Background: A skilled practitioner of localized anesthetic of the airway can facilitate intubation of awake individuals suspected of having difficult intubation due to anatomical variations or airway disease that make direct laryngoscopy of the glottis difficult or impossible. Aim: Comparing between the influence of ketofol versus the effect of airway block on intubation conditions during awake fiberoptic nasotracheal intubation regarding; intubation scores, patient tolerance, intubation time, hemodynamic stability, and satisfaction score. Patients and Methods: Eighty-four individuals were assigned randomly to double groups: as Ketofol group contained 42 diseased persons  received intravenous ketofol inwhich the individuals received a loading infusion dose of ketofol 100 mcg/kg/min over ten min until achieving sedation score.   Airway block group contained 42 diseased persons  inwhich superior laryngeal nerve block was done followed by awake fibroptic intubation without any sedation. Results: A notable rise was seen statistically in mean arterial blood pressure (MAP) of patients of AB group at intubation, at 1 minute (min) and at 5 min post-intubation when compared to baseline level. While in the ketofol group, MAP was more stable at intubation, at 1 min and at 5 min post intubation comparing to baseline. Conclusion: Administration of ketofol combined with topical anesthesia (Spray-As-You-Go technique lidocaine 2%) offered better intubation scores, patient tolerance, lesser intubation time, more hemodynamic stability and greater patient satisfaction than effect of airway block combined with topical anesthesia (Spray-As-You-Go technique lignocaine 2%) on patients during performing awake nasotracheal fiberoptic intubation technique.