It may be prudent to immediately go to a surgical airway under local. This allows the patient to continue to maintain their own airway and the clinician to gain control of the airway. This may be the only option if other methods have been exhausted. The apparent difficult airway is frustrating in that it turns a potentially easy airway into a potentially difficult one. In this situation, the difficult airway is known and that it limits options.
Adequate topicalization is essential along with minimal sedation .
The difficult airway that needs to be emergently intubated is a very tenuous situation.