(1) Objectives: Maintenance and safety of the airway is one of the anesthesiologist's goals and skills with intubation is achieved. Although in some reasons, such as difficult air way, awake-approach is recommended by various techniques such as "conscious sedation" . Using the device for fiberoptic intubation typically is used in the operating room. For the patient comfort and minimizing damage to the tracheal tube during awake intubation by drugs such as remifentanil, ketamine and propofol can be used sometimes under local anesthesia. Awake nasotracheal fiberoptic intubation without muscle relaxants has been reported in some papers. (2) Design: This paper compares three methods of single dose usage of IV-Rremifentanil -Propofol and Ketamine as for "conscious sedation" for fiberoptic intubation device that are evaluated complications of intubation, hemodynamic stability, and study of patients satisfaction in maxillofacial Surgery. The fiberoptic device used by an anesthesiologist and anesthetist is responsible for intubation.
(3) Setting and conduct: Fiberoptic intubation with maintenance of spontaneous breathing is a gold standard in cases of difficult airway. The usual treatment for fiberoptic intubation technique can be done under general anesthesia, But for the conscious patients should be careful to do by regional anesthesia with patients tolerance and cardiovascular Hemodynamic stability - provided for safe intubation.
(4) Participants including major eligibility criteria: The patients with Physical status of I and age 15 to 60 years are enrolled; The Patients with systemic disease and or taking any medication will excluded.
(5) Intervention: In patient with Conscious status setting started by midazolam 0.05 mg/kg and fentanyl 0.1 microgram/kg as intraveneus premedication , before fiberoptic procedure, and then route of the patient's air way anesthethized with a local anesthia and then patients will be divided into three groups, the first group: remifentanil, group II: ketamine, group III: propofol is administered as an intravenous infusion, followed awake- nasotracheal fiberoptic intubation is performed
(6) main outcome measures:In this method working quickly, complications during intubation, patients satisfaction, and satisfaction anesthesiologist , patient's hemodynamic stability for three-drug techniques ( remifentanil, ketamine and propofol) are compared.