This essay reviews in brief the anatomy of the upper airway, themethods of assessment of the airway for detection of difficult airwayintubation. In certain situations, muscle relaxants are contraindicated as indifficult airway and anaphylaxis. Tracheal intubation without the use ofneuromuscular blocking agents may be done by many methods asintravenous induction by propofol and short acting opioids, or by volatileinduction by inhalational agents as sevoflurane, or by using fiberoptics inawake state. In this essay we will discuss the indications, advantages anddisadvantages of each method.