Abstract: Objective: To explore reasonable anesthetic management and deminish perioperative mortality of OSAS. Methods: Awake nasotracheal intubation of cocaine topical anesthesia combined with intraveneous drug sedation was applied to 142 patients （except one case with tracheotomy） receiving general anesthesia for UPPP,during which the patients were asleep but had spontaneous ventilation so they could breathe profoundly according to orders and help to be intubed actively by blind,under the direct laryngoscopy and using fiberoptic laryngoscopy in different situation. Signs for extubation: Removed the tube after suction of the pharynx and endotrachea when the patients were entirely awake and SpO₂＞90% with breathing air＞10min. Results: 141 cases nasotracheal intubation included 96 cases blind nasotracheal intubation and 32 cases under the direct laryngoscopy and 13 cases using fiberoptic laryngoscopy,some of which showed slightly respiratory depression during induction but SpO₂ was rapidly higher than 90% after mandatory breathing and oxygen inhalation by face mask. 23 cases were extubated after operation. 115 cases went back ward wearing tubes and were extubed after （10±6） h. 3 cases were tracheostomized at the end of the operation. 3 cases bled after operation,two with tubes and one without tube which suffered from acute respiatary obstrution. No case was dead. Conclusion: Awake nasotracheal intubation combined with timely extubation were effective maneuvers in preventing perioperative death of OSAS.