Objective To report the clinical experience in using the Airtraq® in awake tracheal intubation in patients with known or potential difficult airway, or unstable cervical spine. Methods Case series study. Twenty patients with known or potential difficult airway, or unstable cervical spine who underwent elective operations and might require awake fibreoptic intubation were recruited. After standardised topical anaesthesia of the airway, awake intubation was performed using the Airtraq®. The duration of the intubation procedure, the intubation difficulty scale (IDS), the rate of successful placement of endotracheal tube and patient's satisfaction were recorded. Results Fifteen out of the twenty patients were successfully intubated with the Airtraq® under awake condition leading to an overall success rate of 75%. Eleven of them were intubated in the first attempt. The mean duration of intubation was 1 min 33 s. Concerning the degree of difficulty of intubation using the Airtraq®, as evaluated with the IDS, 20% was ranked as easy and 80% was slightly difficult. Excessive secretion, patient gagging, inability to cooperate and inadequate view of larynx were the major reasons of failed intubation. Eighty percent of the patients considered the intubating procedure with the Airtraq® under awake condition acceptable. In general, patients felt mild pain and discomfort and were satisfied with the intubation process. Conclusion Airtraq® may be a useful alternative of flexible bronchoscope for awake intubation with low rate of minor complications in the elective operation setting. (Hong Kong j.emerg.med. 2015;22:248-255)