Introduction: Establishing a secure airway while the patient is awake has been recommended in the past for patients who were expected to have difficult airways or who really did have difficult airways. As fiberoptic bronchoscopes (FOB) are now regularly accessible in the majority of hospitals, awake fiberoptic intubation (AFOI) has become the "gold standard" for patients who are suspected of having or have been shown to have difficult airways. Aims and objectives: To compare the intubating laryngeal mask airway following general anaesthetic induction to awake fiberoptic intubation in individuals with challenging airways. Material and Methods: 100 Patients with ASA physical status I-III were enrolled for the study and randomly allocated to one of two groups: either the AFOI or the TI with the ILMA. Patients were asked to participate in the research project if it was assessed by a noninvestigating anesthesiologist that the patient will need an AFOI due to clinical predictors or a history of previous problematic intubation. Results: Comparing the induction timings of the ILMA group (675±535 s) to those of the AFOI group (975±335 s), there was a tendency towards quicker induction times in the ILMA group (P=0.05). Patients in the ILMA group reported considerably greater levels of satisfaction on the VAS, with a median score of 10 compared to 9 in the AFOI group (P<0.01). Among the AFOI group, there was no correlation found between the satisfaction score and the dosage of midazolam or the frequency of recall. The AFOI group had a considerably higher rate of TI recall, at 40%, compared to the ILMA group, which had no recall at all (P<0.01). Conclusion: In conclusion, the ILMA has shown a good success rate for ventilation and TI in patients who have challenging airways. When it comes to treating patients who have problematic airways, the ILMA may be a beneficial device.