versed 2 mg, precedex load over 10 minutes (1 mcg/kg), followed by infusion (titrate to drowsy but cooperative), generous local infiltration by surgeon, 30 mg toradol, 1 gm apap.
pt was able to tolerate nasal fiberoptic laryngoscopy and entire procedure without any narcotics, cooperated/able to phonate entire case.
a lot of this case is explaining to the patient what to expect before even stepping into the OR, then titrating sedation to maintain spontaneous ventilation (ppl here sometimes use remi for fast on/off).
also not a bad idea to cover the patients eyes with a towel.
most importantly, having a good fast surgeon helps as well.