What preparedness steps should be taken for a patient with a known difficult airway?

• A. Do nothing special
• B. Use only standard laryngoscope and no advanced devices
• C. Avoid awake intubation
• D. Plan A/B/C strategies; have video laryngoscope, supraglottic airway, and fiberoptic bronchoscope; consider awake intubation

Answer: (D)

When a difficult airway is anticipated, the key idea is thorough preparedness with multiple backup options and the ability to maintain oxygenation throughout the process. The best approach is to plan A, plan B, and plan C strategies and have a range of tools ready: a video laryngoscope to improve visualization if direct laryngoscopy is challenging, a supraglottic airway to provide a rescue means of ventilation if intubation fails, and a fiberoptic bronchoscope for flexible, controlled intubation through difficult anatomy. Awake intubation should be considered when airway difficulties are anticipated, as it preserves spontaneous breathing and reduces the risk if induction makes airway control more problematic. This combination ensures you have multiple pathways to secure the airway safely rather than relying on a single method. In contrast, doing nothing special, depending only on standard laryngoscopy, or avoiding awake intubation misses the protective redundancy and safer options that are essential for known difficult airways.