To the Editor: A 55-yr-old woman was anesthetized for an arthroscopic acromionplasty operation. We induced anesthesia with propofol 120 mg, alfentanil 1 mg, and rocuronium 36 mg. The patient’s lungs were easy to ventilate. However, four attempts by a trainee and two by attending anesthesiologists yielded a Cormack Lehane Grade III view, resulting in failure to intubate the trachea. We placed a classic laryngeal mask airway (LMA), facilitating ventilation. We then introduced a 2.7-mm diameter pediatric fiberoptic bronchoscope and visualized the end of the LMA lumen and the laryngeal channel. We then connected a Frova introducer to an oxygen source, and guided it through the vocal cords (Fig. 1) using the bronchoscope. We withdrew the pediatric fiberoptic bronchoscope and the LMA and then passed a 7.5-size endotracheal tube over the Frova introducer, facilitated with a laryngoscope. The combination of a LMA, a pediatric bronchoscope, and the Frova introducer facilitated intubation while maintaining good oxygenation.Figure 1.: Visualization of LMA lumen and Frova intubating introducer through the vocal cords.Maurizio Cecconi, MD Department of General Intensive Care St George’s Hospital London, UK Luca Miceli, MD Giorgio Della Rocca, MD Department of Anaesthesia and Intensive Care University of Udine Udine, Italy [email protected]