In game play, what can you do build a dramatic scene? If you're my dad, you do the above.
Not everyone has those resources. What if you are doing purely theater of the mind? What can give your players a sense of tension and drama?
Here are some of my favorites when playing D&D.
1. Use Morale. Morale is an often ignored mechanic. It usually means someone runs away from danger, not in to danger. But by basic definition, it means someone is confident or not. Perhaps over confident.
Make your monsters and villains act accordingly. High morale causes cockiness. Let some of your antagonists miscalculate the situation. They start of with no weapons, then pull out the big guns as the players take away some of that spirit.
Mechanically, as the villains lose hope, you could start putting minuses on their attack rolls before they actually break and run for it.
2. Force the players to use a caller. A caller is there to help the DM run through a routine set of tasks. By forcing the players to use a caller, it creates the expectation of routines. Everything has a place and an order. As the DM establishes order and the caller implements it, taking it away leaves the players on the edge of their seats. Bypassing the caller by saying, "Ok, Ted. What will you do?" is jarring. It also needs to be reserved for truly dramatic effects.
The inclination of the DM to impose this sort of chaos is usually a negative thing, but it doesn't have to be. Indiana Jones vs. the Swordsman is a classic example of having the character's routine actions changed in a positive way. Laughter is an expression of intense happiness, just like sweating is to fear. Whatever you do, taking away the established routine of a caller can really elevate people.
In all cases, it's better to remove a social convention such as the caller than it is change a game mechanic to pump up the drama.
3. Failure isn't death. There's the old line, "A fate worse than death". Nothing jolts the players so much as moving the goal post. Suddenly, it's not about life and death, but something more upsetting.
A good example of this is the characters are fighting on the rooftops of a town. The danger of falling or dying is ever present. Imagine how they will react if they realize the reason they are up there is a rouse to get them away from gates as the enemy pours in? What if their long time friend is dragged into a wagon on the street below? That changes the dynamic. Instead of win or die, the situation is about escape or die or pursue or lose a friend.
4. Abuse the button. The first 3 items throw the players into an elevated state, physical responses are not in tune with reality. No one at the table is ever in danger of being eaten by an orc, but if you get the player in the spirit of things, they will be sweating about an unreal situation. And you can use that to really lay on the dramatic.
With TV shows and to a lesser extent movies, the biggest dramatic moment is the cliffhanger. Now, if you tried this with a run of the mill combat session the players would be confused. However, you can fake it. When the party sets of for the big brawl, you slam your book closed and announce:
"Well, this is as good a place to stop as any..."
This is the exact the same trick the grandfather pulls on Fred Savage in the Princess Bride. And you should play it as such. "Ok, I guess we can play this out. If you don't mind." Don't actually force an ending on the players. But if you abuse that button and it works, you know you've got the party's attention.
These techniques of abusing the button can be for good or ill.
If the party is trying to do something quietly, start whispering until the proper wham moment arrives. Then make it a literal wham. You don't need to shout, you can simply go back to a normal voice.
In an outdoor game session, I pretended to be distracted by the cicadas' buzz. It goes up and down, and starts and stops suddenly. I kept it up all session, forcing the player's awareness of the noise. When cicadas naturally stopped, I leaned forward and said, "All of the forest's sounds stop." Their eyes got really big.
This is a very strong technique. It needs to be used with care, because if you put the players on the edge of their seats, kicking them too often isn't a good idea. Nor should these moments always lean to the negative. As much as you can shock a group, you're main effort should be engaging the group.