj. Propofol 2-3 mg/kg IV and Inj.Vecuronium 0.1 mg/kg IV or Inj. Atracurium 0.5 mg/kg IV. Anaesthesia will be maintained with Oxygen and Nitrous Oxide (50:50), Sevoflurane up to 2% v/v and intermittent dose of Vecuronium 0.02 mg/kg IV for muscle relaxation. Reversal will be given with Inj.Neostigmine 2.5 mg and Inj. Glycopyrrolate 0.5 mg IV at the end of the surgery. Postoperatively, after 24 hours patient satisfaction will be assessed using the grading system.